Goodbye 2017, hello 2018!

Drawing on lessons from our Patient Safety team’s recent away day, Nathalie Delaney shares a few creative and collaborative ideas to review what you’ve achieved as a team in the past year and how this might inform your plans for the coming year.

At the end of the year, it can be a good time to reflect on the achievements and learning of the past year and make intentional plans for a successful year ahead.

The West of England AHSN’s Patient Safety team met at the end of 2017 to do this together, and I thought I’d share our process here as you may want to reflect on this yourself or with your own team.

Goodbye 2017

As an icebreaker, we looked at the strengths of our team using the 16 personality types. Who’s in your team? What are your strengths? Then we looked back to celebrate the past year and asked ourselves:

  • What were our successes and achievements in the past 12 months?
  • What have we learned about ourselves and our members this year?
  • What were our biggest lessons this year?
  • Was there anything that surprised us?

If you are doing this as an individual, you may want to start by reviewing your calendar for the past year to identify key milestones and achievements. Alternatively you could create a shared timeline as a team. The Sign Up to Safety Kitchen Table Scribble Sheet has some other prompts that may help you do a freeform download of what’s on your mind.

Based on this we made a list of: what might we change or maintain in our work in 2018?

Looking ahead

We then had a presentation from our Managing Director, Deborah Evans, and Chief Operating Officer, Tasha Swinscoe, on the ‘big picture’ for the year ahead, both nationally and locally. From these, we identified what opportunities and challenges might arise in the year ahead?

Each member of the team was asked to nominate their theme song before the workshop. We held a short quiz to try to guess which song belongs to each team member, based on 20-second snippets from Spotify. As a team, we were surprisingly bad at this and it was a good way to find out something new about colleagues we work with. In case you’re interested, mine was ELO’s Mr Blue Sky.

Hello 2018!

The afternoon was spent creating a shared vision for 2018. We split this into aspects about how we, the team worked, and also our projects.

For our team we asked:

  • What should we stop this year?
  • What should we continue this year?
  • What should we start this year?

You can download a template to use with your team or consider the questions individually.

After a quick cake break, we discussed our projects and objectives, using the MoSCoW framework to identify our key aspirations and the impact we wanted to see:

  • Must do
  • Should do
  • Could do
  • Won’t do.

Our next steps are to identify what results we want to see and break these down into our large goals and smaller steps as driver diagrams using Quality Improvement methodology. As a team, we are moving to using Verto to manage our programme in the New Year. If you prefer paper to digital, you can print out our handy calendar for 2018 and add in your own goals and actions.

Over to you…

How can we in the West of England AHSN help you reach your goals in 2018? There are plenty of opportunities for support whatever your aspirations.

If your goal is to learn more about Quality Improvement, why not sign up to study the Quality Improvement in Healthcare MOOC starting in February 2018. This is a free six week course delivered online. You can also sign up for a free account for LifeQI which is a web-based platform designed to assist frontline staff running Quality and Safety improvement. The LifeQI system has recently been majorly upgraded and is free to access for West of England AHSN members.

Opportunities to join the Q community, an initiative connecting people with improvement expertise across the UK will re-open in 2018. Register your interest to be notified when applications are open.

If you are working in primary care, recruitment will open soon for Cohort Three of our successful primary care collaborative. Find out more and register your interest.

If your goal is to share learning from an innovative, measurable solution to a patient safety issue then why not enter the National Patient Safety and Quality Improvement Poster competition. Enter online by 16 March 2018. Short-listed entries will be invited to present a poster at the Bristol Patient Safety Conference on 16 May 2018.

If you are working in business check out our business support video which includes an introduction to our work with businesses and innovators and sign up for our newsletters including our funding finder which provides regular up-to-date funding opportunities for health innovators. This includes opportunities from Innovate UK, Department of Business, Innovation & Skills, Horizon 2020, The National Institute for Health Research and NHS England.

If you want to meet and share ideas with others who share your passion about improving and innovating healthcare, then you need to sign up for hyvr, our new social network for citizens, innovators, healthcare professionals – and well anyone really!

And if you would like to know more about evidence and evaluation or involving public contributors we have a range of toolkits to help you with practical steps in your day-to-day work. NIHR CLAHRC West provide a range of excellent training courses aimed at developing of skills in understanding, using and producing evidence for the health, public health and commissioning workforce, and patients and members of the public. You can also join our evaluation online network, a virtual peer to peer support group for all things evaluation related.

Evidence Works – an evidence-informed commissioning toolkit

Evaluation Works – a service evaluation toolkit.

Working Together – A toolkit for health professionals on how to involve the public

All the best wishes for a fantastic 2018!

“So what do you do?”

Nathalie Delaney, Improvement Lead in our Patient Safety team, shares her experiences of trying to explain what she does at work and, trickier still, what on earth is human factors…

“So, what do you do?” It’s the question we all get asked at parties.

Explaining Academic Health Science Networks is hard enough to people inside the NHS so I usually go with: “I work for the NHS,” as my opening line. Generally in my social circle there’s a one-in-four chance that I’m speaking to a fellow NHSian so we move onto “Where do you work?” and try and figure out people we both know.

“As a nurse?”

This is the usual follow-up question the other three times. Not sure why people’s minds jump to this conclusion – there are hundreds of job roles in the NHS, all working as part of the team. (If you want to take a test to find out what role you are suited for, Step into the NHS is great fun.) Anyway, I go on to explain that I work in projects in the patient safety team to get us on more familiar ground.

“Ok, what are you working on at the moment?”

So I explain I’ve been working with community providers in the region on training staff in human factors, and we’re now expanding this into GP practices and giving talks as part of the local maternity network too.

“Human factors? What’s that?”

Now human factors is a difficult topic to define, I usually start my sessions with a prompt question – “What makes your working day easier or harder?” and from there gather a variety of human factors that can affect us, ranging from physical things (like being hungry or tired), emotional things (stressful situations), the environment and design of our kit (frustration with computers is a really common issue people raise). But essentially my cocktail party definition is that “human factors are what mean we can’t be replaced by robots – but also mean that we are fallible and can make mistakes.” Sometimes I’ll give a few examples of human factors in practice.

“Surely that’s just common sense… the NHS needs people to train them in this?!”

Well, yes and no. A lot of human factors are common sense, but often our systems are designed for people who think like robots, rather than individuals with all our quirks and eccentricities.

For example, we all know what we need to do to keep healthy, but who can honestly say they do exercise for 30 minutes, drink eight glasses of water, eat five pieces of fruit and get enough sleep every day? (Maybe that is you, in which case, well done and keep going!) An awareness of human factors can help you notice where you might be at risk of making an error, or why the design of a task is frustrating you, and from there you can start to change it.

Recently the University Hospitals of Leicester launched an excellent series of videos was raising awareness of human factors in maternity care, “The Little Voice Inside”, and the original human factors video “Just a Routine Operation” still has much to teach us today.

“I don’t agree with this – if someone makes an error then they just need to be trained to do the right thing next time.”

That’s the old way of thinking, and the NHS has made a massive culture change over the last decade or so to turn this around into understanding that often it is the system around people that creates the conditions for error. The old way of thinking is about giving people remedial training, or even worse, putting signs on everything. Because, of course, that works…

As an aside, I love spotting signs that people have added onto things. Usually it is because of some previous behaviour that they want to change or poor design (as in the image at the top of this post). Signs are a really good way of finding where your system can be improved. I also like to spot “emotionally intelligent” signs which use an understanding of human factors to get a better result.

Another question I ask participants is, “What workarounds do you use at work to get things done?”

“Ok, so you just systemise everything and then it will be fine.”

Well, if we could do that, then we could replace everyone with robots. And as I’ve explained, frustration with technology is a big issue for people, so I don’t think it’s the best solution at the moment (although my colleagues in the Enterprise team may have a better idea about the future of technology – I’ve heard intriguing things about robot trousers being developed at the University of Bristol).

And actually the special thing about healthcare is the human connection – the compassion of staff caring for patients and each other. As Helen Bevan tweeted the other day, “Kindness is a superpower.” Human factors is about the people within the system too, and there are some brilliant movements in the NHS which are appreciating this, starting with Kate Granger’s #hellomynameis campaign, Sign Up To Safety, Civility Saves Lives, and the Circle of Care video.

Organisations are starting to move away from focusing on safety by avoiding harm to looking at excellent practice and where we can learn from what goes well too, for example Learning from Excellence, which our colleagues at the West Midlands AHSN helped to develop and which won an HSJ Patient Safety award in 2017 or the #MatExp movement (read this great blog post from Florence Wilcock).

As Suzette Woodward has said, it is about “noticing, understanding and learning from small moments of organisational life.”

https://twitter.com/FWmaternitykhft/status/882958222730174466

“This all sounds very fluffy. Where’s the evidence?”

The two best sources are the Clinical Human Factors Group and the Chartered Institute of Ergonomics and Human Factors who have lots of case studies, resources and research evidence on their websites. It’s an academic subject; some people do PhD studies in human factors, and I don’t claim to be an academic expert – only as lived experience in being human and not a robot. Bleep bloop!

For more information on our human factors project, including a step-by-step guide to implementing in your own organisation, please visit www.weahsn.net/human-factors.

 

Image sources:

Making every day a good NEWS day

Whenever I reflect on my role as a Patient Safety Improvement Lead here at the West of England AHSN I consider myself a very privileged person.

My day to day working life involves interacting with inspirational clinicians and patient safety leads from NHS and provider organisations across the region. Our little team encourages and supports them to work with us and collaborate across geographical and sector boundaries on programmes to improve healthcare safety for our population.

We ask busy people to be even busier and I am constantly humbled by the effort and goodwill we receive in response.

The success of our AHSN-led regional patient safety programmes relies heavily on organisations at the coal face doing the work for us. As improvement leads we don’t deliver patient safety improvements to patients; we only encourage and support them.

Last week I found myself in the unusual position of being the ‘deliverer’ – not directly to patients I hasten to add (with no clinical qualifications to speak of, that would clearly be bad for patient safety!) – but delivering presentations on two of our programmes that are attracting attention from health professionals across the country. The first of these is our fantastic cross-system work to roll out the National Early Warning Score (NEWS) across the West of England, and then there’s our support of the adoption and spread of the Emergency Department (ED) Safety Checklist; an elegantly simple but brilliantly effective patient safety intervention now in use in six out of seven of our EDs.

Sharing-the-NEWS_crop

Anne Pullyblank is Clinical Director for Patient Safety at the West of England AHSN and Colorectal Surgeon at North Bristol NHS Trust. Anne and I were asked to talk at a national Deteriorating Patient conference and were joined by delegates from as far afield as Fyfe and the Channel Islands.

People were keen to hear about our ‘Share the NEWS’ concept, which sets out to improve the communication of NEWS at the interfaces of care, in particular the lessons we have learnt from our patient safety collaborative.

We looked back at our achievements since the launch of the West of England’s Deteriorating Patient programme in March 2015.

 

  • All six of our acute trusts have standardised to NEWS across all services, including ED, and this includes NEWS on patient transfers within hospital and in transfers between acute trusts.
  • The ambulance trust now has NEWS embedded into its electronic Patient Care Record, which automatically calculates NEWS from the vital signs monitoring equipment in the response vehicles and is handed over with the patient to the receiving department.
  • All our regional community service organisations are using NEWS to assess cohorts of patients and as a trigger to escalate to either primary or acute care.
  • Both our mental health trusts have improved the accuracy of NEWS calculation on their inpatient wards and are working collaboratively on non-contact physical observation policies and improved communication on transfer to acute trusts.
  • All GP out of hours providers are routinely using NEWS when referring patients to Urgent Care. With the support of the Clinical Commissioning Groups through direct seminars, contractual incentives (primary care offers and CQUINS), far more in-hours GPs are now using NEWS to assess the acuity of patients, specifically when referring patients to hospital.

This is excellent progress in such a short time and we were able to explore our strategies for engaging our cross-system stakeholders. We adopted a hybrid of the Institute for Healthcare Improvement (IHI) model for improvement and standard project management methodology, using six monthly regional learning set events to focus on specific cross-sector themes to support the use of NEWS within organisations and the communication of NEWS at the interfaces of care, combined with regular meetings of sub-regional cross-sector groups to drive this work forward.

Delegates seemed impressed by our achievements and were very interested in the resources we’ve developed (implementation toolkits, information sheets, videos and blog posts – all available on the West of England AHSN website) to support our work. It was great to feel that our region is pushing the envelope in collaborating across systems for common outcomes, and that on a national stage we are one of the pioneers in using NEWS across sectors and at the points of handover of care to ensure patients are seen at the right time, in the right place by the right clinician.

In the same week, I was invited to present our work on the adoption and spread of the ED Safety Checklist to representatives from EDs across the Wessex AHSN region, along with my colleague Emma Redfern who is Associate Director for Patient Safety at the West of England AHSN and ED Consultant at University Hospitals Bristol NHS Foundation Trust (UHB).

Emma Redfern photo
Emma Redfern, Associate Director for Patient Safety

Impressed with the West of England ED Collaborative’s approach, which regularly brings together representatives from all our regional EDs and the ambulance trust to share patient safety innovations and strategies, Wessex AHSN was keen to understand if there was an appetite within their region to adopt a similar model.

To demonstrate the impact of the West of England ED Collaborative, Emma and I presented our work on the adoption and spread of the UHB piloted ED Safety Checklist. We started with why the concept of the ED Safety Checklist had been developed in the first place: to address the issue of consistent crowding in ED leading to poor standards in basic clinical care and avoidable harm. We explained what the ED Safety Checklist is and how it had been developed through a review of baseline data to assess the performance of ED in the delivery of basic clinical care and patient comfort, a review of serious incidents and the employment of quality improvement methodology to rapidly test the use of a systematic hour-by-hour checklist when caring for patients in ED.

We then took delegates through how we rolled out the piloted concept to other EDs in the region, describing the toolkit we have developed which gives top tips on what to do and what not to do when introducing the ED Safety Checklist, and the benefits of the ED Collaborative as a network for sharing good practice. It was good to be able to show the impact of this work to date, which clearly shows an improving trend in the key performance indicators for standard clinical care such as NEWS and pain score at triage to ED, and timely instigation of appropriate investigations across the region (measured as an average across our implementation sites).

Again, the quality of our collaborative patient safety work was recognised, which is all about the sharing of good practice and the clear impact this is having on patient safety in a constantly pressured and stressed NHS department.

When reflecting on my experiences last week, I have to say it felt good to be a ‘deliverer’. I am honoured to have had the opportunity to represent our region and our fantastic stakeholders, and to promote our collaborative achievements. My hope is that we have inspired others to follow our lead; to breakdown geographical and sectoral boundaries within heath communities, to work together to achieve common aims and ultimately deliver safer standards of care to every patient.

I may not be a direct ‘deliverer’ of patient safety improvements, but I really am privileged to work with inspirational individuals and organisations that do.

It’s a wrap!

In this latest blog post Sarah White, Quality Improvement Lead, has a few timely tips to share on the festive art of gift wrapping…

‘Tis the season to be jolly and to wrap presents. Some people love the wrapping part, adorning their gifts in feathers, bows and all kinds of bells and whistles. Some people, like me, only buy gifts from shops that provide a wrapping service.

Here at the West of England AHSN we decided to take the Christmas spirit and repackage it as a learning activity. Our Quality Improvement team were recently asked to deliver training to Bristol pharmacists to help them understand process mapping (or should that be process wrapping?), which presented the perfect opportunity.

The activity demonstrates how everything has a process – a flow in which smaller tasks combine together to make an overall task.

We furnished small teams with the necessary equipment: a gift, some paper, a label, sticky tape, all the accouterments required to make a lovely gift for someone.  They were then asked to spend 10 minutes setting out their workstation to make the process of wrapping the present as easy as possible.  They were given some simple rules to follow:

The gift must be neatly wrapped:

  • No bits of present visible
  • No loose corners or edges of paper
  • Sticky tape not visible.

The gift must be labelled:

  • Attached by string
  • To whom
  • Message
  • From whom.

Once they had designed the process they would have 10 seconds to wrap their present.

The teams got to work – setting out their process, discussing the merits of various techniques, laying out their equipment, labels, gift and paper in ways that would make that 10 second wrap a doddle.  The teams were working together, collaborating and generating ideas. It was all going so well until…

The trainers called time on their process mapping and everyone was all set to get down to the business of putting it into action, but (and here’s the good bit) we then asked them to swap workstations!

The teams had to use someone else’s process.

There were all kinds of complaints, but the rules were unequivocal. You have to swap teams and use a process that you have not been involved in designing.  The 10 second countdown started as did the shouts of dismay.

The presents were wrapped – kind of.  Using another team’s process was more difficult as the participants hadn’t designed the process; it slowed them down and made less sense than their own.

Afterwards, we asked them how it felt to have a process foisted upon them with no consultation and I’m sure you can guess the responses. The exercise was fun and clearly demonstrated the benefits of building consensus, utilising existing skills within the team, and having ownership of a process, whatever it may be.

In terms of Quality Improvement, this exercise is great to quickly demonstrate the importance of bringing teams together to understand their processes, especially when it comes to making changes.