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Leadership and team building in gastrointestinal endoscopy

https://doi.org/10.1016/j.bpg.2016.04.007Get rights and content

Abstract

A modern endoscopy service delivers high volume procedures that can be daunting, embarrassing and uncomfortable for patients [1]. Endoscopy is hugely beneficial to patients but only if it is performed to high standards [2]. Some consequences of poor quality endoscopy include worse outcomes for cancer and gastrointestinal bleeding, unnecessary repeat procedures, needless damage to patients and even avoidable death [3]. New endoscopy technology and more rigorous decontamination procedures have made endoscopy more effective and safer, but they have placed additional demands on the service. Ever-scarcer resources require more efficient, higher turnover of patients, which can be at odds with a good patient experience, and with quality and safety.

It is clear from the demands put upon it, that to deliver a modern endoscopy service requires effective leadership and team working [4]. This chapter explores what constitutes effective leadership and what makes great clinical teams. It makes the point that endoscopy services are not usually isolated, independent units, and as such are dependent for success on the organisations they sit within. It will explain how endoscopy services are affected by the wider policy and governance context. Finally, within the context of the collection of papers in this edition of Best Practice & Research: Clinical Gastroenterology, it explores the potentially conflicting relationship between training of endoscopists and service delivery.

The effectiveness of leadership and teams is rarely the subject of classic experimental designs such as randomized controlled trials. Nevertheless there is a substantial literature on this subject within and particularly outside healthcare [5]. The authors draw on this wider, more diffuse literature and on their experience of delivering a Team Leadership Programme (TLP) to the leaders of 70 endoscopy teams during the period 2008–2012.

(Team Leadership Programme Link-http://www.qsfh.co.uk/Page.aspx?PageId=Public).

Section snippets

Background

In many places endoscopy services have grown up in an ad hoc fashion, in a variety of settings and with a variety of business models. As a consequence, endoscopy services have not had the same recognition as other diagnostic services such as radiology or pathology. Moreover, there has not been a tradition of leadership and management structures that other diagnostic services take for granted.

There has been a massive growth in the volume of endoscopy in the last 20–30 years [6]. Procedures have

Service delivery

If you ask different people what constitutes an excellent service you will get different answers. Endoscopists, most of whom are doctors, will focus on quality and safety [9]. Nurses will primarily focus on team working and the patient experience [10]. The key concern for managers will be waiting lists, throughput, efficiency and productivity [11]. Most patients don't understand what quality really means and naively assume that quality is at least adequate. Their main concerns relate to

What makes a highly effective endoscopy service?

Ultimately it is a clinical team that delivers the service to patients. However, a number of things need to be in place before the team can be effective; including training, appropriate equipment, administration support, scheduling, a suitable environment, and policies and procedures to name just a few. It is the leaders of the service who ensure that the team has all it requires and that it is supported to do its job properly.

Most endoscopy services do not exist in isolation so the leaders, in

Summary

A modern endoscopy unit requires highly competent leaders supported by great teams to provide high volume, high quality, safe, efficient and patient-centred endoscopy. Team members need to be clear as to what is expected of them, trained to do their job, motivated to excel and provided with all the necessary support. It is the leaders of the service who provide team members with the guidance, training and support they need. Very importantly, they are responsible for developing a culture within

Conflict of interest statement

We declare the following interest: Roland Valori and Debbie Johnston are members of Quality Solutions for Healthcare LLP, a small consulting company based in the United Kingdom which specializes in service improvement and quality assurance of clinical services.

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