1. Foundation Year 1 Leadership and Management Project: Leighton Hospital, Mid Cheshire Hospitals NHS Foundation Trust Dr Naomi Brown, Dr Zaynab Baha, Dr Salman Zaman Abstract Background: All doctors have to develop leadership skills. This has been formalised within the ‘Medical Leadership Competency Framework’ (MLCF) (1) to be integrated into undergraduate and postgraduate curricula. To aid the acquisition of these skills FY1 doctors at Leighton Hospital completed leadership projects. ‘The Challenge’ – Identify a problem within the Trust, then design and implement a solution. Methods: Each group was allocated a mentor from within Trust management and given access to resources. Results: Four projects were completed. Conclusions: Great opportunity to make a real difference in the Trust. Allows the development of a wide range of skills from several MLCF domains (1). Feedback suggests the format needs to be more structured. Background Whether it is working within primary or secondary care doctors contribute to the running of their organisation. The role of doctors as leaders is increasing and has been recognised by the Medical Leadership and Competency Framework (MLCF) (1) (figure 1) which is now embedded within both undergraduate and postgraduate curricula. A pilot project in Leighton Hospital sought to address this learning need by challenging F1s with the objective; identify a ‘problem’ then design and implement a solution. Methods F1s were divided into groups and allocated a mentor from Trust management to provide guidance. Given access to appropriate resources and time for project work during bleep free teaching. Final presentations with representatives from Postgraduate Centre, Trust management and Mersey Deanery Postgraduate Centre, Leighton Hospital, Mid Cheshire Hospitals NHS Foundation Trust. Crewe, Cheshire, UK Results Figure 1. Medical Leadership Competency Framework – focus for Postgraduate areas of development (dark blue) Wk1Wk2Wk3Wk4Wk5Wk6Wk7Wk8 MonEAUnightDOward eve TuesEAUnightDOward eveward WedEAUDOnightward eveward ThurEAUDOnightwardeveward FriEAUnightDOeveward Satnightday Sunnightday Night = 2100 – 0930 Day = 0900 – 2130 EAU = 0900 – 1700 Evening = 1630 – 2130 Figure 2: New F1 medicine rota with acute block AugustGood Clinical Care/Maintaining Good Medical Practice SeptemberRecognition of the Acutely Ill Patient OctoberManagement of the Take and Discharge Planning NovemberFocus on Medicine DecemberManagement, Leadership, Life in the NHS & Psychiatry JanuaryCareers / Looking at F2 FebruarySexual & Reproductive Health and Health Promotion MarchPaediatrics and Child Health AprilFocus on Surgery MayRelationships and Communication with Patients JuneTeaching & Training, Probity, Professionalism & Health JulyPreparing for F2 and Resuscitation Figure 3: F1 involvement in development of new teaching programme Switch ON to switching OFF Ten computers left on overnight = £1400 p/a One nurse = £1400 p/m Figure 4: Energy saving campaign Conclusions Allows the development of a wide range of skills from several MLCF domains including: personal qualities, working with others, improving services and managing service as well as limited experience of setting direction. Great opportunity to make a difference within the Trust but there was a variable degree of engagement from F1 doctors. The F1 teaching programme will be changing to a one day a month format from August 2010 with F1 input at all stages of developing the new programme. The F1 rota in medicine now incorporates an acute block and should improve continuity of care for patient as well as an improved training experience for F1 doctors. Heightened awareness of the bleep policy and a more structured referrals process from nurses to doctors to improve prioritisation on call. Idea of campaign to galvanise hospital staff into saving energy and installing solar panels to generate electricity. Feedback suggests project needs to be more structured to encourage doctors to play more active role. References 1.NHS Insitute for Innovation and Improvement ‘Medical Leadership Competency Framework’ http://www.institute.nhs.uk/assessment_tool/general/medical_leadership_competency_framework_-_homepage.html (accesssed 11/03/10) Acknowledgements Sally Price for her help and support Lisa Gresty for her mentorship Project 3: Increasing Efficiency On-Call Anecdotal evidence suggested the ‘bleep’ is used inappropriately by nursing staff during on-call shifts and doctors were expected to complete routine tasks. A night shift bleep audit found the most common reasons for bleeping F1 on call included reviewing sick patients, routine procedures, death verification. Questionnaire of doctors and nurses asked about their awareness of the existing bleep policy and opinions on measures to improve on call referrals from nurses to doctors. Developed a patient referral form to be completed prior to bleeping doctor to ensure all necessary information is available. Aim is to pilot on selected wards initially. Project 2: Review of FY1 Teaching Programme Focus groups, a survey and stakeholder interviews identified recurring themes in the F1 teaching programme: problems with attendance due to lack of ward cover, impact of EWTD, foundation doctors enjoy clinical lectures and skills more than management. When asked about changing from 1 afternoon/week week to 1 day/month: F1s were undecided whereas the F2s were against it as they felt it would be impossible from a service provision perspective. Foundation Programme Director took decision to move to 1 day/month to increase attendance and provide a new improved, more relevant programme. New teaching programme has been designed with F1 input (figure 3) at all stages from curriculum mapping to the individual programmes for each day: Project 4: Waste Disposal and Recycling Invesitgated theoretical methods of reducing expenditure on waste management and utilities. The Energy Manger was consulted and a number of possible energy saving avenues explored. ‘Switch on to switching off' campaign to galvanise staff by equating simple measures such as turning off computers to money (and jobs!) saved (figure 4) Using the roof for solar panels to generate revenue and free electricity was also suggested. Project 1: FY1 Medicine Rota Survey of F1s and F2s on impact of F1 medicine rota on patient care, education and personal wellbeing. Rota redesigned to incorporate 3 week acute block and 5 weeks on ward to improve continuity of care. New rota (figure 2) implemented in April and F1s resurveyed following one complete 8 week cycle. Both rotas have a significant impact on all 3 domains: on old rota 85% of respondents felt the rota had a significant or very significant impact on patient care, 77% on education and personal wellbeing compared to the new rota with responses of 58% for patient care, 43% for education and 86% for personal wellbeing.