Picture the scene in full PPE, with limited opportunity to rest and reflect, how do we all learn and change in response the patients’ needs and the new environment when caring for Covid19 positive patients. Within, NHSScotland we are testing a system where change and improvement is actioned at every opportunity from the bedside to the board. In this blog I will share how that these processes are designed and driven by the front line.
In response to the Covid-19 pandemic, NHS Scotland commissioned a new 1000 bed hospital, the NHS Louisa Jordan, to be established in the Scottish Events Campus (SEC) within 20 days from start to finish.
At the beginning of March, as an NHS retiree, all I knew of this was what I could gain from the National news from the Government daily briefings. After a text from Ann Gow, the Executive Nurse Director and Deputy CEO at Healthcare Improvement Scotland, with a simple one line “Can you get to the SEC?” I thought it random and rather strange. As it was a lovely day, I let two hours pass and I was in the garden enjoying the warm (use your imagination) Scottish spring weather. I popped back into the house checked my phone to see Ann’s next message “BY 2PM”. Following a quick call to accept the brief, and in quick time I set off on the short 1 hour 15-minute journey (lockdown has its benefits), usually a 2 hour drag.
I arrived at an SEC like I’d never seen it before. With over 800 contractors and many familiar NHS faces we set to work to build a hospital including systems, processes, staff equipment to be ready for patients within 20 days.
While many aspects of healthcare are standardised and easy to adapt, there was lots of freedom to operate to design new systems and processes that are truly person centred. However, we would be building a system “work as imagined”. Could we build a care system, 1 patient,1 staff member at a time and explore the unique opportunity to learn and change the system as we go?, while being risk and safety focused.
We wanted to create a “whole system” of learning from the bedside to the Board, less bureaucracy, more action and change while continuously improving the safety and quality of care. If the hospital was to be at full capacity, communication would need to be person centred focused on safety and improvement at the core and start at the bedside.
Within 10 days we had over 150 staff recruited to work in the hospital.
At induction for all staff, our intent was to offer a framework for learning that could be designed by those who provide direct patient at the bedside. We suggested that on each shift, 3 times a day a member of the team would have the opportunity to stop their daily tasks and check-in with colleagues of all disciplines.
A few simple questions may help identify if any changes at all were required to improve patient care, the environment and staff wellbeing. The new recruits suggested and developed the following:
- What went well yesterday?
- What is going well today?
- Things that could be better?
- How are you feeling?
- Changes we have made?
- Anything you need or need help with?
Many of these staff are working in environments currently caring for Covid-19 positive patients and in the spirit of improvement they are testing this system in the live environment (work as done). More on this later in an article that will describe the processes and the learning so far.
Once the data is gathered using the questions, above the information is shared at the beginning of the shift huddle, end of the shift huddles, the whole hospital huddle and executive group every day. Communications and issues requiring immediate address, happen daily at the bedside ‘in the moment’, at the ward level, at whole hospital level and with the executives escalating directly to Scottish Government should a major change be required.
Whole system changes can happen in hours.
Across the whole team: porters, pharmacists, cleaners, allied health professionals, nurses, doctors, managers and ambulance staff are engaged in driving change. They make and change the rules in collaboration with each other to create a person centred healthcare system with improvement at every step. As they say, never waste a crisis. We cannot go back to the way it was before this pandemic.
The staff developing this system are currently working in the most difficult care environments.
In co-design with the teams building these new systems in the NHS Louisa Jordan Hospital, all staff will have freedom to operate offering suggestions and changes for improvement throughout their working day. In collaboration with colleagues from the “Bedside to the board” they are connected in a fast pace communication system to change, improve and learn.
So, going forward we will continue to develop these practices for rapid change and improvement “in the moment” beyond the pandemic.
We would love to connect with others wishing to try this out and hope you can adapt and adopt the above questions for learning capture for your own environment.
Please contact ISQua if you would like to be put in touch with Pat O’Connor
About the Author
Dr Patricia O’Connor has a clinical background as a nurse and midwife with over forty-two years’ experience in the NHS and other healthcare settings. She led the pioneer site for the UK’s 1st patient safety programme: The Safer Patients Initiative. During her tenure at the Scottish Government she led the implementation of the Scottish Patient Safety Programme, including building a national model for quality improvement capability building. As the Deputy Chief Executive of Healthcare Improvement Scotland, Pat has considerable experience of accreditation and improvement implementation on a national scale. She has a PhD from St Andrews University focused on patient safety walk rounds. Pat is a faculty member of the Institute of Healthcare Improvement, and an Honorary Professor at the University of Dundee, School of Management. Pat has extensive experience in the delivery of quality improvement training and education both nationally and internationally with particular emphasis on the patient and family voice at the centre.
