Review: Advanced Structures for Clinical Leadership

• As a clinical lead, managing staff and implementing policies requires subtle grammar structures. This section reviews past tenses, the future in the past, verb-object-infinitive patterns, habits, and the unreal past to help you express expectations, hypotheticals, and professional frustrations clearly.
• Structure
• Usage
• Example at Boston General
• Future in the past
• To describe plans that were expected but changed
• We were going to launch the new audit cycle last Tuesday.
• Verb + object + infinitive
• To influence or describe others' actions
• The medical director expected us to hit the ground running.
• Habits & Annoyance
• To express repetitive, frustrating workplace behaviors
• The senior registrars would always complain about red tape.
• Unreal Past
• To express hypothetical preferences or urgent actions
• It is high time the department set clear priorities.
• Remember
• Use 'was going to' or 'was supposed to' for plans in the past that did not happen as expected.
• Certain verbs like 'expect', 'encourage', 'allow', and 'persuade' require an object followed by a to-infinitive.
• Use 'always' with the continuous form (e.g., 'is always complaining') to express annoyance at repeated actions.
• After 'would rather', 'it is high time', or 'suppose', use a past tense to refer to the unreal present or future.
• Examples
• The clinic lead was about to start her listening tour when the emergency call came.
• Dr. Miller would rather the board approved the clinical governance strategy today.
• Our predecessor was always taking credit for work he did not complete.
• Common mistakes
• It is high time the board decides on the new key performance indicators.
• It is high time the board decided on the new key performance indicators.
• The director wanted that we implement the strategy immediately.
• The director wanted us to implement the strategy immediately.

Complete the sentences

• Dr. Carter was worried because he (suppose) ____ the Seattle clinic did not approve the budget.
• I would rather you (not submit) ____ the audit report to the London board before I review it.
• The clinical lead kept (complain) ____ about the inherited problems at Chicago General.
• It is high time the department (adopt) ____ the new quality improvement framework.
• We were (go) ____ to meet the key stakeholders, but the meeting was canceled.
• The administration expects the consultants (lead) ____ by example during this transition.

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