Learning from localities – Making Safety Visible

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Improvement Science Fellow Dr Hannah Baird guest blogs for Haelo on her learning from the Making Safety Visible third and final learning session.

As part of my Improvement Science Fellowship I have had the opportunity to join the Haelo team who are leading the Making Safety Visible programme for the GM North East Sector. The programme has included three learning sessions all featuring inspiring local and national leaders.

While all the learning sessions were interesting and I enjoyed seeing the journey the locality groups has been on, the third and final learning session was without doubt, the pinnacle.

The first speaker was Prof Martin Vernon, the National Clinical Director for older people, presenting on prevention and prediction to improve the system flow and outcomes for older people living with frailty, he shared with us his vision that ‘Everybody should know what to do next when presented with a person living with frailty and/or cognitive disorder’.

Prof Vernon revealed shocking statistics on our aging population and the economic impact. More crucially however he discussed that by recognising and assessing frailty we can appropriately risk stratify people and target interventions, such as referring patients for community based strength training to reduce the risk of falls. An idea trailed in New Zealand called the OTAGO Exercise Programme, which has shown to reduce falls in the home by 35%!

 

One statistic given was that patients of 85 year olds admitted to hospital they have a mortality of 50% in the coming year. This prompted a discussion about patient choice to be discharged despite potential ‘risk of harm’ and how effective we are at having end of life discussions with patients. End of life being not only the last few days and hours of life, but the last months.

Hugh McCaughey CEO from South Eastern Health and Social Care Trust – a full integrated system – was the next speaker. He gave an account of the voyage undertaken by his organisation but also his own journey. He referred to Atul Gwande’s book ‘Better’ as an inspiring influence on him. Why settle for being average when we can do better? Being a huge Atul Gwande fan I couldn’t help but agree, and the with the thought my personal favourite Gwande book ‘Being mortal’ it made me think back to the discussions around how we could do better with patients reaching the end of their life, and how we need to ensure they are not spending their last year revolving around the system but asking them and ensuring they are where they want to be.

He described the journey that his organisation has been on – using a ‘SQE’ approach.

  • Assure the Safety?
  • Improve the Quality?
  • Test the Experience?

He talked about the importance of getting a bottom up approach and creating ownership of improvement and safety at the coal face. He touched on the need for politicians to do this to change the way they ask the Health Service for accountability.

From Ireland to Chester – the next speaker was Tony Chambers CEO of the Countess of Chester Hospital speaking about the importance of high reliability systems. He introduced us to the Model Hospital project being undertaken at Chester to create such a system. This ‘live’ patient tracker system allows the patient journey to be tracked and aims to improve flow, by giving up to date and location information on patients, staff and equipment. This sounded incredible – and left me with only one question for Tony – can I please have a job? I will be interested to see the impact of this system on flow and as an A+E trainee and how this will impact those working the front door.

The final speaker of the day, and admittedly my most anticipated, was Professor Michael West, Kings Fund. Having read some of his work around staff engagement I was eager to hear his thoughts on compassionate leadership. His comments on what makes a compassionate leader really struck home with me. He said that leaders need to be:

  1. Attending: that they pay attention to staff and ‘listening with fascination’
  2. Understanding: and have a shared understanding of what they face
  3. Empathising
  4. Helping: taking intelligent action and asking people how you can help them.

Currently we all work in a pressured environment within the NHS and moving into winter, the stress is high. It is easy when things are pressured to lose sight of what our purpose is and compassion can on occasion be forgotten. He talked at length about compassion starting not only with our patients but with ourselves, something I think we in the NHS often struggle to do. We all see colleagues coughing and spluttering in work, scared to take the day off due to poor staffing levels or at least I know I do. How can we take care of others if we don’t take care of ourselves?

How often do we take the time to process traumatic events and reflect on how they made us feel? Professor West talked about the importance of this, and how the highest performing teams, are ‘reflexive’: they take the time to reflect, not only on situations, but on their purpose, their objectives and their environment.

I admit his talk left me feeling restless – how can I be better at being a compassionate leader and how can we take this learning and share it, to improve the satisfaction of our colleagues and in-turn the experience and safety of our patients?

What do you think?

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