Clinical Director, ECIST Dr Vincent Connolly Clinical Director, ECIST

Emergency Care is a wicked problem A social or cultural problem that is difficult or impossible to solve because Of incomplete or contradictory knowledge Of the number of people/opinions involved Of the large economic burden Of the interconnected nature of this and other problems Solutions, depend on the framing of the problem, may be only partially correct, lack evidence and are not definitive

What’s new: Duties of a doctor in the workplace Doctors must: Engage with colleagues to maintain and improve the safety and quality of patient care. Contribute to discussions and decisions about improving the quality of services and outcomes. Raise and act on concerns about patient safety. Demonstrate effective team working and leadership. Promote a working environment free from unfair discrimination, bullying and harassment, bearing in mind that colleagues and patients come from diverse backgrounds. Contribute to teaching and training doctors and other healthcare professionals, including by acting as a positive role model. Use resources efficiently for the benefit of patients and the public. (para 2) Paragraph 1 of the guidance states: ‘Doctors make an important contribution to the management and leadership of health services and the delivery of healthcare across the UK as part of a multidisciplinary team. All doctors have some responsibilities for using resources; many will also lead teams or be involved in supervising colleagues.’ Paragraph 2 above then acts as a proxy summary of the entire guidance. It contains the broad principles within the guidance as a whole. Colleagues are defined as those a doctor works with, including managers of services, whether or not they are also doctors.

''Once you start out on one of these long events you get into a frame of mind that is your own. It's hard to explain exactly what it's like but you are totally and absolutely immersed in your own thoughts and you are on a real high. It's almost like floating. If you get it right there is a point on an event like this where you are just running on a high and even after 60-80 miles you can still feel that it is fantastic, it's brilliant!" - Joss Naylor

What are we trying to achieve? Getting patients better faster and safer Pursuing Perfection • No avoidable deaths • No harm • No unnecessary pain • No waste • No delays • No feelings of helplessness • No inequality Safety Reliability Flow Ideal Care

Result = Safer patient care is compromised Challenge excuses Our data/results are OK – ‘Flaw of averages’ How are HSMR or Harm events calculated? Our patients are different Not believing the data Simple solution – ‘just compare yourself with yourself’ – are we improving enough – outliers and extra beds? We’re a Teaching Hospital – So what! We are special – resources, facilities, rural, urban The problem is with someone else: Social services Care Homes Diagnostics The patients ie complex elderly - is blaming the patients a good idea? Result = Safer patient care is compromised

Top tips Listen, learn & lead Legacy Show concern, empathy, sincerity, trust Focus on Quality & safety Holy Trinity Credibility Accept “no” & “yes” with dignity What’s in it for me…..rewards Focus on the end result

The more time I spent on the site the more I came to think of Wales as some kind of Queen Ant, letting the vast colony go about its work, at the centre of a system where the knowledge of the community is infinitely larger than the sum of experience of all its individuals.