Leadership for all Consultants

A well-organised and led department is essential for the safe and effective delivery of care for trauma and planned orthopaedic surgery. The size of orthopaedic departments has increased in recent years, which has made their leadership and management requirements more complex. In addition separation of elective and emergency facilities require more complex oncall arrangements, job planning detail and travel.
Each department must have a clear management framework. The primary focus of a well-led department must be to facilitate the delivery of best care to each patient. This means that everything possible is done to facilitate rather than hinder the interaction of the clinician with the patient and the clinicians’ endeavours to deliver good care and a satisfactory outcome. This also means that unnecessary bureaucracy that decreases the available clinical time should be kept under control.

Lead Clinician

In many cases the orthopaedic department will be part of a Surgical Directorate and have a Lead Consultant, but in some instances it may be large enough to be designated a Directorate with its own Clinical Director. The Clinical Director/ Lead is responsible to the Divisional Medical Director and further the executive team for the clinical services provided by the department.

The Lead Consultant or Clinical Director is usually appointed by the Trust following agreement with Consultant colleagues. The post is a demanding one and usually renuerated with 1 PA for lead and up to 3 PA for a director position.

The Clinical Director should be a unifying force within the department, supporting colleagues’ efforts to maintain the highest professional standards in dealing with the
health requirements of the local population. They should facilitate the two-way flow of information between clinicians and management so as to foster a sound, supportive and constructive working relationship. The Clinical Directorship is, therefore, an appointment that should be based on management, leadership and communications skills. The clinical Director will be facing trustwide complex issues and needs to be able to interact at Divisional or exec level in order to be heard.

The Clinical Director or Lead Clinician should be given adequate time and secretarial support for this work. The BOA recommends that Clinical Directors join the British Orthopaedic Directors Society (BODS), which has an important role in communication between Directors and provides peer discussions and support.

Teamwork

Although the Clinical Director/Lead Consultant is likely to take on much of the managerial work of the department, there is too much to be done by one individual.
Other consultants in the department are likely to take on the organisation of or lead for: - clinical governance, audit, appraisal, trauma, as well as other official and unofficial posts such as BOA Regional Advisers and RCS England Regional Specialty Professional Advisors, AAC College representatives, JCIE Examiners, College Tutors, Clinical network leads etc.

Management should be made aware that some of these duties can be just as onerous as those of the Clinical Director and such commitments must be taken into account when considering the staffing requirements of the department. These roles would usually be remunerated through additional SPA time usually at 0.5 PA per position  based on transparent team job planning principles.

Meetings

Collaboration between consultants is fundamental to a smooth-running department and so regular meetings are very important. Time should be set aside from clinical activity for all the consultants to take part in the business meeting. Additionally, staff at all levels should be involved to discuss general department issues and time should be set aside for this at least on a monthly basis. All meetings should have a formal agenda and minutes to function efficiently. For day to day and more pressing issues the use of secure messaging groups and virtual collaboration platforms are needed to facilitate prompt communication in times of pressure .

Training and Education

The department should appoint individuals who are responsible for the organisation of medical education and training at all levels (medical students, junior doctors and StR’s, non-medical staff). The education and training lead should be responsible to the Trust’s Director of Education or Training for the provision of education and training in the Directorate. This is time-consuming and they should be given time and secretarial support for this work. These individuals should be members of the local Training Committees in Orthopaedic Surgery, School of Surgery and Local Education and Training Board. Regula MCR/ training faculty meetings and involvement in GMC Training and surveys as well as a GMC approved Trainer portfolio are essential.