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Found 51 results
  1. Content Article
    Why use this tool? To allow a team to explore the possible reasons, root causes and possible solutions for a problem To visually represent the reasons, root causes and possible solutions for a problem To help identify change ideas and develop an improvement plan To enable team to focus on content of the problem, not on the history or differing personal interests.
  2. Content Article
    Why use this tool? To capture and visually represent all the steps in an existing process. To show everyone in a team how a process works in practice now, rather than what they think is happening, To help identify change ideas for improvement. To visually represent a new process. To assist team building as it should involve all team members in accurately capturing current process and the design of any new process.
  3. Content Article
    What is an ad hoc team? An ‘ad hoc’ team is a team that is made up of various healthcare workers that have never met before. An example of this is the medical emergency team or the cardiac arrest team – doctors, anaesthetists, nurses and other allied health professionals scrambled from around the hospital expected to assess and treat a patient in crisis. Often, we don’t know each other’s names, roles or what skills we each have. What we did in Brighton is to get to know each other… We had a MET meeting every morning. We all got together and introduced ourselves, found out what skills we all had and made full use of any learning opportunities that arose. The ad hoc team worked well. We all knew what to expect, even when a complex situation arose – we all knew who to contact and how we could get the best for our patient. Then in comes a pandemic... Staff have been redeployed; rotas have been changed; the usual rhythm of the hospital has disappeared. Our regular meeting doesn’t happen. This causes problems: Who is who? What skills do people have? Has everyone been fit tested? Where do we get the PPE from during a MET call? How do we communicate to each other? What is the guidance to take blood, do an ECG, defibrillate, order an X-ray during the pandemic? All these questions and anxieties could be discussed at this meeting, but due to a change in working patterns, the change in doctors seeing different patients (Green and Red – COVID + or COVID –), its not possible to meet up. Our technical skills are not a problem – the team have great skills in advanced life support, using life saving equipment. What we are finding difficult is the non-technical skills: communicating, tone of voice, body language. It was hard enough to communicate in a high stress situation before all this pandemic… now its even harder and so much more important! Simulation Simulation has been a large part of how we train in low volume, high risk scenarios in hospital. Cardiac arrests, medical emergencies, emergency intubation, transfer, pacing… you name it we have probably simulated it here at Brighton. I have been on the medical emergency team for 9 years now. I like to think I have experience in most emergencies and know what to do and who to call. All of a sudden, I feel a novice. I don’t even know how to go into the room correctly, I don’t know what I should take in to the room, I don’t know what I should wear; every action, every protocol I would normally do can't happen due to current constraints. I am worrying so much that I feel paralysed to do anything for fear I’m doing it wrong. We have simulations every day at 3 pm at our hospital. These simulations are very low fidelity and include how a medical emergency or cardiac arrest in the COVID-19 patient should run. Simulation can never replace what a real-life scenario will feel like. What simulation can do is allow you to understand what needs to happen, in what order and lets you make mistakes in order for you to learn. Most adults learn from ‘doing’ and from experiences – I am so glad we had this simulation as I was about to attend my first MET call a few days later. My experience attending an airway medical emergency The call went out. "Medical emergency XXX ward – COVID positive". Shortly followed by "Anaesthetic emergency XXX ward- COVID positive". I ran faster knowing that as a team we all had to get there and put full PPE on before we could attend to the patient. If the patient has an airway problem, they will not be able to breathe properly and be at high risk of stopping breathing. I remembered at the simulation exercise that one person needs to be the ‘gate keeper’. I decided to take on this role as I wasn’t sure who had attended the simulation before and knew about this role. My role as gate keeper is to make a note of who is in the room, what role they have and to take messages in and out of the room from the doorway. The notes are not able to be taken into the room, so it would be the gate keeper's role to get the information across to the team inside. I was opening and closing the door and trying to hear muffled voices; I was equally trying to convey important medical information, but they couldn’t hear me well enough. It didn’t help that for many of the team English is not their first language; this made it even more difficult. Our anaesthetic team simulate situations on a regular basis as part of normal work. They turned up at the call already kitted up in PPE and wheeling a trolley with everything they needed on it; all their drugs and equipment were there. One of them – the lead anaesthetist – had a headset on which was connected to a walkie talkie. This made conversing with the team so much easier. We could ask questions from outside the room into the room and vice versa without having to open the door. Clearly, they had rehearsed this scenario before – they too couldn’t hear well so had solved the problem by obtaining walkie talkie devices. They asked for equipment, called for X-ray or asked for more information and I could either relay information, pass equipment or order tests for them – so much easier and safer. The patient had a complex airway and needed to be seen by a specialist. A consultant arrived; one I had not met before. He arrived anxious. He was worried about donning the PPE in the correct order and in swift time. I helped him donn and, while I did that, I reassured him on who was in the room, what had happened and what treatment the patient had had. He entered the room knowing he had the right gear on and what he was facing. This enabled him to think clearly and treat the patient. When it was time to transfer the patient to intensive care, we came across a problem. We had two differing protocols. One was from yesterday, the other was rewritten this morning… which was correct? This was quickly cleared up by calling the author of the protocol, but what would happen at 3 am if this was to happen again? Reflections It was my first time as gate keeper. To be honest, I didn’t know what I should be doing… some of the information from the simulation flew from my mind. Looking back, I should have asked for the name and role of who walked into the room and wrote it on their PPE or used stickers. People were in such a rush to get in and save the patient's life that it didn’t feel like a priority at the time. The walkie talkies were a genius idea from the anaesthetists – this is something that I will take back and see if we can implement the same for all MET calls (anaesthetists do not attend MET calls normally). It reduced the opening and closing of the door, which reduced the amount of aerosoled particles to come out from the room that may increase risk of infection to others. Flattened hierarchy – the moment I had with the consultant outside that room was something I hadn’t experienced before. I noticed his vulnerability, he looked for me – a nurse – for reassurance and guidance which was given with no judgement. At that moment we knew we were one team. Protocols keep changing. We are working where national guidance and local policy changes daily. Without robust ways of disseminating this information we run the risk of doing the wrong thing. As clinicians we are not at our desks monitoring for changes in guidance – we need ways of getting this information to us. We use the ‘workplace’ app – we have a ‘microguide’ for all our up to date policies. This is great to use in normal circumstances but when dressed in PPE we are not always able to access our mobile phones. I wasn’t inside the room. I could see the patient. I could see that he was scared. He couldn’t breathe, he was unable to talk anyway due to his altered airway. How were the team communicating with him? How was he being reassured? Our facial expressions say a thousand words – behind a mask the patient sees nothing. I have heard of the CARDMEDIC flash cards, but can we use them in an emergency? Perhaps we could add them on to the cardiac arrest trolley? The patient is doing well on intensive care now. It would have been ideal for us to debrief; however, half the team go with the patient the other half of the team need to get back to other sick patients, so this can't happen. So much learning comes from these calls; we haven’t got this bit right yet.
  4. Content Article
    So, you have a network in place, a few allies and that’s working well. Your curiosity means that you are asking great questions. Then you hit a brick wall Push a few boundaries and you may find yourself in the middle of a disagreement, whether that’s you as a leader sharing power with your team or as the one brave soul who says "you don’t have the full picture". Whilst it may seem that people ‘in authority’ must find this easy to handle, otherwise they wouldn’t be in charge, at the end of the day this can be scary stuff wherever you sit within your team and the wider system. You could turn back at this stage, but I hope that you don’t. Top tips for dealing with conflict Here’s a few more tips from me, all drawn from my experience of working with individuals and teams wanting to make the right difference for their patients: Pause and take a long hard listen to what’s being said. Stephen Covey says that most people do not listen with the intent to understand, they listen with the intent to reply (1). Take a moment to reflect on how you listen. Empathic listening is not listening until you understand, it’s listening until the other person feels understood. Combine this with patience. Rome wasn’t built in a day and a big shift in the way things happen may take time. Use this opportunity to grow your network of people who share your passion for making a real difference. Last time I talked about power; from our formal positions, expert power derived from our knowledge and experience, and personal power. There’s also a wonderful power expressed through appreciation (2). Nancy Kline recommends a 5 to 1 ratio of praise to criticism. Researchers studied how appreciation effects blood flow to the brain. Less flows when we are thinking critical thoughts. Appreciation is necessary for optimal brain function. It moves to the heart to stimulate the brain to work better. Infectious, it goes a long way especially when someone may be quietly wondering whether something was the right thing (3). And, unusually, emails and texts can be the unsung heroes of appreciation. Being appreciated for what you did that day, that week makes a real difference. So far so good but what if you really cannot agree with the direction of travel? Well you can disagree respectfully and politely. There is a time and place for agreement and disagreement (4). And finally seek some feedback. One of the real benefits of building a network of support is that it can help you hone your practice and build your confidence. It can be difficult to fully engage, give your best and then know how you landed. Was I clear in that meeting? Could people understand what I was trying to say? Was I too forceful? But you can identify a trusted colleague and ask if they will give you some feedback. I often suggest people set this up ahead of time, you receive richer feedback as a result. The Healthcare Leadership Model is also a brilliant tool (5). It’s not just for people with leader in their title. It’s made up of nine leadership dimensions that you can explore at your own pace and then, if the time is right for you, seek feedback from others using the online tool. In return you receive a comprehensive 360 report along with a session with a trained facilitator to help you get the best out of your report. Thanks for reading this – let me know your experiences. Next time I am going to be talking about our responses to change and why it really is a bit Marmite – some of us are wired for change, others less so. But it’s a little more predictable than you might think… References 1 Stephen R. Covey. The seven habits of highly effective people. Franklin Covey, 1990. 2 Video: French and Raven's Bases of Power. YouTube. 2017. 3 Nancy Kline. Time to Think: Listening to Ignite the Human Mind. Ward Lock, 1999. 4 Peter Khoury. How to Disagree Respectfully, magneticspeaking.com 5 Healthcare Leadership Model. NHS Leadership Academy.
  5. Content Article
    The Gloucestershire Hospitals NHS Foundation Trust combined learning from Nottingham’s model and project meetings with education and operational colleagues to determine what would work best for newly qualified staff in Gloucestershire. This programme offered the trust’s most talented newly qualified recruits leadership development, including a diploma in leadership and management, quality improvement training, leadership coaching, facilitated action learning sets and mentoring opportunities with the Chief Nurse. It also resulted in improvements to retention, with all fellows reporting they now felt they had the courage, confidence and skills to pursue their next role within the trust.
  6. Content Article
    In this video, Senior Paediatric Intensivist, Adrian Plunkett from Birmingham Childrens Hospital UK, discusses positive reporting (as opposed to incident reporting) in improving morale and outcome in sepsis.
  7. Community Post
    Here's a recent interesting blog post on leadership under pressure https://www.med-led.co.uk/2019/08/19/under-pressure/
  8. Content Article
    This document outlines the seven Caldicott Principles to be adhered to with in all sectors of the NHS: Principle 1 - Justify the purpose(s) for using confidential information. Principle 2 - Don't use personal confidential data unless it is absolutely necessary. Principle 3 - Use the minimum necessary personal confidential data. Principle 4 - Access to personal confidential data should be on a strict need-to-know basis. Principle 5 - Everyone with access to personal confidential data should be aware of their responsibilities. Principle 6 - Comply with the law. Principle 7 - The duty to share information can be as important as the duty to protect patient confidentiality.
  9. Content Article
    Ward leader, Sarah King, had only been in post for 1 month when all of these concerns came to light and she was set an improvement action plan to improve the feel of the ward by developing the leadership team and creating a strong and supportive environment for a junior workforce. Following the inspection, Sarah developed an action plan that included setting the leadership team clear goals and objectives, improving record keeping, improving medicines management, addressing low moral on the ward and changing a chaotic feeling ward into a busy but controlled feeling ward.
  10. Content Article
    What will I learn? Within the toolkit you will find: The SBAR (Situation-Background-Assessment-Recommendation) technique, which provides a framework for communication between members of the health care team about a patient's condition. Action Hierarchy, a component of RCA2 that will assist teams in identifying which actions will have the strongest effect for successful and sustained system improvement. A daily huddle agenda, which gives teams a way to proactively manage quality and safety. Failure Modes and Effects Analysis (FMEA): also used in Lean management and Six Sigma, FMEA is a systematic, proactive method for identifying potential risks and their impact.
  11. Content Article
    What can I learn? This web page gives you information on: the friends and family test patient insight group an animation on how the quality framework works.
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