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| Amanda Huddleston |
The NHS and public sector as a whole are experiencing unprecedented demand; the daily battle to deliver safe, timely and effective care is a huge challenge. At the sharp end, this is more and more leading to increased harm, poor patient experience, delays and a clapped out workforce on a daily basis.
As an NHS ‘lifer’ with over 20 years nursing experience, this makes me feel helpless, sad and angry. So, when I was given the opportunity to attend the BMJ/IHI International Forum on Quality and Safety in London, (to co-present the AQuA poster about ‘using safety culture assessments to drive safety improvement’) I grabbed the chance to see what the rest of the UK and indeed the world are doing to fix our NHS.
After surviving the inevitable commute (does anyone in London look happy?), I set off in search of a panacea. Whilst mingling with the other 2999 international delegates from over 70 countries, I noted five key things:
- Silver bullets sadly don’t exist
- No matter where you are from in the world, we are essentially all seeking to improve quality and safety
- Quality improvement science and the IHI model are a proven methodology
- Most people use bits this model but tend to skip the measurement (meaning it’s a pet project not an improvement and sadly change isn’t sustained)
- The ‘soft’ elements of quality improvement are the most important bit
The conference focused on the ‘softer elements’. I have felt for a long time these aspects have been underestimated and have in the past been neglected. It was great to hear throughout the sessions the evidence to support a more holistic view of quality improvement.
Encouraging ‘curious leadership’ to change culture
An interesting seminar from NHS Wales kickstarted my conference by advocating ‘curious leadership’, in which Emma Thomas (1000 Lives Programme Manager) shared findings of a huge programme to build a quality improvement focused workforce by training all student AHPs, medics and nurses.
Their findings demonstrated the benefits of this approach, as there was a positive shift in the culture of the whole workforce, including a reduction in negative behaviour deriving from hierarchy. Supporting students to be more curious and challenge and question the status quo benefited everyone, as it generated fresh ideas and new approaches to old problems.
For those of us NHS oldies with a few miles on the clock, the culture shift and leadership element requires us to build confidence in others and take a step back to allow experiential learning.
The benefits and evidence to support a less direct leadership approach were also echoed in the keynote from Derek Feely (President and CEO of the IHI) and his ‘sidekick’ Jason Leitch (National Clinical Director, Healthcare Quality).
The quote of the conference for me was: “heroic leadership is out! New leaders need to be comfortable with complexity and generous with power.” So, tempting as it is to don a cape (or a uniform) and wade in to do a quick fix, it is best to hold back.
I’ve been guilty of jumping in myself; my inner nurse is very eager to make things better at all costs! The evidence and learning shows the only way we can fix our broken system is to create a bottom-up, patient and front line staff quality improvement revolution.
Using Root Cause Analysis to drive improvement
Throughout the conference I also picked up a few new ways to tune in and before acting, understand the context and scope of what’s happening and what needs to be achieved. Using root cause analysis (RCA) to establish special or common cause bizarrely floated my boat.
The session lead by Carol Haraden (IHI Vice-President) and Amelia Brooks (IHI European Director of Patient Safety) to take RCA to the next level explained using understanding of measures and problems to drive improvement.
Listening to RCAs and seeing them as stories from those who are part of the system is a fantastic way of moving RCA from a negative, punitive task to a true source learning. Real food for thought and some ideas that will be implemented into an AQuA programme coming your way soon!
In summary, my takeaway thought (confirmed with so many examples) is that, if you give others permission to act and to be the agents of change, it will increase the likelihood of success and sustainability. This requires us to be brave, give up power, and to become facilitative, rather than managerial.
At a time of targets and pressure to perform, this may prove difficult but the evidence at the IHI event clearly demonstrated this shift as being productive, safer, better for patients and importantly, will help to shift the negative feeling of helplessness and will give us the much needed shot of joy and positivity needed to resuscitate the NHS.
If you’d like to share your own thoughts with Amanda, you can get in touch on Twitter via @MCR_Nurse, or email Amanda.Huddleston@srft.nhs.uk. You can also follow the conversation from the IHI conference via #Quality2017.
Their findings demonstrated the benefits of this approach, as there was a positive shift in the culture of the whole workforce, including a reduction in negative behaviour deriving from hierarchy. Supporting students to be more curious and challenge and question the status quo benefited everyone, as it generated fresh ideas and new approaches to old problems.
For those of us NHS oldies with a few miles on the clock, the culture shift and leadership element requires us to build confidence in others and take a step back to allow experiential learning.
The benefits and evidence to support a less direct leadership approach were also echoed in the keynote from Derek Feely (President and CEO of the IHI) and his ‘sidekick’ Jason Leitch (National Clinical Director, Healthcare Quality).
The quote of the conference for me was: “heroic leadership is out! New leaders need to be comfortable with complexity and generous with power.” So, tempting as it is to don a cape (or a uniform) and wade in to do a quick fix, it is best to hold back.
I’ve been guilty of jumping in myself; my inner nurse is very eager to make things better at all costs! The evidence and learning shows the only way we can fix our broken system is to create a bottom-up, patient and front line staff quality improvement revolution.
Using Root Cause Analysis to drive improvement
Throughout the conference I also picked up a few new ways to tune in and before acting, understand the context and scope of what’s happening and what needs to be achieved. Using root cause analysis (RCA) to establish special or common cause bizarrely floated my boat.
The session lead by Carol Haraden (IHI Vice-President) and Amelia Brooks (IHI European Director of Patient Safety) to take RCA to the next level explained using understanding of measures and problems to drive improvement.
Listening to RCAs and seeing them as stories from those who are part of the system is a fantastic way of moving RCA from a negative, punitive task to a true source learning. Real food for thought and some ideas that will be implemented into an AQuA programme coming your way soon!
In summary, my takeaway thought (confirmed with so many examples) is that, if you give others permission to act and to be the agents of change, it will increase the likelihood of success and sustainability. This requires us to be brave, give up power, and to become facilitative, rather than managerial.
At a time of targets and pressure to perform, this may prove difficult but the evidence at the IHI event clearly demonstrated this shift as being productive, safer, better for patients and importantly, will help to shift the negative feeling of helplessness and will give us the much needed shot of joy and positivity needed to resuscitate the NHS.
If you’d like to share your own thoughts with Amanda, you can get in touch on Twitter via @MCR_Nurse, or email Amanda.Huddleston@srft.nhs.uk. You can also follow the conversation from the IHI conference via #Quality2017.
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