Aug 292017

Can you remember when you visited the theatre? What was memorable and enjoyable? Are you looking forward to visiting again?

If it was an operating theatre, would you feel differently? Imagine if:

  • You couldn’t understand what was happening, or why;
  • You were made to wear someone else’s clothes (a hospital gown);
  • On your way to the theatre the people stared/ looked away;
  • The theatre smelled and the lights were very bright;
  • In the theatre noisy machines had flashing lights;
  • You didn’t know any of the people who all wore the same clothes;
  • You kept saying you were confused and scared, but no one noticed;
  • You wanted to leave, but they stopped you. The people appeared to be annoyed?

It would be memorable, but would you want to visit again?

Can we comprehend how a person with a learning disability experiences a hospital? Do we understand how previous experiences influence future behaviour? It may be a typical day for healthcare workers but a very different day for hospital users. It is essential we demonstrate empathy, compassion and understand how the environment and processes within a hospital may be very difficult for others. Whether, we are aware through the learning disability hospital passport, our knowledge or because we have listened to the person and their carers, it is essential we meet those essential reasonable adjustments for treatment.

Our team developed the Soothing Patients Anxiety “SPA” Experience to deliver a less distressing day and a positive experience within the theatre in a hospital. We achieved this by using iterative Plan Do Study Act cycles and other techniques taught by the Silver IQT course to ensure constant refinement of our processes. Patients and/or their carers are equal partners in planning their care. Reflection on every interaction and constant feedback provide new learning for continuous service improvement. An enjoyable memorable day is achieved through patient choice distraction techniques during induction of the general anaesthetic that we call “stealth or themed anaesthesia” which minimises/avoids sedation/and or positive behavioural management (restraint). All techniques are practiced within the theatre with the patient and carers prior to the day of operation, “a dress rehearsal”.

  • Stealth anaesthesia – covert administration of the anaesthetic whilst the individual involved in their favourite activity and chosen distraction technique.
  • Themed anaesthesia- the journey is built around a favourite thing. A gentleman with a learning disability during our dedicated pre anaesthetic assessment clinic remarked that the anaesthetic facemask reminded him of what fighter pilots used in his favourite film Top Gun. The morning of the operation he watched the movie. Walking to theatre he listened to the theme music. In theatre he was involved in a pre flight/anaesthetic checklist. He drifted off to sleep holding his facemask he watched an aerial flight scene via an i-pod in front of his eyes. On waking he received a Top Gun flight certificate.

Awards embody the opportunity to share learning and influence care external to your organisation. Last year the team won the NHS Wales Citizens at the Centre of Service Redesign Award and this year BMJ Anaesthesia Team of the Year. We are honoured to work with people with learning disabilities and the intrinsic opportunity to challenge the norms of healthcare. Our diverse and unique service users ensures constant learning and quality improvement as they each inspire new possibilities/options for future users.

Question: What would you need for a memorable and enjoyable visit to theatre?

For more information email:

YouTube: NHS Wales Awards The Spa experience

May 152014
Liz Smith

Liz Smith

There was something different about this year’s Quality Forum and it took me a poster tour to work out what it was.

As an abstract reviewer, when that 5 pm deadline in November looms and my inbox becomes full, I am always inspired by the number and variety of proposals people submit. The way these abstracts are written is important; they need to make people say, “Tell me more”.

And that’s the same with the sights and sounds you are bombarded with from all the stands at the Forum. They need to grab your attention and draw you in. They need to make you want to hear more.

This year, I agreed to host a number of the poster tours. These involve moving between posters stands and giving a few minutes to each presenter to share the work they came to display and discuss, and to take any questions. There had been thousands of submissions from people who wanted to share their work on a poster at the forum, and only 700 had been accepted. Continue reading »