“We’re off to see the Wizard!” by Allister Kelly

My recent personal account of being tornadoed into the world of acute medicine (Oz)

I have  proudly worked in the NHS for over 35yrs,  predominantly in the Community, the key focus in the Community at present is the development of Home Teams (to try and prevent the tornadoes!) 

My take on the term ‘Home Team’, rather than Neighbourhood teams, Community team, One team etc. also relates to the WoOz. 

Dorothy repeats her wish “there’s no place like home, there’s no place like home”.In saying this she is not just talking about a house, or even aunt Em’s farm..or the surrounding village, she is referring to Kansas. So where we have ‘The Machars’ for example, as an early adopter site, the Home Team encompasses, houses, neighbourhoods, communities, areas linked by common geography and a collective resilience. ie somewhere that people call ‘Home’.

Every decade or so my otherwise normal black n white ‘home’ gets thrown into the land of extreme bustle, bright lights, buzzers, scanners, monitor’s and casts of many (in front and behind the scenes)in acute care.

This recent one was courtesy of two large pulmonary embolisms (blood clots in my lungs)

Late on a Tuesday night after reponding to my call, two ambulance men made sure I was safe n steady to go to the emergency department of DGRI.I then spent a couple of hours in the Combined Assessment Unit, diagnosed, stablised then transferred to the Critcal Care Unit for 36 hrs before being moved to B2 Respiratory ward.

A week later I was discharged home to convalescence before returning to work.

As ever my experience in ‘Oz’ was a good one, well cared for in excellent facilities, well informed, a slick system where all of the departments, day and night staff perform their roles with utmost professionalism.

 But most importantly there was an overwhelmingly feeling of being cared for, by caring people.

What does that look like to the patient?

In Oz Judy Garland’s character would take every opportunity when speaking with anyone new, to immediately introduce herself “Hi my name’s Dorothy!”.

For all staff out there, regardless of where you are based PLEASE do not underestimate the Power of “Hello my name is….”, when people are at their lowest (more than ever at present when family cannot accompany or visit) and when staff have to wear face masks, many full PPE including visors or goggles {and name badges always seem to rest with the reverse side showing} it means so much to be introduced in this way and also to be asked what you as a patient/person would like to be called.

Staff who are very busy, but take 2-3 mins for some general chat about  what is going on in their life, whilst carrying out their duties, provide more therapeutic care than they will ever realise. (I’m sorry I cannot remember everyone I met along the way to thank them, I have tried to capture as many as possible below, but I also know there were many staff behind the scenes I never met, to whom I am also grateful)

However as shown in the recent biopic ‘Judy’ not all is as it seems on screen, many of the staff I met were undertaking extra hours, covering for absences through, vacancies, AL, SL, child care issues and were obviously stressed and stretched [add to the fact these areas were/are the frontline for Covid when it calls!]

There are poor consequences for staff constantly working at high tempo, as many staff across the directorate have been doing the last few months, especially as many have to deal with personal family issues  on top of what they have to manage at work.

The blame for this pressure if often aimed at “the organisation”  “the high heid yins”, not enough staff, not enough resources, not enough time. I have always regarded  ‘the organisation’ as ‘us’ rather than, ‘it’ or ‘them’ and certainly not a ‘him’ or ‘her’. No Great Oz behind the curtain making all the decisions pulling all the strings I’m afraid.

 This is an unprecedented period for Health and everyone who is part of it, we are all finding our way in uncertain times, no matter what our role is in the organisation.

NHS D&G operates/exists because of us ..each and every staff member is part of ‘it’ , drives ‘it’ , makes it a success.

We are a people service, by people for people and it is the support we give each other that will get us through this.

As the strap-line to the WoOz said..”It’s not where you go, it’s who you meet along the way” that makes the journey.

So as the credits finally stop rolling, I would like to end by saying, NHS colleagues, be Proud of what you all do and even Prouder of how you can/do make people feel !

                                                                                   Thank you♡

 🌈 Dr John Ward, Dr Prajapati, Robyn, Emily, Anita, Holly, Corrie, Wallace, Nancy, Mary, Lisa, Tylar, Shirley, Wendy, Jennifer, Fiona, Maureen, Cathy, Mr Little and Team, Laura, Wendy, Christine, and others🌈

Allister Kelly is Interim AHP Service Manager for Community Health and Social Care for NHS Dumfries and Galloway

World Patient Safety Day by Moira Dowden

This week we are celebrating The World Health Organisation (WHO) World Patient Safety Day with the aim of raising awareness and improving  understanding of patient safety issues.

The global theme for this year’s event is Health Worker Safety: A Priority for Patient Safety which focuses on the inter-relationship between staff safety and patient safety –  illustrated in the WHO slogan ‘Safe health workers, Safe patients’.

The WHO has proposed a call for action, “Speak up for health worker safety!” appealing for urgent and sustainable actions by all to recognise and invest in the safety of staff as a priority for safety as a whole.

The Scottish call to action to ‘Speak up for staff safety’ has never felt more relevant given the unprecedented times we are all living in as we adjust and adapt to the ever-changing ‘new normal’ and prepare for what lies ahead.

Staff and volunteers across the partnership are championing Scotland’s approach at a local level acknowledging the new challenges they have been facing, and will continue to face, in the light of the Covid-19 pandemic. Here are some examples:

Volunteers

During Covid 19 one of our direct NHS volunteers provided volunteering support 4 mornings each week (150 volunteer hours) to patients in ward C4 through the Falls Prevention Programme.  A snapshot was taken during April – June 2020 showing that over 200 engagement opportunities took place.  As there were no visitors during the height of lockdown some of the activities the volunteer engaged in with the patients to help reduce falls were:

• Chatting with patients everyday
• Calling for a nurse to help patient to toilet
• Providing another blanket for the patient
• Reading the newspaper
• Opening the orange juice and getting a tumbler
• Wrapping a blanket around the patient as he was cold sitting in his chair.
• Putting on the television as no remote control
• Put some alcohol gel on towels so the patient could clean his hands before eating his lunch
• Found their polygrip for their dentures
• Got their hearing aids out of the bag the family brought in
• Picked up the Guardian and found their dressing gown which had gone to stores
• Having a good conversations that distracted patients until the nurse:
  •  came to wash them
  • To tell them they were going home

Falls Prevention – Volunteer Support 1st April – 30th June 2020
	Number Of Patients	Male	Female	Volunteering Hours
April	63	36	27	45 hours
May	78	23	55	51 hours
June	95	26	69	54 hours
Total	236	85	151	150 hours

It often is the little things that matter most; that contribute to ‘safestaff safe patients’and the overall experience of care.

Pharmacy

Karen Harper, Risk Manager with the PSI team went behind the scenes in pharmacy to walk the Medicines Safety Journey, highlighting how pharmacy and ward teams are working together to promote patient and staff safety.

Teams keep staff and patients safe.

Acute Pharmacy Manager, Alison Bell, took us on a tour behind the hatch and introduced us to some team members who spoke about their roles in keeping staff, and in turn patients, safe from harm.  The medicines journey is complex and not as straightforward as you may imagine. From procurement to receiving and controlling stock, the role of the robots and the hustle and bustle in pharmacy – the process never stops.  We were shown the huge walk-in fridges for fluids and vaccines, a clinical trials area, the safe storage of controlled drugs, the aseptic room where chemotherapy is constituted, and finally the dispatch area which would normally be the only visible area.  A very interesting and enlightening visit.

We then visited the Critical Care Unit (CCU), the Combined Assessment Unit (CAU) and finally Ward B2 (Respiratory and Elderly Care) to hear from staff, in their own words, how the pharmacy team members take their roles and responsibilities seriously to support safe processes which help ensure that the wider multidisciplinary team including nurses and doctors are safe in their practice and in turn provide safe patient care.

In this video you will see and hear Alison Bell, Gillian Sturrock, Laura McLean, Jade Stewart, Christine Benson and Shona McKinley talk about Safe Staff and Safe Care.

Women and Children’s

For World Patient Safety Day this year, the Women and Children’s directorate celebrated all of the different quality improvement work that has been done or is underway by staff.  They are promoting and displaying all of their improvement posters, within The Willows, Garden Hill, Oak Tree Family Centre and within DGRI.  Please take the opportunity to go and have a look at the great work the team have on display and be inspired to improve staff and patient safety. If you can’t visit in person check out the team social media platforms:

https://www.facebook.com/DGCAMHS

Tweets by CAMHS_DG_NHS

Staff from across the organisation are engaging in activities and online events to share, to learn, support each other and celebrate World Patient Safety Day throughout the whole of the month of September. This includes videos, posters, blogs and time out to consider what the theme of safe staff, safe care means to them and how they implement this in and out of work. There are great examples being shared on social media on our Facebook and Twitter feeds:

Tweets by DG_Improvers

Tweets by DGNHS

https://www.facebook.com/NHSDG

What do you do to keep yourself safe?  How do you promote your own wellbeing and that of your team and patients?  We all have our own ways of restoring and replenishing our reserves.

This is mine- fresh air, sea views and a dog or two for company.

As we reflect on World Patient Safety Day in an extraordinary year I would encourage you to enjoy the great contributions from colleagues which have been shared online this week and take the time to consider, and maybe share, how you look after yourself as well as looking after others.

Useful links and sources of support:

Staff Support Service 01387 241 303                                                                

dumf-uhb.mhstaffsupport@nhs.net

Red staff support button on Beacon

   visit The National Wellbeing Hub for support & advice:

https://www.promis.scot/

Thanks to Maureen Stevenson, Karen Harper, Kim Britton, Margaret McGroggan, Alison Telfer, the PSI team and everyone across the organisation who has contributed content to this year’s World Patient Safety Day celebration.

Moira Dowden is a Trainee Improvement Advisor at NHS Dumfries and Galloway

Safe Staff, Safe Care by Suzy Saunderson, Moira Dowden & Michelle Edgar

Thursday 17^th September is World Patient Safety Day. Whether you are clinical, non-clinical, patient facing or not, patient safety is part of all of our roles and common goal across the Partnership. This day is a chance to celebrate the work we all do.  

This year’s message is “Safe Staff, Safe Care”, and over the next week we are very excited to be showing video clips from your colleagues sharing how they create the conditions and opportunity for to keep staff safe either through new working practices or through supporting our own wellbeing.   These will be posted on NHS Dumfries and Galloway Facebook page and on twitter @DGNHS. Thank you to everyone who took to time to create these messages and send to us.   

We are the Trainee Improvement Advisors in the Patient Safety & Improvement Team and want to share with you our experience of ‘Safe Staff, Safe Care’.  

Compassionate Leadership 

I’m Michelle Edgar, and currently work as a Trainee Improvement Advisor (TIA) along with my substantive role in Organisational Development & Learning (ODL). I completed the SIS programme and applied to be a TIA to further develop my skills in quality improvement, the role has been a great learning opportunity and highlighted to me the close links between ODL and Patient Safety.  

Did you know when staff feel engaged and valued in their workplace it improves patient outcomes?  

There is extensive research into the impact of staff wellbeing on patient outcomes. Professor Michael West and his team at the King’s Fund found that the better the staff experience in work, the better the experience of patients.  

They found that when staff feel engaged and valued in their organisation, they are more motivated and have higher morale, there are lower infection issues, fewer errors, higher productivity and the patient mortality rate drops by 7%. 

Valuing yourself, each other, your team; being compassionate, being a compassionate leader.  

We are all leaders; you are, your colleagues are. We can all role model a culture of compassion.  West identifies 4 components of a compassionate leader: 

Attending, really actively listening to your team;

Understanding, listening to understand what they are saying;

Empathising, feel what your team are telling you;

Helping, having the motivation to help.

“Every interaction by every individual every day, shapes or nurtures the culture of the organisation” (West, 2017) 

In the recent Scottish Improvement Skills (SIS) Celebration event, a participant said the experience of completing an improvement project showed “improvement from the ground up, SIS has helped us find our voice”. The confidence, the energy and the buzz from the participants in the celebration event was evident: sharing their projects and experience of working collaboratively across professions and teams to reach the aim of better patient outcomes.  

Michael West is hosting a Webex on 17^th September 3-4pm -The Courage of Compassion for High Quality Health and Care. The PSI team will be screening the webex in the Lecture Theatres at both Mountainhall and DGRI, if you would like to attend please email – dumf-uhb.patientsafety@nhs.net  

Team Coaching - IV fluids  

I’m Moira Dowden- I joined the PSI Team as a Trainee Improvement Advisor earlier this year from a background in practice and community nursing. My role is primarily working on the IV fluids programme. This has given me the new challenge I was looking for through using my clinical experience in a completely different environment while developing my knowledge and skills in quality improvement.  

How do teams find the space in a busy workplace for continuous improvement of the care they deliver?  

The PSI team and Ward C5 at DGRI are building a ‘big room’ to focus on safe IV fluid prescribing and management in the Acute and Diagnostic directorate. The multi professional team in C5 are using weekly team coaching sessions to come together to understand their current processes around fluid prescribing and recording and develop ideas to improve the quality and safety of patient care in the ward.  

The team sessions take place within a ‘big room’ which is a physical and currently a virtual space where everyone in the team has an equal voice and is able to contribute to the project as a whole. There is no hierarchy within the group - the big room is a safe space to have open discussions and voice concerns about current practice, taking time to reflect on and understand the issues before moving to solutions. The input of a medical consultant, a health care support worker or any other member of the multidisciplinary team are all equally valued.   

The ‘big room’ in ward C5  

This project is not owned by PSI but by the ward team, and they decide on and implement tests of change while being supported with quality improvement methodology and team coaching. All of the changes being planned and results are visible in the room for all of the ward staff to see and comment on, as well as in the virtual big room on Microsoft Teams.  

IV fluid prescribing and recording has long been recognised as an aspect of care which ‘could be better’ and this approach is empowering staff at ward level to use their expertise to drive change and improve patient safety. The project is in its early stages but already there is a feeling of momentum that change is happening and can be sustained.  

For me, the big room is a great example of safe staff, safe care - frontline teams taking ownership of the of the care they deliver and working together to improve quality and safety for patients and their families.  

The big room and team coaching approach are also being used in the Women and Children’s Directorate to support teams in the delivery of change within the Best Start programme and CAMHS clinical pathways.   

The ‘big room’ is adapted from Sheffield’s Microsytem Coaching Academy 

 www.sheffieldmca.org.uk/about-us  

Good Catch  

Hi I’m Suzy Saunderson and here I am experiencing my first encounter of NHS Dumfries and Galloway at aged 4.  As you can see, I feel very safe with my book and my teddies.  Yes, I have zoomed in to see the old-fashioned Lucozade bottle wrapped up in crinkly paper which was a big treat then, you had to be ill to receive one.

It was 12 years later I started my working journey into NHS and I am fortunate enough at the moment to be on secondment as a trainee improvement advisor. I applied to become part of the Patient Safety and Improvement team as I wanted to be more involved with making a contribution to changes and improvements in the patient journey.  

I am currently working on promoting near miss reporting as I think there is so much we can learn from those ‘Good Catches’ 

I am also supporting the Women, Children and Sexual Health directorate with their SPSP priorities.  I am learning about a Value management approach to Quality improvement which combines QI and Value drawing on my substantive knowledge from my other post in finance. 

Patient safety focuses on the avoidance of unintended or unexpected harm making sure reasonable steps are taken to ensure safe care.  Providing a culture where staff safety is a priority means we feel psychologically safe to speak up about incidents, near misses, good catches and share opportunities for improvement. 

What have been your experiences with near misses and reporting them? Do you have any ideas to promote near misses reporting?  You may have had a bad experience or equally a good experience of reporting near misses.  What learning have you taken from near misses? 

There is a lot we can learn from other industries, other health systems and of course from each other.  

If you would be interested in becoming part of a short life working group or even to share your stories and experiences please get in touch with the Patient safety and improvement team at dumf-uhb.patientsafety@nhs.net  or myself at suzy.saunderson@nhs.net. 

Follow the PSI team on twitter @DG_Improvers 

Safe Staff, Safe Care 

Covid-19 cloud and its silver linings by Louise Cumbley

I admit I was wrong.  Not easy to say but this is the way I now feel about remote ways of working that, before the covid-19 pandemic, I felt certain was not possible.  Psychological therapy is a difficult but rewarding thing to offer.  Clients need to develop trust and rapport with a therapist and talk about the intimate parts of their inner world, their thoughts and feelings. Some tell us things they may never have spoken out loud before.  It really is a position of privilege and we are honoured to hold such information about people and these things are only possible if you are in a room with a person…or so I thought.

Before covid-19, I was involved in the roll-out of Near Me in the Mental Health Directorate.  I was supportive of Near Me and could see its benefits but had some reservations about remote psychological therapy.  I had all sorts of caveats in my head, not for the first appointment, not for risky clients, not for those with trauma, and so on.  However when covid-19 came, we had no choice to shift our therapy to working remotely with clients.   Face to face work was suspended  and, over a 2 week period staff started to offer remote therapy.  Most clients did not want to come to clinic settings anymore, but still wanted our help.  Since then, locally and nationally we have been drawing on the evidence for remote therapy and in the early days, I was surprised to hear from colleagues all over the country of their use of Near Me to treat complex trauma.  Some services in the islands have been doing so for years.   I watched a webinar of a child psychiatrist who has been working remotely to the Western Isles offering urgent assessment for young people living significant distance from mainland specialist services.  I was amazed at the breadth of service she could offer remotely but more importantly safely and effectively.  There are always caveats but sometimes we  can put up hurdles before we really have the evidence to support this.   This is particularly apparent when we are stressed and feel uncertain about what we are doing, which is undoubtedly true during a pandemic.

In April , as we adjusted to new ways of working, we did not have the luxury of offering a face to face first appointment so had to dive straight in with remote working with clients we may not have met before.  We wrote protocols to manage risk, wrote guidelines for staff and clients and were immensely grateful to IT for the provision of all the kit to make this happen so that staff could work remotely too.  As the days and weeks went by, the feedback from staff and clients was amazing.  Some were equally sceptical as me but were soon seeing the fruits of their labour. Evidence that engagement and rapport was faster to develop,  working with those with trauma was achievable, and for some being behind a screen made them feel safer than if they had to come to a clinic out of their comfort zone.  Our DNA rate has reduced compared to face to face therapy for the same time period last year and the Psychology Department is now offering in excess of 700 remote appointments a month by phone or near me.

At the same time, our colleagues at NES have completed a literature review of the evidence-base for remote therapy and have found that there is good evidence that remote therapy is as good and can even be better than asking a client to come into a clinic.  There are always exceptions and for some the challenge is lack of broadband, equipment or maybe the confidence to use technology.   It is clear that as I tuck into my humble pie, whilst there is still work to do on improving accessibility for everyone, we need to embrace new ways of working alongside traditional model to offer a blended approach based on the needs of our clients.  There are some therapies which require a face to face interaction such as play or attachment based therapies or neuropsychological assessments that require close observation of someone.   This requires a balanced approach and considering whether the risks of face to face interaction are outweighed by the benefits to the client.   Clinicians have also had to be mindful of those who have been living with domestic conflict and violence, where lockdown may have increased the risk to their personal safety.  The importance of understanding clients and offering these clients a safe place for therapy away from home is a clear example when a face to face interaction has far more benefits than risks.

As we prepared for Covid-19 in Psychology department, remote working was not the only change we needed to embrace.  Looking at the evidence for managing psychological distress in a crisis situation, it was clear we needed to take a measured but responsive approach.   Over a short period of time, the department reduced its routine work to create capacity to open a wellbeing hub.  Staff worked hard to create a new webpage full of advice that was safe and evidence-based.  We needed to do this quickly to counter a lot of misinformation that was circulating and ensure our clients were safe and well informed.  At the same time, staff also moved to provide psychological first aid to those who needed it in our communities.  The public could speak to a Clinical Psychologist or therapist within 24 hours, sometimes sooner and get brief therapy that met their needs.  Other staff in the department were deployed to offer staff support and reach out to teams who were in the midst of the pandemic or teams who had been newly formed in response to the crisis.   I am immensely proud of their ability to adapt, to embrace new things, create an accessible service for the public and staff that has been overwhelmingly well received.

Our colleagues in NHS Grampian had adopted a similar public facing resilience hub to support people during the pandemic.  This type of support became more obviously needed during the Stonehaven derailment only a few weeks ago.  The Psychology Department in Grampian were able to offer well-informed, well evidenced advice and guidance not only to the public but to the health and social care workforce dealing with the aftermath of the event.  So maybe our new ways of working need to be in place beyond covid-19?  Whatever happens,  Covid-19 has challenged all our perceptions.  Remote therapy works for the majority of the population and having a fast-access service to meet with their needs has certainly been welcomed.  However,  where remote therapy is not appropriate or possible, we need to learn and adapt our ways of working to continue services to those most in need.

Louise Cumbley is a Consultant Clinical Psychologist & Director of Psychology and HSCP Professional Lead at NHS D&G