Do 'Technical' Clinical Skills Still Matter?

I was facilitating a Board Strategy away-day last week for an acute FT. One session was spent generating new insights into how best to approach partnership working with other, similar Trusts in the Region, especially in relation to re-patterning various specialist services. More specifically a lot of energy was spent on exploring whether or not a legal partnership vehicle could be constructed to allow all partners to benefit financially from surpluses, even if a particular Trust did not make any direct contribution to a particular service line’s bottom line.

During a break I fell into conversation with the Chief Executive. Our chat meandered onto the question of how ambitious these new regional partnerships might be. I suggested that a really effective partnership might lead to the new network becoming a national leader in several specialist services. He thought this unlikely, reminding me that ‘leading edge’ or ambitious clinicians did not choose to work in this part of the country and/or for these particular Trusts.

This quick exchange has stuck with me for a week now. Niggling questions keep popping into my head. Questions like:

1. How much scope is there to improve clinical outcomes by systematically seeking to improve the clinical skills of the medical staff?  
   
2. Are the potential rewards for a focus on improving clinicians' technical skills dwarfed by the potential benefits promised by the more familiar pursuit of effective partnership working, team working, good communication skills, use of high quality of medical devices and the application of proven system improvement methodologies?
   
3. Just how much scope is there for a specialist clinician to improve her ‘technical’ skills, 5%, 10%, 25%? and what do personal improvement curves look like over time? Do people ‘flatten out’ quite quickly or can they keep on making incremental and useful improvements over a long period of time?    
   
4. To what extent do acute Trusts focus on spotting and attracting technically talented clinicians?
   
5. To what extent do Medical Directors and senior HR managers and Boards focus on the metrics of skill improvement and might this change as more outcome measures make it into the public domain?

Although it's not fashionable to ask, do 'technical' clinical skills still matter?

nhstrainingskills

Comments

[steve]

Dear Steve

To my mind the answer is simple - if you look at he Dartmouth Atlas data run by Elliot Fisher - we see that the leading academic centres in the US - presumably with all the 'best' doctors - they spend much more on care and get WORSE outcomes.

In my speciality Neurology - there are effective treatments - but the impacts are limited and dwarfed by the failure of effective Long term condition management.Also medicine is best viewed through a biopsychosocial lens - 50% of all outpatient care in aimed at patients with unexplained symptoms - yet the existing literature shows these patients have treatable psychological and social conditions. which are currenty ignored in secondary care.

Add to that the Juran Institute estimate 40% of all healthcare costs relate to waste - the current answer is clear - process of care improvements dwarf the existing potential of more medical care.

Certainly at no point in my career have I been in an interview when anyone selected a candidate on the basis of their process of ability or care ability or their team building capabilities - yet almost every department I have worked in - has had significant dysfunction.

On a more postive note I know head up a department of system improvement in mu Trust and we do have the ambition to be the best Trust in the country based on process of care improvements!!