#003 Wins in the Workplace: New equipment for the MAU/on-call doctors’ office – Dr Chris Bodimeade

Grievance/initial motivation

Lack of adequate computer and telephone equipment in the MAU/on-call doctors’ office. This means all medical doctors on-call or during the day shifts were sharing a single phone and 4 computers, making an already challenging job significantly and unnecessarily harder.

Research – what information did you have to find out to ensure that you had all the necessary facts and couldn’t be tripped up at any point? How did you go about finding this information?

The junior doctors had been complaining about the conditions in their office for more than 18 months. This included directly contacting the Medical Director, raising the issue with the Estates and IT departments and telling consultants about their difficulties. We therefore had a record of this longstanding grievance in official documentation. Disappointingly, despite assurances that this problem was a priority, there had been no progress.

Target – as a result of your research, which individual, group, committee or organization did you identify as having the power to enact the change you wanted to see?

We wanted at least 5 new computers, each with a phone and a single printer in the room. We thought the Junior Doctors Forum (JDF) was the best venue to continue to raise the issue, because the Guardian of Safe Working and senior managers were in attendance, minutes were taken to document action points/progress for accountability and the meetings were held regularly so that we could continue to keep the issue prominent.

Allies – who did you identify as potentially on your side?

The Guardian of Safe Working and the medical service manager were the two greatest allies.

Resources – what resources were available to help you win? This could include volunteers, online survey tools, social media skills, negotiation skills etc.

We did not use any resources apart from our time and powers of persuasion. In retrospect, it would have been easier to compile evidence - use survey tools from doctors affected and documenting efforts to contact the IT department / Medical Director.

Barriers – what were the main things in your way? This could include apathy amongst your supporters, push-back from your target or anything else that you found challenging.

The senior management and consultants were always very sympathetic to the doctors' technical problems, but for whatever reason never seemed to put any sincere effort into helping us rectify the situation. The IT department and Estates were next to useless in their response to enquiries for help in fixing the computers and telephones. They tend to be pretty non-responsive to doctors and this was compounded by multiple people contacting them about the same issue, but no single person being able to follow up on all the tickets that were raised. Finally, everything took time and all doctors rotate position, so there was a constant flow of new doctors coming, complaining about the conditions, then moving on before any progress is made. The cycle repeated itself many times and high turnover was a significant barrier.

Strategy – Based on your research and an understanding of your target, allies, resources and barriers, what strategy did you then employ to win?

Our strategy was to continue raising the issue at the JDF until something was done. Initially our focus was on the senior management and the IT department, but actually these groups are not overly concerned with the junior doctors' concerns, they have many other priorities which compete for attention. We needed to find people who did have leverage on the senior management and IT department. In that regard we identified the Guardian of Safe Working as someone who had the ear of senior management, attended the JDF and could raise this problem as a patient safety issue. We also contacted the service manager for medicine who is responsible for the non-medical equipment. They were familiar with how to negotiate the bureaucratic complexities of procurement and installation with the IT and Estates Departments, due to their existing long-term knowledge

Outcome – what happened?

In January 2021, after complaining of the issue since the summer of 2019, 5 new computers, 4 phones and a printer were installed - all of which made the life of the junior doctors on the on call team significantly easier.

Evaluation

1. What went well? Using the Junior Doctor Forum to raise and escalate the issue to get the importance of the issue recognised and acted upon. This required a medical manager’s intervention, because apparently IT did not respond to doctors.

2. What went not so well? The timelines were unacceptable, from the point of the initial complaint being made to the Clinical Director to the problem being solved, was approximately 18 months. With multiple requests to IT in between and broken promises that it would be solved imminently.

3. What could be done differently next time? Escalating the problem sooner beyond a departmental level and involving the Guardian of Safe Working.

4. What could the BMA do to help support and replicate the success of this campaign in future in other locations? Help to facilitate and train junior doctors to engage with the Junior Doctor Forums to promote this kind of work.

5. What advice would you give to other doctors wanting to do something similar? Escalate sooner if it is a clear problem. Be polite but insistent and use the existing management structures to your advantage.

If you’d like to ask Chris any questions or are considering running a similar campaign in your own workplace, you can email him on chris.bodimeade@nhs.net