Haelo’s Chief Executive Professor Maxine Power has been across the pond in Orlando, Florida, for the 28th IHI Annual National Forum on Quality Improvement in Healthcare.
In her latest blog, inspired by the keynote speakers, Maxine reflects on the pressures facing frontline teams in healthcare, the importance of teamwork and how improvement offers to relieve the strain.
As I sit here in the USA ready to come back to the UK I am struck by the enormous responsibility borne by frontline teams in healthcare. Pressures were evident in July with unprecedented numbers of vulnerable people coming through the doors of our emergency departments. All of our capacity is open and it isn’t even January yet. The day I left the UK our A&E at Salford Royal had experienced overwhelming activity with over 100 patients waiting longer than four hours. Many of you will know that my daughter Charlotte is a newly qualified nurse. In Haelo we work with many nurses and doctors who report ‘unprecedented’ levels of activity in the system which challenge our professionals every day. I wanted to offer our gratitude and my gift of reflection from the IHI conference.
At times like this (holiday season) we often justifiably hear that we ‘don’t have time’ to get involved in improvement projects. I wanted to share my thoughts over the last week about how an understanding of improvement might help us during these stressful times. The first speaker was Captain Scott Kelly, an astronaut who spent over 365 days in space. His message was clear, if I can, you can! He described his humble background and failure in the academic system, he even described his rather average attempts at becoming a US naval fighter pilot but what he reinforced was that his achievements were all a result of taking something which seemed impossible as a whole and breaking it down into manageable goals. Making the unachievable more reachable. This is also what I hear my daughter talking about – when you are faced with overwhelming pressures, its your ability to focus task by task which gets you through. More important, however, is the action of the team. At times of pressure we need to be able to reach out to our colleagues and ask for their help, being sure that they will work with us.
Here at the Forum I heard one of the best examples of team work I have ever had the privilege to hear. This year, Pulse nightclub in Orlando experienced a devastating bigoted attack, when a lone shooter entered the nightclub at 2am and began shooting at random. About one mile down the road the A&E staff at Orlando Health were going about their business – it was a ‘regular Saturday night’. Little did they know that within the next 30 minutes they were going to to receive over 30 people with life threatening gun shot wounds through their doors. We heard from the staff nurse who worked as part of the team and the ER doctor who led the first response. That night, they described how it felt to have one patient after another come into their Emergency Department and the decisions they had to make about the treatments they were able to offer. Their love for their work, their patients and one another was palpable. In the aftermath of the event they have worked together to heal both themselves, their patients and families. What struck me the most was the narrative of the nurse on duty, she said ‘I was being asked to do things I had never done before, to give treatments and drugs normally only given by a doctor, to work outside my licence and to take risks but I knew that if I listened to my colleagues (referring specifically to the doctor in charge) that he would guide me through. We are a team, I wouldn’t let him down and he wouldn’t let me down.’ The room was speechless as she described pausing during the chaos to turn to her friend and colleague to tell her how much she loved her.
You see, improvement isn’t just technical, it’s about emotions and feelings, how we behave with one another, how we lead and how we follow. It’s my genuine belief that it’s the little things that matter. Not what we say, but how we say it. I know this can be challenging when we are under pressure, but when we are under pressure, its even more important that we pull together. If I had one plea over Christmas it’s for us all to be more tolerant and to work outside the traditional box. I know the circumstances at Orlando Health were exceptional but their survival was an absolute masterclass in team work. I think there is an awful lot the NHS can learn from this over the Christmas period and its something I will be thinking about the value of in our improvement work over the coming months. Most improvement costs absolutely nothing. It’s within everyone’s gift to improve their teamwork and interactions.
Somewhat circuitously, my lasting memories of my last conversation with Charlotte are her ‘delight’ that the consultant surgeon was prepared to enter a prescription onto the EPR system because they had no junior doctor to do it. Her delight wasn’t that he did it, more that he did it without objection or rancour and with a smile on his face!
Happy holidays and hang in there our clinical colleagues – you are amazing!
During the conference, Maxine delivered a session: Make Your Data Sing, jointly with Lloyd Provost, Statistician, Associates in Process Improvement. You can read the blog, watch the video and access the slides here.