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NHS Wales
Betsi Cadwaladr University Health Board
JOB DESCRIPTION
Post Title:
Accountable to:
Key Relationships:
Secondary Care Medical Director Professionally accountable through Executive Medical Director to
LHB Chief Executive and Board for professional and regulatory
issues for doctors in Secondary Care. Operational accountability through Secondary Care Director to
Chief Operating Officer. Secondary Care Director
Secondary Care Nurse Director
Area Directors
Area Medical Directors
Director of Quality Assurance
Finance Director for Secondary Care Services
Hospital Medical Directors
Hospital Directors
Hospital Nurse Directors
The Therapy Professions and Professional Groups
BCUHB Board
Senior clinicians and clinicians across all sectors, directors and
management team
Unified Public Health Service
Other NHS organisations
Local Authorities
Local and national voluntary organisations
Members of the Stakeholder Reference group
Staff representatives and trade unions
Professional bodies and associations
Patients I service users and their relatives/carers
The public
CHCs
Local partnerships Independent
Contractors Professional and
regulatory bodies
Educational institutions (higher and further) Postgraduate Dean
Advisory Committees
AMs. MPs, Ministers and WAG Officials
Members of the National Advisory Board and National Delivery
Group
Remuneration and
Terms and Conditions:
Location:
As determined by the BCUHB Remuneration and
Terms of Service Committee within the Policy
Framework set by the Welsh Assembly Government
Co location with Secondary Care Director, Secondary Care Nurse Director
JOB PURPOSE
The Secondary Care Medical Director will be responsible for medical leadership,
building, motivating and developing a team of clinicians, to drive forward service
transformation across the three acute hospital sites (Ysbyty Gwynedd, Ysbyty Gian
Clwyd and Ysbyty Maelor) as well as Abergele and Llandudno Hospitals. As a member
of the Secondary Care Leadership and Management Team the Secondary Care
Medical Director will hold responsibility jointly with other members of the secondary
care team for the strategic direction, and operational delivery of services. The Secondary
Care Medical Director will provide Medical Leadership on behalf of the Office of the
Medical Director for Implementing the Quality Improvement Strategy and promoting a
culture of Prudent and Compassionate Health Care. The Secondary Care Medical Director will promote the five key objectives of the Office of the Medical Director.
• The strategic planning of clinical services and meeting healthcare standards.
• Improving communication and collaboration between secondary and primary care.
• Developing a culture of quality improvement and compassionate care
• Leading and developing the Medical and Dental Profession in North Wales
• Building relationships and a positive reputation with our people, our patients, the
media and other organisations within and external to Wales
They will also: • Ensure that the LHB makes a significant contribution to health improvement and the
reduction of health inequalities. • Work with the Hospital Medical Directors and be the principal source of medical advice to
the Executive Medical Director. They will act as the professional lead for all
secondary care doctors and clinical networks within the healthcare community employed by
the LHB.
Support the Responsible Officer by overseeing the appraisal process for all secondary care
doctors within the LHB to allow revalidation decisions to be made.
• Provide Medical Leadership for clinical governance and assurance, in conjunction
with the Secondary Care Nurse Director and the Director of Quality Assurance,
for the overall discharge of clinical governance in the LHB.
• Provide leadership on the medical implications of service reconfiguration,
clinical performance and conduct, medical education, research and development,
senior doctor appraisal and validation across the health community.
• Create an environment in which excellence, research and development, public
protection and patient safety can flourish to meet the challenges of the 21st Century.
KEY ACCOUNTABILITIES
Improving Population Health and Patient Services
• Championing the change in emphasis from in-hospital care to effective prevention, early
intervention and long-term community based support.
• Drive the redesign and modernisation agenda across the healthcare community.
• Lead and foster effective clinical leadership and promote clinical engagement so that the
LHB provides safe, high quality, acceptable care for patients I service users in accordance
with the prudent health care approach and NHS standards for services in Wales.
• Initiate and facilitate effective partnerships and alliances between the LHB and other
agencies, and NHS providers in Wales and the rest of the United Kingdom (and in the
North West in particular) so as to influence the agendas of these bodies and to draw on
their experiences and perspectives in creating local NHS and community strategies,
policies and actions, to deliver long-term health improvements.
• Delivery of an integrated healthcare system across primary, secondary and community
sectors by working with the Area Directors, Area Nursing Directors and Area Medical
Directors, the Director of Mental Health & Learning Disabilities and the Director of Public
Health; providing leadership and management of the integration of the various components
of the LHB, to develop a unified organisation which delivers a service that:
delivers improved population health and wellbeing;
1000 Lives Campaign
reduces inequalities and
improves patient safety.
• Motivate all clinical staff to benchmark services continuously against best
practice evidence, research and audit, to ensure high quality standards of patient care.
• Foster a culture which embraces and recognises the opportunities for the utilisation of
new clinical and service technologies.
Quality, Safety and Patient Experience I Quality Improvement
• Fu l l y supp o r t the Implementation of the Health Board's Quality Improvement Strategy
and ensure effective organisational arrangements and capacity in secondary care that
enables the Health Board to meet its strategic aims within a framework of strong, effective
governance. This should be consistent with the standards of good governance set for the
NHS in Wales, which are based on the Assembly Government's Citizen Centred
Governance Principles.
• Accountability for all medical clinical governance issues in secondary care and shared
responsibility with the Secondary Care Nurse Director for the overall discharge of clinical
governance and provision of assurance in Secondary Care. To ensure active participation
by all medical staff.
• Establish clear lines of accountability and ensure that all relevant clinical staff in secondary
care are managed, supervised and trained appropriately with regard to clinical services,
managing through a strong governance framework and in accordance with the regulatory
requirements.
• Ensure a robust and clearly understood approach is taken to the management of clinical
risk including the major risks held in secondary care are properly reported on the risk
register. • Supporting the Hospital Medical Director to deliver key areas of the Quality Strategy
(the quality priorities) to include Mortality, Sepsis, Hospital Acquired Thrombosis and
RRAILS, on each site.
• To ensure a robust system of monitoring of clinical outcomes and effective clinical audit. To
ensure a direct link between national & local audit priorities and the audit programme. • Monitor the quality of patient care against national and local indicators. Ensure the safer
patient groups across major hospital sites are well coordinated and focus on major patient
safety issues (e.g. Hospital Acquired Infection and Thrombosis, response to the
deteriorating patient, and safer prescribing) • Through coordination of safer patient groups ensure there is sufficient "spread" of lessons
learnt from concerns, complaints, Safety Incident reporting (DATIX), Serious Incident
Reviews, Root Cause Analysis and Coroners cases. • Improving the quality of prescribing by giving expert medical support to the Prescribing
Advisory Team and others as required.
• Within secondary care to co-ordinate inspections by external bodies including the Royal
Colleges, the Deanery and response to National Confidential Enquiries. The Secondary
Care Medical Director will advise the Executive Medical Director of the outcome and
implications of external inspections and will ensure that recommended actions are
implemented.
Performance
• As a member of the Secondary Care Leadership and Management team, to ensure
effective clinical and managerial structures are in place in Secondary Care to achieve the
financial and corporate objectives set for the LHB.
• To ensure the effective, efficient and economical use of resources in achieving planned
activity and delivery of all required performance targets, with a drive for optimum
productivity.
• Ensure the development of clinical information strategies, to assess health needs and to
support evidence based decision making.
• Responsibility for effective local systems, which will enable individual doctors and clinical
professionals to discharge their professional obligation to report clinical colleagues if there
is cause for concern, or reason to believe that their conduct, performance or health might
present a threat to patients I service users as outlined in 'Duties of a Doctor' and to raise
these concerns in confidence.
Strategic Development and Partnership Working
• Take strategic responsibility for service and policy development, particularly relating to
national or regional initiatives and directives from the National Institute of Clinical
Excellence (NICE), Health Inspectorate Wales, the Annual Operating Framework and the
Local Delivery Plan.
• Engage with and promote co-operation and collaboration with other organisations, to
develop strategic partnerships and alliances to improve the health of local communities
and ensure effective partnership working.
• Actively support the development of effective strategic links between health service
planning and delivery and the public health function.
• Support the development of a culture of public involvement that is open and transparent,
ensuring that users, carers and the general public's views are effectively represented and
appropriately incorporated into decision making across the LHB.
• Develop effective relationships with the Community Health Councils, Professional Fora and
Stakeholder Reference Groups, to ensure strategic plans are developed with full
cognisance of their views.
Leadership of the Medical Profession • To provide visible leadership for medical staff on both professional and managerial issues. • Establish and head up a strong team across secondary care which will provide
clinical leadership for acute services.
• Develop processes, which ensure the optimisation of clinical leadership, full
engagement and commitment of all clinicians, to deliver improvements to patient
accessibility and clinical outcomes. To ensure regular communication with medical staff,
ensuring that they are engaged with the development of service plans and policies. • Develop an organisational culture that supports clinical engagement in decision
making, a drive for continuous service change and improvement, and a learning
environment to deliver high quality, safe services in the new environment.
• Working with the Executive and Deputy Medical Director ensure effective medical
workforce planning in order to provide the appropriate level and mix of skilled clinical
staff to address the health needs of the LHB, both now and in the future. To take
a proactive approach in the management and governance of locum and agency medical
staff.
• Advise the Executive Medical Director and the Board on the impact of legislation, and
national policy on the LHB's ability to deliver secondary care services e.g. European
Working Time Directive, Modernising Medical Careers, the implementation of the
amended Consultant Contract, SAS Contract, and the introduction of reduced
working hours.
• Provide advice on medical staffing issues, having regard to statutory requirements
and national and local policy and guidance. This includes the implementation of
national policy, directives and the use of clinical indicators, to ensure safe and
appropriate standards in medical practice.
• Take a lead role in the resolution of any employment matters for the LHB
Secondary Care medical staff, working closely with the Executive Medical
Director and the Director of Workforce and Organisational Development. This relates
to conduct, capability, competence or performance and to manage the exclusion
and disciplinary procedure for medical and dental staff, on behalf of the LHB,
ensuring that there are appropriate processes in place to embrace all medical and
dental staff across the LHB area
• Support the site Medical Directors to ensure that appraisal and job planning for doctors
and dentists occurs and is carried out to a high standard with clear objectives being given.
Support the site Medical Directors to manage regulatory and performance issues within the
secondary care medical staff groups.
Education, Research and Development
• Maintain and develop links with Higher Education Institutions, ensuring
robust communication takes place with the Postgraduate Dean and Royal College
Advisors on postgraduate training issues and the Medical School. Ensure that all
recommendations from external visits have an action plan and that these are implemented.
• Ensure that standards of postgraduate medical education and training for secondary
care meet national requirements and contribute to the successful recruitment and
retention of doctors in training, across all areas of healthcare.
• Oversee processes for the delivery of undergraduate education in secondary care in
conjunction with Undergraduate Organisers
• Ensure that appropriate medical education is in place for doctors in training and for all
career grade doctors within the LHB.
• Contribute to the LHB's research and development (R and D) agenda in collaboration with
the associate Medical Director for (R and D) to ensure that outcomes of relevant
research are assessed within the LHB. This will include fostering an evidence based
culture by working with clinical colleagues to ensure appropriate use of research
evidence in order to improve practice and service delivery.
• Take a key role in the Research and Development strategy for secondary care, working
closely with the R&D Director
Building Positive Relationships
• To attend the Local Negotiating Committee and develop the relationship between the
Health Board and the British Medical Association.
• To contribute to NHS Wales strategy development and delivery and to actively engage
in work at a national level.
• As one of the cadre of senior leaders within Wales, to contribute to the wider health
and organisational agenda of NHS Wales and WAG. • The Secondary Care Medical Director will act as one of the ambassadors of the LHB and
NHS Wales. • To meet community groups and other partners who have an interest in our services
OTHER RESPONSIBILITIES
The post holder may be required to undertake other relevant duties, including the operational
lead for specific services and localities, as required by the Chief Executive.
PERFORMANCE APPRAISAL
Performance will be appraised and objectives agreed on an annual basis with the Secondary
Care Director, with corporate and professional input from the Executive Medical Director and
the Chief Operating Officer.
PERSON SPECIFICATION
Qualifications
Qualified Medical professional with an unblemished registration with the GMC
• Evidence of continued professional development.
• Further evidence of management training and a commitment to ongoing professional development.
Experience and Knowledge • Must have significant experience working as a practicing GP or specialist hospital doctor
• Clinical Governance.
• Medical Management
• Significant organisational change experience I managing difficult and complex change.
• A track record of achievement in: o Effective performance management; o Introducing robust systems and processes; and o Facilitation of groups.
• Undertaking sensitive negotiations.
• Successful initiation and facilitation of strategic partnership working and alliances.
• A good understanding of the health and social care management environment in Wales and of roles and responsibilities within it.
• A good understanding of national targets.
• A good understanding of performance management methodology.
• Developing an organisational culture that promotes clinical engagement in decision making and leading continuous change and improvement in services, encouraging the use of new clinical and service technologies.
• The Safety and standards agenda. • An understanding of the principles of Public Health Medicine that are relevant to, and
underpin the work of the LHB.
Abilities and Personal Qualities
• Innovative, with strong service focused approach, exceptional communication, interpersonal, negotiating and influencing skills.
• Ability to think and act strategically and to articulate a clear sense of direction and vision to a wide audience.
• Ability to build effective relationships with a range of internal and external stakeholders.
• Demonstrable leadership and ambassadorial skills with an ability to demonstrate a flexible leadership style.
• Commitment and passion for citizen focused service with the ability to embed such an ethos at all levels of the organisation.
• High level of; o Negotiating skills; o Interpersonal skills; and o Communication skills.
• Ability to contribute to policy development. • Decisive leader, capable and committed to translating policy and analysis into practical
actions.
• Strong prioritization, skills with the ability to manage competing demands.
• High degree of analytic skills.
• High degree of report writing skills.
• T earn player with experience of managing teams.
• Ability to deal with the media.
Setting Direction
Seizing the • Acts now to articulate, shape and implement a compelling, shared vision that takes current s ervice
developments into a coherent future strategy.
• Acts quickly and decisively in a crisis and builds new programmes and capabilities rapidly .
• Introduces flexible, innovative approaches to achieve service improvements and promotes organisational ability to cope with change and shape the future.
• Leads continuous service improvement, encouraging the use of new clinical & service technologies
future Thinks and acts
for the future.
Intellectual
• Synthesises, reframes and prioritises complex demands, consequences and critical points from a
mass of disparate and conflicting data
• Demonstrates ability to move between significant detail on the ground and the strategic big picture,
modifying plans and actions to take account of new/diverse views, information and standpoints.
• Interprets complex medical workforce strategic agenda into action on the ground .
Handles
information and
clarifies
comolexitv.
Broad scanning • Checks what is happening on the ground, asking patients I service users, their carers and staff
about their experience of services and is visible and accessible at all levels - "walking the talk".
• Actively seeks out diverse viewpoints, promoting inclusivity .
• Purposely uses wider networks to keep up with developments in medicine, health, social care, housing, and education, building relationships with partners, clinical and academic colleagues.
Gathers
information from
a wide range of
sources.
Political Astuteness
• Builds consensus alliances through purposeful engagement with key networks of interest groups and
influencers to shape and deliver change.
• Demonstrates understanding of complex stakeholder networks and ensures actions take account of political sensitivities in building agreements.
• Balances political, professional, technical, financial and cultural considerations to achieve change
Understands
the politics I power bases.
Drive for • Focuses and clarifies objectives and boundaries and is goal focused, resisting any pressure to be deflected f r o m achieving quantifiable service improvements.
• Takes calculated risks within integrated governance, to achieve longer-term service improvements creating enduring benefits of improved healthcare for patients I service users and carers.
• Wants to make a real difference to people's health and well-being by delivering a high quality service and by developing improvements to service.
• Uses a range of strategies to shift the organisational emphasis from in-hospital care to effective
prevention, early intervention & long term community based care
• Ensures high standards of medical care, using audit and clinical information strategies to demonstrate
quality outcomes for oatients and their carers.
results Sustains a
focus on
improving
performance to
meet
challenging
goals.
Financial
• Contributes to the management of financial flows in the LHB to deliver short & long term objectives.
• Focuses use of resources on achieving the future vision of the organisation, advising on the impact of diverting resources from current programmes to invest in development and change.
• Demonstrates financial literacy/quantitative problem-solving skills.
• Contributes to the delivery of agreed recovery plan and contributes to resolving deficits
• Ensures a high standard of financial management and control, with financial systems I procedures promoting the efficient and economical conduct of business, safeguarding financial proprietary,
governance and regularity throughout within the organisation.
Leadership Ensures
sustainable
financial viability
and most
effective use of
resources to
achieve
stratecic aims.
Delivering the Service
Leading change through people Makes change
inclusive
mobilising
people's energy
and
commitment
• Engages others as partners in developing a shared vision within the organisation and across the
local health and social care and academic community to achieve buy-in and commitment.
• Aligns efforts and shares leadership and power to achieve integrated service improvements,
winning and retaining the respect of other clinicians.
• Builds organisational frameworks for continuously improving quality and safeguarding high standards of care supporting others who lead implementation.
• Builds effective clinical leaders and teams, removing obstacles to effective working. Holds team members to account through stretching performance and rewards systems.
NHS Wales Secondary Care Medical Director - Behavioural Competence Structure
Drawn from NHS Wales Leadership Qualities Framework, NHS Wales Executives Behavioural Competency
Structure and other strategic documents.
flexibilit~
Holding to • Accepts personal responsibility for the medical workforce, holding others directly accountable for
delivering what has been agreed, both within and outside of the organisation
• Intervenes swiftly and consistently to address poor performance or inappropriate behaviour where
this is impacting on patient safety and effective service delivery. Challenges and confronts conflict
affecting service standards or safety, brokering agreement.
• Embeds the duty of providing high quality patient I service user care throughout the organisation, ensuring that the Board receives reports on quality and safety and that appropriate action is taken.
• Provides high quality advice to the Board on all matters relating to medicine.
• Ensures statutory and regulatory aspects of medicine are delivered, including validation requirements for all doctors.
(cont.)
account Promotes a high performance culture.
Empowering • Delegates effectively, securing resources as required and providing space for others to be creative.
• Takes risks with others, coaching their development using failure as an opportunity to learn.
• Explains clearly and concisely the reasons for plans and actions to affected people, stakeholders and partners and listens and acts on responses.
• Leads the investment in talent management, ensuring that appropriate development processes are
in place for the medical workforce (including succession management). Coaches and mentors
others to help them maximise their contribution.
others Fosters independence.
Effective and • Uses a range of effective influencing strategies that will bring about desired outcomes and long term
change in health services, building and using extended networks of influence.
• Gains commitment and credibility from the local community through responsive involvement of local
people, staff and other agencies in shaping local health priorities and strategy.
• Champions the organisation in external forums e.g. local authorities, Government bodies and
national organisations and represents both the organisation and the medical profession at local,
national and international level.
strategic
influencing Uses range of influencing strategies.
Collaborative • Creates the conditions to promote sustainable partnerships and works closely with health, social care and academic partners on all important investment decisions to ensure joined up action which
creates enduring benefits for stakeholders.
• Leads the shared duty to engage the public and other bodies in planning and monitoring services and is informed on the current and changing priorities of partners, modifying own plans in order to
seek "win-win" outcomes.
• Demonstrates effective management of relationship with Chief Executive, Chair and Board members, jointly creating cohesive strategies for delivering a world class health care.
working Engages constructively with internal and external stakeholders.
Personal Qualities
Self belief • Takes on stretching challenges that some peers may back way from.
• Constructively challenges others, regardless of position or status.
• Willing to take tough decisions and is openly optimistic about achievement of goals.
• Stand up for what they believe in, speaking up and have a can do sense of confidence . • Makes the care of people first concern, treating them as individuals respecting their dignity .
Inner confidence to succeed.
Self awareness Understands the nature and cause of own emotional reactions to particular situations and takes
account of the likely implications and impact of own behaviour.
• Role models effective behaviours and shows understanding of own strengths and limitations in providing leadership that makes a difference to patientsIservice users, carers and staff.
Understands own emotions, strengths and limitations.
Self management
• Manages responses and reactions consistently when under pressure remaining calm in a crisis and
without transferring unnecessary stress on others.
• Takes conscious steps to manage own emotions and absorbs and deals constructively with criticism
and performance feedback.
• Models a healthy approach to work I life balance, having a range of interests outside of work .
Manages own emotions and demonstrates resilience.
Personal • Stands up for that which is consistent with stated NHS values and delivers on own commitments
even when this is difficult and there may be personal cost.
• Acts as a consistent role model for engaging staff, patients I service users and other stakeholders at
all times, taking a fair and inclusive approach to decision making within a framework of integrated
NHS governance.
• Open, and honest, acts with integrity and uphold the reputation of the medical profession. Requires
and expects others to be open and honest in their communication.
• Works with others to protect and promote the health and wellbeing of patients I service users, their
families and carers, and the wider community.
• Provides a high standard of practice and care at all times, respecting people’s confidentiality
integrity Commitment to openness, honesty, inclusiveness and high standards.
Professional • Models a professional approach to medicine and maintains practical competency and credibility
• Nurtures doctor's ability to lead and encourages the development of clinical leaders
•
Integrity Commitment to the medical profession and to standards of conduct and ethics
• Accountable for actions and omissions in personal clinical practice and is always able to justify own decisions.
• Always acts lawfully, whether those laws relate to own professional practice or personal life.
• Maintains clear professional boundaries with those in their care or anyone close to them.
. .
References:
NHS Wales - Leadership Qualities Framework ("LQF") -; NHS Wales Chief Executive Development Center - Competence Framework Welsh Assembly Government - Accountable Officer Memorandum for Chief Executives of NHS Trusts Welsh Assembly Government - Accountability, Performance and Development Handbook for NHS Wales Chief Executives Welsh Assembly Government - "One Wales"
Welsh Assembly Government - Consultation Document on Reorganisation NHS Institute for Innovation and Improvement - Leadership Indicators NHS England - Competence and Experience Framework for Chief Executives
NHS Wales & IHM - Leadership Framework; Audit Commission Report - Financial Failures in NHS Trusts, Department of Health UK - Kennedy Bristol Inquiry Report on Care of Children; Leadership Roles in Meeting the Challenge of Change - University of Leeds
Review of Leadership Theory and Competence Frameworks - Exeter University Centre for Leadership Studies Seven Leadership Leverage Points - Institute for Healthcare Improvement (MDcomp framework v2 0309)