Stephen Bush

What Clinical Directors should do to ensure workforce satisfaction and sustainability?

By Stephen Bush.

Click here for the video summary.

Read the review by Dafydd Hammond-Jones.

Click here to view the speaker slides.

– Clinical Director Urgent Care Leeds Teaching Hospitals, Chair ATLS UK.

Reviewer – Dafydd Hammond-Jones Speciality Trainee Year 6 Emergency Medicine (EM) Leeds Teaching Hospitals Trust (LTHT)


Overview of what Job satisfaction means, overview of clinical director role, an example of a complex problem and how it was overcome


What is Job Satisfaction?

Mr Bush started his talk on what job satisfaction is. He said that if you type ‘medical workforce satisfaction factors’ into Google you get 52,200,000 results, which implies that it is a well talked about subject. If you type in ‘link between workforce satisfaction and sustainability’ you get 31,900,00 results again suggesting it is a well talked about subject. He then went on to explain a mathematical problem where the solution came from an unexpected source and used this as a metaphor to say that not all simple problems have simple solutions. We need to get job satisfaction right and get sustainability right. To help with job satisfaction you need to make sure that the work itself is satisfying, including the responsibility you have, the interest you have and the growth. You need good quality of support and technical help, you need good relationships with co-workers, you need to have promotion opportunities and be paid adequately. Within the work itself you also need to consider, engagement, prioritisation, sustainable working practices, maintaining wellbeing, and wider system solutions. Mr Bush then mentioned the RCEM document on creating successful, satisfying and sustainable careers in Emergency Medicine, which goes into these issues in more detail.


What does a Clinical Director do?

Mr Bush then showed us a quick snapshot of his Job description and then described what it means. He is the ‘accountable officer’ for the Clinical Service Unit, as well as being a line manager, colleague, problem solver, referee, conduit, advocate, enabler, catalyst, and role model. Within the organisation he interfaces with other CDs and the executive team, and externally he deals with commissioners, other providers and regulatory bodies.


A Complex Problem

A problem that the CSU had was the ED Consultant job plan. Mr Bush explained how dropping numbers of registrars and increased demand to have Consultants around 24 hours a day meant that consultants were working night shifts at a significant cost. Mr Bush came up with an idea that would alter the job plan so that consultants can work nights, be rewarded appropriately and yet not bankrupt the CSU. He explained how when he thought of the idea, he was excited and took the idea to his manager and head nurse, then to the executive board and finance team. He talked about using tactics and not doing it all at once but doing enough to make a difference. It is important to share with key stakeholders who have interest and power. The result was better department coverage, less solo working, more time off, 3 new colleagues, and it was cheaper with fewer locums who do not know the department. He talked about how a there is no permanent solution like a temporary solution but in this case is was a good solution.


Attributes to be a Successful Clinical Director

Mr Bush also talked about other things a CD needs to have. Consistency, he said that you cannot just have a go for a couple of years and then pass to someone else. You also need to be available, supportive to everyone, be a good interface and have vision and engagement, encouraging others to make change.

Mr Bush finished by saying he enjoys his job, appreciates the variety, he does what feels right as it often works but he finds that preparation really does help.

In the discussion at the end of the talk, the chair spoke about how Mr Bush’s success was down to his style and values.



My take home message is that to be a successful Clinical Director you need to understand job satisfaction, and be there for your team in every way you can whilst interacting with the hospital at large, the executive team, and the commissioners.

I particularly liked the use of an abstract mathematical theory to get the point across that simple solutions do not have simple answers. Mr Bush seems to juggle to the role of friend and boss very well.


Leave a Reply