Trust income could be given a boost by rebalancing older consultants’ roles between surgery and management

The quality, innovation, productivity and prevention drive has been with us for some time, but productivity is now at the top of the agenda as “prices will be calculated on the basis of the most efficient, high quality services rather than average cost”.

Service line reporting shows the performance of a specialty, but it only takes a couple of unproductive consultants to turn a viable specialty into a loss maker. Managing individual productivity through the creative use of skills and preferences can turn this around.

So, have you braved improving consultant productivity, yet? Or are the painful memories of cutting consultant paid hours and limiting their non-direct care time holding you back? These negative experiences can be avoided by a combination of clinical leadership, giving consultants a clear role in the decision making and the management of resources, with incentives, better information and bespoke personal development and career plans.

A vital first step would be to secure board ownership. The medical director, working closely with the human resources director, should be the project sponsors. A consultant champion is crucial to drive the work forward and to enthuse other clinicians. The remaining pieces of the jigsaw are a project board representing all the functions concerned and a project manager to make sure all the tasks set out below are undertaken to an agreed timetable.

One of the most effective incentives for consultants would be to permit them to retain productivity savings over target for developing their specialty, enabling them, for example, to buy new equipment or employ a research nurse or data clerk. In one trust, once consultants had greater financial flexibility, they became the driving force behind plans to make £1m pathology savings - in stark contrast to their previous disengagement. This approach is also a great opportunity for HR and medical directors to work closely with their directorate colleagues.

Complex qualities

For productivity monitoring to be acceptable to clinicians, it is not enough only to measure throughput; it is crucial to measure complexity as well. This can be achieved by calculating how much income individual surgeons earn the trust, because more complex procedures are paid at a higher tariff, adjusting the results to take account of part time working.

Obviously quality must also be measured, as excessive speed can have dire consequences, but slowness can also present problems. One trust that assessed the productivity of its surgeons was pleased with the results for most but found that they had a few earning £0.75m less a year than average. The data was double checked for errors, but none were found. It turned out that one surgeon in particular was known to have “slow hands”. Nobody had realised how much it was costing the trust each year.

Is it reasonable to expect everyone in a physically demanding profession keeps up with the pace of their younger colleagues, even when they are approaching retirement?

Why do consultants have about the same balance of direct clinical care and non-clinical work (supporting professional activities), regardless of age or other factors? What about a more positive focus, with opportunities to deploy their knowledge and experience where it would be most valued?

So for some consultants, it would mean less physically demanding and time pressured roles, with more time for training, research, and directorate management.

Some consultants may require coaching and development to undertake their enhanced management responsibilities. This might include soft skills, such as how to have difficult conversations and performance appraisal. Others, more likely from an older generation, may need to improve skills for analysis and planning. Development programmes need to be highly flexible, and usually one to one at a time of the consultant’s choosing.

Working together

Getting to grips with productivity usually requires integrating activity, finance and workforce information. This is often difficult as these functions can work quite independently. The first steps are to coordinate these data providers and for them to work together.

The last thing busy clinicians and managers need is a flood of separate reports, each with their own layout, all vying for their attention. The best way to avoid this problem is by developing a clinicians’ dashboard covering all types of information. This should be easy to read, by highlighting topics that need immediate action with a red “traffic light”. Ideally, if you can afford it, this should be produced by a data warehouse, which extracts data from different software programs.

Some trusts have supported these changes with teambuilding programmes and colocation, with the clinical directorate chair, the directorate nurse, the general manager and their finance and HR counterparts sharing the same office. This assists informal information sharing and problem solving and reduces the need for formal communication.