Richard E. Field, consultant orthopaedic surgeon and director of research at the South West London Elective Orthopaedic Centre (SWLEOC), on how to manage surgeons

Most surgeons have type A personalities, are driven and are happiest when operating. If somebody stops us from doing our job, we feel that we are wasting time, and it's when we are not busy that we make trouble. Brian Wells, the director of SWLEOC, understands these needs and that to make SWLEOC surgeons effective, he must enable us to be productive.

SWLEOC opened in January 2004 after four trusts agreed we would have a better environment to undertake joint replacement surgery if we worked in a dedicated centre rather than in our district general hospitals. We adopted the ethos of the Hospital for Special Surgery (HSS) in New York, which says everything depends on having the surgeon and the patient in the operating theatre, at the agreed time, with the appropriate equipment. If you structure everything to achieve that, then patients get treated.

Our first director articulated the SWLEOC vision and secured the support of our stakeholders. However, by November 2004, the reality of trying to run a centre from scratch had become apparent and we realised that we didn't have all the processes in place to meet our targets. Too often, we had surgeons standing at the operating table but too few patients had been cleared for admission or theatre staff had experienced problems getting our equipment sterilised on time.

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Brian was appointed as our second director. He had excellent operational skills and experience and he spoke the right language. He had been a nurse in the Army, so he had experience of orthopaedic operating theatres. Brian quickly embraced the HSS ethos, so we were all singing from the same hymn sheet.

Brian was very good at dealing with each problem. The pre-assessment team started to work more smoothly, more patients were available for surgery on the agreed date, we started to fill our operating lists and the equipment we needed was available. That became the critical moment in our turnaround.

From our shaky start, we went from a first year deficit of £4million to a second year deficit of £400,000, a small profit in the third year and

we are now running with enough profit to look at new service developments.

Boys with toys

Surgeons can be really intimidating, says Brian Wells, director of SWLEOC. “They're very intelligent, they're noisy and they're boys with toys.” But he adds: “I feed off people like that, so it's been very easy for me to work with them because I like people who've got an entrepreneurial spirit.”

Managers can be guilty of ignoring the clinical body on the shop floor, but Wells is aware that without clinicians' backing neither he nor SWLEOC could succeed. He has spoken to the NHS Institute for Innovation and Improvement about how he has built this relationship.

Manager baiting can be a bit of a hobby for some, he warns, so it's crucial to find a way of facing that off. “If you show that you're intimidated, the surgeons, because of their predatory nature, will go for it and they'll have fun.”

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