Opening leadership pathways for SAS doctors

Key benefits and outcomes

• Demonstrated how SAS leadership can strengthen decision making by bringing frontline insight directly into departmental management.
• The appointment has resulted in increased awareness, visibility and support for the department’s SAS workforce and promotes fairer, more informed management decisions that take account of the specific needs of the SAS workforce. 
• Improved recruitment and retention by creating clearer developmental pathways and a more supportive environment for SAS doctors.
• Encouraged cultural change by showing how SAS doctors can successfully contribute to senior leadership positions. 

What the organisation faced

University Hospitals of Derby and Burton NHS Foundation Trust (UHDB) has an extensive SAS workforce that contributes vastly to the running of the trust. 

Historically, the department had SAS representatives to advocate and support the workforce, but when the tenure ended, funding constraints saw the role discontinued. Although there were SAS advocates, at trust-level position, the SAS workforce lacked a representative at departmental level for years, creating a disconnect between frontline insight and strategic decision making. This limited the organisation’s ability to respond effectively to the SAS workforce and cater for the role’s distinct needs.

What the organisation did

After being approached by the SAS advocate, the chief medical officer, and clinical director, the trust advertised for a vacant associate clinical director (ACD) leadership position.

The advert was put out through traditional recruitment channels and made available to both the consultant and SAS workforce within the department. Following a successful application, the position was taken up by a SAS doctor within UHDB’s anaesthetics department. Taking on this role made them one of the five ACDs under the clinical director and the first and only SAS doctor to date to be appointed to the position within the department.

Results and benefits

Putting a SAS doctor into the ACD role benefitted the SAS workforce and wider anaesthesia department at UHDB, including:

• Job planning: the unique SAS insight that the ACD brought to the role has enabled better job planning that supports SAS doctors’ development. Hosting direct meetings with clinicians has improved understanding of the purpose and processes of job planning, making the process more effective and accessible.
• Revising the annualised agreement: by working with the clinical team to revise the agreement by developing a tabulated PA system to show accrued activities based on shift timing, this has streamlined the process of overseeing workload distribution by providing clear and transparent reference points for calculation. 
• Recruitment: the ACD is working on better defining the role of the SAS and supporting the development of early career SAS doctors. With UHDB colleagues the ACD is helping develop the portfolio pathway, aimed at boosting retention and expanding career opportunities for SAS doctors.
• Supporting the SAS workforce: the ACD has supported the SAS workforce by embedding SAS doctors’ perspective into executive decision-making, promoting fairness and improving recognition across the department. Relationships have improved with consultants, and an increasing number of SAS doctors are coming to the ACD with concerns. Increased engagement from SAS doctors demonstrates greater visibility of the SAS doctors within UHDB’s anaesthetics department.
• Waiting list initiative: traditionally led by consultants, the ACD played a key role in shifting the culture surrounding this, developing criteria and policy to enable SAS doctors to be involved in this process, if they wished.

Overcoming obstacles

Although appointing an SAS doctor to the ACD position was a success, the move did not come without its struggles. The ACD described several different factors - both personal and organisational - that they faced while grappling with the role, such as:

• Lack of self-belief: the mental block faced when considering stepping into a consultant-dominated role was something that they overcame with the support of others within the department, who encouraged their appointment to the role.  The ACD found the consultant workforce to be very welcoming and supportive once in position which helped.
• Demands of the role: despite being well equipped, the clinical director noted the role’s significant demands and need for resilience. The ACD demonstrated both, alongside strong credibility with UHDB’s SAS workforce through remaining involved in clinical duties, enabling them to excel.

Top tips for employers

• Choosing the right person: potential candidates should be determined and ambitious, willing to work through the difficulties of the role to make a difference to the SAS workforce. Credibility among the SAS workforce and experience performing the duties of the role, is also an asset.
• Clarity of vision: on taking up the role, the ACD was required to define their own KPIs and objectives. Having already been carrying out elements of the role, their insight into its demands meant this evolutionary approach to her appointment worked well. Employers looking to follow UHDB’s lead should allocate time to define expectations and set clear, measurable objectives. 
• Taking the leap: The SAS advocate encourages employers to place SAS doctors in leadership roles, emphasising they will reap the benefits.
• Fostering the right culture: cultivating a cultural shift like this will likely require clinicians to take steps out of their comfort zone. Fostering a supportive environment can help appointees settle into the role and maximise the benefits to both workforce and department.