LEADERSHIP & MANAGEMENT
Left: The Board of The Christie
themselves, and even in reducing costs due to the nature of the decisions people tend to take.
Decisions about treating cancer at The Christie defi nitely are shared, Shaw told us, but it is a complex area, and the close in- volvement of the family rather than just the patient in many decisions actually makes it more complex again.
She explained: “This is a very personal view. I think it depends on the relationship between the patient and the clinician, and how the clinician wants to manage it.
‘live’ – because while people want choice, and want to use us, it enables us to develop our services.
“So, we proactively market ourselves, but with that, you have to ensure that patients have a good experience. We’ve learnt – while some hate using the word ‘brand’ – that brand management is extremely good while you’re getting good results, and the patient’s having a wonderful experience, and you’re very driven, and you’re developing. As soon as something’s gone slightly wrong, you’ve also got to manage the media in that way.
“Then on staff engagement, you’ve also got to get it right. We have reduced our costs here, and we’ve been quite radical. But because we’re such a public brand, it’s very easy to get on the evening news when we do that.
“It’s got to be appropriate and you’ve got make sure the right processes and systems are in place. You’ve got to be ‘live’, part of The Christie – I don’t spend my life here in the of- fi ce, I’m out there, talking to people and fi nd- ing things out. As a chief executive, you get all the data in the world, you get your perfor- mance reports, but you need to triangulate that with your patients and fi nd out what’s really happening. They will tell you.”
Far and wide
That growing reputation has led to more and more patients from further afi eld in the UK wanting to be treated at The Chris- tie and being referred there – around 25% of patients are from outside its immediate Greater Manchester and Cheshire region.
But Shaw hopes that proportion will con- tinue to rise, telling us: “We’re a very spe- cialised service, and we do see that pro-
portion increasing in the future. I’ve been speaking to the nurses today and they’ve noticed it themselves; they’ve seen people from Scotland right down to the Midlands and those numbers have been growing.
“We do something called pseudomyxoma surgery, for example; there’s only two places in the country that do it, us and Bas- ingstoke. If you think of the pressures we’ll face in the future, I think there will be a lot more rationalisation of services; not just for cancer, but I think a lot of high-spec, integrated services will be in fewer places.”
The hospital’s brand has also encouraged the growth of a large community of fund- raisers, and it is second only to Great Or- mond Street hospital in terms of charitable donations.
Shaw said: “It’s important as an income stream of course, it’s £12m – but it’s also important for us because it’s about the rep- utation and brand of the organisation. But it’s a very driven business, and very com- petitive. We have to work extremely hard at it, because we do run it as a business.
“People don’t understand it, and I didn’t when I fi rst came here. I thought it was people shaking buckets everywhere. But no; we break it down into income tar- gets, we review the numbers, follow it all through. It’s an active part of the business.”
Making the call
On page 22-24 this edition, health policy experts address the need for truly shared decision-making between clinicians and patients – and highlight that this is not only of benefi t to patients, but can be a good thing for the medical professionals
“I would say, with cancer, that as a person’s being treated, especially someone who’s trying more and more treatments – if we’re just monitoring their cancer and not curing their cancer – what I’ve seen and observed here of the process is that a majority of de- cisions are shared. There are always a lot of discussions about what can be done for patients and what it means, and what can- not be done.
“That really came across on our trial pro- gramme. We say to people ‘we’ve tried eve- rything that’s available on the NHS – we’ve got these trials you can go into if you fi t the criteria, but it’s absolutely your decision, with this information and evidence, wheth- er you do it.’
“With cancer especially, there is a lot of that shared decision-making. That’s because the timespan for treatment is so long, and because it is so invasive, when you’re hav- ing chemo particularly, and radiotherapy: you really need to understand the implica- tions and the predicted outcome, and how it’s going to affect your lifestyle.”
In diffi cult cases, if a patient feels treatment isn’t working, it can cause special concerns for families, who often want to try anything that may work.
Shaw said: “If someone’s given bad news, the patient has gone through that treat- ment, is tired and realises enough is enough, whereas the relatives, quite often, want something different. With cancer, it’s not just a dual-shared decision between cli- nician and patient – it’s a tri-shared deci- sion, with the family too. I think if people understood more, in general, about clinical outcomes and the cost implications across the board, not just in cancer, I think they would make different decisions.”
FOR MORE INFORMATION For details on The Christie’s 2020 Vision consultation and to contribute please visit:
www.christie.nhs.uk
national health executive Sep/Oct 11 | 29
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