I have been reflecting on the comments made by a trainee who was waxing lyrical about their experience. Once a week the trainee travelled with the consultant in their car to a peripheral clinic and back. This afforded them literally and figuratively time to chat. I then recalled one of the nominees for the Silver Scalpel Award who worked in the Highlands and he too drove to a peripheral clinic with a consultant - a round trip of up to three hours. The trainees themselves referred to this commute as a very useful time to chat. Time and space were created, de facto, for both the trainer and trainee to be present to listen, enquire, coach, advise and support. This enhanced the opportunity to share values and purpose. This is an informal opportunistic exchange to discuss cases, context, and careers. This is also establishing the necessary sense of belonging and shared identity. Admittedly, the exchange could be anecdotal or reinforce banal or stereotypical practice. It has become very clear to me overseeing the Silver Scalpel Award for twenty years that the trainer – trainee relationship is not a Guru/Chela one-direction transactional relationship but very much a bidirectional transformative relationship that has benefitted both the trainee and the trainer. This starts with time to chat.
Our practice has seen many changes over the years. The one thing that strikes me is that we have lost and continue to lose opportunities for time to chat and share experiences. The doctors’ mess and doctors’ dining rooms have been consigned to the bin of historical inappropriateness by ascetic institutions. Reasoning aside, what have we lost? Daniel Kahneman, the Nobel laureate, observed that decision-making amongst doctors was predominantly experiential and based on rules of thumb and the swapping of stories. Decisions are a result of a fluid exchange of ideas, problems, solutions, and participants, all interacting to generate outcomes and solutions. We need to create time and space for discourse and discussion. Our team used to have a regular meeting every week. We did not have an agenda and a colleague described it as an opportunity to itch, scratch and address niggles before they became issues – a pause to establish camaraderie and shared purpose. We used to decant to the pub on a regular basis but that has withered on the vine and run dry. Why and what have we lost?
The importance of the casual encounter in the chaotic and complex field in which we work cannot be underestimated. The new Francis Crick Institute behind the British Library was designed by architects to encourage and create opportunities for people to bump into each other. The creativity and curiosity generated by happenchance is exploited by companies like Google who actively encourage people to follow creative opportunities. I liken this to creating a Large Hadron Collider bringing people together. I am pleased to see that this has shifted to the ubiquitous caffeine emporiums that now occupy the lobbies of our healthcare institutions. Teams regularly retire to refuel on caffeine. It is not surprising that the coffee shop in our hospital is now serving more coffee that all the other outlets in the city and sales continue to rise. Sadly, though this is taken on the run and in COVID-19 the seating area is closed. Time and space have literally been removed.
There is an insatiable desire in all of us to chat. It is what makes the world go round. We are after all sentient social beings that crave that relatedness need. This is the foundation for cohesion. The relatedness is realised through a recognition of identity, sharing of values and knowledge that is even reflected in the chemistry of the brain. This sharing levels the playing field, reduces power distances and swaps subjugation creating the opportunity for self-actualisation. The collective worth improves the efficacy of the team. It engenders collegiality and professional growth and respect. Acknowledgement invites participation. The shared and expressed worth creates results positive culture.
Edgar Schein, a former MIT professor and guru on organisational culture, proffers the idea that the sharing of time and space are two of the five basic assumptions of organisational culture with the whole process becoming ‘one of sharing and with sharing is being and being is becoming’. I recall in my early years of training, the ward round included the matron/sister and the secretary and we chatted over tea and cakes. Schein goes on to describe that in complex high technical environments (we all agree hospitals meet that criteria) we need to value relationships to achieve a high level of trust and communication that will make problem solving and solutions possible. I worry that we run the risk of losing the tea and cakes in the space-time continuum of our hurly-burly work.
This has been exaggerated by COVID-19 enforced distances. The social construct of work is being eroded and runs the risk of being diluted if not washed away in the COVID-19 pandemic. COVID-19 has challenged people-to-people relationship. But they are also being eroded by economic drivers, professional silos, and poor attitudes. Our functional units and professions are coloured by tribal identities, insecurities, segregation, authoritarianism that all culminate in lack of cooperation and learning. This has recently been reported in the media at the team level in many organisations.
I reflect that many of the trainers cited for the Silver Scalpel Award hosted social events in their own time and in their own homes. Whilst this admirable and perhaps the reason they were nominated, I ask to you to reflect why this is not possible during work hours? Are our organisations forgetting that we are in a people business? We should be caring for people who care for people. Together let us reinstate the time and space for tea and a chat.
Trainers have an important role to play in shaping and facilitating change by nurturing the next generation and role modelling and must enable trainees and others to adapt and grow. The trainer-trainee relationship depends on time to chat – it grows stronger when we can share and recognise, we believe in the same things. It is an opportunity to express fallibility and enquire. Integrity and honesty are paramount. There needs to be mutual respect. At a meso team level and at the macro level, work is a social construct that depends on people. We all need to be more mindful that we are dependent on WHO with regards to reengineering our services and not WHAT will be reengineered.
“The greatest waste ….is failure to use the ability of people.”
W. Edwards Deming
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About the author:
David O'Regan is the Director of the Faculty of Surgical Trainers. He has been a Consultant adult Cardiac Surgeon in Leeds since 2001.
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