“Don’t Mess With My Tutu” by Sasha Sigley

For a few seconds can you close your eyes and remember what your favourite hobbies were as a child? The ones that made you grin or stick your tongue out in sheer concentration.  Now, stay there for a second.  Felt good didn’t it?  Mine was 3 years old gleefully spinning in that glorious tutu.

If someone were to ask me what my hobbies are, in my 20s, I don’t think I could answer that other than replying…’what hobbies?’  On closing my eyes I see myself dancing at 3 years old and how I adored this until I was 16. Looking back, it was such a valuable and enjoyable time in my life and one I have passed on to my daughter.  I suppose I live my dancing dream through her now. However, if someone asked me now ‘why did you stop then?’ I could not specifically answer. Tutus maybe weren’t ‘cool’ at 16? Or maybe as a young mother it was life, work, chores?  These can easily get in the way at any age.  Just like our health can.  This loss is something I recognise frequently working with people within reablement STARS.  When I ask that key question ‘What matters to you?’ replies can be vague.  Something seems to happen as we become older adults.  Be it lost confidence, impaired health, isolation or culture of protection that dull the belief that we can all return to enjoying what we once did and endlessly explore new experiences.

I have worked in various departments within the NHS and have predominately worked with adults and children within the nursing sector.  Then I secured a new role as an occupational therapy assistant practitioner (OT-AP).  I am pleasantly surprised at the fulfilment this role brings to my working life and how it changes the way I think in my personal life. It is a very rewarding role to work in.  What intrigued me the most was that question ‘What matters to you?’ and how the answers to that question immediately become merged into service-user led goals.  Our main aim is to enable independence and ensure service-users feel empowered in their lives.  This is achieved through participation in assessment, agreeing realistic goals then practising therapeutic techniques to reactivate abilities. The aim is to improve quality of life and reignite that spark for living a happy life.

As part of the Occupational Therapy family I have learned about the Occupational Performance Model (AM J, 1994) which includes ‘Play/Leisure’ as a core part of well-being. You could say my vocational role in society is as an OT-AP with STARS and my leisure/play was dance.  I am now mindful of taking this into account, when meeting service users, and often discover we have shared interests. I meet people daily, who had hobbies that they cannot/do not do anymore due to obstacles in their lives. I now understand we can prevent this by encouraging people to enjoy their interests again, adapting them if necessary by focusing on abilities rather than disabilities. I have had many conversations with service-users’ about joining a group/class in relation to their remaining active and combating loneliness.  With over 3.6 million older adults living alone in the UK and more than 50% experiencing feelings of loneliness and isolation (Age UK, 2019) it has never been as important to ensure we address this.  Exploring opportunities to reconnect through accessing social and community activities that can be enjoyed long after short term support finishes.

It took me to experience a new role at work that promotes value in hobbies to fully appreciate that we must never give up doing what we love.   Participating in interests and socialising seem to be the first things to go in life as we prioritise other demands, experience frailty or poor health.  This is despite us knowing we are intrinsically social beings.  Knowing we cannot fully satisfy our needs or happily survive without social co-operation.   So one day soon I aim to get my dancing shoes back on.  Maybe I won’t mess with the tutu look again!  But I will keep encouraging our service user’s to have fun.

103 year old Eileen Kramer still performing, choreographing  and dancing.

Sasha Sigley is an OT-Assistant Practitioner in reablement service STARS

World Patient Safety Day by Emma Murphy, Caroline Cooksey and Maureen Stevenson

Tuesday 17^th September is World Patient Safety Day.  This is an annual event organised this year by the World Health Organisation as an opportunity to raise global awareness about patient safety and encourage action.  The theme this year was ‘Speak up for Patient Safety!

You may have come across or been involved in a number of events that were happening across the region and in your work areas this week.  Some of these activities were captured on social media:

Jeff Ace, Chief Executive for Dumfries and Galloway Health Board, giving his support to a display at Mountain Hall Treatment Centre.

The most powerful message of all came from both staff and members of the public who took the time to ‘star’ in videos for social media and/or complete statement cards on why patient safety matters to them:

 https://m.youtube.com/watch?v=kYi7fSeBsCM

This inter-relationship between patient experience, staff experience and improvement builds the culture around patient safety within a health and care organisation and the rest of this blog focuses on these areas specifically:

Patient Experience and Patient Safety

By Emma Murphy, Patient Feedback Manager:

People often assume that when patients complain, they are looking for compensation or for some kind of disciplinary action to be taken.   The truth is, most of the time they are just looking for us to learn.  One of the most common phrases I hear when talking to people about their feedback is

‘I just don’t want anyone else to go through what I have’.

They want to feel like their feedback can make a difference, and whilst we are generally good at trying to put it right for those individuals, we often miss the opportunity to take wider learning. 

When I was asked to write a short piece for this blog, my initial plan was to focus on why learning is important, but I don’t think that is our challenge.  We know that we need to learn from the experiences of those that use, and work in, our services.    It’s not the why we are struggling with, it’s the how.  Busy is the new norm, and with competing demands and constant pressures, it can be difficult to find the time (and headspace) to learn in a meaningful way. Below are some top tips on how to make that a little easier:

• Create time to learn – I know that’s easier said than done, but as my wise old granny would have said ‘a stitch in time saves nine’.  Try adding learning as a regular agenda item in to your team meetings.  Commit to identifying at least one piece of learning each month and where possible converting that in to improvement.

• Use that time wisely – Decide what you want to focus on.  Reviewing the findings of a specific complaint or incident can help to prompt a learning discussion.  Positive feedback creates a great opportunity to learn what we are doing well too.   Think about how that good practice could be spread? Create some structure so that the time is best used.  

• Use the tools available – The learning summary template can be really helpful for guiding and capturing the discussion.  The template and guide can be found via the Datix landing page here.  The SPSO also have some helpful guidance on learning in their investigation toolkit here (see page 16 onwards).

• Involve the right people – Think about who should be round the table.    Involve staff, colleagues, patients and families where you can.  Think about the different perspectives that might be helpful.  We often assume we know what will ‘fix’ a problem, without asking for input from those that need to implement the change or those that will be on the receiving end of it.

• Complete the cycle – Take time to review whether any changes have made a difference.  Patient feedback and adverse event data can be helpful here.

• Share – Think who might be interested in the learning you’ve identified.  Could it be helpful to other teams, services or Boards?  Would patients and the wider public be interested (the answer is usually yes)?  The learning summary template mentioned above, provides a clear, easy to read, format for sharing learning.   

• Celebrate – Take time to celebrate your successes.

If you want to find out more about learning, the Patient Services and Patient Safety & Improvement teams would be happy to help.

Staff Experience and Patient Safety

By Caroline Cooksey, Workforce Director:

I am an optimist. I believe that we all come to work each shift and each day planning to do a great job; keeping people safe and taking every opportunity that comes our way to make small (and big) improvements which will positively impact on the quality of care and outcomes for each and every patient and client we care for.

I am also a realist, and I recognise that sometimes my day can go a bit wonky, for all sorts of reasons, and things that happen get in my way of my ambition to keep the people who access our services as safe as I would like.

My experience as a staff member drives what I think and believe, and this in turn impacts on how I behave in the moment. So what, you might ask, has this got to do with patient safety?

Well, two (and probably many more things) actually.

First, there’s CULTURE.

I think this says it all. If I experience our organisation to be one in which we all believe, live and demonstrate our CORE values of Compassion, Openness, Respect and Excellence, then the concept, and the practical reality of patient safety being at the heart of what we do, and how we think is so much easier. Our culture (which we create together as a collective of 4500 colleagues) drives our (including my) attitudes, which in turn drive our (and my) behaviours, which will either keep people safe, or increase the risk that they may come to harm in our care.

The second thing is about CHEESE

I remember when we first started talking about this new ‘thing’ called patient safety, (it was a while ago now) the then Nurse Director explained the SWISS CHEESE concept, and it has stayed with me ever since. His idea is that we are constantly working with levels of uncertainly and risk in the work that we do, however most of the time, the ‘holes’ (risks)  are sufficiently separate and distinct that the checks and balances in between ensure that nothing actually goes wrong. 

But what about the day when the car won’t start, and the bus is late, and so I am late and a bit stressed out and so the handover doesn’t happen as it should, and then another team member is off sick, and so we are all stretched as a team, and I mis-read (or misunderstand) a key but quite nuanced message on a note and … and … and …………you know the story.  

There was no intent on my part for that particular day to be a ‘bad’ day, but it’s at those most challenging times that the holes in the swiss cheese have a very nasty habit of lining up – and the unexpected, unplanned, and unwanted adverse event sometimes happens. 

We have many safeguards in place at individual, team and organisational levels to help to prevent this happening; our policies and procedures, training and development, professional supervision, annual development review processes, i-matter team action planning, adverse incident reporting, audit, and many more. However, in that moment, how  much compassion do I show to myself, and to others to enable us all to openly and respectfully share and learn together from our experience,  and possibly mistakes, so that I and we can be better and stronger tomorrow than  on that ‘bad cheese’ day?

Our staff experience and our CORE values can play a massive part in our patient safety culture –let’s  keep working together every day to be compassionate, open, and respectful and the best that we can be.

Patient Safety and Improvement

By Maureen Stevenson.  Patient Safety and Improvement Manager:

As I browse around me for inspiration, I catch sight of the “The Health Foundations Safer Patient Initiative” folder, Atwal Gawande’s book “The Checklist Manifesto” and a Duty of Candour poster.  All of these and my personal experiences of Healthcare remind me of why Patient Safety matters and why World Patient Safety Day is so important. 

No one should be harmed while seeking care.

(World Health Organisation 2019)

# Patient Safety

Globally 134 million adverse events contributed to 2.6 million deaths each year due to unsafe care. 

Today – Tuesday 17^th September 2019; The World Health Organisation (WHO) urges us to raise awareness about patient safety to encourage global solidarity and action.  The NHS in Dumfries and Galloway joined the Patient Safety movement some 12 years ago when we were selected to work with the Health Foundations and Institute Healthcare Improvement (IHI) on the groundbreaking Patient Safety initiative.  We worked with partners from across the 4 home nations to understand patient harm in acute settings and to work to reduce harm and improve safety.  We have continued on that journey, supported by the Scottish Patient Safety Programme (SPSP), to introduce patient safety programmes in Mental Health, General Practice, Care Homes and in Maternity and Children’s services. Teams from across our organisation have worked to reduce and, in some cases, eliminate harm from Healthcare Associated Infections; Medication Errors, Communication and reliability of complex interventions / diagnosis. 

It is estimated that around 1 in 10 people who come into contact with acute healthcare and, 4 out of 10 people in primary and community care are harmed. 

Delivering health and care to our population is complex.  Planning and delivering care safely for every person every time is our ambition, not only because we know it is the right thing to do but also because we know it is more effective. Recent evidence from WHO shows that 15% of hospital expenditure in developed countries is a direct result of adverse events with the most burdensome adverse events being blood clots, pressure ulcers and infections.  Across Dumfries and Galloway we are working to eliminate these and many more harms.

The Duty of Candour legislation, introduced in April 2018 requires us to acknowledge when things go wrong, and to work with families and our staff to understand why and what we might do to reduce the likelihood of such an event happening in the future. 

A willingness to admit our mistakes, to listen and learn, to show compassion and provide support for patients and their families and our staff create the conditions for us to move forward together. Creating the conditions for improvement and learning is about culture, a willingness to accept our fallibility, to seek to understand and to learn when things go wrong. 

In NHS Dumfries and Galloway we are committed to continue our journey towards safe, reliable , compassionate care for every person every time.

Patient Safety is our duty and our passion.  Each and every one of us will be a patient, a friend or a relative of a person in our care,  lets continue to strive together to continually improve Patient Safety.  How to get things right first time every time is our challenge. Atul Gawande, an eminent surgeon and writer gives a straightforward account of how seemingly simple interventions like a checklist support teams and individuals to breakdown complexity, to over write insufficiencies of human memory and hierarchy, and to feel safe in the knowledge that we’ve done the right things reliably.

Patient Safety Matters to me and to you to let us collectively continue our work……..

Emma Murphy, Patient Feedback Manager

Caroline Cooksey, Workforce Director

Maureen Stevenson, Patient Safety and Improvement Manager

All at NHS Dumfries and Galloway

 

 

Preparing for the Long Haul by Julie White

During this time of unprecedented demand on health and social care, workforce challenges and the gloomy financial outlook, thinking afresh about the future shape of services through our emerging Sustainability and Modernisation (SAM) Programme could seem an impossible task.  Thankfully, after touring Dumfries and Galloway with Jeff Ace, Chief Executive of NHS D&G, and meeting almost 400 staff across the Health and Social Care Partnership, it is clear there is no shortage of people with great ideas and undaunted commitment to finding better ways to deliver health, care and support to the people of our region.

It is important that we recognise the three key drivers of our SAM programme:

1. The needs of our local population are changing. We are experiencing a rise in demand for all traditional health and social care services, and demand is forecast to continue growing – with the number of people aged over 85 in D&G projected to more than double by 2037.
2. Our working age population is falling. If we do not change the way health, care and support is provided in our region, we will need every school leaver in D&G to work in health and social care by 2033! These are not long-term statistics we can leave for others to deal with in the future. 2033 is only 14 years away, and I am sure many of us can remember 2005 like it was yesterday!  We’re not going to recruit every school leaver into health and social care, nor should this be our ambition given we want a region with a flourishing economy and diverse workforce.  A core part of our SAM programme is therefore developing a redesigned system with a sustainable workforce where we offer rewarding, exciting, innovative and attractive roles.
3. The financial gap for 2019/20 is over £20M, and the predictions for the next 3-5 years show costs continuing to rise at a faster rate than our income. More money on its own will not transform health and social care.  That is why SAM has been established to create radical and innovative change to address all three key drivers – demand, workforce and the financial position!

We know the future of health and social care will look very different to what we have today.  Technology and research are changing how we are able to deliver services, and the way people want to receive services is also changing.  SAM is an opportunity to ensure we’re well positioned to continue to deliver high quality health and social care in the future.

HEARD IT ALL BEFORE?

I’m aware many of you may feel like you’ve heard all of this before.  This time, however, the challenge around workforce and finance is greater than anything we’ve previously experienced.

If we don’t act now, we will fail to have the services, the workforce or financial resource to meet our communities’ needs.

We need to make difficult decisions around any current activity that adds limited value so that we can continue to invest in modern ways of providing health and support.

‘Turnaround teams’ have been brought into health and social care organisation in other parts of Scotland and England to develop financial recovery plans. Although there’s much to learn from these teams in terms of pace of change, staff engagement and the focus on delivery, our ambition in D&G is to keep local control of the solutions to overcome the challenges we face.

For me, the success of the SAM programme will be as much about ‘how’ we do it as ‘what’ we do.

THE DUMFRIES AND GALLOWAY WAY – TEAMWORK AND COMPASSIONATE LEADERSHIP

Previous blogs by Medical Director Ken Donaldson have highlighted the importance of compassionate leadership.

At the heart of the programme is a belief that the most sustainable way of transforming health and social care is to redesign the system by giving teams the power and the opportunity to be innovative.

The biggest risk we can take right now is NOT to change, as we know that a future health and care system based on our existing model will not meet the needs of our population.

Compassionate leadership supports improvement and innovation by promoting learning and encouraging people to take balanced risks to develop new and improved ways of delivering our services.  Innovation takes time, and we may not always get it right straight away.  Through perseverance, American inventor Thomas Edison worked through many ideas before finally arriving at the incredible innovations for which he is remembered.  He did this whilst also facing ridicule from the media and his peers.

“The greatest glory in living lies not in never falling but in rising every time we fall.”

Nelson Mandela

Changing the way in which we deliver health and care in the future will not be easy, and there may be some difficult decisions along the way.  We need to have confidence to be open and honest about what is not working and create an environment where it is ok to challenge and question the norm.

While responding to the financial challenge, our approach recognises that most of us are more motivated by the need to modernise and improve the quality of our services.  The SAM programme does not mean that we will not invest money if it is the right thing to do, but there will be a greater focus on spend to save schemes to support transformation.

Our Health and Social Care Partnership recently invested in our recruitment and marketing resource to promote D&G as the best place to work, live and play.  The single, largest impact we could have on our financial position is to recruit to every essential vacant post we have across our Partnership, thus reducing our locum/agency spend.  More importantly, however, we recognise that by investing in colleagues and having fully staffed teams, we will improve the quality of services and give people the space and time to think about transforming services for the future.

HOLDING THE MIRROR UP

Through SAM, we are encouraging individuals and teams, including the Senior Leadership Team, to ‘hold the mirror up’ and question our own current approach to the challenges we face and our attitudes towards transformation and modernisation.  Are we ready for transformation, or are we defending the way things have always been? Traditional ways of working that are based in siloes, hierarchical and afraid of failure will not provide the agility needed to meet the changing needs of our population.

We are asking individuals and teams to reflect on how they currently work.  Our teams are best placed to know about things we do that don’t add value to the experience of our patients or service users, and things that do not support a positive staff experience and inefficiencies in our current delivery of health and social care.  They are also well placed to help us consider changes we need to make, along with identifying opportunities for transformation and modernisation.

We would encourage teams to reflect on the following questions:

• Consider what we could stop doing; what do you do that doesn’t add value?
• Can technology be used to improve the way we deliver services; what are your ideas?
• What could we change that would be better for our service users and for our teams?

We have a history of being very successful in delivering major change programmes.  It was our teams and their commitment to delivering the best possible health and social care that was key to the success of projects such as: transformation in our models of mental health from hospital focused services to community-based models, introducing personal budgets in social care, development of new facilities at Galloway Community Hospital, Midpark and our new DGRI and the ongoing work to transform Primary Care Services as a result of the new GMS contract.

Again, it is our teams who will be key to ensuring delivery of our SAM programme, developing a health and social care system that is fit for the future.

HOW TO GET INVOLVED

Thank you to almost 400 staff for attending the SAM presentations held across the region at the end of August.  A number of themes emerged and will be included in our SAM agenda moving forwards, including the need for a greater focus on digital technology, remodelling of care at home and reablement services, increasing the pace and scale of change, encouraging support from the third and independent sector and crucially engaging with the public on this vital transformation programme.

During our region-wide tour, Jeff and I launched an ideas pool called ‘small change matters’.  Individuals across the Partnership are invited to submit ideas and suggestions about changes (big and small!) that can improve outcomes for our patients and service users, improve the experience of our staff and save money.  To date, over 190 ideas have been submitted.  A huge thank you to everyone who has taken the time to contribute.  Each idea is being considered by the Project Team, and individuals will receive feedback on their submissions. Look out for some ‘You said….We did’ feedback from the SAM team.

Ideas can be submitted via Beacon for staff who have access to the NHS intranet or via dg.asksam@nhs.net. 

You can find a link to the video of our SAM tour presentation here!

AND FINALLY……..

We need to be prepared for the long haul. Anything worth achieving will take a long time, effort and persistence.

Regardless of our roles within health and social care – whether as a health or social care professional, a clinician, an administrator, a member of our support services team – we are all here ultimately for the same reason – to improve the health and well being of the people we serve.  Each and every one of us has a contribution to make to the SAM programme to ensure the future sustainability of our health and social care system in D&G.

Julie White is Chief Operating officer for NHS Dumfries and Galloway and Chief Officer for the Integrated Joint Board

 

Value, not just Cost by Graeme Bryson

 

I came into post in early 2019 and am delighted to be asked to contribute to the blog. One of the first things that struck me about NHS D&G was our person centred approach. For this blog I decided to share one of my personal experiences of NHS services and how it has shaped & motivated me as a healthcare professional.

That is my dad & I in 1981 on our annual family holiday

My dad had a perforated duoedemal ulcer in the late 70’s & for years after took gallons of antacids but was never trouble free. Around the time of this picture he was prescribed a proton pump inhibitor (PPI) & it is fair to say that this was a medicine that changed my dad’s & our family’s life.

Can you imagine the concern in his voice when he called me one day nearly twenty years later to say his medication was being changed?

As a relatively newly qualified pharmacist I took a keen interest in the change to an alternative proton pump inhibitor.

This involved

• Reviewing the evidence of comparative effect
• Checking that the side effect profile was the same
• Considering factors like would it mean he had to take extra doses or when he took his meds wwasn’t going to cause him any worries
• Then practical aspects like was the size of the capsule any different in case he had any problems swallowing

This was at a time when medicine formularies were in their infancy – the information gathering and review process professionally floated my boat.

Next – a conversation was had with his GP practice about why they were changing his treatment. They were up front with us – The alternative medicine was clinically the same but cost less. They were trying to make the best use of NHS resources and felt that they were doing the right thing for all their patients but had treated my dad like an individual.

With the assurance of the knowing these facts and that he had been treated as an individual my dad was willing to give it a go. He remained on the new PPI for many years after.

This experience shaped my career.

It taught me that medicines have a value not just a cost.

The value was that it changed my dad’s life but would the change to the new drug cost anything in terms of short term impact on his health?

But longer term cost could have been if the change wasn’t done well then it would have impacted on his confidence in the NHS as a whole.

The science said it was a simple change but the art of it said it came with a huge responsibility!

It inspired me to take this process of ‘therapeutic substitution’ of medicines and research into it further. I was particularly interested in how acceptable patients find it as a principle and how best we can make sure the process supports our own dads, mums, aunts and uncles if we change any aspect of their medicines to make more efficient use of resources.

What I found was that patients on the whole are willing to try an alternative if they are assured that there is assurance of no change in how they will feel and that they have been treated as an individual. As the health service has evolved we now have such campaigns as ‘what matters to me’ and I have seen that approach being integrated into how individual patients therapeutic substitution reviews are taking place across the Health Boards in Scotland.

For me a simple change in PPI in a relative has impacted on my professional life so much and motivates me every day. Within pharmacy we are having conversations about keeping hold of what motivates you as leader in medicines use. We aim to make D&G a centre of pharmacy excellence in Scotland and we need to know our own personal motivation as well as striving to a collective aim.

And more broadly as we progress through programs such as Sustainability & Modernisation (SAM)and Realistic Medicine- I’d like us to remember the process we go through to identify any substitution of a patients medicine to help make the £s go further.

These decisions are not taken lightly and the checks & balances we have in place are vital. This includes rigorous debate between medical, pharmacy and nursing staff to thrash through the evidence as well as considering those so important people factors. We then work within the medicines governance structure (Drugs & Therapeutics Committee) to make sure the local formulary choices support any changes.

Most importantly the process is therapeutic substitution reviews NOT mandatory switches – after the science has been dealt with we need to apply the art of working with the people of D&G to secure the change.

This will allow us to build on work we have done so far to continue to improve the effective & efficient use of medicines in D&G in a safe & patient centred way.

Graeme Bryson is Director of Pharmacy at NHS Dumfries and Galloway