Recognising the difference people can make
By Ghada Ramadan
When you start to see things change for the better, what matters is not just what you can measure but how it makes you feel. It’s important to take a moment to recognise the real difference people can make in their efforts to help others work safely.
Here Dr Ghada Ramadan, Associate Medical Director for patient safety at Medway NHS Foundation Trust, tells us a little about the journey they have been on, from special measures through to seeing evidence that improvements are happening. This is not just about seeing a change in terms of data, but also a shift in feeling, of how people are embracing the need to talk to each other about making care safer and taking the steps needed to make a difference to the safety culture in the longer term.
It’s been quite a journey, Ghada says. As for everyone reading this blog, providing safer care for our patients remained our number one priority. However, this imposed numerous and often complex challenges for us as a Trust as we were already placed in quality special measures by the CQC.
We started our safety journey by critically reviewing our Datix reports and serious incidents data. We examined the Trust performance in key safety thermometer metrics and looked at health outcomes data which were available from a number of sources like Dr Foster intelligence, HQIP national audit reports and Healthcare Evaluation Data.
We gathered a wealth of information which revealed the Trust’s safety profile at the time. We then placed each piece in a constellation which led to the formation of our first patient safety strategy for the Trust. The strategy incorporated Trust wide key safety objectives where we could see ourselves doing better, like; reduction of falls leading to severe harm, better sepsis screening and management, compliance with Acute Kidney Injury (AKI) care bundle, early recognition of pressure damage and improvements in national medication safety thermometer metrics. These are just a few of many other objectives which sat within our strategy.
We knew that underpinning any safety work there would need to be a positive shift in the safety culture and attitudes of staff which is reflected on the whole organisation.
We wanted all patients to feel safe under our care and for our staff to feel able to speak up and be supported when things go wrong or when they raise concerns.
We attempted to reach out to every member in the organisation in order to shift people’s mind-sets around what it takes to be brilliant as part of our Better, Best, Brilliant programme. We did this by engaging staff around working more safely.
We held various safety conversations in positive and supported environments in which staff felt encouraged to connect with what we were trying to do. These were in the form of safety briefings, and a number of safety seminars were introduced across the organisation to cascade learning from incidents and look at ways to preventing them from happening in the first place. SWARM events were hugely popular too. This is a novel way of cluster safety learning in specialist groups, which helps to connect, raise the bar and solve issues through group thinking.
By far, the best safety focused round table conversation we held was around “what is risky in your area?”. These conversations gave us a lot of insight about the day to day management of a busy hospital ward and how this can have an impact on patient safety if issues were to be overlooked. This led us to think about introducing “pause and challenge” twice a day, in the form of safety huddles on the wards where safety issues can be identified and ironed-out promptly for better patient care.
Talking to people, listening to them, being available to staff when they need you, appointing patient safety champions and freedom of speech guardians, has all been absolutely central to the approach we’ve taken.
What has really helped us in our safety improvement journey is the support we’ve consistently had from the Trust’s executive leadership team. Everyone’s main focus and drive has been delivering safe and quality care for our patients for whatever it takes. Having support from a project management team helped with pace and keeping the momentum of our work. The establishment of new Trust governance processes and reporting arrangements helped the delivery and sustainability of this work.
We were fortunate to have had the support from Guy’s and St Thomas’ NHS Foundation Trust (GSTT), who collaborated with us for 18 months as part of a ‘buddying’ agreement. The length of time it has taken to recover from quality special measures has surprised us, but through the agreement, we were able to work alongside, and talk things through with, experienced teams who supported us in delivering key milestones of the safety strategy.
Throughout this journey, we’ve learnt that changing cultural norms “the way we do things here” is not easy. Everyone needs time and space to reflect on what is possible to achieve, as change won’t just happen overnight. Changing culture is a constantly evolving process and one should not shy away from challenging the status quo. Changing the culture we work in spanned beyond organisational barriers. We have worked with commissioners to change pathways of referrals and discharges for example; a project which was key to improving flow and hence safety in the organisation.
Like everywhere, we had some non-believers who thought that we couldn’t achieve what we were able to. A number of newly appointed senior medical leaders took on the challenge and led on key safety roles with grace and courage confirming that both leadership and followership is crucial in any success journey.
I’ve learned a lot personally. I didn’t know that I can be so resilient at difficult times. There have been moments where I had little confidence that our recovery was ever possible.
It’s difficult when people say ‘no we can’t do this’ or are resistant to changing the way it’s always been done. What I find starts to shift the conversation is to say ‘please tell me how you would do it, and I will support you to do so’. This is really powerful.
This journey was a mammoth task involving every single member of staff in the Trust being on the same path. My proudest moment so far was when the Trust was taken out of quality special measures in 2017 by the CQC. This success has been helped hugely by our staff who have been brilliant and supported the safety work at the Trust. They have put patient safety at the heart of every decision and action they make. Now our HSMR (Hospital Standardised Mortality Rate) is within the national benchmark, our falls data is below national average and sepsis 6 and AKI bundle compliance is high.
Our staff have been very complimentary too, and in the staff survey 2016, results showed that safety culture and quality of care has improved so I feel we’re moving from better to brilliant every day. Next for us is to keep working on our safety culture. There’s still plenty to do, but we’re on our way to recovery.
Recently we were visited by the Secretary of State for Health, which made us feel so very proud that our efforts have been appreciated and that our contribution to Sign up to Safety has been recognised. We were specifically asked to show how our participation in the campaign led to improved safety in the Trust.
We highlighted details of how we embraced the five pledges and put them in to action and at the heart of our working plans. The conversation we had together that day represented the core of my work at Medway, and our mission to deliver excellent and safer patient care. It felt like a moment when I could say to myself… ‘Hard work pays off in the end!’. It made me want to work even harder and to do more to excel in my day to day job as the visit meant a lot to me personally, and to the clinical teams who helped us on this path of improvement.
Thank you to Ghada for her insights and personal reflections.
At Sign up to Safety we help people talk to each other. To us, this means helping you have conversations where people have a chance to speak, to be listened to, to feel heard and understood; conversations where you can really connect with each other around working safely. We’d love to help you talk in more detail about the ideas and issues Ghada tells us about here. If you would like to ask her about these experiences, or you have a problem you would like our wider community to help you with that relates to any of the above, email us and we’ll get the ball rolling on a conversation for you.