Summer of Celebrations Part 1 by the SPSP Team

Reflections from Improvement Advisor, Paul Sammons

As an improvement advisor with no clinical background, I work closely with people who want to change things for the better, and who know their teams and roles well, but who don’t always have the skills to structure improvement work.  They may not have the capability to use the ‘model for improvement’ – a proven methodology that helps focus aims, identify change ideas and to measure what difference if any, a change actually makes.  Having completed the Scottish Improvement Leader programme (ScIL) in 2015/16 I do have that capability which, when brought together with practitioners who have a will and an urgency to change things for the better, can be very powerful.   I enjoy the privilege of working alongside, enabling, and learning from some fantastic individuals and teams who strive to improve services of their patients and service users.

Some of these moments will be with me forever – I recall working with Dr. Grecy Bell to motivate and enthuse a group of primary care staff about Medicines Reconciliation – not the most lively of topics, but Grecy created the ‘med rec fairy’ concept – a local champion in each GP practice who would carry the ‘wand’ to ensure their team saw med rec as a vital part of their work.

Another great memory for me was working alongside Dr. Mark Colwell – we teamed up to lead a local dental improvement collaborative, creating a structure around better decision making and treatment planning for patients on high risk medication.  Mark showed me how ceding power to his team enabled a flat hierarchy where all team members were able to critically observe each other’s practices, and contribute towards a more collaborative approach to patient care.   With the practices involved we improved much – starting even before patients arrived for their appointments – maximising the use of text messaging, moving through the patient’s journey. The work involved reception staff to engage with patients to obtain highest quality patient histories, and enabling dental nurses to observe and to prompt their bosses into even better patient conversations.

I have observed people in health and social care who once invigorated with a little QI magic, will stop at nothing to deliver better care, and who seem to have the energy to drive improvement forward in the most unlikely circumstances.  I spend time with Julia Hutchison in DG Smile dental practice, and I leave with a real spring in my step.  What is it about these people and all of the others that I get to support that is courageous, different and special?  I do reflect on a wee video that helps me answer that question.  You might like it too.  It is available on YouTube and can be viewed here.

I believe that attention to QI capability and capacity is key to improving services, and that we will see this develop through our local ever-expanding network of QI capable practitioners.  In the near future we will expand our practitioner level QI education and training – to ensure managers and leaders are well equipped to support, coach and supervise improvement projects.  In 2018/19 I plan to focus improvement efforts into the Women’s and Children’s teams as they settle into their new DGRI home.  I contribute to the improvement force field that is growing stronger across Dumfries and Galloway in health care and in social care.  I work as part of a small but wonderful team of hand-picked curious and quirky individuals – who quietly and tirelessly support each other, creating a synergy of support to our customers.  Perhaps you are close to that growing network of improvers – perhaps you feel the force like I do?  Well I do, and as I work with a widening spectrum of fabulous people I can honestly say that there is much joy in my work.  Long may it continue…

 

Why wont MY ‘thing’ go viral? by Ros Gray

Dreams are made when your great idea gets out there in this social world and goes viral. The very thought that thousands of people (likeminded as you) are looking at your good idea and thinking – “That’s a great idea, I could do that”
especially in our health and social care world when it isn’t necessarily the idea that’s new (although sometimes it is) but the ability to engage others to get them to follow your lead, for the benefit of patients and families.

So when things take off in this way, is it just good luck, or is there something we can learn? How does a good idea move from being MY great idea to something that a lot of other people want to do too?

In his New Yorker article ‘Slow ideas’ Gawande started my thinking on this topic (and a million other things!) when he discussed the evolution of surgical anaesthesia compared with the uptake of antiseptics to prevent sepsis. He described how the former spread almost worldwide in 7 years, the latter taking more than 30 years (and you might argue that the inability to clean our hands consistently even today means that we still haven’t cracked it).
It’s easy to imagine the difficulty undertaking any surgical procedure on a patient not anaesthetised (not least for the patient) – having your colleagues hold down the poor patient until such time as they (hopefully) passed out with the agony of the ordeal. Then you hear of an innovation where the patient inhales a gas and goes gently to sleep, allowing the procedure to be done with ease – a no brainer in terms of its likelihood to be adopted by others… and swiftly! The action of holding down the screaming patient and wrestling to undertake the procedure was clearly very personal and real for all those present.
However, the use of antiseptics to prevent an infection that the practitioner might never even see personally, leaves a lot to the imagination and limited personal cost, with the exception more latterly of professional reputation and in some quarters accreditation.
This situation was also exacerbated by the unpleasantness of the environment, where the practice of good antisepsis in the early days meant that theatres were gassed with antiseptics, hands scrubbed raw with early chemicals – all to prevent something that the practitioner might never witness… Perhaps, then, it’s easy to see why that adoption took longer than 30 years. Or is there more to it than that?

Gawande’s article goes much further and is very thought provoking but he fundamentally sets out how, if we want our ‘thing’ to be taken up by others at scale, then “…technology and incentive programs are not enough. “Diffusion is essentially a social process through which people talking to people spread an innovation,” wrote Everett Rogers, the great scholar of how new ideas are communicated and spread.”
He goes on to say that while our new social world can get the ideas out there
as Rogers showed, “…people follow the lead of other people they know and trust when they decide whether to take it up. Every change requires effort, and the decision to make that effort is a social process.”

I think these might be key concepts for us to consider with our personal improvement efforts. How hard do we make it to do the right thing?

Looking around at some other recent great ideas gone viral that I have become aware of – I thought it might be helpful for us to take a closer look at these and consider their spread from this perspective – I thank Delivering the Future Cohort 11 for their help with my developing thinking #DTFcohort11.

And also to consider how would the business world more broadly consider this issue?
Great marketers certainly start with two concepts that absolutely relate to our world and reflect Gawande’s thinking:
Know your audience
and
Make an emotional connection.

So looking at 3 examples of great ideas that have gone viral a little closer to home, can we identify the critical success factors that made them work so that we can apply that learning to our own work?

Case 1 – What matters to me

Who	Jennifer Rodgers @jenfrodgers Lead Nurse for Paediatrics NHS GG&C
What	What Matters To Me (WMTM) WMTM is a 3 step approach 1 Asking what matters 2 Listening to what matters 3 Doing what matters
Why	“Clinicians, in turn, need to relinquish their role as the single, paternalistic authority and train to become more effective coaches or partners — learning, in other words, how to ask, ‘What matters to you?’ as well as ‘What is the matter?’”
Where	Yorkhill Children’s Hospital Glasgow – global
When	Last 4 years
How	Originally Jens’ Quality and Safety Fellowship project, building on the concept of Lauren’s list in the USA; national and international presentations, Used the Model for Improvement as the improvement method. Started by asking one child to draw what mattered to them, and staff making every effort to include and react positively to this information –  now used routinely as part of the paediatric admission process. Spread includes other specialties such as the Care of Older People and those with Dementia.

Case 2 Hello my name is…

Who	The sadly very recently deceased Kate Granger (http://hellomynameis.org.uk @grangerkate) a young doctor battling at the time with terminal cancer, made observations about the human interactions she was struggling with at a very vulnerable time.
What	Kate decided to start a campaign, primarily using social media initially, to encourage and remind healthcare staff about the importance of introductions in healthcare.
Why	She made the stark observation that many staff looking after her did not introduce themselves before delivering her care. She felt it incredibly wrong that such a basic step in communication was missing. After ranting at her husband during one evening visiting time he encouraged her to “stop whinging and do something!”
Where	NHS England – Global
When	Last 3 years
How	Twitter campaign initially – #hellomynameis has made over 1 billion impressions since its inception with an average of 6 tweets an hour. Kate has left an incredible legacy with #hellomynameis that will continue to impact positively for patients.

Case 3 The Daily Mile

Who	Elaine Wylie – Headteacher (recently retired) St Ninian’s Primary School, Stirling thedailymile.co.uk
What	The aim of the Daily Mile is to improve the physical, emotional and social health and wellbeing of our children –regardless of age or personal circumstances.
Why	It is a profoundly simple but effective concept, which any primary school or nursery can implement. Its impact can be transformational- improving not only the childrens’ fitness, but also their concentration levels, mood, behaviour and general wellbeing.
Where	St Ninian’s Primary School, Stirling – global
When	Last 3 years
How	The Daily Mile takes place over just 15 minutes, with children averaging a mile each day. Children run outside in the fresh air – and the weather is a benefit, not a barrier.  There’s no set up, tidy up, or equipment required. Children run in their uniforms so no kit or changing time is needed. It’s social, non-competitive and fun. It’s fully inclusive; every child succeeds, whatever their circumstances, age or ability. Elaine demonstrated huge impact on eliminating obesity in her primary one class that had stated the Daily Mile in Nursery.

In each of the cases the idea started with one individual who had a simple, sensible, not necessarily unique idea, but certainly something that was a bit different from the status quo – perhaps even challenging and making the status quo uncomfortable.
Each leader had a degree of power and autonomy in their local context, for Kate this was as an informed patient, so some might argue her ability to influence would have been limited.
Each idea was simple and easy to try in different arenas.
Each was free or relatively low cost to implement, even at scale.
The impact on patients or children was obvious or in the course of early testing clearly demonstrated.
Each leader used social platforms as a spread mechanism.
In every case, the idea clearly feels like it was the right thing to do, or scandalous that it wasn’t happening routinely, something each of us would want to happen if we were the subjects in question. Perhaps even the standard we apply every day in our professional or personal lives and assume that everyone else does too.
So clear evidence to support Rodgers view that “Diffusion is essentially a social process through which people talking to people spread an innovation,” – Perhaps the easy access to social platforms in these cases made ‘people talking to people’ helped in these cases?
Each leader knew their audience and played to that strength – but also and perhaps most importantly in each case, the emotional connection is huge, but each from a very different perspective.
Is the emotional connection the critical success factor in these cases – and something we should consider carefully if we want our work to spread?
Which emotions might you tap in to when trying to engage folk in your great idea? Emotions described in pairs of polar opposites might give you some food for thought and a place to start with your great idea:
Joy or sadness
Anticipation or surprise
Fear or anger
Disgust or trust

You will have many more thoughts than time permits here, but I leave you with a thought of mine… perhaps we all have an opportunity to use a more considered approach to the scale up and spread of good intentions by learning from those that have done that well.
If not you, who? If not now, when?

Simple checklist
How simple have I described my great idea – Have I got my 1-minute ‘elevator pitch’ worked out to easily influence others?
Does it feel the right thing to do?
Is it relatively cheap or free? If not who will fund the idea, now and then at scale?
Am I convinced that it isn’t happening to every patient/family every time, reliably? Do I have the data that proves that?
Do I have the power to influence, or if not, who do I have to get on board?
Do I have the data and story to describe how it works and how easy it is to adopt, including the impact?
What social platform for spread will I use?
Which emotions are triggered, or will I aim to tap in to, in order to engage people to want to do things differently?

Ros Gray recently retired from her post as National Lead for the Early Years Collaborative. Prior to that post she was Head of Patient Safety for Healthcare Improvement Scotland.

 

Fire in your belly by Euan Macleod

What is the fire in your belly?

When it comes to what you do? Do you feel passion for it and are you excited about the possibilities that could come your way, or is it a bit like the guys with the Gaviscon have just hosed you down and your fire is quelled?

 

 

Fire in your belly-you know when you’ve got it

You feel it

Sometimes it is hard to find time to listen to our feelings in the midst of busy work schedules, the passion that you first felt when you entered a career in the NHS may have become blunted by the daily trudge-is it always going to be like that?

I recently mentioned in a blog the creation of the NHS and the welfare state.

Beveridge had a passion for that, but where did that passion come from?

Beveridge’ report might have been destined to be another dry and dusty Government document. What made it a huge public best seller was its breathtaking vision and passionate language. The fiery rhetoric largely came from Scotland after weekends spent with Jessy Mair in the spring and summer of 1942.

Jessy was Beveridge’s close confidante and companion for many years. His biographer, Jose Harris, highlights her influence on him during his visits north of the border:

“Much of his report was drafted after weekends with her in Edinburgh and it was she who urged him to imbue his proposals with a ‘Cromwellian spirit’ and messianic tone. ‘How I hope you are going to preach against all gangsters,’ she wrote. ‘who for their mutual gain support one another in upholding all the rest. For that is really what is happening still in England’. . . .”

Beveridge didn’t miss; the report sold 100,000 copies within a month. Special editions were printed for the forces.

The gangsters referred to by Jessy Mair were the deliverers of health care who profited from the sickness, squalor and disease prevalent at that time. Beveridge clarion call to a sense of community welfare based on need and not ability to pay heralded the start of the NHS.

No surprise that today many of us remain passionate about the values and aspirations of the health service, a service that many of us have experienced as employees, patients and carers of loved ones. There is still some fiery rhetoric and a will to retain and improve on the values and service which the NHS provides.

But it won’t be easy in this time of austerity.

It might need

Guts-More fight

Grit-More passion

Gumption-Being courageous

It means that you find a way to get better

It means that you’re putting in every ounce of extra effort you have

It means that you get pushed down but don’t stay there

Easy to say

Perhaps harder to achieve

But unstoppable when it starts

So what’s your passion and where is it taking you? Share the fire in your belly, it could start a bonfire

Euan McLeod is a Senior Project Officer for the National Bed Planning Toolkit

 

 

 

 

Recreation and Wellbeing by Catherine Mackereth and Michele McCoy

September is well past the holiday season for most people, but we are both just about to go on ours (separately – we see plenty of each other at work!). We both enjoy holidays as it is a chance to relax, a change of scenery, explore new places, try out new things. It’s about recreation. But what do we mean by recreation?

Recreation is about re-creating, about being creative, in whatever way suits us. It is the key to getting refreshed, revitalised and energised. Creativity is a fundamental part of being human and we should take every opportunity to engage in activities that will promote that side of our lives. It is about looking at the world with fresh eyes, whether looking at a piece of art in a gallery, reading a good book, listening to the birds sing, spending time with friends and family, smelling the new mown grass…or making your surroundings look lovely!

 

Public Health as a function recognises the importance of creativity and its contribution to wellbeing.

Not only do we seek to promote it in other people, we are looking at how we can promote creativity in all our work. One example is around how we engage with communities and the general public. There is lots of talk about community engagement at the moment, but are we any good at it? Of course we are interested in engaging about the health and wellbeing of the population whether that is in regard to; promoting healthy behavior, working with colleagues to develop new services, establish positive environments for people. However, what we need to know is whether or not we are really doing that in an effective way?

The questions we need to ask are:

Will a questionnaire, received by email really prompt the kind of engagement that we are looking for? Will a notice in the local paper help us access the people that we really need to talk to? We all lead busy lives , yet we know that talking and exploring ideas will lead to creativity and finding solutions that we may not have found through simply asking a set of questions via the more obvious channels. This is not to say that these approaches are not applicable, but they must not be the only approach. If this is all we do, people may simply disengage. We need to capture the imagination and passion to achieve the sort of engagement which will help to inform our decisions.

We have been talking about what it would feel like if someone was trying to engage with us. We wondered about venue…maybe a comfortable coffee shop, or a trendy wine bar? What about being offered interesting food to make it worth our while? Or a voucher as a token of thanks for our time? None of these are likely in these times of austerity, but maybe we need to start using our creativity to make the whole process more enjoyable.

We have been developing skills across the region in Participatory Appraisal. This is a way of engaging local people using lots of different techniques, such as focus groups, or fun activities which allow conversations to take place as you do something (one of the most enjoyable was going on a boat trip – a captive audience!). Most people enjoy being asked their views, probably because they feel valued, and most people are clear about what would be best for their health, wellbeing and happiness. Given the time, space and the right environment we all have the ability to be creative about solutions for ourselves and others.

Sharing views, then finding solutions and ways of changing how we work to provide the best results are what true engagement is about. Not just being asked what we want, and information being taken away to have something ‘done’ with it. Real engagement might be a longer route, but it is the way of truly empowering people to be part of the decision making process and ultimately supporting communities to take on responsibilities, using the strengths within those individuals and communities, to improve health and wellbeing.

All too often we are working in situations when we feel the need to be logical, be analytical, instead of being creative. We have both experienced the reaction from colleagues when telling them that we have been engaging with communities and spent time drawing images to symbolise a certain situation, but then when they saw how it added value to the words, or the description they began to understand what we were doing and why. So, we would encourage you to welcome creative ideas, whenever they are expressed. It is amazing to see what solutions can be found when you explore that seemingly wacky idea, and at the very least they will keep us entertained. After all, even if there is no obvious solution, a laugh on the way will help make us all feel better. Those of you reading this short piece who are lucky enough to find they can express their creativity in work should count themselves blessed. For those who aren’t, well, maybe it is about finding those little moments that provide an opportunity to inject a new insight or idea into the workplace when possible. And going out at lunchtime to smell the new mown grass and watch the clouds go by may help.

This is a developing area and we have included the couple of links below which may be of interest

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2804629/

https://www.liv.ac.uk/media/livacuk/instituteofpsychology/research-groups/The_Arts_and_Public_Health_Research_Proposal_Final_shortened.pdf

Health and Social Care Integration and the development of the new hospital offer opportunities for being creative in finding solutions to new challenges and ways of working.

We began this blog by stating we were each going off on our respective holidays and whilst these will be different, we will both be making sure that we find every opportunity to be creative and come back to work refreshed.

Catherine Mackereth and Michele McCoy are Consultants in Public Health at NHS Dumfries and Galloway