Staff progression
Treat career progression as a deliberate lever for retention.
Career progression, long an afterthought, is recast here as an urgent retention problem, sharpened by strikes, the pandemic and the workforce shortfalls the WHO projects. Headcount targets, the authors argue, miss the point, and they offer five metacognitive areas instead: quality improvement, breaking down professional silos, more adaptive careers, a healthier relationship with failure and making good use of prestige. The concrete ideas include national repositories for improvement projects, out-of-hours shadowing reframed as active learning, tailored consultant contracts and senior clinicians speaking openly about their mistakes. They draw on Daniel Pink's autonomy, mastery and purpose, and contrast healthcare's blame culture with aviation while warning that aviation's fixes do not transplant cleanly.
Three takeaways
- Training more staff will not fill the vacancies for a decade
- Quality improvement needs protected time and a shared home, not tick boxes
- Lateral moves and cross-silo shadowing are real development
Reflection
Questions for this chapter
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