North Manchester General Hospital’s commitment to listening to Junior Doctors earned them a place in the final of the 2021 HSJ Awards.
The work of the Junior Doctor Leadership Group was commended for giving Junior Doctors a mechanism to speak up to highlight barriers to them providing excellent care to patients.
Due to the rotational nature of their roles, junior doctors face unique barriers to speaking up. Many junior doctors feel unable to speak up due to a lack of knowledge of routes available, or find it difficult to instigate change. This can lead to an assumption that they are uninterested or unable to get involved in system change and improvement.
At North Manchester General Hospital (NMGH), some juniors reported feeling like outsiders when they rotated into a new clinical area, only to rotate out again when they were beginning to establish relationships with colleagues.
In response to the pandemic, senior leaders at NMGH recognised that the demands on junior doctors would be significant, and a new approach was required to maximise morale and engagement. To address these barriers, the Junior Doctors Leadership Group (JDLG) was formed.
Modelled on ‘shadow boards’ from the corporate world, the JDLG is comprised of groups of junior medical staff. This group was set up to improve organisational agility and responsiveness by identifying issues at an early stage and having open access to leaders to take action early.
Members of the JDLG have been invited to represent colleagues at senior leadership meetings including silver command, postgraduate medical education committee, hospital management board and clinical directors’ meetings.
The JDLG was designed to provide clear and robust two-way communication channels between juniors and senior management. It also provides development opportunities, by giving juniors exposure to strategic decision-making required to become health leaders of the future.
Nearly all NMGH committees, which lead on different aspects of change, transformation and pandemic service provision, now feature JDLG representation, including digital transformation, clinical leaders’ forums and hospital redevelopment board. A junior doctor also sits as a permanent member on the seven-member Senior Medical Leadership Team, comprising of the medical director, deputy medical directors and divisional clinical directors.
The JDLG has been a success at NMGH in providing an alternative forum for Junior Doctors to speak up, without having to go directly to their manager or the Freedom to Speak Up Guardian. Prior to introduction of the JDLG, only 4.4 per cent of juniors reported they could take their breaks, and many left late on a daily basis. However, only an average of four exceptions reports were submitted each quarter, and only one colleague attended the Junior Doctors Forum to represent colleagues. Following the formation of the JDLG, Junior Doctor Forum representation increased by about 800 per cent and exception reports increased 400 per cent.
Joanne Williamson, Freedom to Speak Up Guardian in NMGH, is a supporter of the JDLG. She has a strong relationship with the JDLG, providing plenty of opportunities for informal chats and to give advice when needed.
Joanne said, “It is so important for Junior Doctors to be able to Speak Up about matters that affect patient safety or their wellbeing at work. The JDLG provides an excellent route for this. Often issues can be resolved quickly because the JDLG has greater access to Senior Leaders and other key personnel who might be involved in Following Up on concerns. Since the group was created at North Manchester General Hospital, I have received less Freedom to Speak Up cases from Junior Doctors.”
Medical Directors Leadership Fellow, Joe Home said: “The JDLG was formed to consolidate juniors into a stronger, more cohesive voice, allowing for better representation within organisational decision making and increased credibility with senior leaders. Its offer of support is both reactive – providing a platform to speak up – and proactive, giving juniors tools and opportunities to develop leadership skills for the future. This has resulted in a flattened hierarchy, a more open culture, greater clinical engagement and confidence in speaking up.”