Clifford Mann

Leading Emergency Care Systems and their design – what do we need?

By Dr Clifford Mann.

Click here for the video summary.

Read the review by Amanda Pine.

– Emergency Medicine Consultant in Taunton, Somerset. He was elected president of the Royal College of Emergency Medicine in 2013.

Reviewer – Amanda Pine Clinical Fellow in Trauma Leeds Teaching Hospitals Trust (LTHT)


How can leaders influence change effectively including examples from the Royal College of Emergency Medicine.



Dr Mann opened the talk by stating that there are many qualities and ideals that successful leaders should aspire to, but that perhaps above all else they should be visible and authentic. Dr Mann works as a full time Emergency Medicine consultant as well as the President of the Royal College of Emergency Medicine, which demonstrates this brilliantly. Remaining in a clinical role as a front line leader and clinician provides an understanding of the common goals and struggles of the team within which you work, it also ensures you remain visible to those whom you lead.

Dr Mann described the fact that as a leader, whether in a clinical or non-clinical setting, it often feels like you are in the middle of chaos rather than leading the way. In order to navigate this you must simplify the message for the team around you there must be a clear, concise and constructive message, the team needs to be able to focus on a common goal.

An example of this within the Royal College is the CEM 10 document, which highlighted the impending crisis and the challenges faced by Emergency Departments such as underfunding, under filled training posts and the pressure of being judged by a single 4-hour metric target. The document was a single page and consisted of 10 priorities for resolving the crisis in Emergency Departments, 5 areas that the Royal College would address and 5 areas that the government and NHS leadership needed to address. Dr Mann spoke about how having a clear, concise message with a specific set of requirements, such as the CEM 10 document, can enable it to become a focus of discussion and provide a common agenda, it provides a framework for engagement. He also highlighted the need to approach the right people and approach those that have the ability and position to eeffect change.

Dr Mann also noted that when considering solutions to a perceived crisis you don’t allow yourself to be the victim. There needs to be a positive message surrounding Emergency Medicine as a career choice and in fact it is a very popular career and has the highest fill rates in many countries around the world particularly North America and Australia and indeed fill rates to training in the first year in the UK are high. We should focus on the fact that there is nothing intrinsically wrong with Emergency Medicine in the UK and with the right senior leadership, right investment and the right paradigm there is no reason why it can’t be a great career choice in the UK as it is in other countries.

You must also be prepared to take initiative, but to do this you must know your own department and you must know the data relevant to it. It is very difficult to argue a case for change if you don’t have the data to back it up. For example Dr Mann was involved in a RCEM study that looked at whether Emergency Department attendances were appropriate as the nationally quoted data stated that 40% were not. This study, which looked at 20 departments across England, found that this figure was actually between 15-20%.

Dr Mann advised that within your own department you need to consider demand, capacity, outcomes and flow and seek out data relevant to each. The demand on a department depends on the volume and the case mix of patients. It is easy to obtain data regarding volume, for example we know that Emergency Departments across the country see 14.8 million attendances however it can be much more difficult to obtain data on the case mix.

Dr Mann spoke about the many assumptions that are made about the Emergency Department, both by the general public and specialist teams within the hospital. It is important to correct these assumptions and separate the myths from the facts. It is easy to assume that you understand the roles and priorities of others within the team, however this is often not the case. Dr Mann explained that the RCEM had produced a fact sheet available on line that aimed to dispel many of these myths and assumptions. Whilst facts are important and undoubtedly necessary it is also important to have a patient narrative. Some individuals within an organisation who have a non-clinical role and who are tasked with effecting positive change may require a story that is relatable in order to understand the difficulties faced by the clinical team.

Dr Mann ended on a positive note and highlighted the fact that as leaders it is often easy to focus on perceived failures and to forget the success you have had. As a profession we are in this together and that the common goal of better patient conditions and improved patient care is more important than the role of any one individual.



I think the overwhelming message from this talk is that to be an effective leader you need to be both visible and authentic. Teams within the NHS need frontline leaders who work both within them and for them to effect positive change. As an individual you must not be afraid to take the initiative within your own department but you must be careful not to invest time and energy into ideas that have been proven not to work.


Leave a Reply