The Winter's Tale

Top 10 Tips

1. Look to the future not the past

Don’t waste time analysing what has gone wrong; devote your energies to finding a way forward. Use resources such as the Academy of Fabulous Stuff, NHS Improvement, the Emergency Care Intensive Support Team (ECIST) and the Royal College of Emergency Medicine to identify good practice. Start with the things that will make the biggest difference, and measure everything that matters.

2. Get a grip

If you are in a crisis, move quickly to provide your team with visible leadership, structure and direction. Break the tasks down to manageable chunks, and explain the reasoning behind your decisions. Be as directional as is necessary to get out of the immediate difficulties, but move from directional leadership to engagement as soon as possible.

3. The whole hospital is part of the solution

The chief executive, medical director and other senior clinicians and managers need to demonstrate that every part of the hospital has to own the problem and the solution. The people leading the emergency department need to eradicate any hints of a bunker mentality and communicate relentlessly with the rest of the organisation to ensure they get the message.

4. Build mutually supportive relationships across the health and care system

Involve everyone from primary care to ambulance crews in building and executing your plan.

5. Put confident, senior staff at the front door day and night

Having staff with the confidence and experience to send people back out of the door and to prioritise serious cases quickly will transform your emergency department.

6. Give your emergency medicine consultants the power, skills, confidence and responsibility to lead the change

Demoralised consultants are toxic to the system. Rebuild their confidence, train them in the skills they need to change the way the department runs, help them break down barriers to change, and give them both the power and the responsibility to drive improvement.

7. Therapists are your secret weapon

Therapists can have a major impact on patient flow through the hospital and patients’ quality of life. Working with other clinicians they can keep frail patients out of the emergency department, prevent further deterioration in their condition by keeping them mobilised, and provide support in getting them back home as quickly possible.

8. Social workers should be everywhere

The social care team should be an integral part of hospital care, not just a way to clear people out of beds. They should be a routine presence on ward rounds as well as planning and delivering the emergency care improvement programme.

9. Be relentless on process, detail and measurement

Success depends not on grand strategies but on paying attention to the details.

10. Look after yourself

Working to the point of exhaustion is not leadership. You owe it to yourself and your colleagues to take care of your physical and mental health.

Top tips were written by Richard Vize - @RichardVize