Blog – How Improvement Can Resuscitate the NHS – Amanda Huddleston

Amanda Huddleston is AQuA’s Quality Improvement Lead for Safety & Mortality. Following her recent visit to the recent International Forum for Quality & Safety in Healthcare conference in London, she shares her thoughts on challenging leadership culture, and using root cause analysis for improvement.

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:

1. Silver bullets sadly don’t exist
2. No matter where you are from in the world, we are essentially all seeking to improve quality and safety
3. Quality improvement science and the IHI model are a proven methodology 
4. 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)
5. 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.

Blog - Patient: Engaging, sharing, supporting – Part 2

Kayleigh Price is AQuA’s Improvement Lead for Safety & Mortality. In the first part of her Quality Forum blog she shared her thoughts on patient experience. For part two, she explores how innovation and technology can play a part in improving patient experience.

Kayleigh Price

In this second part of my blog I want to draw on patient innovators and tech. Thanks for staying tuned…

#Wearenotwaiting- How can we safely spread patient innovations and involvement?

Health care is notoriously reticent in using new technology; requiring many rounds of testing before anything can be deemed as fully safe. I’m not saying that this is wrong but we sometimes seem too scared of this tech to let out patients use it. Despite our fears, they are using it anyway. In fact they are using it and then some!

We heard from some patient innovators who had a very strong message for healthcare. This message was beautiful in its simplicity - #Wearenotwaiting (go away and search for it on Twitter- I promise you will be impressed).

Tic tacs for monitoring diabetes and finger tap apps for Parkinsons?

We also heard from Tim Omer who has Type 1 Diabetes. He, along with a number of fellow diabetics, has hacked his monitoring kit. He showed us a tic-tac box which had been emptied (I assume he didn’t eat all of the sweets!) and filled with some simple electronic circuits.

This then connected to his monitoring device to give him real time consistent monitoring of his blood sugar levels, without the need for him to constantly check it. He had then connected this to his smartwatch so that he could easily view this data and make adjustments according to what his body was telling him. Not only that, but this group of diabetics have created over 100 artificial pancreata, just by connecting all of these bits together.

Then there was Sara Riggare, who is living with Parkinson’s disease. She is using apps on her smartphone to measure and monitor her tremor, and uses this data to discuss with her care provider the best options for her care, depending on how her condition is manifesting in real time.

This blew my mind in a couple of ways. Firstly that people have the ingenuity to go out and create these things for themselves. Secondly, that they are having to in the first place.

Are our healthcare systems letting us down so much that patients have to take it in to their own hands to create solutions, often dicing with death whilst they tweak and finesse their systems? (I feel the need to point out that this is not just the NHS - Sara was from Sweden and some of the other speakers were from America and India)

Innovations and engagement for all?

The third and perhaps most important way that all of this has blown my mind is this - How can we as healthcare providers catch up to the innovations our service users are creating? How can we safely ensure access to these innovations for the vast majority of our patients, rather than the very small minority of activated and vocal patients?

And this is the real point I wanted to make - yes patients want to be involved in decisions about their care - of course they do. Let’s be honest, it doesn’t take a genius to work that out. But how best to do it? Not every patient is brave enough to push themselves forwards, or has time (or even the ability) to sit and develop innovative ways to assist themselves. Even those who are leaders in their field often cede all power once they become a patient.

I recently read a book called ‘When breath becomes air’ by Paul and Lucy Kalanithi (I thoroughly recommend this for ANYONE working within health and social care). Paul trained for years to become a neurosurgeon and this book outlines his story as he transformed from highly trained medical practitioner to end of life patient, and the feeling of loss of power that went alongside this.

If even someone who knew the system inside out felt unable to speak up about his care, how can we expect all of our patients to do so? How can we expect them to know what the best options are for them, and how they should go about researching them?

How can we truly engage our patients in their care, ensuring that all of the options (including those we may not have the power to offer them) are outlined? And how can we in health and social care ensure that this is done in a safe and inclusive way?

How can we adopt and adapt the technologies our patients are developing to ensure that access to these innovations becomes widespread? How can we do this in a system that is straining under the pressure? With staff who are stretched as thinly as possible without snapping? Who are trying their best to deliver the highest standards of care, but are facing ever growing numbers of patients, with less financial support and higher patient expectations?

I don’t pretend to have the answers to these questions, but I would love to hear your ideas for how we could do this. So, let’s start a conversation!

Tweet me @kayleighprice14 or email me at Kayleigh.price@srft.nhs.uk and share your ideas.  Maybe by working together we can come up with some ideas that might be testable, and we can move towards enabling our patients to fly. 

Blog - The Promise of Manager-Clinician Partnerships in the NHS

Andrew Wilson is a Senior Business Intelligence Analyst at AQuA. Following his visit to April’s International Forum on Quality and Safety in Healthcare in London, he shares his thoughts on how the NHS needs to bridge the gap between clinicians and managers…

Andy Wilson

There were many fault lines that scarred society in 2016. Deep divisions between young and old, town and country, were evident across the social fabric of these shores throughout the last year. When we think back to the world of 2015, it feels more distant rather than a mere eighteen months ago.

Whilst there is no doubt that, like any other area of government, the process of leaving the European Union will have a significant impact on healthcare, the opening paragraph was not written with Brexit in mind.

Whilst Brexit will undoubtedly have an impact on the NHS, the focus of this blog is on junior doctors. In early 2016, the junior doctors’ strikes were leading news stories for several weeks. Strong opinions were held on both sides of the argument about the morality of the strikes, their impact on patients, the main protestations of junior doctors and who is responsible for this disagreement reaching this point.

Whichever side or viewpoint you took on the junior doctors’ strikes, I’m sure that you would agree that these are the clinicians who in five, ten or twenty years from now will be clinical leaders across the NHS.

Throw into the mix the pressure the NHS will be suffering over the next decade, a larger population with greater healthcare needs, you could be forgiven for thinking that the chasm between junior doctor and management of the NHS is not traversable.

Learning from Guy’s and St Thomas’ example

At the Quality Forum conference I was fortunate enough to attend a presentation by Joanne Ward (a deputy general manager) and Chris Meadows (a Critical Care Consultant) at Guy’s and St Thomas’ NHS Foundation Trust.

Joanne spoke of how she felt it was critical that she spent more time in the clinical setting she was managing, to better understand the work the clinical team undertook, and their perspective of how the NHS functioned.

Chris told delegates of his experience as a new consultant, attempting to encourage his juniors to develop a better understanding of the work NHS managers do, and how the NHS functions. He also spoke about how their roles cross paths, and how the Trust had developed a programme to pair similar junior doctors and NHS managers, with the idea of letting them lead on a quality improvement project.

The programme consisted of a series of workshops and shadowing of roles to match managers and clinicians. The result of this was to have a formidable partnership that could engage with fellow clinicians to establish the underlying problem affecting patient care and work with managers to explore all options to achieve an improvement. Joanne and Chris also went on to talk about the various achievements of these partnerships had had at the Trust.

Hope for positive partnerships

So despite the picture of doom I painted earlier in this, I want to stress that here is just one (and I’m sure there are many more) tangible example of quality improvement working alongside the clinical leaders of tomorrow.

The gains in fostering more of these Manager-Clinician relationships are potentially massive in patient and experience terms, and there is a simplicity to their work financially too.

Link junior doctors with people who have the capability to change patient pathways, and you can achieve improved patient outcomes and a more engaged staff.

Blog - Thinking Safety at the Quality Forum

Andrea McGuinness is AQuA’s Programme Lead for Safety & Mortality. Here she shares her some of her early points from April’s International Forum on Quality & Safety in Healthcare Conference.

Andrea McGuinness

Even as I write this just half a day through the conference, I am already overwhelmed with the sheer volume and brilliance of health and care staff from across the globe.

The passion and ingenuity of people and most importantly, the pride with which they continue driving safety and quality, humbles me.

Here I just wanted to share with you a few key themes picked up from the conference so far…

Doing care with, not to

We need to make it the norm to have patients and families leading safety improvement. After all, who has most to lose when care goes wrong?  We have endless possibilities available to us once we get over doing to, and move to doing with patients and families.

Quality improvement and safety culture

The second theme making a massive impact on me is the power of quality improvement to provide safer cultures within all teams and across all aspects of health and social care. 

Speakers here are sharing how QI with leadership support releases staff to make services safer. It creates purpose and meaning for staff who are often frustrated and caught in a spiral of dissatisfaction about the services in which they work.

We have to choose to make a positive experience

My final theme is around the value and passion, commitment and concern that our staff have for the services they work in. What role do we have in creating positive environments for all those who experience health and care? Those who use and those who work within them?

Leadership, influence, permission and values are something every single one of us can affect. We all have the choice to do this. We can choose to make a positive difference   No one chooses to make a negative impact but do we sometimes choose not to bother?

What we see and hear from AQuA members, and from the international safety community, is that when we learn and share together we make it easier to make a positive difference, and we’ll be sharing more of our learning from the conference in the coming weeks.

You can find more about our work to improve safety on our website. Please do drop us a line if you’d like to discuss this, or anything in this blog further, at either @1McGuinness on Twitter, or via andrea.mcguinness@srft.nhs.uk.

Multimedia Recap - IHI Accelerated Patient Safety Programme

Earlier this month, the Institute for Healthcare Improvement (IHI) and AQuA welcomed over 50 delegates to an exciting four day event, designed to support organisations to develop and implement safer health and social care systems.

Taking place at Hotel Football, Manchester, our expert faculty guided delegates through the vital skills and knowledge needed to apply improvements to their individual roles and environments.

We've put together a multimedia recap of the best tweets, photos and videos from across the four days. For full information about the course, please visit www.AQuAnw.nhs.uk/IHI