Burned-out doctor Adam Kay is struggling to look after patients in an understaffed ward, and his superior gives him the impossible task of discharging more patients during a busy shift. Judgement clouded by stress and lack of sleep, he sends home a woman who turns out to have serious complications. He is also reported by his colleague, who says that his poor decisions are affecting staff. But could better communication and management have gone some way to helping Adam’s decision-making?
Clearly, the issues affecting NHS staff reach far beyond this example, but one of the most important things for a properly functioning department is for management to take a “consistent, top-down” approach to employee progression, says Resa Galgut, director of 88 Keys Consulting. This takes a while to embed, but a hands-on approach is “essential”, she says.
In particular, Adam’s superior needs to take ownership: “He seems to have an attitude that says: ‘I did it this way, and suffered, so it has to be inflicted on you’,” she says. If he had intervened after Adam mistakenly sent the patient home, instead of “brushing it under the carpet”, some of the wider issues around stress, lack of sleep and poor job design may have surfaced earlier.
A performance review system would have gone some way to helping Adam, who seems to default to an “if I don’t know the answer, I’ll just make it up” response. If someone had outlined clearly what is expected of him, and signposted him to wellbeing resources, then the situations seen in the show may have been avoided.
It’s clear a cultural change is needed in this workplace, says Galgut. “It could be as simple as HR having a coffee with everyone to find out what is going on and how it could be improved,” she says.