Leading the way

JUST over two years ago a small group of junior doctors were discussing the lack of opportunities for trainees to help change the way the NHS is run. They talked about the barriers that they had to overcome to get involved in leadership and management, and the lack of understanding amongst trainee doctors about the organisational structures of hospitals, trusts and the NHS as a whole.

As a result of this conversation, BAMMbino was born – the junior doctor arm of BAMM, the British Association of Medical Managers. While BAMM (a charitable organisation) provided a network for the support and development of senior clinicians involved in management positions, BAMMbino aimed to provide the same for junior doctors interested in management and leadership in healthcare. The organisation aimed to empower junior doctors to help the NHS to work better, not just for those who use it but also for those who work within it.

Unfortunately, as you may be aware from the press, BAMM and therefore BAMMbino ceased trading on Friday, June 11, 2010. The details of this remain uncertain for now but the former BAMMbino Board are clear that a network for junior doctors andmedical students interested in clinical leadership and medical management is still crucial.

Empowerment

So why was BAMMbino so important to its members? Before joining the organisation many clinicians felt isolated in their enthusiasm to change the way things are done. They often faced a series of disappointing “no’s” when trying to suggest even the most minor changes to practice and ways of working in their own organisations.

It can be hard to experience endless deadends and not feel helpless in the situation. The change suggested may offer great potential but those proposing it may not have the skills or ‘tools’ to see their suggestion taken seriously.

The mindset “this doesn’t apply to me” is common amongst doctors in training. However, many will find themselves responsible for budgets, teams and even directorates in their working lives. The responsibility for major organisational improvements is also likely to land on the shoulders of clinicians as time passes. It is therefore vital that the natural leadership tendencies we already possess are developed to make us effective leaders of the future.

One of the great strengths of BAMMbino lay in its ability to provide a network of like-minded individuals. Through regular regional ‘night schools’ members had the opportunity to meet and share ideas. One of the greatest impacts of this network of passionate people was that it created a true sense of empowerment: it gave many members confidence to know “it can be done.” And when faced with those ‘dead-ends’ and ‘stone walls’, it gave support and inspiration to its members to ‘keep pushing on through’.

Whilst we wait to find out what happens next with BAMMbino, it is useful to share some of the work we have done. Most of this can be replicated at a local level with very little, if any, funding required. Only vision, determination, hard work and enthusiasm are needed.

A strong start

Following its launch in 2008, BAMMbino membership and activity grew fast. The organisation provided an outlet for junior doctors who previously felt under-qualified to join in the debate. Or maybe those with a long-standing secret love affair with the ‘dark side’ of management and clinical leadership finally felt able to ‘come out’ and confess all, safe in the knowledge that there was a sizeable group of the similarly-minded ready to be heard.

This network of junior doctors met regularly at local and national events. Night schools provided opportunities to encounter senior colleagues and NHS leaders as well as peers with similar interests. The ambitions of participating members varied from those who saw management skills holding relevance in future careers as jobbing GPs or consultants, right through to budding medical directors and chief executives.

The night school series offered tangible personal development with sessions on MBTI and presentation skills. There were also sessions to “Meet the Board” and to gain hints and tips on getting involved in quality of care, patient safety and patient experience improvement projects. In addition to the sessions, BAMMbino provided a ‘Night School in a Box’ SMARTkit for any junior doctor wanting to follow a step-bystep, do-it-yourself guide.

National events also brought leaders such as Professor Sir Bruce Keogh (NHS Medical Director) and former CMO Sir Liam Donaldson directly to junior doctors.

In the North West of England, in partnership with the Junior Doctor Advisory Team, we ran our first ‘Dragon’s Den’ session with up to £50,000 up for grabs. Industry leaders grilled junior doctor applicants bidding for funding to support their ideas on how to improve patient safety, service delivery and education and training within a 48-hour working week. Read more about this at www.tinyurl.com/34zoyoz

We also ran the annual BAMMbinnovation awards to recognise innovative projects and set up working groups to get more juniors involved, while our medical student colleagues set up BAMMdot: Doctors of Tomorrow in autumn 2009.

Take the initiative The NHS faces challenges. The pressures of increasing demand, restricted growth and the continuing advances in scientific discovery add to the pressure cooker of healthcare provision in the UK. How services continue to provide safe, relevant and worthwhile care is really up to the clinicians that work in them.

Providing these services amidst a changing political, social and economic context can seem daunting and overwhelming. The necessary abilities are not learnt in a classroom – neither are the skills essential for being an effective negotiator and savvy operator in this brave new world. These are best absorbed from stories, colleagues and seeing what works and why.

It is becoming clear that doctors in training are a significant untapped resource for change, innovation and improvement. As we face the major challenges of restructuring and budgetary restraint, the leadership capacity and creative capital within the junior doctor workforce is increasingly vital. When this potential is harnessed, nurtured and developed, the possibilities are endless.

We hope this has inspired you to get involved and perhaps start up your own group based on BAMMbino’s experiences. For more information or guidance, contact Dr Ahmed- Little at yasmin.ahmedlittle@gmail.com

Dr Yasmin Ahmed-Little is a specialty registrar in public health in Manchester and was vice-chair of BAMMbino. Dr Joe Collum is a Medical Advisor with the Junior Doctor's Advisory Team for NHS Northwest.

A PERSONAL STORY: BAMMbino and me by Mona Stokes

From the beginning of my working life as a junior doctor I have always wanted to make things work more efficiently. This manifested as a house officer in the meticulous organisation of the filing cabinet in the doctor’s office so that frequently used forms were in the top drawers and so that related forms were near each other. It was a small thing. But it did not go unnoticed and this act was my first of many to change things to make them better for all.

I was the mess president in my SHO years and met with the board to present junior doctor issues. I lobbied my directorate head for split nights, but I felt like a lone voice as many of my peers were happy to leave it to me. Many of these changes and actions sprang from my frustrations with the system and as time went on I felt increasingly disillusioned with my senior colleagues.

During my GP registrar training I was fortunate to be at a site where management issues were a top priority of the trainers. In realising that effective management was a key part of my future career I started to look for opportunities to develop this aspect of my professional life. BAMMbino was recommended by a colleague and I found it a really useful addition to my portfolio of interests. I often attended the night schools andafter one of these events a colleague and I came up with the North West Junior Doctor Dragons’ Den concept, which has been fantastic to be a part of. I have recently been involved with the North West Working Group and, if possible, hope to continue involvement with BAMMbino and BAMM, even after I get my CCT.