Outpatient Parenteral Antimicrobial Therapy (OPAT) – from Cellulitis to Meningioma by Audrey Morris and Shirley Buchan

OPAT as a service has been in use in many countries for the last 30 years. It is a method of delivering intra-venous antimicrobial therapy in an outpatient setting, as an alternative to remaining an inpatient.

Preparation of a typhoid shot in the medical clinicThe advantages of providing this service for the patient means that they have a reduced hospital stay and can return home and rehabilitate in their own environment. In certain cases the patient can continue to work whilst receiving IV antimicrobial therapy therefore causing them minimal disruption to their daily life. Psychologically the patient feels happier, eats better, sleeps better and is more likely to recover quicker in their own home.

In DGRI the service started in 2012 under the “What if?” project. Its main aim at this point was treatment of non-complicated cellulitis leading to the reduction of patient admissions for short term IV antimicrobials. In the intervening years we have developed to become more involved with complicated infections requiring longer lengths of treatment i.e. up to 12 weeks of IV antimicrobials, but the patient is otherwise fit enough return home.

From January 2016 to the end of March 2017 we have released 1419 beds, an average of 3.2 per day. We have treated patients with Cellulitis, Osteomyelitis, Infected Joint Replacements, ESBL, UTI’s, Pseudomonas, Osteoradionecrosis, Lyme disease, Endocarditis, Discitis, Peripheral Vascular Disease, Actinomycosis, SAB, Urosepsis, E-Coli ESBL and Meningioma.


Why do we need OPAT?

In December 2015 a 30 year old man, who we will call John, was referred to us. He is a high functioning gentleman with Spina bifida who regularly competes in Shot Putt events, all over the World. He had been admitted 6 weeks previously with an infection of his hip. He was clinically improving and ready for home. His family were also keen for his discharge. On discharge John was keen to return to weekly training but due the nature of his infection this had to be put on hold. He attended the clinic daily for 12 weeks either at Dumfries or nearer his home at Castle Douglas Community Hospital, even attending on Christmas day. John had a Hickman line in-site and he decided that in order to assist us he would dress according to which lumen we were using, red top red lumen white top white lumen. He made a good recovery and was discharged from us a year ago. John still phones us now and again and had informed us he is back to full fitness, competing again and even throwing further than before. His one regret he told us, was that due to illness he was not selected for last year’s Paralympics but he is working hard to go the next event in 2020.
So why do we need OPAT? To give people like John an effective patient-focused service as good as inpatient care in an out-patient environment. Our aim is to provide patient centred care nearer to home. In some cases we train the patient or their relative/carer to administer IV antimicrobials in their own home, leading to increased independence and putting the patient at the centre of their own care.

Main aims of OPAT.

To provide a high quality efficient clinical service using robust pathways, guidelines and protocols.
Reduce inpatient time and therefore reduce the risk of hospital acquired infections.
Develop the service to meet the changing demands on an overstretched service. With the opening of the new hospital imminent and the call for care nearer to home OPAT can help reduce demands on beds.
image3Improved quality of life for patients. They eat better, sleep better and generally feel better in the own home environment.
Increase patient involvement in delivery of care, continuity of care and communication.
Provide ongoing support at home and utilise a pathway for re-admission if required.
Reduce the length of inpatient stays therefore utilising acute beds more efficiently.
Structured pathway from referral to discharge.
Staff development.

Patient journey from Inpatient to OPAT patient.

We aim to make the transition from inpatient to OPAT patient as quick and painless as possible but have to follow guidelines. Once a patient has been identified by their Consultant as a potential OPAT patient the first step is to complete an SBAR referral form (In Beacon use ‘search for document’ option). On receipt of this we visit the patient to assess them and their needs for OPAT. There are certain criteria which must be met but these are listed on our SBAR referral form and should be considered prior to referral.
The patient is then seen by our Consultant and the OPAT nurse team. If they are suitable and want to become an OPAT patient then the discharge process can begin.
So in summary OPAT provides patient centred care led by a small dedicated team. It clearly reduces the length of inpatient stays, which can be from 2 days to 12 weeks. Patients are very much involved in the method of delivery of their care, they can opt to be trained to do it themselves at home or we try to deliver care as near to their home as possible. We work around their commitments e.g. an elderly patient who has carers in the morning can get a later appointment or in the case of the patient who continues to work we can see them early in the morning to allow then to get to work. Patients feel better at home, they sleep better, eat better and psychologically feel better. They are more in control of their treatment and have continuity of care.

In the words of one of our patients we “made a bad situation better”.


Audrey Morris & Shirley Buchan are Clinical Nurse Specialists in the OPAT team.

Inspirational by Eddie Docherty

As the new Nursing, Midwifery and Allied Health Professions Executive Director I’ve now been in post since February 1st. As I write this blog almost exactly 4 months since starting, Id like to use this opportunity to introduce myself to as many staff as possible, and share some of my initial thoughts.

Prior to starting in NHS Dumfries and Galloway I’d worked in a number of health boards. Initially working in NHS Lanarkshire, in critical care and advanced practice, I moved to NHS Ayrshire and Arran in 2007, initially as nurse consultant for the acutely unwell adult, moving on to senior nurse consultant then associate nurse director. During this period I also worked in NHS Orkney as associate nurse director for 8 months, learning about the challenges and rewards of working in a remote and rural setting. For the year prior to commencing in D&G I worked as the lead nurse for East Ayrshire Integrated Joint Board and Associate Nurse Director for Primary care and Community Nursing. I’ve been incredibly lucky in my career, supported and developed by truly inspirational staff throughout the years, and have maintained roles which have allowed for direct patient contact through most of my time in nursing. Working with patients and staff has always been a key priority for me- its why I started nursing.

This link to inspirational staff continues as I’ve moved to NHS Dumfries and Galloway. At the last Twitter conversation held by the Chief Nursing Officer, Professor Fiona McQueen, one of the questions posed was: – What are you most proud of in your current role? I didn’t hesitate in my answer. I spoke of the compassion I see and hear about everyday from the staff in NHS D&G. The value of compassion is clearly embedded throughout our teams, from the Board to the staff directly delivering care to our patients. The key attitude of compassion in our delivery of care is reflected in the shared behaviours and attitudes I’ve seen in the last 4 months and is the springboard for the excellence in care we all strive for. Of course we aren’t perfect, but on the whole, compassion is being displayed. What I would ask everyone is this- are we compassionate to each other? Are you compassionate to yourself? The organisation is in a period of unprecedented change as we join an integrated world and build a new hospital. D&G couldn’t do just one major change at a time! The financial challenge is more acute than ever as we try to do the same, or even more, with less. If we are not compassionate towards ourselves and each other we may find ourselves overwhelmed and begin to lose touch with the reasons we all came into health care? Something to think about.

We often speak of our challenges, but clearly this period brings significant opportunities. I believe that each team hold the answers to most problems within their areas. The ability to adapt and innovate, to find solutions to complex problems, lie within the gift of all of our teams. If empowerment of staff is to truly have meaning then the staff have to feel empowered to enact change. The application of quality improvement methodology and an understanding of the theories of profound knowledge are the survival tools of the 21st century health care team. I have spoken to staff around our areas about the need for innovation and commonly say “The answer is in the room” It usually is. Someone within the area has the exact answer to the problem. If all staff members can see that improvement is something they do rather than have done to them, combined with the skills and understanding of the science of improvement, we can absolutely change the landscape we all work in.

Speaking to senior nursing, midwifery and AHP staff I have been incredibly impressed with the projects and ideas being developed, and in many areas there is great work being done in one key area: patient experience and satisfaction. For many years patient experience and satisfaction have been placed in the ‘nice to do’ category of work. As we move forward it is clear that the patient experiences of our systems are key to understanding how effective we are. There are many great local examples of this, from such areas as mental health, critical care, occupational therapy and medicine, but we haven’t yet shown our ability to do this at scale and share our learning across the entire organisation. I’m confident we will, following the discussions I’ve had with various teams, but it’s not something we can do without anymore. We look at, and report on, complaints as they come in and use them to look at individual areas of improvement, however, working in Scotland, we don’t spend any time looking at compliments and positive feedback. If we can capture the learning points from the good and bad episodes of the patient experience we can gain a better understanding of the impact we have in a balanced way.

I feel honoured to be Executive Director for Nursing, Midwifery and Allied Health Professions within NHS Dumfries and Galloway. Everywhere I look I see staff members that are committed to the care and well being of their patients and who place the person at the heart of everything they do. We have challenges and opportunities ahead of us and I’m absolutely convinced we can shape the future of our services together to meet the needs of our patients and improve the health of our communities.

Eddie Docherty is Director of Nursing at NHS Dumfries and Galloway


Sometimes you can’t see the wood for the trees… by Laura White

In September 2015 when my team and I were at the glittering Excellence in Care Awards ceremony at Easterbrook Hall after being nominated for not one, but two awards, I found myself pondering what it took for us to get from our lowest low to our highest high…

In early 2014 the Healthcare Environment Inspectorate walked into ICU unannounced and unearthed a catalogue of issues that turned our world upside down. In an instant our team went from a well-oiled machine to a rusty old tractor not knowing how to function.

The title of the blog sums up what we thought, as an organisation none of us could see what the Healthcare Inspectorate saw, we were in fact too close, too involved. For all our nursing care was never in question, we still doubted our abilities as nurses and wondered whether we were failing at the job we worked so hard at and got so much satisfaction from. The shame and embarrassment of having our place of work discussed in the newspapers and throughout the hospital, whilst trying to ‘keep it together’ still caring for critically ill patients and their families, was an overwhelmingly stressful time for all of us. The whole time we seemed to only have one question for each other…”How did this happen?” We put all our time and effort in to caring for our patients, did it matter that there wasn’t a record of the shelves being wiped down? Yes it did.

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We listened to feedback, sought advice and did extensive research around the way we did things. We really dug deep and relearned our roles to include a vast new array of cleaning and infection control measures. It took months of liaising with the Infection Control Team, Domestic Services, Medics, Management, and Estates to name a few. There was clarification sought for EVERYTHING, from everyday things like bed bathing a patient to the fear of the effects of excessive Actichlor on our health.

The transition period between the inspection and the refurbishment of ICU put strain on everyone involved, however during this time it became apparent how well we pulled together, worked as a team and were committed to putting the broken pieces back together in order to be the best we could be. Staff came in to help in their own time, worked extra shifts and there was actually a lot of excitement about working in the newly refurbished unit, it was like a blank canvas. Don’t get me wrong, it wasn’t all plain sailing, the months following the inspection included periods of extremely low staff morale, increased sickness absence and an emotionally fragile workforce who at times found it difficult to talk about what happened to us. We eventually found that discussing the experience with colleagues and other professionals did help to rid us of some of the mixed emotions we were struggling with. Thankfully there did come a time when we realised we had to stop looking back and start looking forward and take the good from a bad situation.

We slowly began to regain confidence in ourselves and became very proud of our ‘new’ unit. During this time it became clear just how many of us had ‘a touch of OCD’! There were times when you could probably have eaten your dinner off the floor in ICU, and we just stopped short of putting Actichlor in our cereal! We now work relentlessly keeping our very extensive cleaning schedule up to date and everyone is involved in adhering to our philosophy of cleanliness, God help anyone who tries to put their gloves and aprons in a domestic stream waste bin! We really are acutely aware of everything now.

We knew that changing habits would be the hardest part but also that these changes had to be sustainable and over time these changes have become the new norm for us. These are the changes which are now the norm to the new staff that have joined us since the inspection and will undoubtedly evolve and develop in the future, as everything does in nursing.  The HEI inspectors have since returned to the unit and saw a drastic improvement in all aspects of cleanliness, which we knew they would.

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Winning the Excellence in Care award for Infection Prevention in a way closed the chapter on the hard times we faced in 2014 and reinforced to us how we took the best from it and got to where we are today. We are dedicated, committed and knowledgeable in Infection Prevention and have regained the confidence we lost when our unit was put under the microscope.

As the saying goes “what doesn’t kill you makes you stronger”.

Laura White is the Senior Charge Nurse for ICU and Surgical HDU at DGRI


12 days……….and so much more by the Patient Safety Team

Sing this to the tune of ‘The 12 Days of Christmas’. Go on you know you want to!!

Safety 1

On the 1st day of Christmas the safety team said to me A pledge to be harm free.

We are all working towards achieving the aims of the Scottish Patient Safety Programme and you can help us achieve this.


On the 2nd day of Christmas the safety team said to me 2 improvement advisors, 2 improvement trainees and a couple of Project Officers to support and guide you to make patient care even safer.

For more information on Patient Safety and Improvement team contact us on ext 34138/34154.

On the 3rd day of Christmas the safety team said to me 3 leaders on a walk round.

There have been 37 leadership walk rounds this year across NHS Dumfries and Galloway. These provide an opportunity for frontline staff to meet with the senior management team and have a structured conversation. This helps to keep leaders in touch with issues for frontline staff that help deliver safe, effective, person centred care and to promote and share areas of good practice.

Safety 2On the 4th day of Christmas the safety team said to me Get it Right For Every Child with: 4 Early Years work streams.

The early years collaborative aims to make Scotland the best place to grow up. It is the first collaborative of its kind in the world that incorporates health, education and social care. There is a huge amount of work going on across our region to improve the care given to babies, children and families.

Take inspiration from this short video showing how nursery children are becoming involved.    http://vimeo.com/102914044

On the 5th day of Christmas the safety team said to me (lets improve handovers with…) 5 Handover questions.

November saw our 1st handover week in NHS D and G. We are the 1st board to focus our improvement work on handovers. We have recognised handover as a priority and for this reason handover has been added to the 9 point of care priorities for DGRI. We are also leading the way for national improvements. Interested? Them please get in touch and

Ask yourself these 5 questions next time you pass over information and see if you can improve the quality of the handover ….

Safety 3

On the 6th day of Christmas the safety team said to me sock it to sepsis! Sepsis 6 saves lives; so can you!

Safety 4The national sepsis awareness day was promoted in DGRI in September. Craig Stobo (from F.E.A.T) came to talk about his very personal account of sepsis. Both he and his pregnant wife contracted Sepsis, Craig survived but very sadly his wife and child did not. Craig also ‘stole shamelessly’ from NHS D and G the idea of the farthest travelled ‘sock it to sepsis’ socks. Here are some of ours. Any guesses as to where we travelled? A real conversation starter as you can imagine!Safety 5

On the 7th day of Christmas the safety team said to me 7 improvement programmes.

The patient safety and improvement team support all of these programmes

  • We manage the programmes
  • provide local learning events
  • coach and teach people
  • offer support and advice
  • link with national teams
  • provide monthly reports to drive improvement at ward level
  • Provide reports for various management boards.

PHEW! Most importantly we want to remain visible to those providing the care and those working on improvements.

On the 8th day of Christmas the safety team said to me 8 (hundred) ICU days between.

Well we thought we were onto a winner here with ICU having 888 days between a central line blood stream infection. However they are actually even better with 994 days today! Almost at 1000 days!!!!   What a fantastic achievement. Well done to all involved!!!!

Safety 6

On the 9th day of Christmas the safety team said to me 9 point of care priorities (plus one).

Surgical site infections                                            Falls                    

Catheter Associated Urinary Tract Infections         Pressure Ulcers

Sepsis                                                                      Safer use of medicines

Heart Failure                                                             Venous thrombo embolism

Deteriorating patient                                                 Handover

Improvement teams have been set up to drive improvement in these areas. If you are interested in any of the above or have some great ideas please contact us and we will put you in contact with the clinical lead.

On the 10th day of Christmas the safety team said to me 10 safety essentials in routine practice.

These are the areas of work that have been the focus since the start of the Scottish Patient Safety Programme in 2008. The trainee improvement advisors have been visiting all areas in DGRI to validate the data around these essentials and have been supporting teams to plan for the future.

11th day of Christmas the safety team said to me 11 local learning events.

In 2014 we provided 11 local learning events …WOW!!!!!!  Our team works extremely hard to ensure we inspire, motivate and provide you with the tools to enable you to make improvements for the people you care for.

Feedback has included ‘fantastic event, very well organised’, ‘great to have time out of the ward to focus on improvements’, ‘great day, everyone went away with a game plan and the tools to implement it’.

On the 12th day of Christmas the safety team said to me 12 months of data.

Measuring helps us to understand whether our changes impact on the goal we have set. As an improvement team our goal was to reduce the number of areas in DGRI not reporting data. The results are shown in the run chart below.

We have demonstrated that by increasing the visibility and accessibility of the team we were able to significantly improve. Well done to all areas. 

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Safety 8We would like to take this opportunity to thank everyone for your hard work and continued support.




Safety 9Have a very merry Christmas and a happy new year.

From everyone in the Patient Safety and Improvement Team.

Handover by Barbara Tamburrini

How good do you think your handover technique is? 

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Handover is an area of our clinical role which we all encounter regularly during our working day. We transfer patients between clinical environments and transfer clinical responsibilities at shift changes, all of which require handover actions.

As healthcare providers, we understand the importance of good handover communication and recognise the clear benefits of this for our patients and our delivery of optimal and safe clinical care. However, all too often, we are familiar with ineffective handover practice and witness the consequences of this on both the care delivered to patients and the outcomes they experience as a result.

This issue was highlighted to me quite a few years ago when inaccurate information passed on at a night time handover had a direct influence on my ability to provide an effective care response. A patient with hyperkalaemia which had yet to be fully assessed or treated, was handed over to the H@N team using an incorrect patient name. The correct patient could not be located resulting in a delay to the clinical response. During this time, an emergency call went out involving this patient and the error in handover communication became clear.

Sadly, the resuscitation attempt wasn’t successful and subsequent investigations confirmed that the incorrect handover was unlikely to have significantly contributed towards the outcome. The response time between handover and clinical assessment could certainly have been much better and this is what left its mark upon me. This delay could so easily have been avoided and could prove significant in another situation. Many years later, the impact of this episode remains vivid and this has taught me valuable lessons around the accuracy of handover communication which I use to enhance and improve handover practice wherever possible.

How do we do this though?

How do we improve something which is often taken for granted and which every health care facility nationwide finds challenging? Poor handover quality and a lack of standardisation have both been observed throughout UK healthcare facilities over recent years. In fact, it is acknowledged that this has led to medical errors, inappropriate investigations and prolonged in-patient admissions. This means we in NHS D&G are certainly not alone in needing to work on improving our handovers.

But does it make a difference that this is a national challenge? Well, the answer to that is probably No as well as Yes! It doesn’t matter whether we are isolated or whether every single facility in the world has issues with handover communication – we still need to address this and improve our practice.

Having said that, because this is a national and indeed international ‘hot potato’, there are many ideas, strategies and tools already developed and implemented in many hospitals which we can learn from and adapt for local use. So, yes, it does make a difference that this is such a widespread issue.

So the next question is – what can we do to improve our handovers?

The answer is – lots! We have many tools at our disposal which are widely available, of significant value and easily accessed but we often overlook the most basic of these…

Barbara 2We can, of course, use our verbal communication skills much more effectively to handover but this is much less effective when used in isolation. Research suggests only around 2.5% of patient data is retained through verbal-only handover methods. However, this increases to as much as 99% when a printed, structured and regularly updated handover containing all relevant clinical information is utilized. It’s really that simple!

The SBAR-R approach (Situation, Background, Assessment, Recommendations, Review) provides us with a platform to structure clinical communication to ensure it is concise, relevant and accurate and is delivered and received in an effective manner.

This last bit, the review, is crucial since we have all been in the situation where we have delivered what we feel is appropriate information but this may not have been correctly received for whatever reason…

Barbara 3Improving our clinical handovers doesn’t just involve using an SBAR-R approach correctly though. NHS D&G have formed a multidisciplinary handover group to encourage, support and improve handover practice throughout the organisation. The group have set the aim of achieving, by August 2019, 95% of patient handovers between clinical teams and shifts across NHSDG which contain all the relevant information required.

To achieve this, the group want to develop and launch an organisational handover strategy. Additionally, the group will engage with clinical teams to encourage the formulation of protocols and procedures which are standardised across the organisation whilst remaining specific to each clinical area.

The handover group are hosting a ‘Safer Handover Week’ from 24th to 28th November involving presentations, educational drop-ins and information sessions to raise awareness of handover practice and its improvement in clinical areas. The week will culminate in a full day event on 28th November in Easterbrook Hall where the handover strategy will be launched and high profile national speakers will deliver presentations. The day will also involve presentations highlighting local initiatives, a storyboard competition and practical sessions to begin engagement with this improvement process.

Could you benefit from this valuable local event? I would suggest the answer is most definitely YES!

The handover group is looking for all staff, whatever your departmental area to come along to the Safer Handover Week sessions and learn more. We are also looking for multidisciplinary teams of ideally 3 people from each clinical area to attend the Handover Day. Become actively involved in improving handover practice across the organisation and crucially, you will have a direct, positive impact on improving handover practice in your own clinical area.

So, you’ve heard a very real story of the impact of poor handover communication upon our ability to practice effectively and you’ve seen ways in which we can improve this to deliver safer, higher quality care for our patients.

Therefore, my final question to you is more of a challenge. Can you really afford not to attend the Safer Handover Week?

Barbara 4

For more information contact: Jean Robson, Director of Medical Education or Rebecca Henderson (x34257 or rebecca.henderson@nhs.net)

Barbara Tamburrini is an Advanced Nurse Practitioner for NHS Dumfries and Galloway

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 66th birthday of the NHS (well ok, its tomorrow actually) and spookily the 66th 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 66th 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”.

ShazEmm2We 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.


ShazEmm3In 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 1st 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

ShazEmm4Independently 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





The Value of Values by Julie Booth

Julie B 1Fred Lee’s book “If Disney ran your hospital 9 ½ things you would differently” argues that nobody has ‘moved the cheese’ when it comes to things that matter most to the patient or what motivates and keeps good employees. Whilst healthcare can’t be compared to Disney there is no denying that as an organisation it is amongst the top in providing excellent service to its guests

With that statement in mind let my first blog begin.

Julie B 2Its hard to imagine a more magical place than Walt Disney World, yet its secret is not magic pixie dust. It is its well trained, enthusiastic and motivated workforce.

 As Walt Disney himself realized

 “you can dream, create and design the most wonderful place in the world, but it takes people to make the dream a reality”.

Julie B 3

Whilst there is no doubt that the patient is at the centre of healthcare, I had the notion that as we prepare to “create and design the most the wonderful place “ in the form the new Dumfries and Galloway Royal Infirmary, it would be an opportunity to reflect on our own values and behaviours.

Within NHS Dumfries and Galloway there is no disputing that we have an excellent workforce that, combined, have thousands of years of service. Yet time marches on (even though in my head I still think I am in my twenties) and this workforce is diminishing through retirements. So how do we ensure that the future workforce that we are recruiting continues this legacy? 

The high profile case of care failure at Mid Staffordshire Foundation Trust and the subsequent Francis Report that followed, focused on the quality of care. Within the Francis Report the importance of  values ismentioned no fewer than 49 times. Although it contained a raft of recommendations one key area commented on was that staff recruited into the NHS should have their values and behaviours tested.

Driven by the need to ensure quality care and person centred outcomes there has been a huge increase in the concept of values based recruitment. 

Values based recruitment (VBR) is defined as an approach which attracts and selects employees on the basis that their individual values and behaviours align with the values of the NHS constitution. VBR is about using a range of tools and techniques to help employee recruit staff who have the right attitudes and values for the job.

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Julie B 5Now where does Disney fit into this? At Disney they audition prospective staff. This starts with a pre interview process which clearly outlines Disney’s expectations of its future employees (or cast members as they are known) which align with its core values. It is at this stage some prospective candidates withdraw from the face to face interview process.

So how did I get so absorbed with values and standards. Over a year ago as part of a development project which linked to various initiatives such as the 15 Steps Campaign and Leading Excellence in Care as a team we developed our ward based values and standards

The starting point was asking three simple questions:

What did the ward look like?

What did the ward feel like?

What did the ward sound like?

Julie B 6The responses from everyone were then framed around the Healthcare Quality Strategy for NHS Scotland  

The purpose of these values and standards is to enable us as a team to have a framework for behaviour within our ward which will empower staff to take action and challenge poor behaviours. It has been interesting whilst researching the initial project and for this blog that various NHS and healthcare organisations are moving to developing their own set of values and behaviours.

Given that 50% of complaints received in the NHS involve issues with attitude and behaviour is it time that we reflect on our own attitudes and behaviours!

I will end this blog on the following quotes

“Much of what needs to be done does not require additional financial resources, but changes in attitudes, culture, values and behaviour”. (Francis, 2013)

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 Julie Booth is the Senior Charge Nurse on Ward 3 Dumfries and Galloway Royal Infirmary