A deep respect for Clinical Site Managers

by Susan Maxwell (Patient Governor)—When I was asked if I would like to shadow a member of staff for an hour or two, to get an idea of what their job entailed, I initially misheard. I heard the words 'Site Manager' and, for me, this conjured up an image of a hefty engineer in a hard hat clutching a clipboard. However, the person I was to shadow was, in fact, a 'Clinical' Site Manager (CSM) and believe me, that particular job is a different kettle of fish altogether.

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Susan Maxwell, Patient Governor

E: susan.maxwell@chelwest.nhs.uk

When I was asked if I would like to shadow a member of staff for an hour or two, to get an idea of what their job entailed, I initially misheard. I heard the words 'Site Manager' and, for me, this conjured up an image of a hefty engineer in a hard hat clutching a clipboard. However, the person I was to shadow was, in fact, a 'Clinical' Site Manager (CSM) and believe me, that particular job is a different kettle of fish altogether.

Mari Hayes was the CSM who took me through the job description, and the remit seemed endless. Despite numerous interruptions through telephone calls, bleepers sounding off and emails to be answered immediately, Mari remained calm, efficient and wholly in control of what seemed to be a three-ring circus. She explained patiently that the hospital needed an Operations Room, manned by a CSM, in order to ensure the smooth running of the place.

The CSMs, all of whom have reached at least senior nurse level, are responsible for arranging the allocation to wards of all patients who come into the hospital as either emergencies or planned admissions. The Operations Room runs on a 24/7 basis and out-of-hours the CSM is the most senior nurse on duty in the hospital and is the bleep filter through which all emergency calls are routed.

The CSM is also responsible for the security of the hospital and the safety of patients. Those CSMs who do night duty could be called upon to take on clinical and non-clinical emergencies which could be anything from dealing with a false fire alarm to handling a cardiac arrest.

Quite apart from keeping an ongoing record of what beds are currently available, the CSM is required to update the London Ambulance Service (LAS) on a regular basis of the hospital's emergency intake capacity. This enables the LAS to know which hospital is currently the closest one able to take in accident and emergency patients. It is by such micro-management of detail that the CSMs are able to ensure the smooth and logical flow of patients through the hospital, while anticipating and dealing with myriad problems arising from one minute to the next.

Forward planning is also an important aspect of the job since the hospital has to have a plan in force, in case of a major catastrophe occurring or for the winter when there may be a major flu pandemic. In such emergencies, the CSM is the central figure handling all aspects of the incoming patient pathway.

My poor descriptive powers seem inadequate to describe the complexity of the job but it helps to visualise one of those old 1940 films where the Royal Observer Corps move planes and ships around with long sticks on a huge map of a war zone. As each ship or plane passes through the war zone, it is removed and a new vessel takes its place.

Such is the method of the Operations Room. Whiteboards display all the wards and which beds are occupied and how many are newly vacated. The telephone rings and Mari receives new information about bed availability on one of the wards, so the board is updated.

The atmosphere is akin to Piccadilly Circus as the Operations Room is continually traversed by different staff with varying information to impart. There are daily meetings of ward matrons, infection control, security, etc so that the whole procedure of updating becomes teamwork on a huge scale, and Mari tells me that shortly she will give a briefing to hospital Executives as to the situation as it stands at that time.

We, as patients, never see the work that goes on behind the scenes to ensure our stay is as free from hassle as possible. Most of us are only too grateful that the patient pathway is smooth from the moment of admission to the final discharge. And even then, the CSMs have a duty of care that goes on, arranging transportation where necessary and ensuring that vulnerable patients are discharged into a safe environment with community nursing firmly in place. Their job remit truly does seem endless.

I didn't know this job existed until I shadowed Mari and as I watched her answer bleeps, deal with telephone calls, answer queries from incoming team members, update the LAS, whilst also writing up bed availability, all while continuing to explain the job to me, I found myself in awe of her ability to focus and keep all those balls in the air.

I find I have a deep respect for Clinical Site Managers. They truly are the unsung heroes of the NHS.

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