Patient Safety Leadership Fellowship Progress Report (February- 2011-2012) Dr Serwaa McClean, ST6 Obstetrics and Gynaecology, Yorkshire and the Humber Deanery GMC: 6086356 Introduction: This exciting fellowship started on 7 th February 2011 with introductions to Professor John Wright Director of the Bradford Institute of Health Research (academic supervisor), Professor Derek Tuffnell (workplace supervisor), Consultant Obstetrician and Gynaecologist and Deputy Medical Director, Bradford Teaching Hospitals NHS Foundation Trust and the other Patient Safety Leadership fellow in the West Yorkshire region Dr Victoria Robins, whose background is in Renal Medicine. Prior to starting, there had been the opportunity to review the Patient Safety Leadership handbook which outlined the aims of the programme: To experience practical and academic experience in patient safety and medical leadership from experts in the field. To build a network of expert contacts with today s medical and NHS management leaders. To enhance skills and competencies in patient safety improvement essential for future medical leaders. To develop competencies relevant for the five domains in the Medical Leadership Competency Framework (MLCF) developed by the Academy of Royal Colleges and NHS Institute. 1. Personal qualities and professionalism self-awareness, self-management, selfdevelopment and acting with integrity. 2. Working with others team working, building relationships, and developing networks. 3. Service improvement planning services, managing resources, managing people. 4. Improving services measuring quality and safety of services, promoting innovation and 5. Setting direction understanding contexts for change, applying knowledge and evidence, evaluating impact.
At the first meeting, these aims were discussed and proposed projects were assigned, taking our clinical backgrounds into consideration. Over the next few days, there was a generic induction consisting of introductions to the Executive Board and the remainder of the Patient Safety team at the Bradford Institute of Health Research (BIHR). Individual Projects: On all of these projects I am the assigned leader Mentoring Scheme for Newly Qualified Consultants and General Practitioners Supervisors: Prof John Wright, Prof Clive Kay The first few years as a consultant or General Practitioner is characterised by intensive learning and personal change, and the necessary role development can be a complex and highly variable phenomenon as individuals struggle to cope. Professional support, especially mentorship is believed to facilitate effective role transition and has been seen as a positive development in medicine with considerable official support for it both from the UK government and medical organisations. This stems from a common belief that mentoring is beneficial for doctors. These perceived benefits have been well documented and include greater leadership attributes, improved well-being, job satisfaction, performance and organisational commitment for both the mentee and mentor. There is however little robust evidence to support this, as although there is a large amount of research available which explores mentoring and attempts to evaluate programmes, the data must be treated with some caution. Not only has it been largely collected from medical students and nurses rather than new consultants, but much of the work has been undertaken in US health care organisations which employ a different process of career development for new doctors. In many cases the research is not of high quality as many of the existing studies have not employed rigorous methodological approaches and many articles are descriptive in nature, with authors focusing more on perceptions of the service and the potential value of engaging in mentoring rather than its efficacy in achieving specific outcomes such as improved patient safety and leadership attributes in controlled studies which can delineate causal relationships with any certainty.
As part of a working group with representation from 4 large Acute Trusts, the Yorkshire and the Humber Deanery, the Bradford University School of Management and the Bradford Institute for Health Research (BIHR), we propose to develop a scheme that will not only be to enhance professional skills and socialization as a part of personal development, but also to provide higher quality and safer patient care. This is based on a synthesis of the existing schemes available and the evidence from the literature. Most existing programs lack a concrete structure as well as short and long term evaluation, however our project would be unlike prior work in its goal to bring about change in specific measurable variables such as leadership attributes and outlines a process that might be adopted to develop and evaluate a nation-wide mentoring scheme. Being part of this process has allowed me to develop both academic and clinical skills that enhance my professional and personal development. I have gained experience in conducting literature reviews, semi-structured interviews, writing protocols and qualitative research. I successfully recruited the Leeds Teaching Hospitals NHS Foundation Trust, Doncaster and Bassetlaw Hospitals NHS Foundation Trust, Bradford University School of Management and the Yorkshire and the Humber Post Graduate Deanery (General Practice) as collaborators on the project following discussions with senior representatives of these organisations. Leadership Competencies: Working with others team working, building relationships, and developing networks. Service improvement planning services, managing resources, managing people. Improving services measuring quality and safety of services, promoting innovation and Setting direction understanding contexts for change, applying knowledge and evidence, evaluating impact
Datix Supervisors: Prof Derek Tuffnell, Dr Gerry Armitage The continuing advancement of IT in healthcare has led to an increase in electronic rather than paper reporting. This move towards e-reporting is supported by studies that show that this can lead to not only higher reporting rates but improved quality of the reporting. Datix is a web-based patient safety software package for healthcare risk management applications, which integrates safety, risk and governance elements. It is already being used in the Trust, and supplies the system for data storage and analysis. However, the current reporting system for reporting errors involves the use of paper documentation, even though the analysis is electronic. Practitioners report directly from their clinical base, the report form is then transported by internal mail to their Head of Department or equivalent, and is then sent, again by internal mail, to the Risk Management Department. Once seen by the Risk Management Team, it is then entered into a data base by clerical staffs that transfer the content to a central data base. During this lengthy process, an opportunity is lost to transfer the immediate analysis of the clinician, proximal to the incident, directly to the data base and for timely feedback. Previous work done in the Trust has shown that staff often have a number of concerns about reporting, the general perception being that the process is often a thankless treadmill, characterised by a clumsy method and lacking feedback. As part of my role as Patient Safety Leadership fellow I have been involved in the design and implementation of the Datix incidents module as an electronic reporting tool. I ve worked alongside a multi-professional team with various specialist advisors to develop a bespoke on-line reporting form which was introduced to the Trust in June 2011 to the pilot areas of Women s and Elderly Medicine before rolling out to the remainder of the Trust in a stepwise approach.. Having been trained as a super-user of the system, I am leading the training and dissemination of the new model to users at the sharp end, targeting junior doctors in particular. Leadership Competencies: Personal qualities and professionalism self-awareness, self-management, selfdevelopment and acting with integrity. Working with others team working, building relationships, and developing networks.
Service improvement planning services, managing resources, managing people. Improving services measuring quality and safety of services, promoting innovation and Setting direction understanding contexts for change, applying knowledge and evidence, evaluating impact. Simulation Project Supervisors: Dr Simon Frazer, Prof John Wright The use of medical simulation in the training of healthcare professional is expanding at a rapid pace as the potential to make a significant contribution to improved patient safety becomes more widely recognised. As the face of medical training changes following the introduction of European Working Time Directives, professional bodies (e.g. Royal College of Obstetricians and Gynaecologists) endorse and encourage the use of simulation as a part of core training. On June 7, 2011 a new Simulation Lab and Technical Skills Lab was officially opened at the Bradford Royal Infirmary. As part of the project s working group I attend fortnightly meetings and am gaining valued experience in project management, design of courses and financial business planning. Courses will include multidisciplinary team work training in a simulation setting, aimed to reduce medical adverse outcomes. These will not only focus on developing competencies in procedural skills but also in the generic skills of communication and handover, inadequacies often highlighted in Serious Incidents investigations, and I will be a facilitator. As a part of the research team, we plan to evaluate the use of the new facility. One of the studies we hope to do, in possible collaboration with a US base organisation would involve training doctors to disclose unanticipated outcomes to patients and evaluating whether using simulation as a communication training tool affects patient satisfaction with disclosure and malpractice claims. This study has been done in the US and we would aim to use a similar protocol with UK adaptions. Leadership Competencies: Working with others team working, building relationships, and developing networks. Improving services measuring quality and safety of services, promoting innovation and
Serious Incidents Investigation/Risk Management Supervisors: Prof Derek Tuffnell, Dr Janet Wright I have been a member of the investigation team for serious incidents within the Foundation Trust. Having completed the online NPSA root cause analysis training tool, I am now proficient in techniques such as gap analysis, time lines and can utilise the fish bone model and 5 whys. I have been the lead investigator on a number of internal investigations in Obstetrics and I attend both the department s and the Trust s Risk Management Steering Group and co-ordination meetings. Joint Projects: There are a number of projects that I am involved in with my patient safety leadership fellow colleague Victoria Robins, ST5 Renal Medicine Serious Incident (SI) analysis Supervisors: Rebecca Lawton, Prof John Wright A joint project led by Rebecca Lawton, introducing us to theories surrounding why errors happen with reference to work done by James Reason and Charles Vincent. A contributory factors framework has been developed following the systematic review of 1000 s articles identifying 192 contributory factors, these were then condensed to form 20 contributory factors based on further research done with patients and staff. A total of ninety four (94) completed SI reports ( Trust 1 n=40, Trust 2 n=54) of incidents that occurred over a 2 year period in 2 large Acute hospital Trusts were analysed using the framework; classifying the key factors, contributory factors and root causes. Although key factors are not classically thought of as contributory factors, when analysing the report many important contributory factors and root causes were found amongst the key factors. The reports were analysed individually and results compared with a second analyser giving an initial kappa score of 82%. Areas that didn t correlate often involved different interpretation of what had happened based on prior knowledge of the subject or related areas, or information given earlier in the report. Sometimes disagreement was due to the similarity or overlap involved in the
contributory factors for example, lines of responsibility and leadership and supervision or management of staff/staffing levels and staff workload as these factors are often interlinked and not separable. Interestingly, although bed management came up frequently as a factor stated by patients and staff as to why errors happened, and is often a major factors in SI s involving deteriorating patients, (for example a sick patient being placed on an inappropriate ward, or patients transfer) it did not occur as a stated contributory factor in our analysis. This may be because retrospectively it is hard for the investigating team to work out whether a patient transfer was appropriate or not based on other factors going on the ward. We presented our findings to the Medical Director s office, this was well received and consideration will be given to our recommendations, including the standardisation of reporting styles. We plan to submit our report for publication. Leadership competencies: Working with others team working, building relationships, and developing networks. Improving services measuring quality and safety of services, promoting innovation and Setting direction understanding contexts for change, applying knowledge and evidence, evaluating impact. Training and Action for Patient Safety (TAPS) Supervisor: Beverley Slater The HIEC (Health Innovation Education Cluster) has run a training course in several locations across the region; we have been involved with the latter stages of the project, joining teams from Sheffield and Leeds in analysing their own patient safety problem. The TAPS project involves an organisation identifying teams across their trust. The multiprofessional team identifies an important patient safety problem to their area and taking time out from their usual schedule (2.5 days timetabled over 20 weeks) works together on finding a solution, implementing that solution and measuring the progress. Our roles were to facilitate the groups, providing guidance where necessary and to present our ideas for facilitating change on a wider scale and encouraging social networking to spread patient safety themes.
Leadership Competencies: Working with others team working, building relationships, and developing networks. Service improvement planning services, managing resources, managing people. Improving services measuring quality and safety of services, promoting innovation and Setting direction understanding contexts for change, applying knowledge and evidence, evaluating impact. Clinical Handheld Information System to Support Patient Safety (CHIPS) Supervisors: Dr Simon Frazer, Prof John Wright The transformation from medical student to junior doctor is an exhilarating, exciting and terrifying experience. There is little that can truly make this transition anxiety free. The same can be extrapolated to anyone starting a new job or working on the frontline of a fast-moving constantly changing pressurised environment. The vast amount of information required is difficult to process in one go and retain, especially if that new information does not pertain to the immediate situation. Accessing this information can be time consuming and difficult particularly for staff who are constantly on the move with no dedicated PC access. Guidelines are a particularly underused resource despite the time and effort that goes into producing them. The net result is an inconsistent approach to healthcare which increases the margin for error and therefore compromises patient safety. We aim create a web based app that could provide a source of useful, relevant and important information to all NHS staff that is portable, easy to use and allows rapid access whilst being relevant and up to date, streamlining efficiency and improving safety. The work will initially focus on Bradford teaching hospitals and contain a junior doctor s handbook, information on dealing with common emergencies and other local policies and guidelines. The app could then become a template which other trusts within the Deanery could use to put their own local guidelines and share common policies. We have discussed with external companies and internally about proposed costs and timescales. We have presented the idea to the local Clinical Governance meeting and are working on ideas for
content and how to manage the content in future. We have successfully secured funding from the Yorkshire and the Humber Deanery to develop this innovative project. Leadership Competencies: Personal qualities and professionalism self-awareness, self-management, selfdevelopment and acting with integrity. Working with others team working, building relationships, and developing networks. Service improvement planning services, managing resources, managing people. Improving services measuring quality and safety of services, promoting innovation and Setting direction understanding contexts for change, applying knowledge and evidence, evaluating impact. Venous Thromboembolism Root Cause Analysis (SAFE!) Supervisors: Dr Robin Jeffrey, Prof Derek Tuffnell As part of the SAFE! Campaign, a local hospital program designed to combat problems identified as recurring themes from serious incidents, we have become part of the VTE steering group, developing a RCA tool to be used for all in-hospital VTE and piloting this. We are also assisting in developing wider guidelines such as advice for patients leaving hospital that may require on-going VTE prophylaxis and I have been given the responsibility of depicting this guidance for Obstetrics and Gynaecology in an easy to use flow chart. Leadership Competencies: Improving services measuring quality and safety of services, promoting innovation and
Improving problems with the acute take in the Medicine Directorate Supervisors: Dr Simon Frazer, Dr Robin Jeffrey Vicky and I had the opportunity to be involved in a recent visit to BTHFT by the Yorkshire and the Humber Deanery. The feedback received from the trainees suggested that there were areas of improvement needed within the medical directorate. Being trainees ourselves, we could relate to some of the concerns voiced and following the meeting discussed the option of being involved in the process to identify issues, advise solutions and implement change with the Clinical director of Medicine and the Postgraduate lead for the Trust. This suggestion was welcomed and we are now a part of a steering group which will be informed by ethnographic work, staff interviews and focus groups. Many of which will be co-ordinated by us. Leadership Competencies: Working with others team working, building relationships, and developing networks. Service improvement planning services, managing resources, managing people.. Courses: Leadership and Management Course This course is run by Bradford University School of Management. I worked with a multi-professional group, all of whom hold leadership and/or managerial posts within the organisation, allowing me to network and make valuable contacts in different disciplines; building relationships and enhancing team working skills. I have completed the following modules: Vision and Thinking Strategically Managing and Leading Understanding the Patient Innovation in people management Innovation and the Patient Experience Finance-Asset Management
Post graduate Study- MSc Health Innovation Having explored the available options, I am registered on the University of Leeds MSc Health Innovation program which commenced in September 2011. Our patient safety projects will be considered as the course work for the program. I will be completing the following modules: Dissertation Research Methods Innovation and Evaluation Work based Assessment High Risk maternity Care Leadership in Social and Healthcare Research Involvement: Systematic Review I am undertaking a systematic review Can mentoring be used to develop leaders? as part of my mentoring Scheme project with Reema Sirreyeh, a post graduate student at the University of Leeds. This review will be my dissertation for the MSc I am undertaking. Peer Review (Journal Article) I have had the opportunity to peer review an article for the US based Journal of Patient safety with Dr Gerry Armitage. Case note Review Training I have undertaken case note review training with Prof A Hutchinson a leading expert in this area. This will be a valuable skill for undertaking audits, investigations and empirical research.
Audits: Admissions from the Emergency Department to the Medical Admission Unit at the Bradford Royal Infirmary (September 2011) An Evaluation of the Impact of the RCOG guidance on the recognition of Severe Perineal Trauma (November 2011) Oral Presentations: Life After TAPS (Training and Action for Patient Safety) TAPS workshop, Sheffield May 2011 Electronic Incident Reporting (Datix) Clinical governance meeting, Obstetrics and Gynaecology BTHFT June 2011 Clinical Governance meeting, Paediatrics BTHFT August 2011 Clinical Handheld information System to support Patient Safety (CHIPS) Clinical Governance Steering Group Committee, BTHFT May 2011 Yorkshire and the Humber Deanery Steering Co-ordination Meeting, September 2011 Incident reporting in Healthcare- is it worth the while? A Multi-centred evaluation of drug error reporting scheme Alderhey Children s Hospital, August 2011 Poster Presentations: Admissions from the Emergency Department (ED) to the Medical Admissions Unit (MAU) - an analysis of repetition of data collection. Is it time to streamline the admissions process? The Society for Acute Medicine (SAM) 4 th International Conference, London, September 2011 Training and Action for Patient Safety (TAPS): Patient Safety Skills for General Practice Registrars Royal College of General Practitioners Annual Conference, Liverpool, October 2011
Yorkshire Contributory Factors Framework International Forum on Quality and Safety in Healthcare, Paris, April 2012 An Evaluation of the Impact of the RCOG guidance on the recognition of Severe Perineal Trauma British Maternal and Fetal Medicine Society 15 th Annual Conference, Glasgow, April 2012 Awards/Prizes: 1 st Runner up- Team of the Year 2011 Bradford Hospitals NHS Foundation Trust (Simulation Working Group) Highly Commended- Poster presentation SAM (Admissions from the Emergency Department (ED) to the Medical Admissions Unit (MAU)- an analysis of repetition of data collection. Is it time to streamline the admissions process?) Publications: I have had the opportunity to co-author the introductory chapter of a Patient Safety book targeted at medical students. I also aim to evaluate all of the applied safety programmes that I am involved in and to submit them in due course for publication. Teaching: Under the supervision of Professor Tuffnell I have had the opportunity to Train the Trainers as a member of the faculty on Day 4 of the Royal College of Obstetricians and Gynaecologists Management of the Labour Ward course. This day is aimed at specialty trainees who are completing the Labour Ward Lead advanced Training Skills Module, an ATSM that I wish to undertake myself on my return to clinical training.
As part of my involvement in the technical skills and simulation lab, I have had the opportunity to organise and teach on and the nationally accredited Basic Practical Skills Course for Obstetrics and Gynaecology trainees. Reflection: The valuable experience gained in the area of Patient Safety though the projects I was involved in allowed me to continue to expand my knowledge in this area both through practical experiences, interactions with experts in the field and evidence based information. I continue to improve my time management skills as my work was largely self-directed and I was often asked to present at meetings or chair them. Having regular fortnightly meetings with Prof Wright helped me to remain focussed and motivated, and both he and Prof Tuffnell were supportive and easily accessible. Through observing both of these successful leaders and others, I continue to learn new skills for effective leadership. For example, Prof Wright has a habit of walking around the building and popping into individual offices to ask about our wellbeing and progress on a regular basis. While as a consultant Obstetrician and Gynaecologist it is not likely that I will be able to do this, one of the things I will take away from this year is to encourage the process of a modified open door policy as I have been witness to its success. The team remains motivated, is innovative, dedicated to our cause of improving Patient Safety and develop successful supportive working relationships, inspired by their leader. The opportunity to attend meetings that would normally be outside of my usual remit has been phenomenal! I continue to gain knowledge in the Clinical Governance process and understand the organisational framework of the NHS at local, Strategic Health authority and national levels. By observing different leadership styles, I have a better insight into what makes a meeting successful and continue to gain the confidence to lead these. The opportunity to network with influential clinical and non-clinical staff including general managers has allowed me to have a better understanding and appreciation of the various roles within healthcare organisations. My confidence has also increased having had to approach and recruit other leaders as part of my project work e.g. I was able to set up meetings with the deputy Medical Director at the Leeds Teaching Hospitals Trust and recruit the Trust into the Mentoring Project.
I was encouraged to be innovative and as a result of this, Vicky and I are in the process of developing an app for Junior Doctors aimed to help in our day to day activities. My participation in the Management and Leadership course hosted by the Bradford University School of Management has allowed me to self-reflect; and through psychometric testing I am able to identify my personality profile and learn techniques on how to understand and interact efficiently with other personality types. This has been an advantage for continuing to improve my people management skills. Overall my experience in the post has been challenging but enjoyable. The opportunity allowed me to develop my unique leadership skills. I continue to gain proficiency in clear, concise, consistent communication and am becoming more emotionally mature. I am assertive, self-confident and selfaware and able to build meaningful relationships within my team, organisation and beyond. By adopting these skills and applying them to my clinical practice I am sure that I will achieve my ultimate objective- to improve Patient Safety and be an effective leader. Lead by example Emotionally intelligent Assertive Dynamic Enthusiastic Reliable