[00:00:00] Mat: Welcome to Doctors at Work. My name’s Mat Daniel. I’m an ENT consultant, a medical educator and a coach. Today I have a discussion with Ekpemi Irune, and we talk about issues at work. Now our workplace is full of issues that are complex, multifaceted and with no clear solutions. In this episode, we discuss the challenges of dealing with these complex issues. Ekpemi tells me that good relationships are key. It’s important to be clear on what it is that you want and to take the other person’s perspective into account. I hope it’s useful.
Tell me a little bit about yourself.
[00:00:48] Ekpemi: Hello, Mat. Thank you for having me on this lovely podcast and it’s always a pleasure to see you. My name is Ekpemi Irune and I’m a head and neck surgeon at Addenbrookes Hospital in Cambridge. I’m also involved in a lot of other things such as a little bit of research, technology in surgery and education, mentorship etc. So I’m very much like a lot of other people in the NHS with wearing multiple hats.
[00:01:19] Mat: Thank you very much. And I invited you today to talk about how you find your voice at work. And how you solve issues at work. And I don’t know about you, but at the moment for me, everything that happens at work, it just seems so complicated. So why are workplace problems so difficult to solve?
[00:01:40] Ekpemi: Thank you for the question. I believe that workplace challenges right now are difficult to solve because, and we are speaking about the NHS, because everyone is so tired and the challenges, we’re facing that are longstanding. A lot of people, I’m sure when we speak to them, we tell you these are recurring issues. We within the NHS, we’re working within a resource constrained environment and there are no particular set expectations from one group to the other. We don’t necessarily all speak. The same language in inverted commas, meaning how do we exchange ideas? And it’s personal. What we do is very personal.
Looking after people. It means you give a bit of yourself every time. And being expected to do that very personal work of looking after our patients and their healthcare. Taking responsibility for the decisions we make. And feeling unsupported. And then having to deal with what we perceive as conflict. I think that’s what makes it complicated.
But most importantly, no one gives us the tools to deal with these workplace challenges, and therefore, they spiral out of control, and they become more complicated. whether that’s true in reality or just our perception.
[00:03:11] Mat: Maybe if I start with the big picture thing. So, you talked about that people are tired and it’s a very much a resource constrained service.
So, I’m wondering what can we as doctors do to influence that bigger picture, number one, and number two, how do we as doctors navigate the reality of what is?
[00:03:33] Ekpemi: I’m going to take first, the second thing, the second point, navigating the reality. We have to be telling the truth to the people that are coming behind us.
So, if you’re in a position of responsibility, you have to be setting the scene when you get new people coming in to work with you and reiterating the challenges. When you’re working with other people for longer periods of time. So, I don’t think we should be painting a beautiful rainbow or sugar coating the challenges we have within the workplace.
I think that will allow us prepare people. Yes. In particular, inform them about context when it comes to the kind of work we’re doing. I think that preparation is important. So, for example, if I ha if I had a trainee coming in to work with me, I would hope to be able to say, it’s a very busy service.
We wish we could do more, please be aware of this. However, that’s not necessarily your responsibility. I want you to come and tell me if things are difficult and how we can improve things. Now, do I do that? I don’t do that regularly, right? I wish I did, but What gets in the way. So, do we have to perhaps be, do we have to be more specific and be more deliberate in setting those terms, setting the context and set in terms of engagement within the workplace?
I think that’s, I think we should be doing that more. And then if we go to the big picture thing, what can we be doing? I think we need to be speaking up those of us in risk positions of responsibilities, for example, consultants we need to be changing our habits. So that we can reflect that the way we work might not necessarily be the healthiest ways.
So, for example, the busy clinics, the overbooked clinics, doing them and expecting them that, and then expecting everybody else should do them. Yes. So yes. So, for example, the busy clinics, we’re doing all these busy clinics. And what we should be doing is saying, no, I’m not going to overbook my clinic because I have a trainee with me.
And a group of people getting together and doing the same thing so they can then say, we need an extra member of staff. It’s also trying to role model, what should be done what is appropriate, and the NHS will have no choice but to listen to us. If we do that so we need to be saying, we need more resources and speaking out loud and doing the work that it takes to get more resources, whether it’s writing the business cases.
[00:06:25] Mat: It’s interesting because I might say, or I can see more patients and more patients. And that’s great, isn’t it? You think there’s always more, there’s always more that can be done. And I would agree with you because the problem is that the workload is endless. So, it’s not that the majority of the time it’s X and occasionally you do X plus one.
It’s the fact that it’s X plus one and then next, next month it’s X plus two, next month it’s X plus three. And then that, that, that grows. And also, I wonder how much are we part of the problem? Because we do just absorb all of that extra workload and we do say yes and actually we’re perpetuating the problem.
There isn’t enough capacity. But because all of us are, today we are running, tomorrow, we are burning out. Today we’re part of the problem.
[00:07:11] Ekpemi: Yes, we are part of the problem, isn’t it? We set this on realistic expectations, and we just keep. Keep up the, keep on with the façade. You and I were at a conference some time ago and we were listening to colleagues who were seeing 30 patients in a morning clinic in and I’m sure there’ll be times when there will be more than one patient.
And like you say, the work is not going to end. And so yes, we do need to be changing the way in which we role model what’s should and shouldn’t be allowed. And how do you do that? You’ve just got to wake up and say, today has to be different. And I think if you see a colleague who’s trying to change the way they work and who’s crying out for help, you need to stop and see how you can support that person.
Because we’re all supposed to be in this together, aren’t we? Yeah, so I completely agree with your sentiment.
[00:08:09] Mat: I’m wondering, let’s say that, when it comes to those clinic numbers, and there’s somebody who’s a new registrar, or a new consultant. They are new in role and there is a mismatch between what the department expects that person should be seeing and what the doctor thinks that they should be seeing. And of course, there’s always two sides to every story. But let’s for the sake of our discussions. Let’s assume. that you know that the doctor that’s asking for a reduction in clinic patients, has a perfectly good case to make. Let’s make that assumption. Yeah, the doctor’s got a perfectly correct case to make for reducing clinic numbers. How do you go about that? And how do you make it happen without falling out with everybody?
[00:08:53] Ekpemi: It’s a very good question. And I think I may not have all the answers, but I can certainly tell you what has worked for me in the past and what I think is a better way to manage these sorts of challenges. I think first of all, when you come into an organization, you’ve got to seek information from your educational supervisor.
So, when you sit down for that first meeting, try to make it a little bit more personal rather than didactic. A little bit sterile with the, for surgeons that ISCP thing that comes up and we’ll say. What are your personal, what is your personal development plan, et cetera, and ask the consultant, what is it like working in this department?
What are your challenges? How many cases do you get on average in a clinic? And then tell them really what your goals are. And that should go beyond just, I want to publish a paper, right? Try to make it a little bit more personal. I think when it’s personal, and I think when you do that, you establish a connection with that supervisor and that individual, when it comes to whatever problem you’re trying to deal with, you need to ask yourself how important that problem is to you. And in this situation, if you’re not seeing if you’re seeing too many patients. You’re not going to get the chance to get trained properly.
Gone are the days when we think super high-volume equals excellence. It really doesn’t all the time. It’s a law of diminishing returns. So, I would say, tell them what the situation is in terms of what you want to achieve and say, I will be happy to see X number of patients. I understand that there’s a service provision component for my job.
However, is there any other way we can balance out me having some sessions that are more reflective of the training requirements? And then once in a while I could try and support you in a busier clinic. The point of discussing things in this way, not necessarily with the same words is that you are showing insights.
And sympathy and consideration, your consultants your supervisors are human too. And the last thing anyone wants is always to feel like, wow, this person is just about themselves, right? And yes, it is not your responsibility to look after all the patients and to fund the department, but you’re part of a team and if you don’t show consideration, you’re not that is the antithesis of being part of a team.
I think you know in doing that you can then Negotiate your way into having a ring fence clinic. That’s a limited number of patients and a clinic where sometimes you may have to say I can’t have as much training as normal in this clinic. And I will help get through some of the service provision aspects.
And checking in now and again, going between in, in between clinics and go check on it on your consultants or the nurses there takes two minutes. It’s everybody. Okay. How are you? That’s how you build that personal connection that fosters relationships. I think that’s, I think that works.
[00:12:07] Mat: I like that. So, it’s about being clear as to what my needs are or what my requirements are.
It’s about showing understanding of what the other person’s needs and what their agenda. And what their understanding is and then trying to find common ground, something that meets both of our expectation. And I’m really interested in this idea that personal relationships are important.
Why is that interpersonal relationship so important when it comes to dealing with challenges at work?
[00:12:36] Ekpemi: Because I think we are more empathic when we have a personal connection with someone. And when you’re more empathic, you’re more supportive. And the one thing we need as doctors in the National Health Service and as nurses and as allied healthcare professionals, et cetera, we need the support of our colleagues, or even the impression of the support of our colleagues is that kind word.
It’s the acknowledgement, a lot of people, when they work very hard and they do more than they’re supposed to do, I’m not necessarily looking for a round of applause. It is. Refreshing and rewarding for someone to say, Hey, great job once in a while. And I think also building personal relationship means that we’re more compassionate to one another and are less likely to get offended.
Right within the workplace, we’re more likely to take the time to say, listen, what was that about, if you feel someone has slighted you, if you have a personal connection with that person, you’re more likely to go and have a conversation with them and say, I didn’t like what you said or how it was said and is there something going on, or, and I think trainees also need to learn how to do this.
I believe there’s this myth that I think it’s a myth because when I speak to my consultant colleagues, everyone’s too tired to Bother with trying to destroy other people’s careers. It’s counterintuitive, right? And I think that yes, because we are an extraction of the general population, there will be good people, there will be bad people, there’ll be very sensitive people from all works of life with different sensitivities.
But on the whole, most people just want to come to work and do a good job and go home. I’ll give you a very simple example. So, for example it must have been about two years ago a junior doctor had suddenly had to have their portfolio completed very quickly. There was some change in deadlines, and they needed some help from me, I was their educational supervisor, and they hadn’t been long in the department, hence there, the stresses they were feeling, and they came to find me in theatre with a cup of coffee.
Thank you. And they said, Oh I have got a cup of coffee for you. Will you please do this sit down with me and finish my portfolio? And I thought, and I said, what’s with the cup of coffee? And apparently someone had told them the best way to get anyone to do anything for you is to buy them a cup of coffee.
And I had to say to her, this lovely lady, I said, you don’t owe me a cup of coffee. And that money’s best spent on something else, for example, like the ISCP. And I said, you don’t have to buy anyone a cup of coffee. If you just came and told me what the issue was, of course I will be there. I will make the time and I will do this for you.
But that was a myth that somebody else had perpetuated. So, I also think we have these little stories going on in our departments and these preconceived notions that are literally paralyzing us in the workplace, so we don’t communicate effectively, and we don’t problem solve effectively, because we’re so scared.
[00:15:57] Mat: I think that’s funny and for anybody who’s listening. It’s mint tea for me.
For anybody who happens to be listening you, you said you said it’s really important every now and then to say well done to each other. How good are we at saying that to each other?
[00:16:20] Ekpemi: Oh, we’re awful at it, aren’t we? And. Some of us who haven’t accepted that there is a difference in how people are trained right in the volume of work in the exposure in the culture in expectations still are setting unrealistic expectations for the people we work with.
And if someone falls short of that expectation. Goodness, we’re never going to say well done. And even when they perform. Thank you. To a level that to them feels significant because there is this breakdown in communication and we’re not speaking the same language and we don’t know what is expected of each other.
We still don’t say well done. So that, so I think that’s a big problem. We need to accept that we’re in 2023. And A lot of people who are working with us just have a better and healthier outlook when it comes to what is expected of them in the public health sector, right? This saviour complex is a disease of the older generation, right?
And I think it’s something we really need to be aware of. That’s, that I think is a problem. I know that. I have fallen short in that regard as well, and I’ve had to change the way I look at things. So, I need to be saying well done more and more often. I try to.
[00:17:52] Mat: And I think that saviour complex for me, that goes back to, to, to us being part of the problem.
Yes. We have, or we had. A healthcare system that largely relied on the goodwill of the people and that relied on people or for people who tried to go faster all the time because of the saviour complex. And that’s part of the problem that, people were, that there was never a link between, say, even between salary and outcomes.
Yeah. For example, yeah. Because, if you think as healthcare professionals, we all get paid the same. As consultants, we all get paid the same, at least on the surface of it, whether you do anything or not, or whether you’re any good or not, we all get paid the same. And that, that kind of, that harks back to that idea that, you give people a salary, and then people are going to run as quickly as they can, but the reality is that people are increasingly getting burnt out.
And, and we all keep doing that. And there probably are a few people that are shirking their responsibilities, and their minority and majority of people are, working very fast and trying to run all the time. And things don’t change. Yeah. And then we talk about productivity.
There’s no it’s not productive. And again, for me in clinics, it would be. A metric for me in clinic is, how many patients are you discharging? How many patients are you managing in one clinic? Versus you can have a really busy clinic and everybody’s a follow up because, because it takes five visits to actually fix what’s wrong with them instead of seeing them once and then hopefully you can discharge them.
[00:19:22] Ekpemi: So yes, I agree. I think asking for the reward in the National Health Service is often looked upon as crass or inappropriate and that shouldn’t be the case. Money is a dirty word. And I think that now we are seeing that the tide is turning because we have the strikes, the first time ever we’ve had consultants and junior doctor strikes.
And also, our senior associate specialist, our senior associate specialists and specialty doctors who are also supporting the strike action as well, because we also have to get out of work and earn a living for our families and also live. in this hostile economic climate and come back to work the next day.
So, it’s very difficult now to be a healthcare practitioner.
[00:20:11] Mat: Yeah, I’m agreed. Okay. I’m going to go back to something you said earlier about the fact that we’re not very good at saying Thank you to each other and we’re not very good at praising each other. And I think that’s probably largely because mostly we’re very good at criticizing I think, would you agree?
We’re very good at criticizing each other. Yeah. So how do we change that culture? How do we remove, how do we move from looking for problems in criticizing to acknowledging when people actually done a good job?
[00:20:46] Ekpemi: Again, I think that criticizing is sometimes born out of frustration, and you criticize.
Someone or an activity or process because it doesn’t meet up to your expectation. That’s usually the root cause. And again, that brings us back to how you interact with people that you work with. You have to set your terms of engagement. You have to say in this thing we’re doing together, whether or not it’s a shock procedure or whether or not it’s in conflict resolution, you have to say, this is the demand.
This is what I need. Yeah. From this process. This is why it matters to me. And this is the, this is the outcome that I’m looking for.
If you say that to someone and not necessarily in those words, but if you communicate those things to someone who you’re just meeting for the first time or who has never done this with you before or may have done this with you before and seems to be falling short, you’re more likely to have. An outcome that matches your expectation and if the person isn’t meeting your expectation, you also have to invite opinion and invite them to give their experience to share their experience.
And you say, how did that go for you? This is how it made me feel, or this is. The outcome. And I wasn’t happy with this outcome. These are the reasons why; how do you think I can support you in delivering what I need you to deliver at this particular level that person might turn around and say there isn’t a reality where I’m going to be able to meet up with your expectations.
Imagine if someone told you that, and then you realize okay this is not a good fit. Maybe that person needs to be with a different team or they’re not ready for this particular role, right? And you could have saved yourself a whole load of time, but also, it’s more likely that the person is going to say I probably need to observe you do this, or I need to take my time, or they might end up telling you that they’re neurodiverse.
They might tell you that it takes them longer to process information. They might tell you that you’re not as clear a leader and teacher and enabler as you think you are. But the main thing is that the dialogue and exchange of ideas and exchange of information makes the other party, makes both parties more informed.
And then you’re more likely to be successful in your endeavours together. I think that’s. That’s the way to play it.
[00:23:29] Mat: I hope you’re enjoying the show. If you are, please click subscribe so you will be notified when new episodes come out. This podcast is part of my mission to help doctors create successful and meaningful careers.
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[00:23:51] Ekpemi: One thing not to do when you have conflict with someone or You’re unsatisfied with your environment is to reflect, is to immediately go on social media and post about it without first trying to see if you can settle things locally.
Apart from the fact that the person you post about is likely to see a hostile remark about them. It’s also only your point of view, right? It might make you feel good for a minute, maybe a day that you have all sorts of people empathizing with your misery. But that is one of the least effective ways to solve workplace conflicts.
If it was so effective, we’ll all be doing it. Most importantly, the individual you are posting about has a right of reply. Doesn’t matter whether or not you’re a doctor, you’re subject to the same rules and regulations as the rest of everyone in society. Slander, libel, are both things that are against the law and people can take you to task.
You open yourself to litigation for very little benefit. Now it’s another thing if you’re calling out systemic issues, despite Your best efforts or you are an actual true whistle-blower, right? Okay. But that’s not what we’re talking about here. And I think it’s counterintuitive and it doesn’t help to set the scene for a conducive working environment.
It’s short-term pleasure for very little gain and it exposes you as an individual to adverse consequences. So why does it? It doesn’t help.
[00:25:55] Mat: It’s quite brave, I think to have that conversation where you’re asking, you’re inviting the other person’s thoughts, that, that feels much braver. It’s easy to just criticize and say, you’re rubbish.
That, that feels like an easy thing to do. Whereas a conversation that goes, okay, I’ve got to listen. I’ve got to ask questions. I’ve got to consider your perspective. That feels like a much, much more grown up and much braver thing to do. Then just criticizing.
[00:26:22] Ekpemi: Yes. And some people say I can’t do this because of a power dynamic, or I can’t do this because I don’t think the person’s going to listen, or I can’t do this because I’m worried, they’re going to be so upset with me, they won’t want to work with me.
And this is where some of this is more myth than reality. There are times when it is true that you may have a person who is very difficult to speak to because they’re not willing to listen. But the majority of times. If you find someone and knock on their door and say, listen, can I have a discussion with you?
You need to realize that in the NHS, we don’t work with every single individual working employed in the NHS as a doctor, as a nurse, as a healthcare professional is an adult. Some people are married, some have businesses, some have kids. Basically, we’re making very important decisions on a day-to-day basis and we’re all fostering significant relationships.
Valuable relationships outside of the NHS. Why can’t we do that in the, say in the workplace, when you fall out with your friends or your loved ones, et cetera, or your business partners, you have to talk to them. It should be the same thing in the NHS. I think when you are, when you need to speak to someone and to say, I have a problem, sorry, let me rephrase that.
When you have a problem, you have to ask yourself, how important is this to you? Can I sidestep this issue? And if you can’t sidestep this issue. What does a solution look like to me? And you’ve got to create a strategy, which is a sort of framework for how you manage this particular problem. And you have to go and knock on that person’s door and say, can we have a few minutes?
I would like to listen to your view. And I would like you to listen to my view. And you have an adult conversation. And if you can’t still get through, ask someone to have a chat on your behalf, someone they know, someone they respect. And more times than not, that will solve the problem. But I don’t think we do enough of that.
[00:28:28] Mat: why don’t we do enough of that
[00:28:31] Ekpemi: again, I think it goes to, the environment, how heated our environments are, how unforgiving prejudice, preconceived notions save your complex, all of these things, and the myths around, you can’t talk to that person’s not going to listen to you.
And it’s hard. It takes courage. Like you said. But I think not talking enough, not building personal relationships enough is killing us. It’s destroying our relationships. And when you change the way in which you interact with people in a way that they don’t recognize when if you’re hostile, when you want to speak to someone or convey your point.
It’s very difficult to get your point across. And so, we need to dig even deeper than where we are already as healthcare professionals in this climate. And we need to be finding a way to communicate. We’re all humans. We all feel hurt. We’re all tired. It might not look like it. It might look like one group is having it better than the other, but we really are not.
And so, we need to be more compassionate. To one another. That doesn’t mean you don’t get to call out things. That doesn’t mean you don’t get to bring attention to challenges, but when you do it, try to do it with a view to problem solving. It’s okay to have a range now and again, but you cannot perpetually just complain and demonize.
It’s unhelpful. It’s unhelpful.
[00:30:16] Mat: So, it’s about understanding and about solutions rather than focusing on problems and on demonizing.
[00:30:24] Ekpemi: Yes, the most successful people, whether or not it’s in the healthcare industry or in banking or in finance or, all over the world, industry in general, are the people who problem solve in a lot of other aspects of business.
Strategizing and problem solving is something that is invested in people are taught. They are mentored deliberately with a view to learning how to problem solve, learning how to report, learning how to challenge. We don’t do that in the NHS apart from the fact there is no time. We do not have a culture that fosters that.
And you see the medical students that are coming through the very junior early doctors that are coming through, they want to do this. They want to do this. So, we also have to be role modelling that and make keeping our doors open and saying, come and find me forwards.
[00:31:24] Mat: I would say that a lot of the young doctors, they definitely want to do that.
And I think, when I was a young doctor which is quite a little while ago now, but, also, I wanted to problem solve. And I think one of the things that as time has gone on, I’m probably still trying to problem solve and I’m still speaking up.
But what’s happened over time is. There’s a lot of people that are just too tired and so they’ve stopped and it’s, people come into the profession full of energy, full of wanting to make a difference and change the world. And then what happens is during training, undergraduate and postgraduate, gradually we remove that zest from people.
And, and we produce people who’ve lost the fire a little bit. So yeah. Okay, so let’s stick to this idea of problem solving. Let’s think of generically, not a specific issue, but generic issues. What kind of things would you say really work well when it comes to problem solving? And what doesn’t work very well when it comes to problem solving?
[00:32:33] Ekpemi: I think when you want to problem solve, first of all, I think it’s important not to make everything into a catastrophe. Personality is very important and when you identify something and you think this is a problem to me, be very honest with yourself and say, how have I contributed to that being a problem?
Why is it a problem? Why does it niggle? What is it? And is that something that’s within my control to change or is it a problem that some, is it a factor that, is there a problem that’s been perpetrated because of the actions of another? How important is it? Is it something I encounter once a year or every single day and can I avoid having to deal with this?
Or is it something that is essential to my progress? And then you have to say to yourself. What does the solution look like to me, what am I looking for out of this? And then in addition to that, you say, what about the other person? What could I do to ensure the other person also feels like they’re listened to, right?
If it’s an environment, how can I also show consideration to this environment? And that this is not about me. There’s a book from written by Adam grants. That’s actually very short book. Very easy to read. It’s called think again. Okay. What it’s about is really about how you can change your mind because some of the times when we’re upset about something, we’re upset because we have fixed notions about what that particular environment.
It’s supposed to deliver or what that person is supposed to deliver once in a while, just stop and say to yourself, what will change my mind, right? What is it about this situation? What could this person say that could change my mind and make me see that perhaps I don’t need to be upset about this.
But I think overall, it is about setting a strategy for how important a problem is, and then go and communicate. With the person you cannot sidestep communication when you go, make sure you’re speaking to someone, and you allow ample time to listen as well as to share your opinion. But before you start the conversation, you say, I really would like us to settle this difference.
So, I really like us to, I would like to solve this problem. And I think that’s the framework I think we should be looking for. So sets your intentions from the start. And then launch into what you have to say, read the room. And if the person is not in the mood, you go, okay, maybe we’re not in a good mood now.
Let’s come back to this. Maybe now is not the right time. There’s something going on. There are strikes going on. Maybe you say, maybe this is not the time to ask for that extra PA session. Or this is not the time to talk about the conflict. Let’s regroup. So, I think it’s, you have to be strategic. And you’ve got to think again.
Now what I wouldn’t do, I wouldn’t badmouth one colleague to another person. Doesn’t help. Never helps. And inevitably gets back to them. And I wouldn’t write formal letters off the bat unless someone had done something egregious no to sexual harassment, sexual assault, these are crimes, but where there is a possibility that this could be a perception issue, I think you should give, allow room for reconciliation.
And you can only do that by strategizing and communicating.
[00:36:33] Mat: Wonderful. Thank you very much. I’ll bring us to a close. And maybe, tell me what your top tips would be.
[00:36:41] Ekpemi: Top tips, number one, think again. Number two, strategize about the difficult conversations. And I would say, build personal relationships at work. Doesn’t necessarily mean going to the pub with someone but ask people about themselves.
Yeah, because in this very complex, High powered, supercharged, under resourced, challenging environment we work with. We only have each other. And it’s the best way to ensure that we have a more conducive work, working environment.
[00:37:23] Mat: Wonderful. Thank you very much, Ekpemi.
[00:37:26] Ekpemi: Thank you.