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Position description: Counties Manukau Health 1

POSITION DESCRIPTION

Job Title Senior Medical officer

This role is considered a core children’s worker and will be subject to safety checking as part of the Vulnerable Children Act 2014 or

Position Holder's Name: ........................................................................ Position Holder's Signature: .................................................................. Manager/Supervisor's Name: ............................................................... Manager/Supervisor's Signature: ..........................................................


PURPOSE OF THE POSITION

The Critical Care Complex (CCC) at Middlemore Hospital provides a "SMO lead" clinical service. This means that the Intensive Care Unit (ICU) and High Dependency Unit (HDU) are closed units where every admission, discharge and major planning decision, must be discussed with and preferably reviewed and/or supervised personally at the earliest possible time, by, the Senior Medical Officer (SMO) responsible for the Unit at the time or a delegated member of the SMO Team. The Critical Care staff will endeavour to share knowledge, skills, and attitudes of Critical Care medicine, and foster ongoing development of the specialty. The SMO will ensure that the clinical staff of the CCC strives towards international best practice by clinical practice, exposure to continued medical education, and surveillance of the appropriate medical literature. Work carried out in the CCC should be aligned to policies, procedures and guidelines set by the College of Intensive Care Medicine, Australia and New Zealand Intensive Care Society, the Medical Council of New Zealand and Counties Manukau Health (CMH). It is expected that the SMOs employed to work in the CCC at CMH behave in a highly professional manner with integrity and respect towards other staff members and patients and their families. They must work in collaboration with the team, including (but not limited to), the Primary Team, Nursing Staff, Maaori and Pacific Health Teams, Allied Health Staff, Health Care Assistants, Clerical Staff, patients and their families. Any disagreements or disputes must be dealt with in a timely, constructive, controlled manner without compromising the integrity of those involved or the team environment. Failure to resolve issues should be discussed with the Clinical Head and/or Clinical Director at the earliest convenience.

PLACE IN THE ORGANISATION

Clinical Director, Acute Care General Manager

Head of Department Service Manager

Nurse Manager Registrars Associate Charge Nurse Mangers

House Surgeons Registered Nurses Trainee Interns Administration support

Specialist medical officer Critical Care


NATURE AND SCOPE OF RESPONSIBILITIES

Key Accountabilities

Standards / Achievements

Routine activities include but are not limited to the following:

Lead Clinician on call

When on duty with a Fellow or covering Fellow call :

Attend handover and ward round (WR), taking a lead role, in collaboration with other members of the SMO and Multidisciplinary Team. This should be done at lease twice daily starting at 0830 hours and 2030 hours each day. Then as necessary as patient acuity determines.

Fully assess each patient in the ICU (and HDU on the evening WR) and make a full management plan in collaboration with the Multidisciplinary Team.

Proactive discharge planning

Review all recent, pertinent radiology and other investigations on every patient on the ICU following the morning WR.

Be immediately available by phone to back up and give advice to registrars and to review patients on wards and the emergency department when necessary.

Take phone referrals from other teams regarding, admissions and assess (or delegate to the backup or HDU SMO) patients where necessary.

Ensure decisions made (especially with respect to admission) are understood and agreed to by primary teams.

Physically assess all patients newly admitted to the ICU in a timely manner. This should be as soon as possible when concerns are raised by registrars or senior nursing staff, or if the patient’s status is deteriorating.

Ensure patients (when possible) and their families are kept up to date with progress and are aware of and able to contribute to plans. Be available for scheduled family meetings, whenever reasonable.

Be available to assist and teach registrars with difficult or new procedures or concepts.

Be available to attend urgent “call outs” when the registrars are attending to other urgent situations.

The rostered SMO is still the Lead Clinician for the day and, although the Fellow might take the lead role in the handovers and ward rounds along with admission and discharge planning, it is expected that the SMO maintain close supervision at all times. That is: they are expected to attend all morning ward rounds and handover, conduct an




Handover Clinician:

HDU Clinician:

Backup Clinician (2nd On):

informal round with the Fellow prior to leaving the hospital. They must be immediately available at least by phone at all times and it is advisable to make phone contact with the Fellow at the time of the evening ward round if not already attending. If work load or clinical demand is high, the SMO is expected to stay in the hospital until the workload is manageable and safe for the Fellow to continue.

Attend morning handover and ward round. Ensure there is an accurate handover of each patient, including their problem list, past history, previous day’s issues, pertinent investigations, current plan.

Ensure the ward round is complete and all outstanding questions about the previous 24 hour period are dealt with prior to leaving for home or attending to non-clinical duties.

Complete and sign off daily dictation of ward round summaries on each patient in the ICU before leaving for home or attending to non-clinical duties.

Attend morning handover.

Attend the morning HDU WR with the HDU House Officer and fully assess each patient in the HDU and make a management plan in conjunction with the Multidisciplinary Team.

Review all recent, pertinent radiology and investigations for each patient on the HDU following the morning WR.

Meet and discuss progress and plans with Primary Teams.

Be available to assist and teach House Surgeons and Registrars with new concepts and procedures.

Be immediately available to review any patient in the HDU who is unstable or who others have raised concerns about.

Be available to review HDU level patients prior to admission.

Be available to assist the Lead Clinician while the ICU WR is in progress in the weekends

Handover the HDU patients to the Lead Clinician in the evening (1600-1800), Monday to Friday, or at midday in the weekends.

Carry 2nd On cellphone (and ensure plugged into charger at end of the day)

Take elective referrals from Surgical Teams and Anaesthetist and record in the bookings diary. Be




Ward round Clinician:

available to review these patients personally where necessary.

Cover Lead Clinician’s duties while on the ward round or attending family meetings, doing procedures.

Be available to assist registrars, attend urgent “call outs” when the registrars are attending to other urgent situations.

Meet and discuss progress and plans with Primary and Referral Teams.

Attend the Multidisciplinary Team meeting for long term patients on Tuesday afternoons.

Attend the Multidisciplinary Team meeting for burns patients on Thursday mornings.

Ensure ANZICS audit forms are completed for the day prior to finishing.

Attend clinical handover; ward round and other meetings in the ICU the day prior to becoming Lead Clinician (Monday to Friday only).

Be prepared to take part in group discussions regarding management plans of patients for whom there are particular concerns.

General Clinical Duties for all Clinical Shifts include:

Ensuring the accurate assessment, investigations and undertaking of a clinically appropriate medical plan for patients presenting to the CCC.

Activities included/associated with this include:

Reading documentation (previous case notes, investigation results, and background material).

Completing documentation (case notes, ward round summaries, investigation requests, medication prescription, referral letters, and meetings with families and other practitioners).

Contacting other persons to obtain or give relevant information (relatives, general practitioners).

Discussion of cases with other specialties where necessary.

Meet with Microbiology and Infectious Diseases Team after the morning ward round on Mondays, Wednesdays and Fridays.

Liaison with Nursing Staff.

Liaison with Multidisciplinary Teams.

General clinical administration, i.e. ACC, medical certificates and completion of electronic discharge summaries.

During these sessions the SMO is primarily responsible for overseeing, coordinating, and where appropriate personally providing effective, clinically appropriate, and safe




Supervising the activities of Resident Medical Staff working in the CCC. These include the Fellow, Registrars, House Officers, medical students and other para-medical personnel.

assessment and treatment of patients presenting, in accordance with clinical practice protocols and guidelines, as much as possible within the given resources.

The SMO is accountable for the safe management of patients under their care. This includes obtaining informed consent where required, optimum utilisation of available resources (including time), direction of and/or liaison with nursing staff, and effective communication and liaison with other hospital staff for arranging further treatment/diagnosis and investigations.

Responsible on occasions for inter-hospital transfers, either personally or via allocation of other staff. Also responsible for escorting of patients to other departments within the organisation, personally or via allocation of other staff.

Activities included/associated with these sessions include:

Consultation by junior staff.

Presentation of cases seen by junior staff.

Assessment of these cases.

Discussion and advice on the further management of such cases.

Instruction with respect to medical procedures.

During these sessions the SMO is primarily responsible for supervising the management of patients seen by junior staff.

The SMO is accountable for effective supervision and teaching of assigned medical staff in training.

The level of supervision may vary dependent on workload and level of experience of the RMO at the time.

Supervision can be direct person-to-person advice, on phone advice, interpretation of results, evaluation of history, giving an opinion based on above and/or total re-evaluation of patient including a history and physical examination, this will vary with the workload and level of experience of the RMO




Conducting and/or supervising the "hand-over" of CCC patients within the Complex at the handover meetings and ward rounds.

Liaising with other health professionals and specialties to ensure efficient inter-service communication and patient management with an emphasis on continuity of care.

Leadership relevant to the efficient functioning and flow of the CCC

education of other staff (registrars, house officers, medical students and other personnel both clinical and non-clinical).

This is the primary responsibility of the Supervisor of Training (SOT) and the Head of CCC Education and Research; however a secondary responsibility lies with SMOs as dictated by workload and available resources.

.

Activities included as part of these activities include:

Presentation and discussion of all cases currently in the Complex.

Clarification of the management plan.

The SMO is accountable for effective communication with the nursing and junior medical staff, optimum utilisation of available time, and clear delegations of authority.

This includes a time allowance for:

Ad-hoc discussions as problems arise.

Liaison with visiting teams and specialists in the CCC.

Discussion with other SMOs within the CCC.

The SMO is primarily responsible for the effectiveness of the liaison by themselves with other health professionals.

The SMO is accountable for attendance at the relevant meetings, for effective participation and communication in these meetings, and for the effectiveness of their communication with other health professionals in this capacity, whenever possible as dictated by workload and available resources.

This includes a time allowance for:

Informal discussion on an ad-hoc basis.

Regular departmental (administrative) meetings.

The SMO is primarily responsible for the effectiveness of the liaison by themselves with the relevant people.

The SMO is accountable for attendance at the relevant meetings, for effective participation and communication in these meetings, and for the effectiveness of their communication with relevant people in this capacity.




While a large amount of time is involved in “hands on supervising" (see 2 above), further teaching is given as the clinical opportunities arise (appropriate cases, unusual cases, complex cases, etc). Formal structured teaching and training takes place in the form of regular clinical meetings, tutorials and programs.

Activities included in this are:

Preparation of formal teaching materials.

Tutorial, clinical meetings and teaching program scheduled times.

Informal, "hands on" teaching as the clinical opportunities arise.

Evaluation of teaching and learning experiences.

The SMO is primarily responsible for the effectiveness of the learning experience for their "students".

The SMO is accountable for appropriate preparation, attendance at and taking of teaching sessions, review of the teaching and learning experience.

Be able to release the junior and senior doctors to attend other teaching sessions in the hospital

Non-clinical Duties

Each SMO will receive, on average, at least 10 hours per week to carry out non-clinical (NC) duties. This might be more depending on roles; for example: some clinical leadership roles, SOT work or rostering duties.

This will not be always on any single day and each clinical shift factors in a certain amount of NC time (on average).

WR Clinician: 5 hours.

Backup (2nd on) Clinician: 1.5 hours.

HDU Clinician (weekdays only): 1.5 hours

Handover clinician: 4 hours.

It is expected that the NC time is completed on site at Middlemore Hospital and the SMO is immediately available during this time. Provision is made for offsite activities but must be discussed with and agreed to by the Clinical Head and/or Director in advance.

Personal projects must be discussed with and agreed to by the Clinical Head and/or Director. Attending external educational meetings, courses and work towards other qualifications should be taken as CME leave or equivalent, these must be




.

Non-clinical duties include but are not limited to:

arranged with prior knowledge of the CCC.

The nature of clinical work in the CCC means that occasionally SMOs rostered for non-clinical duties need to be available for clinical work. Should this occur, if necessary, re-allocation of NC time will be made available by the Rosterer in conjunction with the Clinical Head.

It is acknowledged that occasionally an SMO will be required to complete non-clinical work outside of normal hours (e.g. meeting deadlines for PPG, planning meetings and teaching sessions). However; this is currently accommodated for in the job sizing allowance (10 hour weekday). Should this become over onerous for any individual, discussion should be had with the Rosterer and Clinical Head to ensure adequate time is made within the roster and/or reallocation of non-clinical duties to those with a lesser load

Attendance of and participation in regular intra-department meetings:

RMO and SMO teaching including journal club.

SMO meetings.

Representation on Nursing meetings and teaching.

Mortality and morbidity meetings.

Management meetings.

Quality meetings.

Special interest group meetings.

EC/CCC SMO education meetings.

Medical grand-rounds.

Attendance of hospital committee meetings

Asset and capitals.

Trauma.

Paediatric governance.

Surgical governance.

Transfusion.

Hospital quality.

Patient safety.

ICU Trust.

Medication safety.

Clinical Ethics Advisory Group.




Attendance of external meetings:

College meetings and visits.

Vocational training meetings and activities including teaching/training activities.

External representation on other DHB committees.

ANZICS and Intensive Care Foundation Meetings.

Organ Donation New Zealand.

Teaching on recognised courses e.g: CICM, ANZCA, ACEM BASIC, APLS, EMST, and Simulation.

Documentation:

Medical reports for the coroner, Police, CARM, ACC.

Staff appraisals.

Review and update of relevant policies, protocols and guidelines. Liaison with other groups in the hospital eg: Paediatrics, Anaesthesia, and other ICU’s in Auckland/New Zealand.

Research and Audit:

Local and international.

Personal research (must be discussed with the Clinical Head).

Supervision of and collection of data for the ANZICs data base.

Supervision of registrar projects

Utilise Information Technology

Demonstrate an ability to access and use available clinical information systems.

Is conversant with applications required for specific discipline/role. For example, i.PM, Concerto, Outlook, etc.

Maintains own professional development by attending relevant IT educational programmes.


COMMUNICATION AND INTERPERSONAL SKILLS

Will be required to interact on a regular basis with a range of Counties Manukau Health staff members including:

All member of CMH Externally there will be contact with:

Other DHB’S

International units

Research organisations

ACC

Coroner

Patients

Families / Whanau Situations may often call for tact, diplomacy and will require information to be handled in a discreet and sensitive manner. In conflict situations will be required to exercise sound judgement, negotiation and persuasiveness skills, toward facilitating a workable outcome.

PROBLEM COMPLEXITY

Will be regularly challenged by a wide range of Complex Problems. There will be a requirement to be able to prioritise issues and negotiate time frames, while still providing a quality customer service. The range of problems will be diverse and require solutions customised to meet the circumstances of the client. Therefore opportunities will arise to provide innovative options to the client based on proven outcomes.

SCOPE FOR ACTION

Are empowered to make decisions or recommendations relating to ……………………………………………………………………. Are encouraged to use initiative and problem solving skills to develop innovative approaches to issues. Discretion is required to be exercised in releasing confidential information to the appropriate parties.


DIMENSION OF THE POSITION

Will be responsible to the Clinical Head for the achievement of agreed objectives and operates within the confines of Counties Manukau Health.

POSITIONS REPORTING IN THIS ROLE (numbers)

Directly - Registrar House Officer Trainees Indirectly - Students Visiting Staff

PERSON SPECIFICATIONS (requirements for the role)

Minimum Preferred

Qualifications

FICM

Experience (including years)

Critical Care

Skills/Knowledge/ Behaviour

Ability to work in a collaborative team

Personal Qualities


HEALTH AND SAFETY ACCOUNTABILITIES (Management roles) Health and Safety (H&S) is a key accountability of all Counties Manukau Health (CM Health) staff. All CM Health Managers are responsible to:

Zero harm Engage in safe workplace practices and manage the health and safety of your employees and other people in the workplace

Engage in safe work practices

Ensure all Incidents involving staff are reported, investigated and any corrective actions are completed and closed off when completed in the Incident reporting system in line with CM Health Policies and Procedures

Ensure all corrective activities are completed and controls are reviewed after incidents

Ensure all staff are Inducted/Oriented to the division/service/work area and recorded in the OneStaff database and participate in Occupational Health and Safety matters

Risk management Manage all hazards, risks and incidents in the workplace by identifying, evaluating, reporting and controlling them effectively by maintaining a Hazard and Risk Register that is reviewed and kept up to date on an ongoing basis

Stop work where there is an immediate risk of serious harm and escalate to the appropriate manager

Maintain Occupational Health of employees due to workplace hazardous exposures

Safety Management System Requirements

Ensure you and the employees understand and follow CM Health’s Occupational Health and Safety policies and Health and Safety regulations, what your responsibilities are under the policies and implement these requirements effectively into your work area

Manage the work area’s risk profile and how these relate to the corporate risk profile and implement and resource mitigation controls

Engage your employees to participate in Occupational Health and Safety matter.

Work safely Report for duty in a fit state, free from the influence of alcohol or other drugs

Provide and wear the necessary Personal Protective Equipment for yourself and your staff when undertaking specific activities, or when in nominated areas

Ensure procedures are in place for clinical and plant equipment to be operated safely

Participate in relevant safety training, manage and maintain safety related competencies for yourself and your employees

Be in possession of required and current Certificates of Competency (If relevant to your position)


HEALTH AND SAFETY ACCOUNTABILITIES (non-management roles) Health and Safety (H&S) is a key accountability of all Counties Manukau Health (CM Health) staff. All CM Health Employees are responsible to:

Zero Harm Engage in safe workplace practices and take care of the health and safety of themselves, other employees and people in the workplace

Risk Management Identify, evaluate and report all hazards and incidents they are aware of in the workplace

Adhere to apply risk controls, identified in risk assessments, such as ‘Safe Operating Procedures’

Follow safety instructions

Stop work when there is an immediate risk of serious harm and notify the appropriate manager

Ensure nothing they do or don’t do will cause harm to themselves or others

Safety Management System Requirements

Understand and follow CM Health’s Occupational Health and Safety policies, Health and Safety regulations, and personal responsibilities as outlined by these policies

Follow all Occupational Health and Safety policies and procedures

Work Safely Report for duty in a fit state, free from the influence of alcohol or other drugs

Participate in consultation activities regarding matters affecting your health, safety and wellbeing

Wear the required Personal Protective Equipment when undertaking specific activities, or when in nominated areas

Operate clinical or plant equipment safely

Participate in relevant safety training, and maintain safety related competencies

If relevant to your position, be in possession of required and current Certificates of Competency

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