Quality improvement from the dining room table

Summary

Since her last blog for the hub, Claire has moved away from clinical practice as a critical care outreach nurse and has entered the world of patient safety management in a new Trust. Coming out of a second lockdown, Claire reflects on how her experiences working in the NHS are very different from the first lockdown back in March 2020 and the difficulties she's facing doing quality improvement from home.

Content

We have just come out of a second lockdown. This time my experiences working in the NHS are very different from the first lockdown back in March 2020.

As you may have read in my past blogs, the first lockdown wasn’t really a lockdown for me. As a critical care outreach nurse I was going to work as usual; however, the work I was doing had changed. The way we were adapting our environment, our processes was almost exciting – to be able to directly influence rapid change in a usually bureaucratic organisation was novel.  

I remained at work, there was no furlough, and there was no isolation, no Joe Wicks and no cleaning out my cupboards, unlike some of my non-NHS friends.  

This time, the second lockdown, things were different for me. I have come away from clinical practice and have entered the world of patient safety management. Not only have I started a new role, I have started it in a new Trust.

Moving into a new role in a new Trust during a global pandemic has been challenging to say the least. I had spent the past 24 years in the same Trust, the people around me had seen me grow up – literally.  Many of my past colleagues felt like family. It would take me a day to walk round the wards, just once, as every five steps I would meet someone I knew for a chat. I knew who to ask if I had a problem, I knew the nuances of each ward and most importantly, I had tacit knowledge of how work ‘got done’ and how to ‘get it done’.

During the first lockdown I spent much of my time on the intensive care unit and the COVID wards.  There was great sense of comradery, team work and a support network. Yes, the work was difficult, but we had each other and we were able to openly talk about our fears, shed tears and sometimes laugh about what had happened throughout the shift. In an odd way, it felt comfortable.

The second lockdown working for the NHS could not be more different for me.

I have changed roles completely. I have been interested in patient safety for a number of years and have done a little quality improvement (QI).  Quality improvement in the patient safety space is something that I very much enjoyed as a nurse; however, I found that I didn’t have the time, the headspace or, sometimes, the support to immerse myself into a project that made an impact.  It always felt as if I wasn’t doing QI ‘properly’. We were dipping in and out of it, not always following a methodology and grabbing time here and there to write bits up. It often felt we were papering over the cracks and not addressing the bigger problem or tackling multiple problems in a strategic manner.

The upside of doing QI clinically is that you can see the impact your change has made in the work that is being done. Working with many of the stakeholders, who you have a close relationship with, you are able to have brief chats with them about the project without the need for formalised meetings. You feel as if you are making a difference to your world and the patient’s experience.

Being a quality improvement and patient safety manager seemed the logical next step for me. But I now find myself in an alien world. Weirdly my surroundings are very familiar – I’m working from home.

So how do I do QI from my dining room table, in a huge new Trust with people I have never met?

It can’t be done. I can’t make any meaningful change in my own house 60 miles away from a hospital I have not worked in… can I?

During the beginning of my Darzi fellowship we were ‘taught’ to pay attention to the way we were feeling and the stories we were telling ourselves.

The story I was telling myself was not enabling me to be open to the new challenges and opportunities that were awaiting. I remembered being in my comfort zone back in my old role. Yes, I missed that feeling of knowing what I was doing and feeling confident, but I also remembered why I wanted to move. I want to make meaningful differences to the patient experience, safety and to make it easier for staff to do the right thing at the right time.  

If I was going to move to a new role, I was stepping out of my comfort zone. When stepping out of your comfort zone it will feel uncomfortable at times (most of the time).

At the moment I am orbiting the fear zone and trying desperately to break into the learning zone. Although the fear is real, it’s manageable. Slightly odd as it almost feels like excitement too.

Image from 'Step outside your comfort zone' Action Coach

Learning within a new role is always difficult. You might spend time watching others, taking example from role models, shadowing and asking questions when problems or queries arise… but what can you do when there isn’t anyone to ask, when there is no one to watch, no one to guide you?

Skype, MS Teams, Zoom – there are many online tools to help. Interacting with people via a computer is not natural to me. I expect it can’t be natural to anyone? I have come from a role where interacting with people is the main part of the job.  Picking up subtle cues from body language, tone of voice and mannerisms count for so much. This is almost impossible to achieve from a computer screen.

Striking up a rapport with someone new is a real skill and a skill I prided myself on. The skill I had in reality doesn’t seem to work online. My humour is lost (my jokes were rubbish anyway), time is often limited and conversation is structured around tasks – relationship building comes with time, talking at break times and sharing stories.  

The team I work with have been amazing. They are there at the end of the phone at any point. I have been supported. But I’m longing to be surrounded by a bustling environment again. Where ideas can be bounced around, projects discussed and problems resolved rather than booking in one-dimensional, online meetings. This won’t be forever, but we are in the midst of working in a different way and finding our feet.

As for QI from the dining room table… it can’t be done. I can’t make any meaningful change in my own house 60 miles away from a hospital I have not worked in… can I?

Yes you can. You can make a huge difference.  My next blog will be how working remotely you can make relationships, influence and introduce change.

About the Author

Claire is an experienced nurse of over 20 years. She has worked in numerous specialities in the NHS and in different places around the world, from being a repatriation nurse to volunteering in refugee camps and striking up collaborations with nurses in America. More recently, Claire has worked as a Critical Care Outreach Sister since 2011, where her desire for patient safety was ignited.

After winning the Kent Surrey and Sussex Patient Safety Prize in 2016 for her work in cardiac arrest and medical emergency teams, Claire went on to complete the Darzi fellowship in April 2019. It was around this time that Claire began working with Patient Safety Learning.

In September 2020, Claire began an exciting new role as Quality Improvement and Patient Safety Manager for Guys and St Thomas' NHS Foundation Trust. She spends most of her week in this role while working one day a week for Patient Safety Learning as Associate Director of Patient Safety.

Claire's role at Patient Safety Learning includes sourcing content for the hub, Patient Safety Learning’s online platform and community. She also collaborates with health and social care staff, encouraging potential contributors to share their knowledge and experience, helping them to create the content if necessary.