Fuzzy Felt by Kirsty Hyslop

As I sat one night last October, celebrating my birthday with friends, a ping came from my laptop – 1 new email, the contents of which confirmed that having studied towards my Applied Biomedical Science Degree for almost three years, I was one of around twenty students who had been awarded a placement opportunity within the NHS. I was to spend fifteen weeks within the Microbiology Laboratory at DGRI. Although excited at the prospect of gaining valuable experience within a medical laboratory, I was terrified at the thought of actually handling real patient samples. It turned out I really had no need to worry, as when I started in January I was introduced to a great team of friendly, helpful people who were all very patient and willing to support me.

During my time on placement, I was able to learn a great deal about the application of clinical microbiology. I was involved in screening urine samples for signs of infection, isolating bacteria from positive blood cultures, identifying positive MRSA patients and determining some common causes of gastrointestinal upsets. I gained a vast amount of knowledge on many common pathogens and their clinical impact. I was given an introduction to antibiotics and how to determine which organisms will respond to which treatments. In addition, I was lucky enough to be given the opportunity to visit a number of other departments within the hospital, including the Infection Control Team, other diagnostic services such as Biochemistry, Pathology and Haematology as well as many of the wards including the Neonatal Suite, ICU and the Alexandra Unit.

Such an overview of these different areas and the responsibilities of each member of staff I met really helped my understanding of many hospital services and helped me realise the true importance of a multi-disciplinary approach to patient care. From a personal viewpoint, my grandmother was admitted to another Scottish hospital last year and the communication between departments was really poor, resulting in my family developing a complete lack of confidence in the NHS. My Gran had taken a ‘turn’ which I explained in detail to the paramedics, explained again to the A&E staff, explained again to the admittance ward and then had to explain to a doctor and other nursing staff in yet another ward later the same day. Perhaps this was an isolated incident and there had just been a breakdown of communication somewhere, but I found it disheartening, that key information regarding her health and well being was not being communicated to those administering her care.

I’m pleased to say my time in Dumfries has restored my faith in the NHS somewhat. I attended many meetings and staff huddles which focused on patient-centred care. Living in Ayrshire and studying in Glasgow, it is amazing how many people I speak to who agree Dumfries is a lovely town and I have spoken to many people who agree the infirmary is a fantastic hospital.

You may by now be wondering what all this has to do with fuzzy felt! As a leaving gift, I was presented with a beautiful memento of my time in the lab; a framed felt picture of me as a Biomedical Scientist. The picture is beautifully crafted with lots of small pieces of felt stitched together with beaded detail….and I suppose this is a good analogy of the NHS.

The various teams and departments are represented by all the different pieces of fabric. But only when all the individual pieces come together do we have a purpose. And I like to think of the stitching as the staff – an essential component to hold it all together! I met many lovely people during my time in the hospital and so many of you helped me, trained me and offered advice….thanks to each and every one of you!

Kirsty Hyslop is studying Applied Biomedical Science at Glasgow Caledonian University.

 

Just another day! by Heather Currie

From my experience of meeting patients who have submitted a complaint and from hearing patient stories at the local Patient Experience days, I have been struck by their detail of recollection on a day when to us it would have been “just another day”. While we all remember certain key days, moments, procedures, outcomes, encounters of our working days, we are unlikely to have the same vivid memories for most of our working days. Yet to our patients, that experience, provided by us, may be their only patient experience, will be with them forever, will be recounted to friends and family and will often have a lasting impact.

I don’t know why I was surprised to realise this, after all, I have been a patient myself several times. Do you remember what you were doing on Wednesday 20^th January 1988? Possibly not. I remember every detail since I was a patient in Unit A, room 2, Cresswell Maternity Hospital with pre-eclampsia and a known growth-retarded baby at 37 weeks gestation. Fetal heart monitoring showed evidence that my baby was in distress and I was delivered in the evening by emergency Caesarean section under general anaesthesia of my beautiful daughter, weight 1.76kg. Of course I do not recall the events while I was anaesthetised, but all else is as clear as it was that day. My care was superb, the outcome was excellent, yet to everyone involved with my care, it was just another day.

Do you remember what you were doing 11 days later? Possibly not. I do…having been allowed home the evening before, I returned at a pre-arranged time to feed my daughter who was still in the Special Care Baby Unit (SCBU as it was known then) to be met with surprise by the staff who had not been told that I was coming in, had already fed her and asked me what did I think I was doing there. Already struggling to cope with the trauma of going home without baby, the worries of being a first time mum, especially with her being so small, this was not a good experience to be felt unwelcome, in the way and not a proper mum. Tears were shed in private and it took much determination just to go back into the unit, to spend time with MY baby. Again to the staff, just another day yet that one episode had a huge effect and still fills me with emotion.

How we act, what we say, how we say it is as important to our patients as making the diagnosis, initiating the treatment, or carrying out the complex surgery or procedure. Small simple gestures make a huge difference. Of course this does not just apply to how we speak to patients; how we speak to and work with our colleagues is crucial in building teams, learning, understanding each other, feeling safe, enjoying work, in supporting each other to provide the best patient experience possible. So often, the atmosphere on a shift can be changed in a moment by a sentence, a look, a gesture, an e-mail, a hug and how we feel can impact on the care that we provide.

There has been much talk and publication in recent times about culture and behaviour within the NHS and about the importance of clinical leadership in promoting a culture where the focus is always on providing the best patient experience possible, being curious as to how we can make it even better, being able to raise concerns when we don’t get it right and learning from mistakes.

But how do we create this culture on a day to day basis? What can we all do to make a difference?

Clinical leadership applies to many levels, not just to those in specific leadership roles and all of us can make a difference by firstly reflecting on our own behaviour, to then influence and support our colleagues to do a good job. A tool developed from the Delivering the Future leadership programme, cohort 8, can be used as a checklist and is known as VOICES. We all have a Voice and as discussed, the way that we use our voice can make the difference between night and day on the experience of our patients and colleagues and the components of the VOICES tool are key elements in developing the right culture.

 

V—Visible

O—Open

I—Improvement Idea

C—Care and Compassion

E—Ensure focus on patient Experience, Encourage and Enable

S—Safe culture

Ask yourself every day or week the following questions, with adaptation to your own work environment, and mark yourself out of 5, 5 being really good and 1 being really bad.

V—have I been Visible, have I listened to colleagues, have I been involved, have I been visible to my patients, have I spent time with people?

O—Have I been Open and transparent, have I spoken up when things didn’t go well, have I accepted when I could have done better, have I talked to people not about them?

I—Improvement–Have I taken time to reflect, to think how this could be improved for the patient, have I supported others to think, develop or progress an improvement idea? Let’s understand that the people working on the shop floor understand their service better than anyone else and are most likely to know what needs to be improved, and how—“the answers are in the room”.

C—Have I shown that I Care, have I shown Compassion, have I asked how they are, taken time to understand, offered help?

E—Have I Ensured that our focus is always on patient Experience, whatever the other pressures of resources, waiting times, funding, asking ourselves what experience would we want for ourselves, our family, our friends and is that different from what we are providing? Have I Encouraged and Enabled my colleagues to do a great job?

S—Have I helped to provide a Safe, Supportive culture, where we have zero tolerance to bullying, where we can all feel able to politely challenge inappropriate behaviour?

How did you score? The first week that I scored myself, 1 awarded myself 17 out of 30. It was clear that I needed to improve, particularly in Visibility. Second week—22 out of 30 with a gradual improvement since then, but I know that I still can do better!

If we understand how little actions, how we use our VOICE every day can have a huge impact on our colleagues and ultimately the experience of our patients, we can all make a difference. Let tomorrow not be “just another day” make it, and every day, be the day that patients in Dumfries and Galloway can be confident that we will provide the best experience for them that we possibly can.

Dr Heather Currie is an Obstetrician and Gynaecologist and is Clinical Director of Women and Sexual Health at NHS D&G

Happy birthday NHS!!!!! by @shazmcgarva & @Emmcg2

Imagine health care free from harm……

Today is most famously associated with American Independence day but it is also the 66^th birthday of the NHS (well ok, its tomorrow actually) and spookily the 66^th blog from @dghealth.   So lets reflect on the” good old days” and the stories that make the younger generation take a sharp intake of breath and say OMG/SHUT UP!!!!

1948 when it all began – a year where it was common practice to rub alcohol into healthy skin to prevent pressure ulcers (probably followed by a quick swig out of the bottle from the nurse giving this care!)

1978 –moving on to perhaps a more memorial pastime for those still awaiting their own 66^th birthday. Imagine a life pre picolax or moviprep when the alternative was two big tubes, a jug and a 3-5 litre bowel washout!

At the time this wasn’t wrong, it was just how things had always been done. But we are now in a time of innovative, evidence based practice and do not want to hear the well versed “its aye been done like that here”.

We are staff nurses currently doing a secondment as trainee improvement advisors. We have always had a passion for making things better and we are both well known for being safety geeks!

We are here to link people together, support everyone and show that quality improvement can be simple, fun and very rewarding.

 

In April we were lucky enough to attend the International Forum in Quality and Safety in Healthcare in Paris which was an amazing experience.  3000 people from over 75 countries came together to share experiences and learning in quality improvement.  We wore our Scottish flag badges with pride and were quickly given the title of ‘the tartan twins’! Meeting Don Berwick (godfather of Patient Safety) was the highlight!!

One very clear message from Paris was that Scotland are world leaders in healthcare quality improvement. We are the 1st country in the world to adopt a nationwide approach to patient safety and when are we ever 1^st at any team sport? (Andy has let us down, our footie team cannot even qualify for the World Cup finals and even @jefface3’s precious Welsh rugby team are mince.)

What made our pride blossom even further was Maureen Bisognano CEO of IHI (Institute of Healthcare Improvement in America) speaking very highly of the NHS Scotland and quoting ”I am coming to Scotland if I get ill”. 

The world is watching so lets stand tall, be proud and give them something to be in awe of.

Those of you who have had the pleasure of our company will know we are passionate about creating a happy, positive environment and want to encourage people to be proactive and not reactive.

Have you ever said?

• “I can change that?”
• “We can make this better?”
• “I have an idea”

and wondered where to start? Then in true Ghostbusters style we are the ones to call…..

So, a few things to think about to help with the quality improvements you want to make

• Don’t get lost in the jargon
• Follow you instinct
• Communicate with your team
• Take small steps

Independently we all try our best but together we can get it right for every person, every time. Deming was a quality improvement guru best known for revolutionising the Japanese car industry.   His philosophy is one of cooperation and continual improvement and his famous quote is shown here.

If we all take responsibility and the possibilities are endless. Let’s keep believing and keep fighting as Bevan, the founder of the NHS would want.

Here’s to the next 66 years.

Sharon McGarva and Emma McGauchie are Staff Nurses and Improvement Advisors with the Patient Safety Team at NHS Dumfries and Galloway. Sharron works tuesday and wednesday and Emma works wednesday and  thursday. Call us on 34138 and follow us on twitter @shazmcgarva @emmamcg2