Clinical Director - role and job description

RE: Clinical Director - role and job description

grumpyoldman — Tue, 09 Feb 2016 09:47:12 GMT

[quote user="robloxley"]Maybe it pays more than an assistant's job and there are plenty of crummy ones of those[/quote]

There are some good ones too, with prospects, and, without any silent partners living off your back.

RE: Clinical Director - role and job description

grumpyoldman — Tue, 09 Feb 2016 09:43:56 GMT

Just think ultimately you cannot control anything unless you have the ability to hire and fire. If the troops know they can ignore you and get away with it they will.

RE: Clinical Director - role and job description

Hannah Wynne Richards — Tue, 09 Feb 2016 09:14:03 GMT

Realistic

Wynne

RE: Clinical Director - role and job description

Bob Russell — Tue, 09 Feb 2016 09:11:50 GMT

What a cynical bunch we are!

RE: Clinical Director - role and job description

Hannah Wynne Richards — Tue, 09 Feb 2016 08:56:32 GMT

A clinical directors job combines all the bad bits of practice ownership with none of the good bits.

Wynne

RE: Clinical Director - role and job description

Utlendigur — Tue, 09 Feb 2016 00:12:31 GMT

[quote user="An On MRCVS"]I do have responsibility but not authority which is tricky to cope with.[/quote]

I think that's an understatement speaking from experience, and believe me it will just grind you down depending on the situation. If you try to introduce changes or solve problems, you may be able to carry the more engaged and motivated staff with you - but if there are any "problem staff"- the ones who don't like change or are just coasting along comfortably and don't want to be bothered - you cannot actually do anything about it. You can nag, try to do everything yourself, give up - or ask someone who has authority to step in. If they do, it just reinforces how little authority you have, if they don't ....

I suppose it depends on what or how they want you to do things. If it is more of a case of being a mentor for less experienced/confident staff rather than a monitor, that would be better. Making sure the practice is up to date can actually be quite motivating. I used to manage the dispensary and drug ordering in my last practice - as a result I found I was keeping myself more up to date with medicines than I would have done otherwise - and the occasional written update (new indications, new medicines, availability problems/alternatives) avoided everyone else having to hunt around for the same info. You could also look at the topics on Vetsurgeon eg WSAVA vaccination guidelines, dispensing protocols, or other areas of best practice, and use them to start general discussions in staff meetings - then get everyone contributing to keeping the "clinical performance of the practice in line with current thinking" and deciding what practice policies should be.

As far as cases that don't go to plan - could you just include them in a general M+M section of meetings, preferably self reported, so everyone knows it is just part of the meeting - and try to approach it more like the airline industry, less like the NHS in terms of a no blame, focussing on learning, approach. It may be that the vets feel they have someone looking over their shoulders ready to pounce all the time? Maybe also extend it to include unusual cases and ones that have done unexpectedly well, so it's not all negative.

I suspect lot will depend on how things pan out with respect to defining your limits of responsibility, and ensuring you are either given the authority/back up to deal with any problems, or are able to pass them on to someone who has.

RE: Clinical Director - role and job description

Rob Loxley — Mon, 08 Feb 2016 21:09:22 GMT

[quote user="grumpyoldman"]Why does anyone give this shite a second thought ?. [/quote]

Maybe it pays more than an assistant's job and there are plenty of crummy ones of those

RE: Clinical Director - role and job description

grumpyoldman — Mon, 08 Feb 2016 20:48:11 GMT

I hate these jobs "come and work for blue triangle as our lead vet/clin director ,work hard grow our business take responsibility ,suck ass with the punters, and at the end of it all we will pay you 50% of what you could earn in your own little practice ,because we are creaming off the rest for doing the square root of FA." Why does anyone give this shite a second thought ?.

RE: Clinical Director - role and job description

Bob Russell — Mon, 08 Feb 2016 14:17:19 GMT

If you are applying for a job. especially one with grand titles, find out how long the previous clinical director lasted. Quite good to see what level of turnover of staff there is! Nice new premises, cheap prices and rapid burnout!

There seem to be plenty of employers happy to promise the world but expect you to work yourself into the ground.

I agree these jobs seem to be full of responsibility and crap but even the healthy looking salaries are not worth the stress and pressure.

RE: Clinical Director - role and job description

Robin Grimmer — Mon, 08 Feb 2016 13:08:51 GMT

I think these sort of jobs are just a way of dumping all the responsibility and general day to day crap on you, without any of the benefits of practice ownership. (I speak from experience!)

RE: Clinical Director - role and job description

Nhombokisheni — Mon, 08 Feb 2016 12:51:17 GMT

.........if you can't get full authority to carry out your responsibilities as you understand them.....then it maybe time to rethink...

RE: Clinical Director - role and job description

Nhombokisheni — Mon, 08 Feb 2016 12:48:38 GMT

[quote user="An On MRCVS"]

Thanks for the replies everyone - some really useful ideas and thoughts there. I have been at the practice for a year already before this (newly created post) came up..

I do have responsibility but not authority which is tricky to cope with.

[/quote]

You have been here a year.....surely you have had a feel of the place......how about sitting down with the boss for a frank review.......get some concrete objectives down and obtain the authority to do your job.

Personally I don't encourage you continue to tip-toe around vague mandates......if changes have to be made I think you have had long enough to note a few down.........the real danger lies in you not making clear why you are there .........the longer it takes the more difficult it is going to be for you to achieve anything..........because you are watching and allowing habits to develop.......how can you turn around after two years and condemn something you have been witnessing for that long without doing anything concrete??????

What kind of a clinical director do you want to be, what standards do you want to be associated with, why did you take the job.........you may be diplomatic in the implementation as suggested by many.....but you need to be very clear where you want to go......and if you can't get the full authority to carry out your responsibilities as you unrestrained them.......then it maybe time to rethink if you should really be there.........

RE: Clinical Director - role and job description

Virginia Campbell — Mon, 08 Feb 2016 12:47:28 GMT

[quote user="Michael Woodhouse"]What we found helpful is making people do the work. Send one of the assistants to find the evidence for how something is done and to define best practice and decide what may need changing in the practice. Let them present and then discuss as a practice. This works much better than telling them they need to do something differently.[/quote]

This seems a good plan - if they have invested time and thought in something and come up with ideas for change then of course they'll be keen to see things followed through.

Our head nurse and sometimes some of the other senior nurses attend clinical meetings so that the nurses have their input of concerns and ideas so that they don't just get handed down the vet diktats all the time.

Have a look at the RCVS practice standards scheme clinical governance section to form a framework for your job, then have a look through all the other sections. Even if you're not doing the PSS it may be worth assigning different people to a couple of different areas each as if you were doing it- so somebody as a driver for anaesthetic and analgesia protocols, somebody else for inpatient care, another for dental equipment and training, etc. It's sort of like an individual inpatient being somebody's case - if nobody "owns" the case then it'll still be looked after, but it's better one person has primary responsibility for it.

RE: Clinical Director - role and job description

Bob Russell — Mon, 08 Feb 2016 10:48:43 GMT

Most of the 'Clinical Directors' posts seem to reappear in the wanted column so the cynic in me says don't worry too much!

Nastiness over!

Start the job without preconceptions and look at what is going on. Talk to any vet that has been there more than five minutes and sound out what they think is needed.

If previous management has been sound there should be a structure in place that can be tweaked. Best of luck if there has not been good management. Start with the basics and work up!

Look and listen first then act at leisure!

RE: Clinical Director - role and job description

Hannah Wynne Richards — Mon, 08 Feb 2016 10:46:56 GMT

That is an impossible position to be in. It's impossible to be responsible for something without 1st having authority.

One of the many things RCVS should have thought about before allowing lay and corporate ownership of practices. Yours may be an independant, but, unless the owner is a non-veterinarian, why isn't he/she the clinical director?

Wynne

RE: Clinical Director - role and job description

Michael Woodhouse — Sun, 07 Feb 2016 23:36:06 GMT

John Flynn - I'd hope any reasonable boss would take a decent, evidenced based approach centred around patient safety on board. I once saw a bill for a dog that had been stitched up (both literally and figuratively) at a well know OOH provider. Each time it's blood pressure was monitored under anaesthesia was billed.

(in human medicine they absolutely don't always change needle after drawing up a vaccine).

I don't think I'd want to work somewhere where the ONLY motivation was profit.

I do take your points on board and realise I can be rather dogmatic - despite that I am very open to change from all staff if they put a good case to me. That might be more profit, but it might be better working conditions or better patient care. Coming to me and saying they want me to buy something because they fancy one is unlikely to work.

RE: Clinical Director - role and job description

An On MRCVS — Sun, 07 Feb 2016 23:03:18 GMT

[quote user="Mike Dale"]To me, clinical director means you are ultimately responsible for everything that happens to a patient in the care of the practice. The establishment and development of protocols, direction of CPD, and a degree of pastoral care for your team and anything else that influences the delivery of the level of care to which the practice aspires.[/quote]

Thanks for the replies everyone - some really useful ideas and thoughts there. I have been at the practice for a year already before this (newly created post) came up.

I'm trying to do lots of support and watching of back, encouraging joint thoughts and input from everyone about things like improving care in the kennels.

as Mike as said I do feel that I'm responsible to some extent for what happens to a patient in our care. I've seen 1 or 2 cases of in patients where things could have been done better or things were sent home when the case vet wasn't sure what was going on with it. At the moment I don't feel I can step in unless asked but I find that very hard as I do feel I am aware to some extent what is going on with inpatients and have some responsibility for them even though they are not my cases.

I do have responsibility but not authority which is tricky to cope with.

Speaking with the vets and finding out what they have issues with sounds like a great idea and there are a some other good ideas to think about as well.

Thanks!

RE: Clinical Director - role and job description

John Flynn — Sun, 07 Feb 2016 22:50:28 GMT

[quote user="Michael Woodhouse"]

[quote user="John Flynn"]

the vets would all like a capnograph like they had at uni - you need to source one suitable for the clinic at the best price possible and then figure out how to fund it to make the proposal irresistable to mangmeent (probably paying off cost of unit + 10% and running costs over 12 months, e.g. use on neuters is free to get staff experienced in use and charged out as additional cost on other procedures).

[/quote]

Surely no one would charge specifically for the use of basic monitoring equipment? It was one of the first things we bought when we took over the practice. You'd be negligent giving a human a GA without one.

[/quote]

It's a hypothetical example, Michael. If you went to work in a clinic where the owner didn't share your passions, simply telling them all the stuff that is 100% essential and they can't be working without and they must purchase now won't always work out how you want. This is not necessarily them being unreasonable - just a different perspective. If you frame your request in a manner that seems more reasonable than the blank cheque approach and accusations of negligence then you might get further.

There was a post here in last week from someone who works in a clinic without a capnograph - I think you're making a big assumption to think that because you have at least one that everyone else does.

Other options are to increase the fee of all anesthetic procedures to cover the cost/running of the unit, to increase other unconnected fees, to reduce costs somewhere else such as not renewing that Yellow Pages advert, to make less profit for the owner, to ask for everyone to take a little salary cut, to assume that your clinical improvement will drive more footfall and self-fund etc. I think that not charging for use on neuterings and charging a supplement when used on other procedures to pay itself off over a year is a more reasonable approach that is likely not to hit resistance and therefore actually get you what you want. But it was just meant to be an example of thinking how you might achieve an equipment purchase in the presence of an unsympathetic ear when you don't hold the chequebook. If you think no capnograph is negligent, then you should be very happy to charge to use it; however you're not forcing your opinion down the throats of the other vets at the clinic who might reasonably be concerned about the increased cost of doing what they consider a "fancy" anesthetic would deter folk from actually doing procedures and give an overall worse clinical outcome. My point is simply that you just need to be clever about how you manage your boss as well as your subordinates to achieve meaningful improvement. Obviously you need to get to know the stumbling blocks and local clinic culture and personalities to figure how best to do where you are - in your clinic, the vet would only need to tell you it was negligent to inject a human with a needle that hadn't been changed since pentrating a multi-dose vial and you would instantly concede and get out the chequebook for a shipment of cat-friendly 25G needles and thank them for saving you from your incompetent ways [or perhaps that would have the more standard effect of making you defensive and resistant to change...]

RE: Clinical Director - role and job description

Michael Woodhouse — Sun, 07 Feb 2016 22:24:03 GMT

The solution to the OP is to create an environment where cases are discussed and shared. There needs to be no blame put on people's management. Perhaps start by discussing your cases with the other staff - looking for discussion and input.

What we found helpful is making people do the work. Send one of the assistants to find the evidence for how something is done and to define best practice and decide what may need changing in the practice. Let them present and then discuss as a practice. This works much better than telling them they need to do something differently.

The M&M meetings are awkward to start with, but people relax into them. Again - it would be good if you used one of your cases first - if you are new do you have something from your last practice?

Try to facilitate and guide rather than tell - unless you are asked or time is short.

RE: Clinical Director - role and job description

Michael Woodhouse — Sun, 07 Feb 2016 22:18:16 GMT

[quote user="John Flynn"]

the vets would all like a capnograph like they had at uni - you need to source one suitable for the clinic at the best price possible and then figure out how to fund it to make the proposal irresistable to mangmeent (probably paying off cost of unit + 10% and running costs over 12 months, e.g. use on neuters is free to get staff experienced in use and charged out as additional cost on other procedures).

[/quote]

Mike Dale - dare you to comment over on the use of the word gay thread with your signature......

RE: Clinical Director - role and job description

Mike Dale — Sun, 07 Feb 2016 21:53:24 GMT

Take some time to get the feel of the place. Certainly don't begin with a philosophy of feeling obliged to make changes or just to troubleshoot. Find out what works well as much as what does not. Be even with praise and acknowledgment as well as criticism or suggestion for improvement.

I usually start a new position by speaking to each person for whom I am responsible and try to both build a relationship and understand what they think individually might be improved and what they believe is done well. You may find there are one or two common issues to be addressed and that there is support for you in taking the lead. Brief example - I joined a practice that had an unacceptably high rate of of surgical wound complication. A few basic and enforceable changes (that everyone knew ought to have been made but no-one had previously taken the initiative) brought immediate results and cheered everyone up. You sometimes need to lead by example too, so be aware of your personal strengths and exhibit them whenever you can.

If you are not clear about your job description or level of authority - clarify it with your employers sooner rather than later. Have regular meetings with your colleagues - not just when there are issues to put right but grow an environment where discussion, mutual appreciation and audit of clinical practice become second nature to everyone.

To me, clinical director means you are ultimately responsible for everything that happens to a patient in the care of the practice. The establishment and development of protocols, direction of CPD, and a degree of pastoral care for your team and anything else that influences the delivery of the level of care to which the practice aspires.

RE: Clinical Director - role and job description

John Flynn — Sun, 07 Feb 2016 20:52:07 GMT

Sounds a tough one.

My advice to anyone starting a new position is to weather the inevitable storm or conflict between your expectations and the realities and reassess after a year or so ideally.

From your description it sounds like you are being given responsibility but not authority - a difficult position to come to terms with often.

Change of any kind is very difficult to make in an established business even if you ARE the boss, so be realistic about what you might achieve. Personally, I'd take a month to get to know the clinic a bit (I'm assuming that this is a totally new job rather than simply a new role) and restrain myself from commenting on anything and instead get to know the folks you are working with and how the clinic currently works. I wouldn't be idle during this time, but making best use of my fresh perspective to think of where the biggest, real, achievable clinical improvements may lie.

Then I'd pick a simple starter to see how I got on. The ideal would be something that was clearly suboptimal, changing it could clearly make a real difference (even if a small one) and it is unlikely that anyone is going to wish to mount any real opposition (so changing the vaccine policy probably ain't your best place to start!). I'd then try to see it through and would learn in the process what the obstacles to progress might be before I tried anything more challenging.

I'd also try to get as much input from my colleagues (no matter how inexperienced) as possible on what they feel would be the best clinical improvements and see how these could be facilitated.

Of course if you have a budget to work with, then you'll be able to get the other vets on side much quicker if they can see that you actually can make a change - you may not have this luxury. If that is the case, then simply think of yourself as a middleman - an advocate for the clinical staff and concentrate on implementing clinical improvements they feel passionate about by figuring how to voice those in a manner that the managmeent understand.

Let's take an example to show what I mean:

You are disappointed with the anaesthetic safety in the clinic. You spend a month concluding that the biggest issue is the monitoring of patients during and after procedures. You observe 3 issues that you think could be addressed:

1) Anesthetics are monitored by a dedicated person except for the surgeon, but this person answers the phone if it is ringing too long and this can lead to long periods without adequate monitoring - either slowing down the vet operating as they try to observe the patient too or leading to inadequate levels of supervision should a problem occur.

2) No monitoring aids are used.

3) Some of the staff monitoring the anesthetics seem to have insufficient training.

After informal chats with the vets and staff monitoring the anesthetics, you realise that:

they are told to answer the phone if ringing more than 7 times unless sterile - your job is to explain to management why you think this is a bad idea and if they agree that they need to explain the shift in priority to the staff.
the vets would all like a capnograph like they had at uni - you need to source one suitable for the clinic at the best price possible and then figure out how to fund it to make the proposal irresistable to mangmeent (probably paying off cost of unit + 10% and running costs over 12 months, e.g. use on neuters is free to get staff experienced in use and charged out as additional cost on other procedures).
some of the staff would LOVE some additonal training - you need to figure best way to provide it, others think they know enough (don't waste your time trying to force training down their throats just now).

I would focus proactively on work-related issues where the clinical environment is the weak-link rather than retrospectively on errors by individual vets. Vets love to learn and love clinical freedom - if you're more experienced, then making yourself available to advise is infinitely better than spotting mistakes and telling the vet afterwards. If you want to dsicuss case approaches, then far better to make it impersonal rather than focus on real cases that other vets have been treating. If the vets you work with are lazy, uninterested in bettering themselves and their case outcomes, incapable of reflecting on their own case outcomes etc then the problem in the clinic is with hiring and maintaining motivated vets (you're not going to fix this in your tenure).

Finally, respect has to be earned. You will need to earn the respect of the more junior vets if you are to positively influence them. This should actually be an encouragement to you as it means that one of the most important things for you to do is just do what you are already good at - work hard and do your clinical work well, keep yourself up-to-date and try to break down any barriers affecting your own clinical case success and you may be surprised to discover that your colleagues have caught what could not be taught As criticism (no matter how kindly put) rarely has the desired effect (just think of the effect on you of a complaint you may have received which if you're honest was actually justifiable), I'd try to simply support the junior vets so they know I have their back and be the kind of leader I would like to be lead by - however much I might have to bite my tongue at times.

RE: Clinical Director - role and job description

An On MRCVS — Sun, 07 Feb 2016 19:17:29 GMT

In fact it's done the same again!

What I wanted to add is that when I do comment on cases (in the kindest way I can) it is not well received and my boss wants me to leave vets to make their own mistakes and learn from them. As such I don't feel that I can comment on cases or look at in-patient's notes and comment on diagnoses or treatment plans at all.

Personally I don't feel that this is compatible with my role in the practice.

What do others think and how have you overcome similar problems .

RE: Clinical Director - role and job description

An On MRCVS — Sun, 07 Feb 2016 19:10:48 GMT

Sorry for the second posting - I started to write the above twice and the formatting/ cursor to type stopped behaving when I went back a few lines to correct something. It wouldn't let me cut and paste the whole post too start again either.