Finding power without authority: a chief registrar's guide

Dr Ruwani Rupesinghe, respiratory medicine trainee at York Teaching Hospital NHS Foundation Trust, shares her tips on leading change as a new chief registrar in a new trust. 

I’ll start with a confession, I didn’t really know what a chief registrar was when I commenced this job. I knew what I wanted it to be, which isn’t quite the same thing. When I finally settled on a project and drew up a goal (after several re-writes) I thought things would be straightforward. Something akin to siting a chest drain – ultrasound chest, mark spot and insert drain. Simple.

Sadly when no one else knows who you are or what you’re meant to be doing, things get a little bit tricky. So, as a guide for new chief registrars, I have highlighted my three biggest points in dealing with this issue.

1. Meet as many people as you can, especially ones with titles you’ve never heard of

My first few weeks as chief registrar were a combination of night shifts and meetings. One meeting would end with a recommendation to meet someone else, and so the journey continued until I was in the company of the deputy director of patient safety detailing what little I knew of the job and how lost I felt.

A week later we were sharing a desk. The week after that, I was talked into chairing the Junior Doctor Safety Improvement Group. It wasn’t long until I’d shaken hands with the chief executive and met a whole host of senior members of the nursing, medical and management teams. 

If we all influence one person to make one positive change, imagine what we can accomplish in the UK’s largest employer.

Dr Ruwani Rupesinghe, chief registrar at York Teaching Hospital NHS Foundation Trust
2. It isn’t about what you know; it’s about whom you know 

It seems a total cliché but never a truer word was spoken. I don’t have the authority to stand up in a room and make operational or strategic diktats, but through the network of contacts I have made over the last few months I am more able to influence those who do. It is very satisfying seeing ideas that I would not have been able to complete on my own reach fruition through a web of people. 

I believe the same principle can be used to improve engagement with quality improvement. By inspiring a small group of doctors I hope to start a ripple effect and generate an army of people all working towards delivering better care in their area of work. 

3. We all have the power to influence change irrespective of our title or our perceived level of authority

The British Cycling team puts its success at the 2012 Olympics down to marginal gains - small improvements in every step of the process. If we all influence one person to make one positive change, imagine what we can accomplish in the UK’s largest employer. The chief registrar scheme has given me the tools and confidence to use this power. I encourage you all to be the pebble that starts a ripple which creates a tide of change. 

  • Dr Ruwani Rupesinghe is chief registrar and respiratory medicine trainee at York Teaching Hospital NHS Foundation Trust.