Jul 112018
 

Kate Mackenzie leading a team trust exercise!

We all know someone who always seems to have boundless energy, a drive that puts Audi to shame. Someone who seems to stuff more into a week than most can in a month – you know the type…the ones with a massively busy job, hectic family with at least 2 dogs and a rescue cat, a baking habit and a highly successful allotment (or amateur dramatics club).

Simply put they are a tour de force (that’s force not France…I won’t stray into cycling analogies). It is precisely these Tours de Force that generally won’t stand for max effort for substandard outcomes and embark upon “sorting things out” or what we like to call “improvement projects”. These are the magicians that yank their metaphorical boots up, declare very loudly that it’s time to change and generally cajole their peers, teams, colleagues to follow suit.

And if that doesn’t work they beg and plead with detractors or pull some supernanny tricks to get them to fall in line (naughty step anyone?). It can be quite a thing to witness.

Problem is that it can quickly become their pet project, their thing, their baby to drive – it is quickly evident in language used “I have to go to a meeting for Chris’ thing” or I need to record some info in Avril’s tool”.

And so for all their success, the Tour de Force worries that it hinges on them being there.

All. The. Time.

And it can. But it needn’t.

Good communication in the early days to make others believe (arghh…the data girl is banging on AGAIN about talking) or identifying another TdF in the midst is a great way of doing a double flanking manoeuvre on the less enthusiastic. It certainly shares the load.

I think great leadership for improvement is about never wavering from your core message, never swaying away from the non-negotiables. Key to the last bit is actually knowing what these are, so that the other stuff, well – let others achieve those in whichever way they choose. Your colleagues are free thinking adults, treat them as such and remember just because you have the drive doesn’t mean you have all the good ideas.

Most importantly drip feed….drip…drip…drip. Same language. Same concepts. If it’s good, it will stick – with or without your presence.

We in 1000 Lives Improvement are always on our own improvement journey, we want to make sure we are using our skills and talents to their best. We had a substantial reboot, 3 years ago heralded by the arrival of an uncompromising English man, very tall, quietly spoken and rather stubborn. He was absolutely insistent about aligning with IHI’s model for improvement and frankly OTT about measurement.

His homeland has come calling and he has answered, leaving our fair and sunny shores. I can’t tell you how many people have asked what will become of 1000 lives improvement without Aidan. Truth is, we know which bits are ingrained in us, which bits still need working on and, of course, there maybe a thing or two that we might revise/quietly let slip.

 

 

 

 

 

It’s an entirely backhanded compliment (but meant in the best possible way) to say “Boss, it’s okay, we don’t need your presence to carry on the great work you started, we got this”

That’s leadership.

May 112018
 

Joanna Doyle, All Wales Nurse Staffing Programme Lead speaking at Quality 2018

I attended the IHI Forum in Amsterdam in May 2018 as part of the 1000 Lives team, showcasing the quality and safety work that is being undertaken in Wales. The Nurse Staffing Programme supports NHS Wales in meeting the requirements of the Nurse Staffing Levels (Wales) Act, which places a legal duty upon Health Boards and Trusts to ensure that they are providing sufficient nurses to allow the nurses time to care for patients sensitively. As Wales is the first country in Europe to legislate on nurse staffing levels, the forum provided the opportunity to showcase the ground breaking work that is being undertaken in Wales, which is generating international interest. As the All Wales Nurse Staffing programme lead, I was delighted to have the opportunity to deliver a poster presentation on the programme of work to healthcare professionals and managers from across the world. The Nurse Staffing Act will prove influential in empowering nurses, providing them with the evidence they need to support their professional judgement when determining the nurse staffing levels they require to deliver safe and effective care to their patients.

The Forum provided the unique opportunity expand my knowledge on a range of quality and safety projects and initiatives. I was able to network with professionals who are actively involved in quality improvement, and have a keen interest in improving the quality and safety of care provided to patients who access healthcare services. The breadth and scope of experience and expertise was extensive and enlightening, providing much food for thought.

I also gained further experience presenting on the national nurse staffing work, this time on an international platform, I was able to talk to delegates from different countries about the challenges they are encountering in relation to nurse staffing within their areas and  how they envisage the Nurse Staffing Programme will benefit patients, nurses and health boards within Wales. Many delegates were keen to find out more about the national programme of work which they acknowledged was a positive way forward with many benefits for stakeholders.

I gained a wealth of knowledge about new and existing quality and safety initiatives that are being introduced in different countries, and this information has provided me with lots of ideas to share with members of the All Wales Nurse Staffing group and colleagues involved in this programme of work.

Aug 292017
 

Allwch chi gofio pryd aethoch chi i’r theatr? Beth oedd yn gofiadwy ac yn bleserus?
Ydych chi’n edrych ymlaen at ymweld â’r theatr eto?

Petai’n theatr llawdriniaethau, a fyddech chi’n teimlo’n wahanol? Dychmygwch:

  • Pe na fyddech yn deall pam neu beth oedd yn digwydd.
  • Petai’n rhaid i chi wisgo dillad rhywun arall (gŵn ysbyty).
  • Ar eich ffordd i’r theatr, roedd pobl yn syllu/ edrych i ffwrdd.
  • Bod y theatr yn arogleuo a bod y goleuadau’n llachar iawn.
  • Yn y theatr, bod golau’n fflachio ar y peiriannau swnllyd.
  • Nad oeddech chi’n adnabod dim un o’r bobl, a oedd yn gwisgo’r un dillad.
  • Eich bod chi’n parhau i ddweud eich bod chi wedi drysu ac yn ofnus, ond bod neb yn cymryd unrhyw sylw. Eich bod chi eisiau gadael, ond eu bod nhw wedi eich atal chi. Bod y bobl yn ymddangos yn flin?

Byddai’n gofiadwy, ond a fyddech chi eisiau ymweld eto?

Allwn ni amgyffred beth yw profiad unigolyn ag anabledd dysgu o ysbyty? A ydym ni’n deall sut mae profiadau blaenorol yn dylanwadu ar ymddygiad yn y dyfodol? Efallai ei fod yn ddiwrnod nodweddiadol ar gyfer gweithwyr gofal iechyd, ond yn ddiwrnod gwahanol iawn i ddefnyddwyr ysbyty. Mae’n hanfodol ein bod ni’n dangos empathi, tosturi, a deall sut gall yr amgylchedd a’r prosesau mewn ysbyty fod yn anodd iawn i bobl eraill. P’un ai a ydym ni’n ymwybodol yn sgil y pasbort ysbyty anabledd dysgu, ein gwybodaeth, neu oherwydd ein bod ni wedi gwrando ar yr unigolyn a’i ofalwyr, mae’n hanfodol ein bod ni’n bodloni’r addasiadau hanfodol, rhesymol hynny ar gyfer triniaeth.

Datblygodd ein tîm Profiad Lleddfu Pryder Cleifion (Soothing Patients Anxiety) “SPA”, i gyflwyno diwrnod llai gofidus a phrofiad cadarnhaol yn y theatr mewn ysbyty. Cyflawnom hyn trwy ddefnyddio cylchau ailadroddol Cynllunio, Gwneud, Astudio, Gweithredu, a thechnegau eraill a addysgwyd gan y cwrs IQT Arian i sicrhau y caiff ein prosesau eu mireinio’n barhaus. Mae cleifion a/neu eu gofalwyr yn bartneriaid cyfartal wrth gynllunio eu gofal. Mae myfyrio ar bob rhyngweithiad ac adborth cyson yn cynnig dysgu newydd i wella’r gwasanaeth yn barhaus. Cyflawnir diwrnod cofiadwy a phleserus trwy dechnegau tynnu sylw y mae’r claf yn eu dewis, wrth roi’r anesthetig cyffredinol, yr ydym yn ei alw’n “anaesthesia diarwybod neu anaesthesia â thema”, sy’n lleihau/osgoi tawelyddiad a/neu reoli ymddygiad yn gadarnhaol (ataliaeth). Caiff yr holl dechnegau eu hymarfer yn y theatr gyda’r claf a’i ofalwyr cyn diwrnod y llawdriniaeth, sesiwn “ymarfer”.

  • Anaesthesia diarwybod – rhoi’r anaesthetig tra bod yr unigolyn dan sylw yn cymryd rhan yn ei hoff weithgarwch a’r dechneg tynnu sylw dewisol.
  • Anaesthesia â thema – caiff y daith ei hadeiladu o gwmpas hoff beth. Fe wnaeth dyn ag anabledd dysgu wneud sylw yn ystod ein clinig asesu cyn anaesthetig pwrpasol, bod y mwgwd wyneb anaesthetig yn ei atgoffa o beth yr oedd peilotiaid awyrennau ymladd yn eu defnyddio yn ei hoff ffilm, Top Gun. Fore’r llawdriniaeth, gwyliodd ef y ffilm. Wrth gerdded i’r theatr, gwrandawodd ar gerddoriaeth thema’r ffilm. Yn y theatr, cymerodd ran mewn rhestr wirio cyn hedfan/anaesthetig. Aeth i gysgu yn dal ei fwgwd wyneb wrth wylio golygfa hediad awyrol trwy i-pod o’i flaen. Ar ôl deffro, derbyniodd dystysgrif hedfan Top Gun.

Mae’r Gwobrau’n ymgorffori’r cyfle i rannu dysgu a dylanwadu ar ofal y tu allan i’ch sefydliad. Y llynedd, enillodd y tîm Wobr Dinasyddion wrth Wraidd Ail-ddylunio Gwasanaeth GIG Cymru, ac eleni, Tîm Anaesthesia  y Flwyddyn BMJ. Mae’n anrhydedd cael gweithio gyda phobl ag anableddau dysgu a’r cyfle cynhenid i herio normau gofal iechyd. Mae ein defnyddwyr gwasanaeth amrywiol ac unigryw yn sicrhau dysgu parhaus a gwella ansawdd, gan fod pob un ohonynt yn ysbrydoli posibiliadau/dewisiadau newydd ar gyfer defnyddwyr yn y dyfodol.

Cwestiwn:

Beth fyddech chi ei angen ar gyfer ymweliad cofiadwy a phleserus â’r theatr?

I gael mwy o wybodaeth:

E-bost: Paul.Harris@wales.nhs.uk

Aug 212017
 

Elinore Macgillivray, National Lead Midwife OBS Cymru

It’s an exciting time in any family’s life when a new baby is expected. With all the assurances of modern healthcare, the expectation is for a pregnancy to end with a healthy mum and baby. Still, for 1 in 20 women obstetric blood loss will be in excess of 1 litre, and for 1 in 200 life threatening bleeding will occur, leading to a number of adverse physical and emotional consequences. Rarely (around once every 3 years in Wales) postpartum haemorrhage (excessive bleeding after childbirth) will result in a baby that goes home without its mother.

Postpartum haemorrhage (PPH) continues to be one of the leading causes that adversely affects maternal well-being (morbidity) in Wales and is in the top 5 quality issues for every maternity unit. OBS Cymru – the Obstetric Bleeding Strategy for Wales is a 3 year national quality improvement project aiming to reduce harm from postpartum haemorrhage. The primary aim of the project is to reduce the number of women suffering a massive obstetric haemorrhage. It also aims to reduce the amount of blood products given, critical care admissions and hysterectomies performed due to PPH.

Over the last 10 years Cardiff and Vale University Health Board has been leading research into understanding the role of blood clotting in PPH. During the sequential research projects undertaken, a reduction in PPH associated morbidity was observed; felt to be not only linked to the impact of the research projects, but to multiple changes in practice.  Following discussion between delivery units across Wales, the themes listed below were identified as crucial to improving mother’s outcomes, and informed the OBS Cymru approach.

How are we going to achieve our aim of reducing harm from PPH?

Wales is in a privileged position of having a dedicated Maternity Network that engages stakeholders from all over country, and provides a forum for sharing ideas, and supporting quality improvement and standardisation nationally. A number of interventions have already been put in place across all Obstetric led labour wards in Wales:

  • Risk Assessment – each woman admitted to an obstetric lead labour ward in Wales will have a standard PPH risk assessment completed, in order to identify those at increased risk.
  • Early identification by means of Measuring Blood Loss – traditionally, we have estimated blood loss following birth, a practice that we are woefully poor at. We are now moving rapidly towards measuring all blood loss following all births, with training supported by the project team.
  • Multidisciplinary Team Working – we have developed a 4 stage PPH management tool which supports a unified approach to multidisciplinary team working. OBS Cymru funds champion teams in each of Wales’ 7 Health Boards consisting of a midwife, anaesthetist, obstetrician and haematologist. These teams have been vital in delivering quality improvement messages.
  • ROTEM point of care testing – machines have been installed in every labour ward in Wales to allow access to rapid coagulation results and guide blood product management.

Of course, in order to demonstrate the positive changes we are expecting, we have a robust system of data collection supported by local OBS Cymru champion teams. This is already beginning to show some positive changes in practice.

Events such as this year’s UK Patient Safety Congress also provide invaluable network opportunities with health professionals all across the UK, and further afield, who share a common interest and commitment to quality improvement in maternity care. These collaborations will allow us to spread improvements across not just Wales, but the rest of the world.

As one of the national midwife leads for OBS Cymru, I passionately believe that this project will have a significant positive impact on reducing harm from postpartum haemorrhage.  After all, no matter what part we play, a healthy mother and baby is what we all strive for.

For more information on OBS CYMRU visit our page

Mar 162017
 

The 2017 #HelloMyNameIs student competition asked healthcare students to submit a 500-word reflective piece on where they’ve used the phrase “Hello! My name is…” and how it’s helped their development as a healthcare professional. Our first winner, Emma Morgan-Williams of Swansea University won on the strength of this submission:


Emma Morgan-Williams, Swansea University

I first became aware of Dr Kate Granger’s ‘Hello my name is’ campaign during the initial lectures I attended at Swansea University. I knew that at some point during my forthcoming placements I would use the phrase, however, I was not expecting it to become one of the very first things I would say.

On the very first day, of my very first ward placement within a local hospital I had the opportunity to use and slightly adapt the phrase ‘Hello my name is’, personally feeling more comfortable with ‘Hiya, I’m Emma’.

My mentor gave me the opportunity to assist in the personal care of a patient who was on end of life pathway. As we entered the patients room my mentor spoke to the family. Before even thinking, the words ‘Hiya I’m Emma, I’m a student nurse. Would you mind if I helped my mentor?’ came out of my mouth.  The family gave permission for me to help, as due to the medication that the patient was having he was not in a position to do so. Even though they had granted me permission, I gave them a further opportunity to change their mind; I did not want them to feel obligated in allowing me to assist. Understanding this was a difficult time for them, I would not have been offended if they had wanted a more experienced pair of hands to care for their Dad at this time.

The simple use of ‘Hiya, I’m Emma’ gave me an instant opening for a conversation with the family. Had I not introduced myself properly I might never have been told how my patient had spent many years working within a hospital setting. I would never have known of his fondness for students. Nor would I have learnt how his daughter thought that it was very fitting that a student was there helping him in his last days. ‘Hiya I’m Emma’ helped me to feel more confident in caring for my patient. ‘Hiya I’m Emma’ meant enabled me to learn more about my patient, due to conversations I subsequently had with the patient’s family. I learnt that he had a nickname that he liked to be called, whereas he hated the name printed on his chart. I found that this aided me when attending to personal care to address the patient with a familiar name. This is something I might never have known if I had not taken the time to introduce myself properly.

This My variation of Dr Kate Granger’s ‘Hello my name is’, ‘Hiya, I’m Emma’ enabled the patient’s family to feel that they could speak to me, that I was approachable and open. This simple introduction made me feel more confident approaching the patient’s family and assisting in the care of the patient. I have used ‘Hiya, I’m Emma’ daily since; I am sure that it will follow me through each and every placement and through the rest of my career.

Mar 162017
 

Emma Morgan-Williams, Prifysgol Abertawe

Y tro cyntaf i mi glywed am ymgyrch ‘Helo fy enw i ydy’ Dr Kate Granger oedd yn fy narlithoedd cyntaf ym Mhrifysgol Abertawe.  Roeddwn yn gwybod y byddwn yn defnyddio’r ymadrodd rhywbryd yn ystod fy lleoliadau, ond nid oeddwn wedi meddwl mai dyma fyddai un o’r pethau cyntaf y byddwn yn ei ddweud.

Ar fy niwrnod cyntaf un, ar fy lleoliad cyntaf ar ward mewn ysbyty lleol, cefais y cyfle i ddefnyddio ac addasu ychydig ar yr ymadrodd ‘Helo fy enw i ydy’; yn bersonol, roeddwn yn teimlo’n fwy cyfforddus yn dweud ‘Haia, Emma ydw i’.

Cefais gyfle gan fy mentor i gynorthwyo gyda gofal personol claf a oedd ar y llwybr diwedd oes.  Wrth fynd i mewn i ystafell y claf fe siaradodd fy mentor gyda’r teulu.  Cyn i mi gael cyfle i feddwl, dywedais y geiriau ‘Haia, Emma ydw i, dwi’n fyfyrwraig nyrsio.  A fyddai’n iawn i mi helpu fy mentor?’.  Cefais ganiatâd y teulu i helpu,  oherwydd ni allai’r claf roi caniatâd o ganlyniad i’r feddyginiaeth yr oedd yn ei derbyn.  Er eu bod wedi rhoi caniatâd i mi, rhoddais gyfle pellach iddynt newid eu meddwl; nid oeddwn eisiau gwneud iddynt deimlo rheidrwydd i mi gael cynorthwyo.  Oherwydd ei fod yn gyfnod anodd iddynt, byddwn wedi deall yn iawn pe byddai’n well ganddynt gael dwylo mwy profiadol i ofalu am eu Tad yn y cyfnod hwn.

Roedd defnyddio ‘Haia, Enw ydw i’, yn ffordd naturiol o ddechrau sgwrs gyda’r teulu.  Pe na fyddwn wedi cyflwyno fy hun yn iawn efallai na fyddwn wedi canfod bod fy nghlaf wedi treulio blynyddoedd lawer yn gweithio mewn ysbyty.  Ni fyddwn wedi clywed am ei hoffter o fyfyrwyr.  Ni fyddwn ychwaith wedi dysgu gan ei ferch y byddai wedi credu ei bod yn briodol i fyfyriwr ei gynorthwyo yn ystod ei ddyddiau olaf.  Roedd dweud ‘Haia, Emma ydw i’ wedi gwneud i mi deimlo’n fwy hyderus yn gofalu am fy nghlaf.  Roedd ‘Haia, Emma ydw i’ yn fy ngalluogi i ddysgu mwy am fy nghlaf, drwy’r sgyrsiau dilynol a gefais gyda theulu’r claf.  Dysgais beth oedd y llysenw yr hoffai i bobl ei alw, a’i fod yn casáu’r enw a oedd ar ei siart.  Roedd hyn yn fy helpu i gyfeirio at y claf gydag enw cyfarwydd wrth roi gofal personol iddo.  Mae’n bosibl na fyddwn wedi cael gwybod hyn oni bai fy mod wedi cyflwyno fy hun yn iawn.

Roedd fy amrywiaeth i ar ymadrodd ‘Helo fy enw i ydy’ Dr Kate Granger, ‘Haia, Emma ydw i’ yn galluogi’r teulu i deimlo y gallant siarad gyda mi, fy mod yn gyfeillgar ac yn agored.  Rhoddodd y cyflwyniad syml hwn fwy o hyder i mi siarad gyda theulu’r claf a chynorthwyo gyda gofal y claf.  Rwyf wedi defnyddio ‘Haia, Emma ydw i’ bob dydd ers hynny; rwy’n siŵr y bydd yn fy nilyn ymhob lleoliad ac am weddill fy ngyrfa.

Sep 132016
 

tdg-tronThe first time I ever saw or heard of Sepsis it was on a death certificate. The death certificate was my brother’s. I remember squinting across the registrar’s table at this little word next to “primary cause of death.” It meant nothing to me.

My brother was… is… Mark. He was 41 years old, married with a 3 year old daughter. He had a family and a future.

At midday on Thursday 31st May, 2012 Mark walked into A&E (London) with stomach pains. By 17.15p.m. he had suffered a cardiac arrest. By 19.00p.m. he was on a ventilator with a 50/50 chance of survival. By 01.00a.m. on Friday 1st June, his kidneys had failed, his odds had shortened and his family were on the M4 having received the phone call nobody wants. The next morning his heart was too weak for dialysis. We know now that he was in septic shock. Multiple organ failure. He fought hard on his last day as did all the ITU staff. Everyone gave everything but sepsis won. He died peacefully lunchtime on Saturday 2nd June.

We couldn’t believe how this had happened. He had a stomach bug. How could we have lost a son, a brother, a husband, and Sophie a dad? Well, what I know now which I didn’t know then is that it can happen, it does happen and it happens far too often. In fact it happens 44,000 times a year in the UK. 2,200 times in Wales. I thought we were one in a million. We were not.

Sepsis is a car crash illness. It is indiscriminate and can affect anyone. It kills nearly a third of all the people it touches. That’s more than breast, bowel and prostate cancer combined. Shocking isn’t it? You know what’s also shocking? If spotted early it’s treatable and preventable.

It’s fair to say that sepsis changed my life. It does that to lives.

Not long after Mark died I met Ron Daniels of the United Kingdom Sepsis Trust and began raising awareness in Wales. I’m now Executive Director of UK Sepsis Trust in Wales. I’ve met Ministers, cycled from West Wales to Westminster fund raising, I speak in schools, at hospitals, to the people in shops and on buses. We have engaged Welsh Government in our work, a cross-party group has been established.  People are listening.

I listen too; to survivors and how they have struggled post sepsis, to the bereaved and how they struggle too.

Awareness and education is everything. People need to know what sepsis is and what it can do. We need to get to a stage where public and health professionals alike are thinking about and recognise sepsis. They need to see it coming because it hides really well. As Mohammed Ali said, “His hands can’t hit what his eyes can’t see” Ironically he recently died from sepsis.

I’ve been helped along the way by some wonderful people both inside and outside healthcare. .  I am on the RRAILS steering group.   As such, I’ve seen first-hand the incredible hard work of dedicated NHS Wales staff committed to improve practice to improve outcomes. The programme is doing some great work striving to educate NHS Wales staff on Sepsis.  We want the same thing.

We’ve even won an award for it! It was fantastic for The Global Sepsis Alliance to recognise and reward NHS Wales for its awareness and education initiatives.

But..

We cannot afford to lose momentum. There can be no resting on laurels. We should celebrate what has been done, be proud but also continue to challenge and champion what still needs to be done. For me, there has to be a collective effort from Community to Cabinet. We need a common language for patients and practice. The patients need a pathway, an All Wales pathway. If we speak about sepsis the same, we can think about sepsis the same. It brings us together and as we say here in Wales… “together, stronger”.

Want to get involved?

@TCTRON

terence@sepsistrust.org

https://www.justgiving.com/fundraising/cycle4sepsis16

Jan 212015
 
Dr Helen Kemp

Dr Helen Kemp

On Wednesday last week, my shared ambition for a one-stop online resource for General Practice became a reality.

The GPOne website was launched by Primary Care Quality and Healthy Working Wales Team in Public Health Wales, with the endorsement of the Welsh Government’s Chief Medical Officer, Dr Ruth Hussey. It was great to feel the support and positive energy at the launch.

After 7 years of development and much collaborative working, this was an exciting time for primary care – the foundation of healthcare in Wales.

Continue reading »

Dec 232014
 
Tracey Cooper

Tracey Cooper

What does work to improve care for patients with leg ulcers, a service that listens to the needs of older people in care homes and a special centre to treat alcohol related injuries have in common?

All these innovations, which were developed by healthcare staff and are making a big difference to patient care, were winners in the NHS Wales Awards earlier this year.

And with just over five weeks until the closing date for entries into next year’s Awards, I can’t wait to see the latest creativity being delivered by staff and students across NHS Wales to transform care for patients.

Continue reading »