Your browser is no longer supported

For the best possible experience using our website we recommend you upgrade to a newer version or another browser.

Your browser appears to have cookies disabled. For the best experience of this website, please enable cookies in your browser

We'll assume we have your consent to use cookies, for example so you won't need to log in each time you visit our site.
Learn more

‘Nurses need to be closely involved in all projects to change patient services’

  • Comment
Management consultants can offer invaluable advice on patient service redesign but they need to do so in a language that clinicians can understand, says Steve Duckworth

I have recently been involved with a firm of management consultants on a patient service improvement project. Whenever I mention this to acquaintances, they always come up with their favourite consultant jokes.

‘A consultant is someone who comes in to solve a problem and stays around long enough to become part of it’ is surpassed only by ‘A consultant is someone who borrows your watch to tell you the time and then keeps your watch’.

All very droll and I’m sure the specialists in question groan in weary exasperation every time these witticisms are trotted out.

Management consultants are much-criticised figures but, despite this, appear to be a ubiquitous part of any public service project or initiative. According to the Management Consultancy Association, expenditure on consultancies in the public sector in

Britain increased from £605m in 2002 to more than £1.9bn in 2004.

It would therefore not be remiss to suggest that the Departments of Health and Education, among others, view the input of such consultants as key to successful project management. There is no doubt that, post Darzi, clinical leaders will be expected to look at services, assess their ‘fitness for purpose’ and redesign them.

Let us set aside, as nurses, the obligatory hour we had concentrating on managing change in our training. I, for one, felt out
of my depth at times trying to manage complex projects and the multitude of different stakeholders involved in any service redesign. Perhaps we do need management consultants to help us navigate this often foreign terrain. So I would like to offer a few thoughts to others embarking on this trip.

Consultants need to speak in a language that clinicians understand. Trust me, enquiring whether ‘I have the bandwidth to deliver the cost driver tree by Thursday’ is not helpful and will have me still scratching my head on Friday.

Insisting I deliver reports and data in a format that is completely alien to me will not help to ‘facilitate us going forward’, although it may mean I do have to cancel a clinic because I’m rushing around trying to get the damn things off to your head office.

Having said that, the project I was involved with was successful. As a result, I was invited to a conference to celebrate our achievements and relay my experience.

I was followed on stage by a management consultant. He regaled the audience with a tale of how he had transformed a failing orthopaedic unit with a regime of process mapping and service redesign.

Of particular importance was the fact that he had concluded that the bedside chairs employed post-operatively were antiquated and impeding rehabilitation. He therefore persuaded the service manager to invest in new chairs and, almost overnight, length-of-stay figures reduced and patient satisfaction shot through the roof. Buoyed up by this, I went off to lunch, only to be collared by an angry nurse who said that staff had been pleading with the service manager to replace said chairs for five years.

What did I take from the experience? There is no doubt that we constantly need to develop and improve services. I also believe that, as nurses, it is important that we become closely involved with any projects to change services.

We often do not have the skills to see through the aims and expectations of this kind of work fully. So we do need help – and who better than people who do this kind of work day in, day out?

However, it needs to be done in a language that we understand and within a process that we find relevant and which is unencumbered by documentation just for the sake of it. We are the ones who require the assistance – so it should be done on our terms.

One final word to trust executives and general managers. If you do highlight a service that needs improving, before you get on the phone to a firm of management consultants, take a stroll down to the unit in question. You may be surprised at the wealth of ideas and skills already there.

Steve Duckworth is stroke director at Kent Cardiovascular Network

Would you like to read more Hot Topic? Justclick on the more by this author link at the top of this page.

  • Comment

Have your say

You must sign in to make a comment

Please remember that the submission of any material is governed by our Terms and Conditions and by submitting material you confirm your agreement to these Terms and Conditions. Links may be included in your comments but HTML is not permitted.