London lives

Published: 09/12/2004, Volume II4, No. 5935 Page 34 35

David Probert is divisional general manager of managed care networks tt Guy's and St Thomas' trust. Lorraine Tinker is paediatrics service manager at Whittington Hospital trust.

David is a firm believer in taking a career break from the health service for two reasons: it makes you realise how good it is, and it shows it is possible to stretch your boundaries. For David, that time away was spent in the US. For Lorraine it was the Cayman Islands.

With the Caribbean now a distant memory she, like David, is firmly ensconced in her current clinical management position, enjoying the motivations of the health service and coping with the challenges of the system.

'Obviously the NHS plan and some of the resources that we need to put in to achieve some of the key targets have been quite challenging, ' says David. 'Coupled with the demands of the European working-time directive, this means you are often looking at how you can most effectively use resources. That has been the big change.' He is not sure whether the differences he has noticed are a result of the rapid change in the roles he has adopted during his six-year NHS career - or there has been a genuine upping of the ante. But he is convinced there has been more emphasis on hard targets.

It is a view shared by Lorraine. 'You feel more like you work in a target-driven environment, particularly when you interface with points like the emergency departments, because It is not just about the work that goes on in those departments, It is how quickly the rest of the hospital responds, ' she says.

Both agree that the targets in themselves are no bad thing, helping to achieve results. Ultimately, says Lorraine, 'they are there to improve patient care'.

The working-time regulations in particular have created some serious pressures. In north central London it is forcing a long talked-about reconfiguration of children's services that is high on Lorraine's agenda. Although consultation on Healthy Start Healthy Futures has now been put back to next summer, other developments are continuing, including a managed neo-natal network for north central London and a partnership with Great Ormond Street, Whittington and North Middlesex hospitals and Haringey primary care trust.

But for both managers, co-operation and teamwork are crucial in achieving results in clinical management. 'I can honestly say I have always worked very well with clinical staff, ' says David. His divisional director is a clinician, but there is no split in terms of one looking after clinical issues and the other managerial:

'we take things head on'.

David says the key to moving forward with achievable but difficult challenges is to be able to explain why the challenges exist, and articulating the way forward.

'There is no way you could achieve half these targets without close co-operations'.

The same goes for Lorraine: 'We work together, because everyone's passionate about their work and drives to improve services.' And her frontline training helps her gain respect from clinical colleagues.

'Having a nursing background helps you tremendously if you are trying to implement change.' It also means she can help out in the day-to-day clinical challenges. 'You do get involved with inpatients, you speak to parents, and you get to know long-term patients.' Lorraine plays her part in improving nursing recruitment to run a fully staffed unit. This has been achieved by reorganising work services, putting bids together and creating new funding, which also helped change the reputation of the organisation and attract back staff previously lost to neighbouring trusts.

Improvements in staff development have also helped this step forward. One example is a creative collaboration with Middlesex University to establish lecturer practitioner posts in paediatrics. This will mean 'an expert nurse to develop somebody's career at the bedside', says Lorraine, 'as well income generated by running their own study days, to which they invite other trusts' nurses'.

But the lack of a medical background is no block to working with clinical colleagues to achieve progress. 'In my last job, as general manager for renal and urology, there were two things I really set my heart on achieving, ' says David.

'We were desperately short of haemodialysis capacity in this sector. So the first challenge was to increase that capacity.' A successful bid later and the funding was there to work with construction companies and NHS Estates to build an 80-person unit in Camberwell. It opened in David's last week in the job.

'I really enjoyed the whole thing, the combination of working very closely with our consultants, with our nurses, especially the lead nurse who looks after dialysis. When I go down there now It is quite nice because you can actually see that having a unit That is really close to people's homes has made a radical difference to their lives.' The second achievement was around successful bids to help develop innovative surgery, especially in urological services and renal transplantation: 'We are now doing things like robotic urological surgery. People who come and donate their kidneys are leaving hospital within a couple of days.'

Of course, daily plans can go out of the window when doctors are off sick, different patient and clinic priorities crop up, or a major incident happens. 'It does mean that I always feel like I never achieve everything, that You have always got this 'must do' list', says Lorraine. But the fact that managers work with clinical colleagues can create improvement is what keeps everyone going.

'Often in the health service It is very hard to go home at the end of the week and say I achieved this or I made this different, ' adds David.

'So It is nice to have a couple of things you can look back on, not just from your CV perspective because That is fairly unimportant, but just in the back of your mind: 'Wow, if I put my mind to it I can make a difference'.' .

David Probert CV . 1998 - Joined NHS management trainee scheme, initially at City and Hackney Community Servics trust, then spent a year at the Boston Institute for Healthcare Improvement, working in improvement projects on the east coast, before returning to Great Ormond Street Hospital as assistant strategic planning manager.

. 2000 - moved to Guy's and St Thomas' Hospital as deputy general manager for the directorate of renal and urology before becoming acting general manager.

. July 2004 - appointed to current position.

Lorraine Tinker CV . 1987-1991 - trained as a nurse at Great Ormond Street Hospital in central London.

. 1991-2000 - rose through the ranks, from senior staff nurse at GOSH to child and adolescent psychiatry sister at Queen Elizabeth Hospital for Children and then nurse manager at the Royal London Hospital's regional paediatric oncology centre.

. 2000-2002 - took a career break to do a stint as one of just five paediatric nurses in the Cayman Islands in the Caribbean.

. 2002 - took on current position as service manager of paediatrics at Whittington Hospital trust.

DAVID AND LORRAINE'S TOP TIPS 1. do not promise anything you do not feel you can deliver on David: 'That is a sure way to damage your relationships.' Lorraine: 'If you do promise something to somebody that is undeliverable or unachievable, people just feel that you have let them down, even if you try and achieve it.' 2. Be flexible David: 'No week will be the same, no day will be the same. You can't be rigid.' 3. Build relationships David: 'You're not there to be an obstacle, you're there to assist. Explain what you're doing and why you're doing it.' 4. Walk the floor Lorraine: 'It is all about valuing your staff and knowing your staff at all levels in all your areas so you're not just a figure that sits in an admin block and a name on a piece of paper.

'I find more out about my staff and what's happening by walking around the shop floor and being stopped in the corridor.

'By talking to patients you find out a lot more about satisfaction with your service than reading a thank-you card or a complaints letter.' David: 'You should always try to give yourself two or three hours a week where you can just walk on the wards, say hello to the ward sisters, say hello to the nurses, pop into various meetings and just understand who people are. When problems arise in those areas It is so much easier if you know who the people are and you pick up a sense of where things are going. Those days when managers were stuck away have hopefully disappeared.' 5. do not be arrogant David: 'There is belief that because You have been titled with general manager or service manager you cannot fall down.

Staff are incredibly perceptive and if you behave like that you can lose friends very quickly.' Lorraine: 'You have to be prepared to work hard and appreciate other people's experience.'