A quartet of quality and safety enthusiasts from NHS Dumfries & Galloway were fortunate to attend the BMJ/IHI International Forum on Quality and Safety in Healthcare last month.
We valiantly and proudly represented our Board and flew the flag for team Scotland with Poster displays on three of our improvement programmes:
- Safer Clinical Systems Approach to reducing Prescribing Errors in our MAU
- CAUTI (Catheter Associated Urinary Tract Infection) prevention bundle
- Active Patient Care – an approach to actively prescribe and deliver personalised nursing care.
We networked and met improvers from across the globe with whom we traded improvement stories, our aspirations for healthcare and put our collective minds to solving contemporary healthcare challenges.
We were inspired, we were motivated we were awed by what has been achieved around the globe and wanted to share some of our stories with you.
Highlights from the Developing World
The highlight had to be Dr Ernest Madu talking about the efficiencies and improvements to health made in the Caribbean and Africa though the use of telehealth. The barriers overcome have been huge, barriers we still don’t seem to be able to overcome with patients and clinicians alike. Faced with having no service though I do see how the introduction of telehealth to create a service may be easier to ‘sell’ to the population that where we are as we could be seen to be offering a lesser service.
Ernest, a cardiologist trained in the UK returned to his native Jamaica to set up Cardiac Services. He firmly believes that all people have the right to world class healthcare regardless of their ability to pay. He founded ‘The Heart Institute of Caribbean’ and set about building world class care. A centre of excellence was built in Kingston, Jamaica with patients paying what they are able or not at all. He described himself as the Robin Hood of heart care, using the wealth of those able to pay to fund care for all. Satellite centres have been built across the Caribbean with telehealth facilities to link local communities and technicians to the advice from a network of consultants across the globe. Patients requiring surgical intervention are airlifted from their local community to Kingston for surgery that day.
Ernest has gone on to set up a virtual Doctors On Call Service in both the Caribbean and Nigeria using mobile phone technology to link remote communities to medical advice, care and treatment. He has championed innovative solutions to replace glucose monitoring strips which were too expensive and impractical for use in sub Saharan Africa – a truly inspirational man with a can do attitude!
The Aravind Eye Care System in India has been described as the McDonald’s of healthcare, designed with mass customisation in mind they have employed lean thinking to develop an eye care system for very remote and poor communities. Their mission is simple – ‘to reduce needless blindness’. They have worked with communities to train locals to perform sight tests, to prescribe and make glasses in local communities. Mass screening camps are set up and IT enabled vision centres have been established in local communities. Those requiring surgery are bussed to regional eye clinics where their surgery is performed and they are returned home the next day. The volume of patients having surgery each day is phenomenal with theatres designed to enable a constant flow of patients.
Do we have something to learn in terms of flow?
How do you work with opposing clinicians/ practitioners?:
- Let them set the standards they want to work to and then ask them to work with finance, exec team, management to work through how that can be best achieved at no additional cost (or lesser cost)
- Allow training opportunities and networks to develop , discussing how service can be delivered and thus giving opportunity for career and professional development/ progression
- YOU WILL NEVER ERADICATE OPPOSITION – YOU MUST HAVE BRAVE PEOPLE INVOLVED WILLING TO PUT THEIR HEAD ABOVE THE PARAPET.
Voice of the Customer – Are we listening?
‘“[The customer] may be dependent on us. We are also dependent on him. He is not an interruption of our work. He is the purpose of it. He is not an outsider to our business. He is part of it. We are not doing him a favour by serving him. He is doing us a favour by giving us the opportunity to do so.” Gandhi, M.
A quote for all staff room/ changing room doors?
15 STEPS CHALLENGE – Alice Williams
‘ I can tell what kind of care my daughter is going to get within 15 steps of walking onto a ward’
Ask patients and carers what their first impressions were and see how staff can enhance this ensuring that we are inspiring confidence and trust even at first impression.
Robert Francis QC
The highlight of the conference for me was Robert Francis speaking about his report into the Mid-Staffordshire Enquiry. He spoke with such passion and care, it felt like he really meant what he was talking about.
“Is the patients voice heard? Don’t let complaints become just a statistic”
He spoke about how we need to learn from what happened in Mid-staff and make the NHS a safe place to be cared for in. I suppose for me, because there was issues with HAI highlighted in Mid-Staff, and it was clear what had gone wrong, I could think about what aims we have in our own infection control team and make sure they mirror those practices that are deliverable and safe, and not those that have no clear/standardised process.
He talked about failures in the healthcare system, saying that all NHS Trusts and NHS Health Boards need to learn from the report. We need to be proactive in assessing what it is we need to be able to deliver safe and effective care. And not all of this costs money…we can start off by having that one person make a change which may impact on organisational culture. Having data available and reports like the Francis report can drive cultural change by identifying the best from the worst performers and learning from the best.
I think the strongest message I took away from it was that everybody has the same common goal – to provide the best possible care for our patients – we just need the right processes in place to be able to do this.
Patient Engagement – The New Blockbuster Drug?
One of the BMJ streams focused on patient engagement, and this made me realise that actually the majority of our systems are designed around us, the staff, instead of our patients. Our homework from this session is to change our questioning from “What is the matter with you today?” to “What matters to you?” Maureen Bisognano, CEO and president of IHI highlighted this with two poignant patient experience examples. Upon entering the ward A there was no member of staff available to check if it was Ok to visit, later the family overhead the clerk asking “who let them in?” Upon entering ward B, the family were assured by staff that they could visit whenever they liked and they should check their relatives daily goals on the whiteboard above their bed. This whiteboard contained the key daily goals that the patient identified from the earlier discussion with the ward round team when they were asked “what matters to you today?”
Which ward would you rather be in?
Social Media – Get Tweeting
I was very glad of the promotion of Twitter by Ken Donaldson, otherwise I would have missed out on several significant opportunities at this conference. Firstly, every session had its own twitter feed which was used to capture learning, comments and questions. This was great for keeping up to speed with sessions which you were unable to attend and spreading learning to others beyond the conference-10,000,000 impressions estimated from the conference. I also find it much faster to search publications such as the BMJ and Health Foundation instead of navigating the websites.
It also provided an invaluable networking opportunity. I resonated with a lot the tweets that one particular person was posting and I asked to meet them at the NHS Scotland stand. This person turned out to be a nurse from Grampian who has been involved in the SPSP medicine reconciliation work so we had lots to share; the power of twitter!
Are you on the bus?
This weeks blog was by Maureen Stevenson, Patient Safety and Improvement Manager, Laura Graham, Clinical Pharmacist, Mhairi Hastings, Nurse manager – Hospitals PCCD West and Natalie Oakes, Senior Infection Control Nurse
Next week our blog will be by the Chief Executive Officer Jeff Ace and will be on “The Weight of History”