Director of Performance and Improvement
Like any profession, training and education will always be a key issue for hospital managers. Unlike doctors or lawyers, there is no professional body dictating the requirements for entry into the profession and yet hospital managers are shouldered with the enormous responsibility of running a hospital and ensuring the timely delivery of quality care. We have covered training and education numerous times in this journal and it is an important issue for the EAHM. Indeed, the EAHM is currently collaborating with other international organisations on the development of healthcare management competencies.
In 2010 we published a cover story on training and education, asking our members to update us on training for hospital managers in their respective countries. This year we are revisiting the topic and discovering what type of training is offered in the smaller countries of Austria and Northern Ireland. Klaus Watzinger introduces us to the activities of the Austrian Institute of Health Care Management and we speak to two healthcare management trainees (past and present) from Northern Ireland.
Healthcare Management Training in Northern Ireland
The Health and Social Care Services Northern Ireland (HSCNI) runs a management training scheme to recruit the next generation of healthcare managers. Successful applicants receive both theoretical and practical management training through a variety of courses and placements, including the unique ‘Cooks Tour’, which enables trainees to learn about the health service from behind the scenes. Louise McMahon (LM) , now Director of Performance and Service Improvement at Health and Social Care Board, Northern Ireland started her career as a graduate trainee and Karen Hamill (KM) is currently coming to the end of her traineeship.
Why did You Decide to Apply for the Trainee Scheme?
LM: I saw an advertisement in the local newspaper looking for ‘Ambitious Graduates’. I had recently graduated, completed a teaching qualification and spent a year teaching in an Irish language school. I loved working with the children, but I felt there was something more that I wanted to do. The health service bridged that gap between a future in education and a move into the private sector, which hadn’t appealed to me at that time.
KH: I wanted a career that was both challenging and rewarding. The Graduate Management Training Scheme with HSCNI looked to tick all the boxes. The scheme provides education through both Manchester and Birmingham University as well as many other opportunities to develop leadership skills to really make a difference in frontline management. To play to their strengths when working to increase effectiveness organisation- wide.
Tell Us a Bit about Your Educational/Professional Background
KH: I studied Law at University of Newcastle upon Tyne but decided that a legal career wasn’t for me. I wanted more of an opportunity to think outside the box and to contribute ideas that could improve services. I really got that chance with the training scheme.
LM: My undergraduate degree is in Celtic Languages and Literature with a music subsidiary. There were not many opportunities in Northern Ireland with those subjects beyond teaching hence a move into a different world completely. I took the Institute of Health Service Management exams as part of the management training scheme – that was quite a lot of work over three years while working and going through the development programme at the same time – good training for managing your workload! I became a member of IHM by that route which entitles me to use the post-nominals DipHSM. I later took an MBA, studying part-time – I found this extremely relevant and useful and enjoyed meeting people from other industries and working together on their management issues. I draw on a lot of the theories and techniques that I learned in the MBA in my job day to day. I have recently started to study for a PhD in health service research – that’s very demanding – taking me back to many of the things I studied as a trainee – public health, health economics but in much more depth. I hope to influence the research and the policy communities to embrace each other’s areas of interest and skills so that we create a culture of evidence-based policy and health service management.
Tell Us a Bit about How the Scheme Works (Length, Number of People, Number of Placements etc).
LM: The scheme when I went through it lasted from September to June – 21 months. There were four trainees from Northern Ireland in my year selected from 400 applications with a demanding but enjoyable selection process. We went to the Health Service Management Unit based in Manchester Business School (University of Manchester) – the training was great and it was good to mix with trainees from the Northern, North Western and East Anglian regions of the U.K.
My substantive post was as ‘Consumer Services Manager’ at Altnagelvin Hospital in Derr – managing the porters and the telephonists – a great learning opportunity. The highlight of my elective placements was across three hospital settings in France – Hotel Dieu de Paris, Hospital Le Chesnay, Versailles and a private clinic in Nice. These placements provided unique insights into the workings of another health system and I met many of the French trainees from Ecole de la Santé Publique, Rennes. I applied for jobs through open competition at the end of the scheme – I was lucky to get a job straight away.
KH: The general management scheme is a two year programme. Intake varies each year, in my year there were three trainees. There is also a training scheme which is HR specific, one for health engineering and 2012 saw the first intake of trainees for a procurement and logistics scheme. I completed my Cooks Tour in the Northern Trust which lasted 3 months. I then completed a 9 month spell in an operational management role in the Belfast Trust. That was followed by what is known as an ‘elective placement’. I spent two months working in healthcare consultancy with Ernst & Young and the following two months in the HSC Leadership Centre working on Service Improvement projects. To complete the scheme I moved to a more strategic placement in planning and performance within the Southern Trust. The scheme provides a real flavour for all aspects of health service management.
Trainees benefit from the best in personal development practice to improve performance and enhance their skills. The scheme is currently run by a learning development partnership and trainees attend workshops in England with other UK graduates throughout the two years.
The ‘Cooks Tour’ Placement Sounds like a Great Opportunity to Learn from the Ground up. How Important was this Aspect of the Training and How has it Helped in other Placements/Posts?
LM: The three month ‘Cooks Tour’ gave me a great insight into the workings of all aspects of health and social care and I met so many people of all disciplines and grades who were proud of their jobs – they educated me thoroughly and many of them I met again at various stages of my career - great preparation for a general management career.
KH: The ‘Cooks Tour’ was without doubt one of the most important and most enjoyable elements of the scheme. I will never forget my day spent working with the porters or the day in delivery suite throughout my career. It gave me a real insight into how all elements of service delivery come together to create the patient experience and helped me understand the system much more clearly. It was also a great way to meet people and build relationships, many of which have proved vital in other placements.
The ‘Cooks Tour’ not only gives a trainee exposure to the workings of an acute hospital but also the chance to spend time at the commissioners, the quality regulator, the ambulance service and the patient and client council. An understanding of the function of these organisations and again the contacts established at such an early point in the scheme are invaluable to a trainee. The experience I had during my ‘Cooks Tour’ will hold me in good stead throughout my management career in the health service.
The Programme Includes Both a Mentor and Buddy Scheme. How does this Work and What are the Benefits?
LM: I had a mentor on the training scheme who was a senior manager and had been a trainee herself – she provided strong guidance and dismissed various myths that I came across. I also learned much from my manager in my substantive post about engaging with senior medical and nursing staff to improve services and deal with difficult situations.
KH: At the beginning of the scheme each trainee is assigned a mentor and a buddy. The mentor is usually a senior figure within the health service. This is a useful relationship but is kept on a casual basis; there is no compulsory element to the mentor scheme. I made great use of the mentor scheme, I asked for advice and discussed any concerns or ideas I had. It is an important relationship and helps a trainee to settle into their post much more easily. The buddy scheme is slightly different, usually someone who has just recently finished the two year training programme. I meet my buddy regularly and I can ask for help or for answers to any questions I may have regarding the scheme.
Health and Social Care is Integrated in Northern Ireland. How does this Affect Management Training and Indeed, Management Decision-Making?
LM: It’s something that we take for granted and it’s interesting that so many other countries are now striving for this goal and having great difficulty grappling with how to cross those organisational boundaries. In terms of management training the social care services are encompassed in the Cooks Tour and training posts. However, since the training is closely linked to the system, much of the educational input focuses on health services – this may change though with the focus on integrated care in England. With regard to management decision-making we cannot underestimate the potential barriers presented by different training (for social workers and health service managers), culture and boundaries within organisations, e.g., budgets, which can inhibit collaboration as people look to protect their own finances. Organisational integration does not automatically mean that the flows for patients will be optimised – this still takes negotiation and agreement and organisation.
KH: I think because health and social care is integrated in Northern Ireland, trainees need a better understanding of how the whole system works together. Patient pathways include both elements of health and social care and it is vital that both work well together and that the channels of communication are open. It is always interesting when the trainees from Northern Ireland attend Manchester Business School; the NHS England trainees are always intrigued as to our system and how it affects our decisionmaking. It is a model of care that is very patient focused and this helps as a trainee to focus every decision on what really matters.
In Your Opinion, What Key Skills are Needed to Become a Successful Healthcare Manager?
KH: I think a range of skills are important to become a successful manager. A mix of drive, leadership qualities and the ability to remain calm under pressure to me are very important. Health and social care is constantly changing and it is crucial that managers are able to drive this change to improve performance. I think a bit of personality and good interpersonal skills also help. Building relationships with all staff and clinicians particularly is key to the role. It is such an interesting career and constantly challenges me to develop and refine my skills. There are so many opportunities in terms of training and learning as a trainee and in that sense I think we are very privileged.
LM: You need to be an extraordinary individual! An endless range of skills are needed – there are the fundamentals, such as
comprehensive knowledge of health and social care policy and delivery– historical and kept up-to-date, law, finance, data analysis but what you need above all is really strong people skills. Health and social services are all about people – those who deliver and those who receive treatment and care and all the support functions that enable that to happen. So it’s essential to have exceptional communication, negotiation, influencing and persuasion skills but also the knowledge and experience in knowing when to challenge to solve problems and get the best outcomes. We work long hours and come under considerable scrutiny from the media and the public in general. The job on a day-to-day basis can be extremely challenging – we have enormous accountability – the lives and well-being of our patients and populations, a substantial proportion of tax payers’ money in a highly political environment – resilience is a skill we all need increasingly.
Health service management is an incredibly interesting job, no two days are the same. For most people it has a strong vocational element reflected in their unswerving commitment and dedication.