TQM (total quality management)

‘Doctors bury their mistakes’ is a truism that may be one reason why clinicians have never really taken organisational quality seriously.  However, one aspect of quality, i.e. trying to enhance patient safety (zero error rate) is very trendy at the moment, and fits with the medical aphorism, ‘primum, non nocere’ (first of all, do no harm).  This concept of ‘fit’ is vitally important.  It means that the effort directed towards improvement must mean something to the people who actually do the productive work, i.e. the clinicians. 

Any model of TQM includes a monitoring function, i.e. how are we doing?  Sometimes, doctors are blasé about outcomes (except when doing research, stangely enough) preferring to look ahead to the next patient rather than pondering about the last. 

However, if you can link activity to outcome in a simple, automatic and timely way, you have the makings of useful feedback.

See my essay on TQM for further information (kind permission of LUBS).

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‘Bad’ behaviour

Clinicians, and especially doctors, are often complained about because of ‘bad’ behaviour.  Indeed, the single most common cause of complaints in the NHS is the ‘attitude’ of staff. 

The context can be varied, and may be in meetings with colleagues (in particular, with managers), consultations with patients, or even one-to-one.  Most people have an intuitive understanding of ‘bad’ behaviour, but often the person doing it has little insight into their behaviour and can be quite surprised, or even shocked, when it’s pointed out.

 So, I thought it might be instructive to be explicit about what I mean by ‘bad’ behaviour.  See if you recognise any of these things in your own, or others, behaviour: 

  • Losing emotional control
    • raising voice
    • shouting
    • crying
    • shaking
    • aggressive gesticulation, e.g finger-pointing, banging fist on table
  • Bullying and harassment
    • Interrupting, talking over, ignoring
    • offensive, intimidating, abusive or insulting behaviour
    • constant criticism, undermining (especially in front of others)
    • belittling, degrading, demeaning, ridiculing, patronising, subjecting to disparaging remarks
    • taunting and teasing where the intention is to embarass and humiliate (this is often, mistakenly, thought to be funny and light-hearted)
    • avoiding eye contact
  • Poor communication
    • body language, e.g. facial expressions, postures, etc convey the above meanings
    • aggressive or unpleasant tone of voice
    • expressing ideas in a vague or ambiguous way
    • poor use of English
    • using dogmatic statements, rather than questions

Tips for talking to journalists

Everyone remembers how you made them feel, but not what you said!  In percentage terms, remember the old communication myth that:

  1. 55% is body language, environment, and clothes (in the public’s eyes, doctors always wear ties!)
  2. 38% is attitude/tone of voice: project warmth, friendliness and enthusiasm.  But, if talking about a tragedy, don’t smile or laugh (like the doctor in the Simpsons!), but be serious, strong and determined
  3. 7% is the actual words you say 

Helpful phrases with difficult questions: 

  • “I’m really sorry to hear you say that because…”
  • “Maybe some people would say that, but…”
  • “I can understand how some people would think like that, but, in fact…”
  • “Well, I’m not sure about that, but I do find that…. (what’s important is)…”

Talking to the ‘media’

Many clinicians find themselves having to contend with the ‘media’.  That means, newspapers, TV, radio, etc.  It always induces anxiety, but there are straightforward things that can vastly improve your confidence and impact.

Firstly, you must prepare.  But, if you do get ‘caught on the hop’, stay polite and never say, ‘no comment’.  (It always sounds guilty and evasive).  Rather, say, “I’d love to give you an interview.  Please give me your contact details and I’ll get back to you today”.  Make sure you get back! When you get back, be really clear in your messages, which should be no more than 1 or 2 key points.  Imagine what you would ideally like to read/hear/see in this publication/programme, and give it to the journalist!

As a clinician, it is very easy to slip into jargon, so keep it to a minimum.  Be aware, however, that a little bit of jargon is very impressive to the general public, but be judicious. Journalists like stories and anecdotes, so prepare some.  Be personal (but protect confidentiality!), use data sparingly; try typical case histories, testimonials and scenarios. 

If you’re asked really difficult questions, acknowledge the question in some way, “Well, some people might say that, but….”, and move on to something you do know about.  It’s perfectly OK to say, “I don’t know, that’s not my area”. 

I find it’s useful to treat journalists like patients from whom I’m trying to get consent, i.e. be very clear about everything!  Or, think of them as being relatives of patients to whom you are trying to explain what’s happened to their loved one.  Ask them what they know already and bring them up to speed on what’s going on.  Fill in the gaps in their knowledge.

See Tips for talking to journalists