Where to Actually Find the KPIs for Your Speciality

Knowing the KPIs for your specialty is key. It's easy to bury your head in the sand, but this won't help you on the day. Before we get into today's episode, if you're prepping for your interview, make sure you're signed up to our free 5-day email crash course. It breaks down exactly what you need to do to stand out, and you can sign up via the link in the description. And the Academy waitlist is now open. If you want structured support for your consultant interview, join via the link in the description.

This week, we're looking at how to find KPIs for your specialty. We're breaking down a golden example about a conflict with a colleague, and we're looking at talking about financial sustainability in your service.

Welcome back to our podcast. Hi, Becky, how are you?

I'm great, thank you. How are you?

Great. Let's go. First up, we've got a student question. This is a question from one of our Academy students. The question is, I'm struggling to find the KPIs for my specialty. Where should I go and look for them?

Okay, so yeah, this is something that you should know before your interview. It's one of the sort of elements of the things that we think about in the academy along the lines of senior-level thinking, where we're thinking about sort of that much bigger picture view that you should have as a consultant, and realistically things that you probably haven't thought about quite so much as a registrar. So, KPIs stand for key performance indicators. And they are the things that we measure in our specialty that demonstrate that we're giving quality service, maintaining patient flow and efficiency.

Yeah. So, it's actually anything that's measurable. And so, when you hear the word metrics or KPIs, they're pretty much, just assume they're the same thing. Anything you can measure that will help assess the quality of care?

So there's many generic ones, and lots of them relate to waiting times. So, you know, for example, RTT, referral to treatment time, you know, things like 18-week pathway. We've got 2-week cancer wait in ED. We've got 15-minute time to triage. We've got the 4-hour target. So those You know, those kind of waiting time type of KPIs and metrics are pretty generic, so there will be some of those for your specialty, and then there'll be some more specialty-specific ones, and they often come from sometimes national guidance, sometimes college guidance, for example, sometimes from GIRFT, and sometimes they can be internal KPIs as well if your department is particularly focusing on certain metrics, maybe because there's been a complaint or an incident about it for whatever reason.

Yeah. So have a look at all these websites, like the RCPCH for paediatrics has Facing the Future standards, which will have some that are relevant to whatever area you're in. And yeah, there'd be societies that might have some, and just ask your colleagues as well. But the reality is, as a non-consultant, you don't really need to think about metrics and KPIs, but you still probably are working towards them. You just haven't had to think of them in that way. So just like any audit you do, any quality improvement project, they are likely working towards improving a KPI. You just haven't needed to think of them that way. So once you start to realize what they are, you'll realize you have loads because we do them every day. Time to antibiotics, time to being reviewed, time to admission, whatever it is. They're like the everyday stuff that you do. And it will be much easier once it clicks into place and you start to see actually all the things you've been doing are working towards that because they're all around delivering a quality service. It will be easier, but you should definitely try. I would say try and pick 3 that you feel good talking about, that you know are relevant to the team that you're applying to, and ideally that you've got something to say about them from your own experience.

Yeah, I think that's the key. If you can align your knowledge of the KPI to something that you personally do, either a daily thing that you do, you know, so I don't know, you're an anaesthetist and you, you know, you have a golden patient initiative, for example, and so you always, you know, do some sort of pre-op you know, conversation or checklist or whatever with your first patient to make sure they always get to theatre on time, and you can demonstrate that your lists run to time as a result. Or, you know, maybe you're doing something particular around post-op nausea and vomiting scores or something like that that you can demonstrate. It's so much stronger if you can say, you know, here's the metric. this is what I'm doing about it, um, either on a day-to-day basis, or here's a big project I've done about it. Um, you know, one of my USPs aligns to this. It's just so much better than saying, um, you know, well, it, you know, it's really important if we, uh, get people through, um, on the 18-week pathway because that's government target.

Yeah, yeah, exactly. And, you know, you, you can choose any, like, you, you— there's, there'll be loads of KPIs, so there's no right or wrong. You're just trying to choose the ones that fit best with them and, and fit Yeah. Best with you. And you may not have a USP for every— for all 3 KPIs. It would be nice if you did, but if you don't, then even just bringing in your experience of where you've seen it, you've worked somewhere where you've seen them doing something that's working towards that KPI, still brings in the specifics. And it takes it from what you're saying, Becky, around just something very general about why it's important to saying, actually, I do have some experience of tackling this, and this is what This is specifically what it is. Important question. Good question. Definitely worth prepping for.

And yeah, it's not something you can make up on the spot.

It's not.

So do spend some time just working out what the KPIs and metrics are because you can't kind of fluff your way through this one, I don't think.

No. Okay, we're going to go on to our golden example of the week. So this is a golden example from one of our Academy students. is about a conflict with a colleague. So the example is, it was a Saturday morning, it was busy. Resus was full, the department was full. There was a patient that was admitted overnight as a trauma who'd had CT scans, everything had been done, and they were supposed to be moved to the ward under cardiothoracics. But there was one outstanding issue, which was that they had a knee laceration and it had to be sutured before the patient was moved to the ward. Because it was busy, my reg had referred the patient to orthopedics for them to suture the wound. But the orthopedics team had said that they were quite busy and it would take them 3 hours before they could come to suture the wound. I asked my reg to suture the wound, but he wasn't happy. I called him, I spoke to him politely instead of challenging him in front of the team, and I took him away and realized that he was prioritizing The workload from the emergency department and the orthopedic team were prioritizing their workloads. And it was just 2 teams trying to do the right thing for the patient from different perspectives. But when I explained that to my reg, he was not happy that I'd asked him to suture the wound because he was very busy. But I did explain to him that sometimes, you know, there's something that's only going to take 10 minutes and it will really help with patient flow and get the patient out of the department and clear up the resus area as well as the rest of the department. What do you think about that?

It's quite a story, isn't it? It's quite a story. Okay, so I think there's— I've got a number of kind of concerns about this, um, in no particular order. So, so one, I think it's probably taken you, I don't know, a couple of minutes to explain that. I don't know. Yeah, that, that level of time. Um, And we haven't even got to what, you know, what you did about it really, and how you sort of de-escalated any conflict. I'm not clear where the conflict is here either. I'm not really clear whether the conflict's with your registrar or—

So it would be better if the conflict was with orthopaedics, where you would need— you just need this wound sutured so that the patient can go to the ward, but they won't come. And they're like obstructive on the phone. And I don't think that's what's happened here though. I think the conflict is that you've asked your reg to do the suturing and the reg doesn't think it's their job, it's orthopaedics' job, and they're really not happy about it.

Yeah. Then I think there's another issue. There's a power imbalance in this conflict. So you as the consultant, or, you know, acting consultant, or, you know, whatever, have asked somebody who is more junior than you to do something, there's been a conflict around that. I think that these conflict examples work better if there's no power imbalance here at all.

Yeah.

Because it's just safer for you to demonstrate that you're able to de-escalate without any hint of, so I was just basically telling somebody to do their job. Appreciate that's not what you were saying, but we don't want it to come across like that in the interview. Um, and we're not, we're not really clear how this was resolved.

No. Um, but I, I, it's, it's got too much detail because it needs to just be a short story so that the most of the answer is actually about the resolution of it. Um, and so all of the stuff about it being Saturday morning or resus being busy, or even whatever the patient's scans or trauma or all of this are in the night before. There's just a lot of extra detail. And what you want to do is just cut out as much as possible so you can get to the point. Like, there is a patient who needs to be moved to the ward, but cannot be moved to the ward until this suturing is done, and they are impeding patient flow. So then it's clear the task is to get this knee sutured efficiently and quickly. And X, you asked— orthopaedics to do it, they wouldn't do it, or whatever it is. There's a potential of a, of an example that would be suitable there if it's someone in the same grade as you in another specialty. But I think having a conflict with your reg about it when it's really like they're being— I don't know, the reg doesn't come off well in this, and so you're kind of making them look bad. Um, yeah, yeah. I—

if we think back to last week's episode And how succinctly that mistake example was explained. This is the—

Yeah.

Opposite of that. And actually, I think what we want is a really clean example that can be delivered in a couple of sentences, and then we can move on to, you know, what you wanted to achieve in this de-escalation. how you did it, and then just reflect on what you've learned about de-escalating conflict as a result. Yeah, because the main body of the answer where you're going to show yourself to, to best effect and score points is in what you did about it and what you've learned about it, not what happened.

Yeah.

And I think this is a common mistake. People over-explain what happened because they're trying to give a bit of context, they're trying to make sure they don't look too They're trying to make sure that we can understand how this arose. Yeah, often people add in a bit of additional clinical detail that not everyone on the panel can understand, you know, all of this kind of stuff where really the conflict example itself just needs to be very short so that we can then move on to the bit that matters.

Yep, agreed. So maybe within here there's potentially something, but it needs a bit of work. to really nail down what the issue is.

Yeah.

Okay, let's go on to our interview question of the week. This is an interview question that's been asked recently, and the question is, how would you ensure financial sustainability in your role as a consultant?

Wow. Okay. I mean, this is the kind of question that you get and you just kind of break out into some kind of cold sweat and have a little panic attack, isn't it? But hold it together.

You've got this.

You can do it. You've totally got this. So the money question, you know, financial stability, money saving, these are— this is essentially, in my view, at the level of, you know, a consultant early in their consultant career, is essentially about efficiency. you're not going to be, you know, doing mega business plans, that multi-million pound business plans for the trust that are going to, you know, generate income. That's not where you are probably.

And you're also not going to be managing the budget in any way really.

Yeah, so don't worry about it. Don't worry about the budget. I'm joking. But the way that you can answer this, I think, is to think about it in way of efficiency. Because actually, if we're efficient with our resources, we only have the right patients in the service at the right time, we move them through quickly, and we do what they need in a, you know, risk-free way. Actually, we're going to spend the minimal amount of money on it, and patients will be happy because they will have had a good service quickly. So we like the— we like to think about this in terms of input, throughput, and output. And this is a way of answering a question about money and efficiency. Is that how you would go with this?

It's a great way to do it because you don't need to get— because I think where people could get tied up is thinking they have to know numbers and finances and budget lines, and realistically they, they're not going to know and they, they don't really need to know. But you do need to understand the, the financial impact of delivering the service. And actually, that whole thinking about flow is so important to it. And even just recognising that having good flow contributes to the financial sustainability of the service in itself is a good connection to make. And I think sometimes when people come into their prep, and maybe if you're a final year trainee, you're just like, oh my God, I don't know anything about finances. How am I going to be able to answer this? But of course, you know about flow, you know about all the things you've worked towards to improve the care, and even the day-to-day things that frustrate you about the service. If they were more efficient, the service would be more financially sustainable. So I think, yeah, that's a good way. And I would reference in your answer that these things do link to financial sustainability. If people are staying in your service for a shorter period of time, clearly it's going to be more cost-effective rather than everyone hanging about and spending longer there. So even at that level, it improves financial sustainability.

Yeah.

So yeah, don't panic when you hear this. You should be able to think about how to improve the overall finances. And that doesn't mean you need to know how much something is worth, how much an inpatient stay is worth, or, you know, how to specifically impact that in numbers. I think it's just overly— will tie you in knots and is actually not needed for your role anyway.

But we had a student this week who gave an absolutely brilliant example when he was asked about I think it was an efficiency question, but it would work in terms of finance. And he said, actually, in terms of our clinic appointments, he was in a surgical specialty, we recognised that actually we didn't need to improve or increase clinic capacity. We recognised that we just needed to decrease demand. And so we actually looked at our routine follow-up patients and how many patients had changing their treatment at their routine follow-up at 12 months. And we recognised that it was basically none of them. So we now offer the first, you know, routine follow-up at 18 months post-surgery. This has improved, you know, our efficiency by decreasing demand. And by the way, we've saved, you know, £300,000 a year doing that or something.

Yeah.

You know, that, that's mega.

Yeah.

So if you can just think about stuff that you and your department have done that improved efficiency, you will probably, you know, as a byproduct of that, be saving money anyway.

Solid advice. So yeah, definitely think about this in advance. It's going to come up in some form or another. Okay, we're going to go on to our tip and trick of the week. So this is, I think, something that we commonly talk to our students about. Which is, control what you can control and don't sweat about the rest. So this is something that comes up regularly, right, with our students, especially as their interview gets closer and closer.

Yeah, and I'm actually thinking of one particular student that we had this week, and I was on a call with her a couple of days before her interview, and she said, I've just realised that actually I'm the only external candidate for this job, and the other people going for it are amazing. And now I'm totally in my head. I can't stop thinking about them. You know, I'm just— I'm completely derailing myself because of this. And we had a little chat. I kind of— I think we had a fairly stern word about it. You've just got to stop this.

There's no time for this now.

You can't be like this. It's not helping you. Um, because— but it's true, you can't control what they've done. They might be absolutely brilliant on the paper. Yeah, they might have been in the job for 6 months. Everyone might hate them there though, you don't know.

Um, also, they might be a terrible interviewee.

They might be awful. They might be terrible at interview. They might have done no prep. You don't know. But what you can control is your own prep. And if you spend 3 days worrying about them, Googling them, checking out their CV, all the rest of it, That's, that's time that you could have spent on your own prep. So, and actually, this student then channeled herself. She must have given the most badass interview because she smashed it, and she's the one in the job.

Yeah.

So I think it goes to show. Yeah.

Yep. No, I agree. I think especially it's like such an easy way to derail yourself in the last few days is this, when the panic sets in and then you start thinking about all the reasons why You're not going to get it. Someone's got a PhD, someone's already in the job, someone's a substantive consultant. So you heard from someone that something, whatever. It's like there's so many things and then you just, your mind goes to that place instead of focusing. And it is wasted time, like you say, time that there is absolutely no benefit in spending the time in the run-up to your interview thinking about that. So yeah, you need to Stay focused. Only focus on the bits you can control, which is your prep, your performance, and your mindset going in. That's it. And if you can push out these thoughts, you can think about them after. When you leave the interview room, you can have all the thoughts about how amazing all the other candidates were, but you have to push them, push these thoughts away until the job is done.

Just go in there and give your interview. Don't worry about the interview that they're giving.

No. And they've all got their own stresses. They might seem like they're great, but they've got their own stuff going on as well. And they're all human beings. Um, so, uh, yeah, don't, don't waste time with the what-ifs. Just focus on the what you can do. We are going to wrap up there. Thank you for another lovely episode. I'll see you next week.

See you next week.