Welcome to the live event blog from the fifth Improving Theatre Safety Clinical Community event, held on Tuesday 18th September 2018 at Wrightington, Wigan & Leigh NHS Foundation Trust.
Using the clinical communities model, member trusts combined their expertise in June 2017 to launch the next stage of this ambitious improvement journey. At the second meeting, a packed agenda was built around the theoretical framework of Deming's Lens of Profound Knowledge and Rogers Diffusion of Innovation. Watch interviews with members in a short film, capturing the journey so far. The third event was held in February 2018 and is captured in this event blog from Zoe Egerickx, NHS Quest Director. The fourth event was held in June 2018 and you can catch up with what went on through our live blog of the day.
Attendees today represent 8 member trusts including Bradford Teaching Hospitals NHSFT, Calderdale & Huddersfield NHSFT, Countess of Chester NHSFT, Royal Surrey County Hospitals NHSFT, Royal United Hospitals Bath NHSFT, Salford Royal NHSFT, Sheffield Teaching Hospitals NHSFT and Wrightington, Wigan & Leigh NHSFT.
What have we learnt in the past 3 months?
What key principles are emerging in the debrief?
How can we refine the key principles of the debrief?
How do we know we're improving culture?
Opening the event, NHS Quest Project Manager, Sarah Snape recaps the last Improving Theatre Safety event from June and gives an overview of the challenges and benefits of undertaking the debrief, alongside evolution and implementation, and human factors that need to be considered. If you missed the last event you can check out the live blog here.
Sarah welcomes familiar and new faces to the community and begins with our Clinical Community Evaluation where attendees can update on their progress and interaction with the community so far. The data collected allows us to evaluate the programme, assess if we've achieved our objectives and support the network as we move forward as a community.
After completing their Clinical Community Evaluation, Sarah moves on to the first activity.
Attendees are asked to think of an occasion where the debrief has resulted in a positive outcome in their theatre for the patient, the team, and the individual. They are then asked to think of a situation where a better outcome may have been achieved if a successful debrief had occurred in their theatre, and what the impact might have been for the patient, the team and the individual.
Beginning a feedback session, attendees note that because the debrief is not yet embedded in the culture it is hard to show outcomes yet. The debrief may also not affect that individual patient, but instead could offer learning opportunities for future patients.
Attendees are now working with a partner that they have not met before to share their reflections. Participants are encouraged to allow their partner to talk, uninterrupted, to elicit the maximum amount of information. Following this, the listener will probe and question their partner to really learn more about their feedback.
Zoe and Sarah lead the feedback session where we hear some great insight about debriefs across our trusts.
It is noted that debriefs mainly occur when there has been an incident, there is a higher level of importance placed on it if something has gone wrong.
Zoe encourages our participants to share personal stories, positive or negative, to engage people with the debrief. She explains that this is more compelling than discussing an abstract scenario.
Our next session is an overview of the My Q Theatre Safety Collaborative. The project was to develop exceptional safety awareness and healthy departmental cultures. Julie Hall, Paula Aaron and Emma Barker from Wrightington, Wigan and Leigh NHSFT lead this next session.
The project team explain the clinical community challenges, identifying the problems and potential focus areas. They began by capturing an opportunity from a team at Western Sussex, and then used The Model for Improvement as part of their actions.
When pulling it all together they considered what is the improvement toolkit required to get greater engagement?
MyQ (My Quality) was launched on 10th October 2017 as a joint initiative between Leigh Theatres and the Ophthalmology department.
Staff have access to the MyQ system and can add tickets to it, detailing any ideas or suggestions they have for improvement.
However, the project team did note that there have been some issues in set-up. There has been some reluctance with involvement but this is slowly improving.
The team summarise the MyQ project and what is next.
Lesley reinforces the importance of testing and learning before further implementation, and championing the need for a PDSA template.
RUH Bath tested the use of a whiteboard in theatres, in the hope to aid teamwork, capture issues and for debrief to occur. Lesley stresses the importance of planning this test of change thoroughly, to ensure all of the learning is captured effectively. Learning was then put into place for the next test, with further testings planned.
The success of a test lies in what is learned from it, no matter how it turns out.
The project has been a constantly developing process, with increased reliability. They have started to build up standard processes fro when it is spread to other theatres, as well as building up evidence of success.
But, has it made a difference?
Lesley goes on to talk about their current test; action and feedback of issues to next day.
They are going to test the issues raised at debrief being fed into morning theatre huddle for theatre leads, and the daily managerial planning meeting.
Their plan encapsulates a review of the issues and themes to be escalated, including staffing and overbooked lists, as well as gathering evidence of what is an overbooked list.
They aim to inform and get buy-in from speciality and theatre managers for issues to be discussed, and also establishing monthly theatre safety meetings.
The project has been progressing and the team at RUH Bath are now looking at the spread of this project; what is in other theatres in terms of whiteboards. There is also scope for this to be spread to other theatres at RUH Bath.
Don't expect successes on outcomes before the process has been made truly reliable.
Don't forget to learn from your testing and adjust process.
Tackle issues as they arise and never stop measuring.
Our final session of the morning is a debrief: feedback and learning session led by Zoe and Sarah.
Sarah begins by identifying the key Tests of Change to come out of the feedback from participants. This feedback was then taken to a panel of experts to ask for their input.
Sarah highlights that we want to understand why a change is effective before this is spread.
A key question arising is how measures are used, these measures need to give us results to add value to a project. This will then encourage willing to engage with wider team members. Measures should have a qualitative focus, to tap in to attitudes, behaviours and feelings of the team, to encourage the development of the debrief going forward.
It has been decided that the Safety Attitude Questionnaire should be used to capture information for this clinical community, and we will be hearing more about this later in the day.
There have been challenges around who owns the debrief and what does a poor debrief look like compared to a good one. Sarah notes that as debriefs are not standardised, each theatre has to find what works best for them.
A great question from the room is raised: have we identified the purpose of a debrief?
Zoe now leads us on to the next part of the session to look at the key principles of the debrief.
What is the purpose of the debrief?
Zoe then asks what the priority should be, and attendees decide it should be to say thank you.
What are the must-dos of a debrief?
Identifying at the pre-list briefing when the debrief should take place and who will lead it?
Asking what could have gone better, and how?
What should we be doing in a debrief…but perhaps need further testing?
Reflect back to the team brief- what worked and why?
Should there be an Standard Operating Procedure?
Our afternoon is starting off with a session led by Stuart Clough, on how can we refine the key principles?
Stuart starts by asking the group to look at what can you test now?
After working in groups to talk about the tests they're going to do, our teams have come up with some great plans. They have been identifying ideas of what to test.
Gary Owen, Culture Lead Theatres at Countess of Chester Hospitals NHSFT is leading our next session on the role of the education, training and culture lead.
The Countess of Chester hospital operates over 10 theatres with over 100 theatre staff. A series of 'never events' in theatre within a relatively short time, cultural issues, staff retention problems and a lack of ownership of education and training led to Gary's new role to be implemented.
Gary then goes on to explain what he wants to achieve over the coming months in his role.
In our final session of the day, Stuart is taking us through the Safety Attitudes Questionnaire (SAQ).
When will staff complete this?
How often will they complete it?
How could it be used to improve?
Stuart then goes on to explain how we can use the data gathered from the SAQ; what charts are best used to display the data, and how we can glean the most important information.
After a really informative session by Stuart, it's over to Sarah to wrap up the day.
And that brings another fantastic, energising and reflective session to a close.
Feedback from member trusts highlighted the great opportunity the event was to network with other colleagues, whilst also learning some great new skills.
We will be meeting again in February 2019 at Bradford Teaching Hospitals NHSFT where we will continue some of these great discussions!