My AHSN connection – Dr Seema Srivastava MBE

Seema was awarded an MBE in the 2018 Queen’s New Year’s Honours list for her services to the NHS in Patient Safety. Here Seema writes about her involvement with the West of England AHSN right from the start, and how we help facilitate the work she’s involved in.

I’ve been involved with the AHSN right from the start; I was already involved in regional Quality Improvement (QI) work. One of the things I remember, right back at the early meetings in 2012 was the range of people I got to meet. I was particularly interested in meeting innovators and people using technology to tackle some of the issues we were facing.

For us at North Bristol NHS Trust (NBT), the National Early Warning Score (NEWS) was high on the priority list right from the start. Working with the AHSN meant we could work alongside others, at University Hospitals Bristol and then in the community. We learn from each other’s successes and failures and take a standardised approach that has rolled out across the region and is now being implemented across the country.

One of the things I value most in working with the AHSN is the way they remove barriers and get people working together. The face to face meetings are both productive and enjoyable. The team there are also great at facilitating remote teams and keeping complex projects with dispersed teams on track.

It’s this ability to bring people together and focus their efforts that has allowed us to progress NEWS with the pace and scale that we have. I’m also working with them on approaches to Learning from Deaths and the ReSPECT advanced care planning tool. These are sensitive areas but with the support of the AHSN we are gaining wide-ranging and senior support and buy-in that will really help the development and adoption of these projects.

This story is a highlight from our 2017/18 annual review: joining the dots to healthcare innovation. Check out the full review here.

What’s your best-fit coaching style?

Our quality improvement project support officer, Kate Phillips reflects on her learning from the West of England Academy Improvement Coach Programme…

I recently took part in a great two-day improvement coaching event hosted by the West of England AHSN, funded by The Health Foundation. The event was attended by 26 of the West of England Qs, a group of people who I am really enjoying getting to know as we share a passion for driving quality improvement (QI) in healthcare. Sue Mellor and Dee Wilkinson, our fabulous facilitators, guided us through three coaching approaches with an emphasis on finding our ‘best fit’ coaching style. This encouragement for honest reflection ensured I left with a bounty of personalised counselling tools.

We started the course by working out our Honey and Mumford personality type which led to conversations around team dynamics and how to make the most of individual talents. I felt a sense of belonging and of ‘finding my people’ as the room was buzzing with personality type ‘private’ jokes. A particularly comical moment was when three ‘activists’ were first up to grab the board pen, while the ‘theorists’ were still discussing the merits of the process!

I initially joined the ‘pragmatists’ as I thrive on finding evidence-based logical solutions. However, following an insightful conversation with a colleague, I scooted myself closer to the ‘reflectors’. She had noticed how I often approach tasks with a reflector mindset, which I reckon comes from a desire to learn best practice from more experienced colleagues (experienced in QI and identifying personality types!).

Having very recently made a jaunty sidestep away from a career in teaching, I am still finding my QI feet… Interestingly I think personality types are fluid and can change depending on the situation we find ourselves in.

For example, if I was to stroll back into a classroom and teach a class about displacement reactions (fire!) you would see a pragmatic Kate, but put me in the office answering the phone you would firstly see me very flustered as I juggle the telephone voice, demands of the caller and transferring the call. However after my heart rate has returned to baseline, I will reflect on the success of the phone call and how I can make it less of an ordeal next time (more fire?).

As I’m sure a lot of QI projects involve taking people out of their comfort zones, I think it is important to recognise that personality types may take a detour away from ‘the norm’ during the changing situation. I can imagine this having quite a big impact on team dynamics.

As the two-day programme unfolded, Sue and Dee skilfully balanced theory-based learning with opportunities to ‘play’ with different coaching approaches, always with the focus on our own QI projects. We worked in triads to explore the benefits of three different coaching approaches:

GROW – Goal, Reality, Options, Will

CLEAR – Contracting, Listening, Exploring, Actions, Review

OSCAR – Outcome, Situation, Choices, Actions, Review.

As both coach and coachee, the chance to experiment with these approaches and to work with different Qs was an invaluable opportunity for me.

As a coach I grasped the power of suspending judgement, in allowing silence to fall in a conversation and the truth that can be discovered by tapping into the conversation energy level as it peaked and troughed. My favourite approach was GROW, as I found the acronym was easy to remember and the conversation often flowed quite naturally along this path.

In the position of a coachee I learnt to approach the conversation honestly and openly. As a result I was rewarded with multiple light bulb moments as QI ideas and feelings bubbled to the surface, simply drawn out with a few pertinent questions and some very active, active listening. I’d like to thank my triads for these delicious moments of clarity.

I left the programme feeling excited by the power of listening and empowered by the ability to harness a 15 minute time slot. My enthusiasm was echoed amongst the other delegates. “It’s powerful stuff for fostering change,” said one.

I’d love to hear your own thoughts and tips about using coaching to promote and accelerate QI projects. You’ll find me on twitter at @IamKateP or @weahsn.

Freewheeling leadership? Not likely…

Last week our Managing Director Deborah Evans won an NHS South West Leadership Award. Here are her reflections on leading system transformation…

The last time I won an award was the cycling proficiency. Perhaps it’s a fitting analogy, as that’s what I did then and still do. Every day.

The same applies to system leadership – it’s just been what I do for many years at work. It doesn’t feel half as free as when I’m on my bike, and unlike being a cyclist and enjoying unconscious competence (that’s my claim!), system leadership needs constant, conscious work.

I felt happy and honoured to have won the South West Leadership Academy’s ‘Leading Systems Transformation’ award and now I feel it’s my responsibility to reflect on Leading System Transformation.

It’s not just about positional power: the ten years as a PCT chief exec and the four years leading the AHSN. It’s about being able to use those positions, in concert with others, to make large scale change. A few examples:

  • It was re-commissioning community children’s services across Bristol and South Gloucestershire to create a national exemplar service worth £100 million over 5 years;
  • It was working with all the chief executives in the South West to re-commission (and decommission) a variety of specialised services, such as bariatric surgery, plastic surgery, specialist paediatrics, low secure mental health
  • It was a number of large scale public health programmes in Bristol and beyond
  • It was chairing the multi agency children’s trust in Bristol in support of a talented city leadership team and councillors
  • And more recently it’s been about working with passionate clinicians and talented managers to bring system wide improvements across the West of England in quality, safety and the use of data for patient benefit.

So what were the scars and what are the lessons from my personal experience?

Firstly it’s about being prepared to commit to a shared enterprise even though it’s tempting to put your own organisation first. I remember feeling very apprehensive when an assessment of Bristol City’s Children and Young People’s Services in about 2002 said that the Council’s potential for improvement lay principally with its partners. And I realised that meant me; and I had no idea how. But as a group of partners (head teachers, the police, Barnardos, social services, young people) we went on to achieve great things.

It’s about realising that one has to commit to other organisations’ agendas. When we wanted the South West Ambulance Trust to adopt the National Early Warning Score we realised that they needed help first on gaining engagement and support from clinicians and trusts for their Electronic Patient Record. So we worked hard at that. Sometimes you just have to help with a partner’s agenda for no obvious gain. It’s about building relationships for the longer term.

It’s about good, genuine engagement and sound processes. Negotiating changes to specialised services with 14 overview and scrutiny committees across the South West was essential but never quick.

Of course it’s about securing and developing a good team. But, for senior leaders, it’s also about visible partnership, modelling behaviours and being willing to follow as well as lead. In these highly pressured times I sometimes see partnerships fracturing and blame squirting everywhere.

System transformation is also about belief. It’s very hard to demonstrate confidence and hope at the moment. However I’ve seen enormous changes accomplished in my years as a chief executive and I’ve been part of health communities that have worked their way out of huge financial deficits and restored compromised services through radical change. It’s not fun; it requires determination and stamina and it takes years.

However we have the skills we need to make transformational change happen. And its like cycling – the more you do it, the fitter you get. So with system wide working and partnership – the more we practice, the better we become.

If we are to make transformational changes, we need to develop a vision with the widest possible engagement. We need to do things differently, draw on innovation and focus on adoption and spread of pre-existing evidence of best practice.

In the 50 years I’ve been a cyclist I don’t think I’ve fallen off my bike more than half a dozen times. But in system leadership it happens a lot, and sometimes there’s a full blown road traffic accident. And when that happens we have to get out on the road again, quickly.

Put your helmets on!