Book now: accredited quality improvement for pharmacy teams launches

The West of England Academy are hosting a new series of five free-to-attend interactive online workshops each Tuesday evening from 1 March. This is the first series of introductory QI workshops tailored specifically by the AHSN for pharmacy teams.

Attendees will gain a basic understanding and practical knowledge of applying Quality Improvement (QI) techniques to real-world pharmacy challenges in healthcare and innovation.

Modelled on our hugely successful QI Summer and Winter Series, this five-week course, held over 90-minutes each Tuesday from 18:30pm can be joined as single sessions or a series.

“This was a fantastic introduction to QI, which is what I needed. I loved how things were explained so clearly and the session was interactive. It really helped my understanding, and I got a lot from the session”.

The accredited workshops have been developed, and will be delivered by, the West of England Academy and Medicines teams alongside guest speakers. Topics include introductions to process mapping, data management and the basics for change management. The series will earn attendees six CPD hours.

Attendees will see how QI can lead to better outcomes for their teams, patients and organisation, gain confidence in applying QI and have time to network with pharmacy colleagues from across the region.

“I am newly appointed as a QI manager so have used all the tools and techniques in my daily work and shared this with other colleagues and teams”.

Attendees can be in any role and/or grade within their pharmacy, and clinical or administration.

Our academy works hard to welcome attendees from a broad range of backgrounds creating a safe and open environment for learning and sharing ideas.

“The practical skills and frameworks are fantastic and such a great way to engage and inspire others. They will definitely help identify why a challenge is a challenge and instigate conversations about how we can overcome and/or improve processes”.

Find out more about the series and book here.

The West of England Academy offers a wide range of free events and resources to healthcare professionals and innovators across the region. To find out more, visit our Academy pages or email weahsn.academy@nhs.net.

QI in pharmacy? It’s a brave new world.

In a new joint blog from Senior Project Manager, Chris Learoyd and Ola Howell, Clinical Pharmacy Lead at the West of England AHSN, we explore the value of Quality Improvement (QI) for pharmacy teams, why it hasn’t really been embedded so far and how pharmacy can get involved.

QI in pharmacy? It’s a brave new world.

In this joint blog from Senior Project Manager, Chris Learoyd and Ola Howell, Clinical Pharmacy Lead at the West of England AHSN, we explore the value of Quality Improvement (QI) for pharmacy teams, why it hasn’t really been embedded so far and how pharmacy can get involved, including at our first-ever Pharmacy Showcase on 12 January.

First we hear from Chris…

As the Senior Project Manager for the Medicines Optimisation team at the West of England AHSN, but a former Physiotherapist, I won’t say it was always easy, but I have finally got my head around the wider challenges and issues with safe prescribing of medications.

The numbers are eye watering – circa 237 million medication errors occurring at some point in the medication cycle per year in the NHS in England and 66 million of these considered potentially clinically significant errors. Reducing medication errors can clearly have a significant and immediate effect on patient safety.

We know that as experts in medication management and optimisation, pharmacists and pharmacy technicians are ideally positioned in the healthcare system to improve current processes and reduce avoidable medication-related harm – and that QI approaches are vital to creating lasting change.

As every pharmacy team will know they are being positioned more centrally within healthcare services and have more clinical autonomy. Services such as the Discharge Medicines Service and Community Pharmacy Consultation Service provide a step change to embed pharmacy professionals as an important first point of call for healthcare information rather than traditional settings such as General Practice / Emergency Departments.

Introducing QI

Despite all this, pharmacists often lack the basic tools required to lead on or participate in QI initiatives as they’ve historically not been trained or required to perform QI projects. This is slowly changing, and here at the AHSN we’re working to drive adoption of QI approaches across pharmacy.

Here we’re handing over to Ola who gives details of the reasons for this, the impact and our new offer for pharmacy colleagues….

I’m a clinical pharmacist and over the last 12 years I’ve worked in a community pharmacy (very many of them), a General Practice (very briefly) and a hospital (or three, to be precise). Over those years I have met hundreds of pharmacy technicians and pharmacists determined to ensure their patients got the best (aka safest) care they could.

But I’ve never worked on QI before – what is it?

We are diligent, we are keen, and we are truly brilliant! No need to argue that. The thing that we are not good at is quality improvement. It is not that we don’t do it well, we simply don’t do it enough… And why would we? If you are anything like me and your registration number starts with 20*****, you would, most likely, had never been taught what QI is and how to do it well.

It wasn’t until the last couple of years that I started hearing about the QIPs, the PDSAs and the “driver diagrams”. Maybe I was not expected to know then, but I am now. (And there are masses of free resources on the West of England Academy website to help anyone embarking on QI work – but join our Pharmacy Showcase on 12 January to hear more about free, interactive and tailored support for your team).

Embracing QI to support our profession and wellbeing

Like never before, we are forced to do more and faster with less resources and time. We need to learn how to improve what we do in order to survive. And we need to do it now. The numbers are scary, with every fourth pharmacist reporting feeling ‘very stressed’ at work, mainly due to the increased demand for services and the lack of funding. That is 37% of community teams (up from 17% last year), 20% of hospital pharmacists (up from 10% in 2020) and 14% of GP and PCN pharmacists (up from 5% in 2020)[1]. I anticipate that the figures among pharmacy technicians follow a similar trend. Grim. Burnout alarm bells ringing all over the place.

When I asked around, I wasn’t surprised by the number of suggested solutions to various work problems we come across every day.

Not-a-surprise No. 1: We often know what goes wrong.

Not-a-surprise No. 2: We also often know a solution (or improvement) to the status quo. We sometimes even make that improvement ourselves!

For some reason, however, we rarely document the before and after and so are unable to prove our intervention has worked. “I am not wasting time on the data collection when I have so much to do”, I heard recently from a fellow pharmacist. “But your idea is brilliant! And it saves time, so if other people knew about this, the impact could be huge”, I reply. “Nah, too much effort”, I hear back. I bet this sounds familiar…

Don’t we all roll our eyes when an audit arrives and we need to fill out a spreadsheet, often without pausing for a moment to question what it’s for, and how the results will affect us in the future. Here in lies the answer – capturing our learning and experiences through QI.

Get involved

So come and meet us on the 12 January at our Pharmacy Showcase to hear about the projects our AHSN is involved in, meet the team, network with other pharmacy colleagues and learn more about a free, tailored Pharmacy for QI course coming in spring 2022.

[1] The Pharmaceutical Journal, PJ, November 2021, Vol 307, No 7955;307(7955)::DOI:10.1211/PJ.2021.1.114907

Marking COPD Awareness Month – improving patient safety

During COPD Awareness Month, the acute hospitals in the West of England have been celebrating their work to improve patient safety as part of the NHS England and Improvement Adoption and Spread Safety Improvement Programme. This has included a 34% increase (to June 2021) in the number of patients receiving all elements (for which they are eligible) of the COPD Discharge Bundle.

The British Lung Foundation describes COPD as a group of lung conditions that make it difficult to empty air out of the lungs because the airways have become narrowed. This causes breathlessness. Worsening of breathlessness (often as a result of infection) is called an exacerbation. Exacerbations of COPD are one of the leading causes of hospital admission, and readmission following exacerbation also occurs frequently. All admissions to hospital have a negative impact on patients both physically and psychologically. Reducing the impact of admissions for lung disease is one of the key ambitions of the NHS Long Term Plan.

Adoption and spread of the COPD Discharge Bundle

Providing COPD patients with a number of simple interventions while they are in hospital, can reduce the chance of readmission. These interventions (listed below) form the COPD Discharge Bundle:

  1. Inhaler technique assessed and corrected
  2. Patient or carer has written information & understands their self-management plan
  3. Provision of rescue medication packs
  4. Smokers referred for smoking cessation
  5. Assessment for enrolment in pulmonary rehabilitation
  6. Appropriate follow-up arranged within 72 hours

The National Patient Safety Improvement Programme project – which started in November 2019 – has focussed on increasing the use of all appropriate elements of the bundle. This work has been coordinated across the region by the West of England AHSN alongside each of our acute hospital trusts:

  • Gloucestershire Hospitals NHS Foundation Trust (GHT)
  • Great Western Hospitals NHS Foundation Trust (GWH)
  • North Bristol Trust (NBT)
  • Royal United Hospital Bath NHS Foundation Trust (RUH)
  • University Hospitals Bristol and Weston Foundation Trust (UHBW)

Improving patient safety

Since commencing the project, we have seen some significant regional and local improvements in delivery of the bundle:

  • 34% of patients in the West of England region received every element of the bundle (for which they are eligible) in June 2021, up from 0% in November 2019.
  • From April to June 2021, between 66-71% of COPD patients across the West of England were provided with a self-management plan.
  • In June and July 2021, 100% of GHT COPD patients had their inhaler technique checked.
  • In June 2021, 91% of GWH COPD patients who smoke were offered smoking cessation support.
  • In July 2021, 95% of RUH COPD patients were assessed for their suitability for pulmonary rehabilitation.
  • In RUH and GWH over 90% of COPD patients had a follow-up appointment arranged.

Working collaboratively to drive improvement

Through a West of England network, the respiratory teams have worked collaboratively to collectively share ideas and overcome barriers to optimise the use of the bundle.

Alongside improvements made to the delivery of the bundle, each team has also completed their own local quality improvement (QI) project to improve aspects of patient care. These projects are related to the bundle elements, including upskilling staff on Brief Intervention Training for smoking cessation, reviewing self-management plans and delivering training to improve front door diagnosis. The outcomes of these projects will be shared and celebrated through the month of November.

Mark Juniper, Respiratory Consultant and Clinical Lead at the West of England AHSN said:

It has been great to work with the teams from different hospitals on this project for the last two years. Despite the pressure on respiratory services during the pandemic, they have managed to improve the care of patients with COPD. This work has provided an ideal focus for improvement and bringing the teams together to share ideas and what they have learned has been really exciting.

What’s next

On 9 November, we are running a joint event with the South West and Wessex AHSNs on the wider aspects of COPD and asthma care. This event is now fully booked however recordings of a number of the sessions will be available afterwards, so please join our waiting list.

The West of England AHSN are also celebrating COPD Awareness Month – and World COPD Day on 17 November – throughout November on Twitter. This will include showcasing the QI projects undertaken by each respiratory team.

The COPD Discharge Bundle is one element of the national Adoption and Spread Patient Safety Improvement Programme. Find out more about our work on the programme here.

PreciSSIon awarded Quality Improvement Team of the Year

We are delighted to announce that PreciSSIon – a regional collaborative to reduce surgical site infection after elective colorectal surgery – has scooped an award in the Quality Improvement category at The BMJ Awards 2021.

The project – in partnership with Royal United Hospitals Bath NHS Foundation Trust; Gloucestershire Hospitals NHS Foundation Trust; North Bristol NHS Trust; University Hospitals Bristol and Weston NHS Foundation Trust; and Great Western Hospitals NHS Foundation Trust – was awarded the accolade for using original ideas in quality improvement to better outcomes for patients.

Anne Pullyblank, Medical Director, West of England AHSN said:

“This has been a fantastic project to be a part of, and the figures we have been able to achieve at such a challenging time for many in hospitals are absolutely incredible. Combined regional average baseline figures showed surgical site infection (SSI) was 18% pre-November 2019. Implementation of the PreciSSIon bundle elements in all trusts between November 2019 and June 2021 resulted in an amazing almost 50% improvement in SSI rate, leading to a regional average of just 9.5%; a significant improvement in patient experience.

The collaborative element enabled staff and trusts to support each other during the difficulties of the COVID-19 pandemic and engagement was high, with theatre teams in particular being empowered to make a difference. It’s amazing for the hard work of everyone involved to be recognised at the BMJ Awards in the Quality Improvement category.”

Read our Celebrating PreciSSIon article: Reducing SSI rates by 50% with estimated savings of over £500k.

The BMJ Awards ceremony took place on the evening of Wednesday 29 September.

This follows PreciSSIon winning the Perioperative and Surgical Care Initiative of the Year at September’s HSJ Patient Safety Awards. The collaborative project was also shortlisted for the Infection Prevention and Control Award.

Find out more about PreciSSIon.

Tracheostomy community of practice supports improvements in patient safety

A national Patient Safety Collaborative programme, led by NHS England and delivered by the AHSN Network, commenced in 2020 to improve the care of patients with tracheostomies within acute hospitals. The programme focussed on ensuring that all patients had three elements:

  • a bedhead sign and emergency algorithm,
  • emergency equipment and
  • a daily care bundle.

A short-term Community of Practice (CoP) with the tracheostomy teams from across Bristol, North Somerset, South Gloucestershire; Gloucestershire and Bath, North East Somerset, Swindon and Wiltshire was set up by the West of England AHSN to facilitate shared learning across the teams to improve the care of tracheostomy patients.

What did the Tracheostomy CoP hope to achieve?

Following an audit to understand how the elements were used in the region’s hospitals, it was established that while most trusts did have the elements in place there was room for improvement in their consistency. The teams therefore set out to improve the consistency and efficiency of their internal systems and to align to the national guidelines for tracheostomy care.

What were the outcomes of the Tracheostomy CoP?

  • Positive multi-disciplinary collaboration for improvement projects
  • Alignment of paperwork to national guidance and inclusion of Response Team number
  • Making emergency equipment boxes the same colour throughout the trust
  • Sealing the emergency equipment boxes to ensure equipment is not removed and reduce the need for regular full checks
  • Training resources developed and delivered to targeted areas e.g. to oncology and ICU,
  • Improved processes for Datix
  • Updated policies
  • Development of a tracheostomy team with the Acute Care Response Team
  • Minimising variation between teams

In University Hospitals Bristol and Weston (UHBW), the tracheostomy programme spearheaded a larger Quality Improvement project involving a group of multidisciplinary enthusiasts. The project aims to reduce the number of preventable tracheostomy related incidents to zero by December 2022 through the change ideas shown in the driver diagram below:

Isabel Barfield, Patient Safety Improvement Nurse, at UHBW said:

“In UHBW it has been great to get the multidisciplinary team across the newly merged trust working together on such an important project. Tracheostomy care has needed streamlining for a while now, so far we’ve written new care plans, discharge documentation, incorporated the NTSP videos into our training, and identified emergency boxes and bedside trolleys to facilitate the best care.”

Mark Juniper, Respiratory Consultant and Clinical Lead at the West of England AHSN said:

“It’s always a privilege to bring acute teams together to enable sharing of learning and ultimately improve patient safety – COVID provided an additional challenge but I am proud of the work we’ve completed as a collaborative. The Tracheostomy Community of Practice has gone from strength to strength and the great work we’ve started will now continue – I am particularly looking forward to hearing more about the progress made in UHBW (as part of their on-going tracheostomy quality improvement work).

I know that any improvements or new ways of working will now be shared with acute trusts across the region, so all tracheostomy patients can benefit”.

What’s next?

The tracheostomy programme has now closed, however teams are continuing on their improvement journeys to enhance tracheostomy care safety with their own local projects.

The tracheostomy community of practice is one element of the national Adoption and Spread Patient Safety Improvement Programme. Find out more about our work on the programme here.

Quality improvement for primary care workshops launch

The West of England Academy are hosting a new series of five free-to-attend interactive online workshops each Friday from 16 April.

Attendees will gain a basic understanding and practical knowledge of applying Quality Improvement (QI) techniques to real-world challenges in primary care.

Modelled on our hugely successful QI Summer and Winter Series, this five-week course, held over 90-minutes each Friday from 12noon can be joined as single sessions or a series.

The workshops have been developed, and will be delivered by, the West of England Academy team alongside guest speakers. Topics include stakeholder mapping, process mapping, data management and the basics for change management.

Attendees can be in any role and/or grade within their organisation, for example from clinical, administration or facilities.

Our academy works hard to welcome attendees from a broad range of backgrounds creating a safe and open environment for learning and sharing ideas.

Find out more about QI for primary care and book here. 

The West of England Academy offers a wide range of free resources to healthcare professionals and innovators across the region. To find out more, visit our Academy pages or email weahsn.academy@nhs.net.

Introducing the quality improvement (QI) winter series

The West of England Academy are hosting a series of five online workshops each Wednesday from 27 January on quality improvement (QI). Free to attend, and for any innovator or employee within healthcare, each one-hour session is standalone so you can choose individual workshops or sign up for the series.

Each workshop will be interactive, so you can apply learning in real-world scenarios. The workshops will be beneficial regardless if you are working on a specific QI project or not. If you encounter challenges in your role (or outside work), and want to consider how these can be tackled through QI, these sessions will help.

Attendees can be in any role or level within their organisation or business; for example clinical, product development, administration or facilities.

Our academy works hard to welcome attendees from a broad range of backgrounds creating a safe and open environment for learning and sharing ideas.

The West of England Academy offers a wide range of free resources to healthcare professionals and innovators across the region. To find out more, visit our Academy pages or email weahsn.academy@nhs.net.

Reflections on hosting virtual interactive workshops

In this Q&A our West of England Academy Project Managers Kate Phillips and Vardeep Deogan share their reflections on the delivery of the Academy’s recent Quality Improvement (QI) Summer Series. They led 10 hours of online interactive workshops and delivery of QI theory by 12 different facilitators to around 60 delegates per session from across the West of England region and beyond. The Academy team have also compiled a series of slides with their top tips on hosting virtual learning.

Vardeep talks about virtual learning

  1. What did you enjoy about the QI Summer Series?

Vardeep: Every part of our workshops had a purpose, so being creative and thinking outside the box with activities without making them complicated was really important. Supporting our guest facilitators was a pleasure too. After our fifth session, we really felt a sense of achievement, and we cannot wait to deliver future online workshops.

Kate: An unanticipated pleasure was coaching our guest facilitators. Vardeep and I were the main hosts, but wanted the series to reflect the wealth of knowledge and range of experiences of working with QI across the West of England. We also figured that our voices might be a bit dull for two hours straight! Considering that online training was a fairly new concept, this meant that Vardeep and I mentored our guest facilitators to deliver their 25 minute activity. The feedback from the guest facilitators was lovely – they felt challenged by the experience but also supported. I think they were all very proud of themselves which was great to see.

The overwhelmingly positive response to the sessions has also been wonderful. Vardeep and I cooked these sessions up, combining our knowledge and experiences and we seemed to have stumbled upon a winning formula!

“Exceeded my expectations – I learnt so much.”

    2. What are the differences between online and face-to-face delivery?

Vardeep: When delivering face to face it’s much easier to ‘read the room’ for non-verbal communication and how people interact with each other, and as a facilitator you respond accordingly. We had to think differently about how to get this feedback during and throughout each workshop. This involved designing activities and including opportunities for feedback using functions like slido, the chat box and voting.

We also considered different learning styles and made certain to include activities that reflected these. Using liberating structures supported this.

Kate: The whole experience is different- quite often I’d be looking at only one or two faces in the corner of my screen, but knowing I was talking to 50+ delegates who had prioritised our training over other work, it’s a bit of a barmy experience really! I think delivering online sessions brings a different type of nervous energy…the adrenaline flows!

   3. Can you tell us about your biggest ‘aha’ moment?

Vardeep: As the series progressed, even though we may have been delivering our fourth or fifth session (and at times felt we were repeating ourselves with instructions for activities etc.) we kept in mind that this may be someone’s first experience on zoom or of virtual learning. I realised the value of clear instructions from the positive feedback we received where our clarity was praised. This was a key learning point.

Kate: For me, a lovely moment during our second session was when Vardeep asked a delegate to turn their mic on and share their experiences verbally with the entire group. We regularly asked delegates to share feedback via the Zoom chat box, but giving individuals the platform to voice their thoughts brought the session alive. It did mean having to relinquish some control, but it was worth it every time. Sharing the platform was important.

“I think I’ve learned more in this two-hour online session than any other face-to-face course I’ve attended!”

    4. Have you learnt any new skills with online facilitation/delivery?

Vardeep: I’ve learnt you have to be even more adaptable and fluid when delivering online. Anything can happen at any time (tech issues!) and you have to be able to step in and pick up anything, whether this is the delivery of a session or an aspect of facilitation. Every member of the team needs to be able to pick up any role and this really stretched me and took me out of my comfort zone – we survived a few hairy moments.

Kate: I had delivered a few online webinars before, but they were very much ‘chalk and talk’ style. I’ve loved learning about, and using, Liberating Structures to keep delegates engaged and to facilitate interaction between them. I’ve also enjoyed thinking creatively to convert traditional face-to-face QI training for online delivery.

   5. Have you learnt anything about yourselves during this project?

Vardeep: Working alongside Kate to plan every session in detail, really enabled me to be fluid and agile to the needs of others, particularly guest facilitators. I’ve learnt that with the right team around you, you can adapt to any last minute change and for it to still feel under control and most importantly – fun.

Kate: I’ve learnt that my happy place is extremely organised and where I’m in control. Fortunately Vardeep is very good at making me feel safe enough to step outside of that and allow space for spontaneity and discussion, and that’s where the magic happens! On the flip-side, I’ve learnt to value the skill of organisation and I don’t think we could have pulled off this series without it.

“Really good workshop today – best I’ve attended during this whole pandemic, so thanks to you and your colleagues”.

  6. What has been the biggest challenge?

Vardeep: You never truly know how you’re being received online until you read the feedback.  Over the five sessions I got used to smiling and talking to a camera instead of being able to make eye contact and responding to non-verbal cues. That often felt odd but it’s vital to the person the other side of the screen.

Kate: At the start I was overwhelmed with the task that lay ahead of us, thinking about all the details. Fortunately I work with brilliant colleagues who made this series a true team effort. I was able to focus on planning and delivering the sessions in a step-by-step way, knowing that the event logistics and marketing of the series were being expertly handled. Breaking down the roles, tasks and working as a team was crucial.

 7. Do you have any top tips for online delivery?

Vardeep: Plenty….

  • As a facilitation team agree a way of communicating with each other behind the scenes (such as Whatsapp). This allows you to adapt, adjust or abandon as you go along.
  • Plan your sessions with timings in mind. This is invaluable and is a skill – things often take longer virtually. This also includes prepping any guests.
  • Allow time for a team pre-brief and de-brief after each session. Kate, Shomais and I always spent time reflecting on what went well, what didn’t go so well and we also captured new ideas to incorporate for the next session on ideaz boards or jamboards.

Kate: I think one of my favourite phrases from this series was “team work makes the dream work”. We couldn’t have delivered such a slick series without the designated online technical support that our colleague Shomais provided. Having clear roles and responsibilities in the team was important, e.g. being clear on who is responding to questions in the chat box, who is co-ordinating break-out rooms and who is introducing facilitators and welcoming delegates back from breaks. I think the clarity of roles and knowing we could depend on each other, created a safe space to do each of our jobs really well.

Thanks to Kate and Vardeep for sharing their experiences.

Further information about the West of England Academy’s online resources and future events can be found here.

Sharing learning from our QI Summer Series

During July and August 2020 the West of England Academy, aided by guest facilitators and speakers, held weekly Quality Improvement (QI) webinars. This season of learning, known as the QI Summer Series, was fully booked with a lengthy waiting list. We are also delighted to say the series received 100% positive feedback from attendees, no mean feat in a world where virtual fatigue is setting in.

Before and during the series our Academy team compiled their thoughts and tips on hosting learning sessions via webinar:  To download the slides as a PowerPoint, please click here

In the coming weeks, our Academy team will also be sharing a Getting Started with QI Guide alongside a blog about their experiences organising and leading the QI Summer Series.

The West of England Academy will be hosting further QI webinars, alongside other virtual events.

You can browse the full range of AHSN events here.

Quality Improvement in the age of COVID – launching PERIPrem

Noshin Menzies, Senior Project Manager, shares her experiences of launching a Quality Improvement programme during COVID.

If you’d told me 4 months ago we would be where we are today with PERIPRem, I’d have wondered what planet you were from. This exciting, ambitious care bundle, the vision of two extraordinary neonatologists, was going to launch in April and change the way that perinatal care is delivered across the entire South West region. It was a seed reliant on collaboration. However, 2020 had other plans…

The fundamentals of PERIPRem – nurturing a regional clinical community dedicated to improving outcomes for our most vulnerable babies and working side by side with women and their families – were, in an instant, stopped in their tracks.

Pre-COVID, I had been lucky enough to attend the Royal College of Obstetrics and Gynaecology’s “Let’s Talk about Race” event for International Women’s Day. The stories I heard further cemented the commitment we had to reducing inequalities.  We could not deliver a perinatal quality improvement project without ensuring that we were actively listening – and considering how to chip away at the barriers that result in Black and Minority Ethnic women being 5 times more likely to die in childbirth and their children to experience poorer outcomes. This was even before we knew the increased risk of COVID to people of colour and the raised chance of preterm labour for those women unfortunate enough to contract the virus whilst pregnant.

Just as we finalised plans for launch, and to get out into the communities and find every opportunity to involve those who lives are imprinted by the experience of preterm birth, COVID hit. Our PERIPRem teams were now on the battle lines, and we were nestled behind our laptop screens, shell shocked. Our ability to be agile and adapt to novel ways of working mattered now more than ever.

I’ll admit, I was sceptical how we could launch what was still a seedling of a programme to twelve units across the whole of the South West, when we were unable to leave our kitchens, let alone realise our plans to provide fertile ground for the creation of a regional PERIPRem clinical community. Without a physical launch, how could we provide space for those small but mighty moments, that when cultivated, have more of an impact than any toolkit or presentation?

I often struggle when I have to describe QI; in my experience it is much bigger than a framework or a process by which you can input your problem and wait for gold-standard results. For me, QI has its foundations in the people, the team and the culture. It is the introductions to new faces, teams huddled together around meeting tables, clinicians whispering to colleagues they had not seen for years and the camaraderie brewed alongside the substandard coffee.  We grow highly functioning teams, and the most exciting part of any QI project, on these blocks. It was boom or bust but I needn’t have worried.

We have formed strong bonds as a PERIPRem team; we have even managed a team social. My treasured counterpart in the South West AHSN and I have never met, we joke that we do not know what each other look like from the shoulders down. We have bonded over the many cameos from the PERIPRem teams’ children – or Assistant QI Coaches as they are now known.

Most importantly, the PERIPRem perinatal teams have flourished. Whilst in the pressure cooker of the pandemic, we gave space and time to focus on delivering patient care – when they got a handle on what it meant for them as clinicians, they came back raring to go.  We have digitised all of our resources and are now holding webinars on each of the bundle elements – they are so well attended we cannot fit on a screen!

People have pushed through discomfort to record themselves sharing the clinical fundamentals and to provide the presence (all be it through a screen) we all miss. We are exploring new ways to engage with the women we were so keen to meet and listen to, and we are forever indebted to our patient representatives who are now pillars of our PERIPRem team.

The takeaway message from that tired trope of “these unprecedented times” is that we are stronger than we think. At the end of each exhausting day, when we have had our fill of fighting for bandwidth with Xboxing teenagers, with tired mouths from calmly saying, “you’re on mute”, we have been and will continue to be successful. More significantly, we have supported frazzled teammates, butted horns and laughed until we cried.

There is a sense of freedom this way of working has granted us. Whilst before, there was a tendency to stick to the tried and tested method of engaging and working with our clinical communities, COVID allowed us to think again. We used technology to enable hospital teams scattered across the entire southwest to meaningfully engage in PERIPRem without ever having to leave their wards. I was worried connecting through screens and keyboards would reinforce the distance between us all, but I am surprised to realise that it has in fact accelerated relationships and in turn progress.

Having to rely on the written word in email has meant that tone and intonation have been more carefully considered and the periods of chat offered through video calls means each sentence really counts. Of more significance, is a flattening of the hierarchy within our team. Each person no matter what their seniority is vital in keeping the PERIPRem wheel turning – be it because they know how to record a MS Teams meeting, or because they have the complex clinical knowledge of a perinatal intervention.  It is not that we did not appreciate this before, but the situation forced us to see beyond the limitations of a job description.

I have reflected on whether, upon return to ‘normality’, if we as a team will revert to the pre-COVID way of working. Whilst I would like to think there would be a time when we are able to sit in offices and meet with units, I do not think that is the whole question. I can honestly say I hope we do not – I do not want to forget our swift response to the restrictions placed on us, or our unwavering faith in our ability to make improvements.

I believe that we have fundamentally changed the way we will approach projects such as this in the future. We are braver in our ways of facilitating community, we have lived experience of delivering change programmes utilising technology rather than travel and we know that when needed, we can free ourselves of the legacy of traditional and more restrictive ways of working.