There's a saying that "If you can't change the person then change the person", and this might be apposite.
There are undoubtedly some lessons to be learned from the UK National Health Service. If you've watched the 1950s film Doctor in the House, there is a memorable scene about a Consultant Surgeon, Sir Lancelot Spratt, and his leadership style (take a look at this vignette at
http://www.youtube.com/watch?v=oVWjAeAa52o ).
We can laugh at it, but many of the older generation of doctors whom I've worked with say that in many respects it represents the hospital culture at that time.
Things have, and are still, moving on in getting the question of medical competence sorted out and taking action on the (fortunately) very small percentage of doctors who are not up to the mark. The latest moves by the General Medical Council, pressured originally by the Blair government and then given an even bigger kick by the Shipman enquiry, is around regular re-licencing as "Fit to practice medicine" for all doctors working in the UK on a five-yearly cycle.
Doctors have to maintain a portfolio of evidence which must include:
- five annual appraisals
- evidence pf professional development and continuous medical education (keeping skills up to date)
- medical performance statistics (including fatalities)
- at least one multi-source feedback (360-degree) survey which includes feedback from peer doctors, junior doctors, health professionals (nurses and the like), management, administration and Patients. The surveys are seen by other doctors trained in feedback-facilitation, and they are (in most hospitals) tasked with taking appropriate action where the feedback is indication that patients may be at risk. Actions can include remedial re-training as well as referral to the GMC and their Royal College, with serious implications for their career. Incompetent doctors will be struck off the medical register.
My company runs the feedback surveys for various NHS Trusts around the UK, and the confidential survey process does provide candid feedback about doctors....and reassuringly for readers, 99% is extremely positive. I've also been treated by Consultants and Specialist Registrars whose surveys I have run beforehand. The experience I've had as a patient has reflected the comments in their reports, again reassuring about survey validity.
So the question is "Are the performance management systems currently in place in the mercantile marine robust and fit for purpose?"
I was looking at my discharge book this morning with its Copy of Report of Character: For Ability and For General Conduct. I seem to remember the options being:
VNC - voyage not completed (jumped ship)
DR - decline to report (naughty boy/girl!)
Good - which really meant bad, but couldn't be pinned down
Very Good - which could range from acceptable to absolutely brilliant
Is this still the case?