CQC – my message for staff

Dear Colleagues

Tomorrow morning, Thursday 10 July, the Care Quality Commission will be publishing its Quality Report into the services provided by the Trust. The report follows CQC’s visit to and inspection of Medway Hospital in April and May this year. Overall the report rates the Trust as inadequate and, as a result, we remain in special measures. Although there are many positive findings in the report, we now face the challenges of urgently addressing those areas found to be inadequate or requiring improvement.

We are clearly disappointed with the outcome. However, the report did acknowledge that colleagues are committed and take pride in their work. I would like to think that applies to everyone at the Trust and that this is reflected in Caring being rated as good. What I want to reassure you all – and in turn our patients and all our other key stakeholders – is that the executive team under Phil Barnes’s leadership is absolutely focused on working with you to make Medway hospital once again the force it could, and should be.

During the staff briefings that I have held this week, I stressed that we have a number of areas where we must make improvements. I also explained the actions that we have already taken and those underway. And I highlighted those areas where we are already performing well, with both critical care and services for children and young people being rated as good. While maternity services were rated as requires improvement, the inspectors nevertheless commented on the real progress made since their previous inspection, adding that the trajectory was ‘very positive’. The Oliver Fisher Neonatal Intensive Care Unit and the Bernard Dementia Unit also came in for praise.

We are working hard to address the challenges around patient flow and we are confident that, in doing so, we will be able to make the improvements required to our emergency and urgent care pathways. Importantly, too, we have taken action to review and make improvements to our governance arrangements and the quality of our data.  And in terms of staff shortages, we have launched a major recruitment campaign, with onsite open days and a dedicated microsite to recruit more qualified doctors and nurses. We should also not forget that we currently have 160 more nurses caring for our patients than we did 12 months ago.

At the recent Quality Summit, the CQC were quite clear that they did not want to see endless pages devoted to strategy.  They wanted to see highly focused plans with measurable outcomes and immediate action to deliver those plans. Over the past few days I have explained some of the actions we have already taken, and those we plan to take to address the issues raised by CQC. At the same time, the divisional directors have been sharing their action plans with their teams through local briefings. I hope that those briefings have succeeded in informing you of what is going to happen in your areas, and the key role you have, individually and collectively, to play in helping achieve those plans.

We have started our journey to transform Medway. We have a committed leadership team and we have a number of important initiatives already in place around our five priorities – improving basic standards, patient flow, recruitment, control and clinical leadership. We have also implemented some urgent actions in response to the concerns raised by CQC, including increasing the size of our short stay Acute Medical Unit (AMU), alleviating congestion in our Emergency Department. We expect to deliver more highly focused solutions like these over the next few weeks and months, as part of our immediate medium and longer term plans to get us back on track.

Please take some time to read the report, and our press release and that of CQC; the links to those documents will be sent to you early tomorrow morning as soon as the documents have been published. The PowerPoint deck I used in my recent colleague briefings  is already available on the intranet under the CQC pages we have created. We intend coming back to you with regular updates on progress, including more briefings from Phil, myself and other members of the executive team.

Thank you for all your help, your efforts and your support during some very challenging and difficult times. The fact that we are not where we want, and indeed have to be, is no reflection on your own efforts, your passion for your work or your dedication to our patients. What we have to do is work smarter, and work together better as a team. We need to find ways of sharing success and best practice more effectively. And the leadership team need to make sure that we engage you fully in the issues that affect you, our patients and the Trust.

You need to know what is happening, you need to be intimately involved in our plans and you need to be empowered to help us transform Medway. We can’t do it without you. Working together we can, and will make a difference to our patients and the communities we serve.

The report can be found here http://www.cqc.org.uk/provider/RPA/inspection-summary

 

SoMe SoYou

Having enjoyed blogging so much last week as part of #RebootMedway I started thinking about why it was important for nursing leaders (or any healthcare leaders for that matter) to consider using Twitter and/or blogging.

There are many great examples of bloggers and Tweeters, all of whom are inspiring, challenging, humorous and most of all passionate about healthcare and patients.

A few worth following @WeNurses @JuneinHE @NHSE_Dean @LIsaSaysThis @nursingtimesed @nurchat

Short and sweet here are my top 10 (and a bit) reasons why social media is simply fabulous

1. Social Media (or SoME) enables us to connect to the global community, be that nursing, health care or any other network – connection is key!
2. It builds solidarity, when you are having a bad day you can guarantee a fellow twitter follower can brighten your day and give you a gentle prod in the right direction
3. In the past 12 months of being on Twitter I have learnt more and borrowed and occasionally and shamefully stolen great ideas (with permission)
4. Being part of the a global community it really is possible to challenge thinking, never before have I had the opportunity to share ideas and have my ideas challenged
5. At a local level, Twitter and SoMe helps me connect with those who are important to me – my team. Whilst only one method of engagement it is nice and informal and doesn’t require an appointment
6. As an NHS leader SoMe drives accountability, transparency and honesty to those we serve – in my opinion, there is nothing more frightening than being held to account by thousands of SoMe users
7. SoMe is a good tool for building awareness of the good things we do in the NHS, there are buckets loads of bad stories, SoMe is one small way of connecting with the outside world and giving them a window to the good stuff
8. In my humble opinion I think SoMe makes us more humble, in the virtual world there is no hierarchy we all connect and communicate as equals
9. SoME gives you confidence in a world where everyone needs to know who you are and what you are – its ok to be anonymous and just lurk for a bit!
10. It’s fun, I have more chocolate cake recipes than James Martin, Jamie Oliver and Delia put together
11. It goes without saying that SoMe is good for social change, each time we tweet we leave a small foot print on our world that can make a differene

SoMe is not without its pitfalls, as professionals we have an obligation to conduct ourselves professionally which ever method of communication we choose to use. As I often say to colleagues “you are an ambassador for your own brand” and brand awareness is key if you want to survive in a modern world.

So, go forth, blog and tweet and see for yourself what benefits you can yield and most importantly what can you give to our world that in your own small way makes a difference.

For now SoMe SoYou…

To be continued

We started with a simple idea, right patient, right time and right bed.  We wanted to harness the power of a social movement for a common aim to deliver Better Care Together.  We wanted to demonstrate that through unity we could start our journey of discovery and design a better system that would enable us to confidently work towards a better destiny.

Our story is simple, we called it #RebootMedway

Yesterday we were reminded that all too often life can change rapidly, however with every twist and turn you can guarantee that the NHS will do its upmost to care for those in need and respond admirably to the challenges it faces.  Whilst we recognise we are not perfect, we are committed to serving our local community and playing our part in creating a happier and healthier future, working with patients, the wider community and our health and social care partners we can ensure that our services are responsive to those who depend on us.

#RebootMedway has been incredible, I am not a great wordsmith so I am struggling to find the words to describe the huge sense of pride I feel towards #TeamMedway they have responded with commitment, dedication, professionalism, compassion and humour.  Each of these attributes describes humanity at its best, it describes #TeamMedway at its best.

Today was day 5 of #RebootMedway our JustDoIt’ers were as energised today as they have been throughout the whole week.  Our emergency response yesterday was a topic of conversation throughout the day, everyone recounting stories of what they did in response to the incident, the role they played and what they observed from a team who in less than 20 minutes from initial call were ready to receive a large volume of casualties.

After the customary bacon butty (#TeamMedway marches on its stomach), explanation and safety briefing it was straight to the wards.

This morning I started the day with Tracey Crouch our local MP, we took the opportunity to visit our JustDoIt’ers and hear first-hand what a difference they have made.  One very special story is worth telling, Robbie was our JustDoIt’ers his enthusiasm was infectious and his stories of increased confidence as a result of #RebootMedway were compelling and inspiring, we had a typical picture with the ward team and all walked out of the ward thinking – WOW we need to bottle that enthusiasm!

There have been countless ‘Robbie’ stories this week, each inspiring, each worthy of a place in our future and each focused on our patients.  I don’t think in my entire career have I ever worked with a team who were as focused and passionate as #TeamMedway this week really has been special.

Like any project of the size there is a great team who have done all the hard work and kept us focused, in particular I would like to thanks Tracy Rouse (@rouse_tracy), Sarah Lang and Susan Osbourne – without their energy and creativity #RebootMedway would have been little more than an aspiration.  I would also pay special thanks to Jane, Kate and Geraldine who have ensured our Silver Command structure functioned so that we remained focused on the tasks that would enable us to realise right patient, right time and right bed.

There is always a risk that when you start mentioning specific people it is all too easy to miss out key people and teams, so for the entire #TeamMedway – thank you, thank you for being part of a great team.

So, to the all-important highlights of the day:

• For the first time in (we can’t remember) our bed state has moved from black (no beds) to GREEN (beds) – Wow
• Over the past three days 99.47% of our patients were seen within 4 hours
• At the start of the week we had 54 patients who were ready to go home with support or to a care facility, today 45 had been discharged – Wow
• Of those we discharged this week four patients had been with us for over 100 days, this is great for them and ensures they can continue their rehabilitation in a an environment more suitable for their needs
• All medical and surgical patients are in the correct speciality and sub speciality ward – this is great for patient safety
• Our pharmacy team have redesigned the systems so that tables to take home took two hours to dispense rather than 4 hours
• Our surgical assessment unit and medical assessment unit were open and functioning normally
• Our clinical decision unit in ED was returned back to ED
• During the week we had 400 discharges
• During the week our midwives helped 64 little people into this world
• We had nearly 200 JustDoIt’ers supporting the week

I think we have found #TheMedwayWay

This is only the start of our journey, #RebootMedway doesn’t stop tomorrow.  So what happens next, here are just a few things we will be doing differently:

• A project team will be established to ensure we use our Bed Occupancy System to full effect
• Our Bed Meetings have now been renamed ‘patient flow meetings’ and will be held earlier in the day
• All supports services are planning how learning from this week will be used to redesign their services, for example pharmacy will support the admissions and discharge ward, maintain their fabulous performance on take home tablets turnaround and be more visible on our wards
• Learning from the successful discharging this week will be incorporated into the new integrated discharge team which is an exciting development between us, Medway Council and Medway Community Health
• We will explore rapidly the role of the Physician Assistant
• A patient transport ambulance is being provided with immediate affect for the sole use of the admission and discharge ward – this will ensure a more responsive service
• Due to our efforts this week we have been able to open our 8 bedded dementia unit
• We have also brought forward plans and have opened our 8 bedded frailty unit, called McCormack ward

Over the next few weeks the project team will be working through the vast amount of information gathered to ensure we capture the learning and start sharing with the rest of the NHS, we have been delighted with the social media interest in #RebootMedway – many have suggested that other NHS organisations could learn from what we have done this week, we want to share, we want to engage and we want you to be successful.

One final thought from me, our idea was simple, our delivery was inspiring, our staff were incredible, our partners enabled and our patients received better care together.

That’s it from me, this story is to be continued…

The unexpected

Much of today was unexpected, and for that reason I start by acknowledging the devastation caused by the Sheppey Bridge road traffic accident, everyone here at Medway Maritime Hospital is thinking of you, and for those in hospital we have everything crossed for a speedy recovery.

As one of a number of receiving hospitals in Kent and surroundings areas we were placed on major incident alert, as the incident unfolded on TV screens and on the radio the scale of the incident was almost unimaginable. It is truly miraculous that despite the horrific sequence of events there were not more casualties and there were no fatalities.

Like every NHS hospital in the United Kingdom we have well tested major incident plans, so it came as no surprise to me that our team acted swiftly with focus, professionalism and compassion.  It is times like this that you really see human endeavour in action, a sight that feels me with huge pride – every team in our organisation was mobilised, everyone enthused to play their part in putting our patients first.

The first action in any major incident is to establish the command and control structure, we call this bronze, silver and gold.  Luckily this command structure was already in place because of #RebootMedway – much of our success today was a result of #RebootMedway. In large major incidents there is even a platinum commander, usually the Chief Constable, during the day I recalled a previous major incident I was involved with and I remember having a ten minute conversation with the Platinum Commander about commercial wet wipes and clinical wet wipes – it was a fascinating conversation and altogether rather bizarre, thankfully no such conversations were required today!

Within 20 minutes of the major incident being declared our ED was ready to receive trauma patients, our ward teams led by senior nurses and doctors quickly identified patients who could be safely discharged – our focus at this time was ensuring we had sufficient capacity to deal with a high volume of poorly patients and an even higher volume of walking wounded – we also needed to ensure that we could maintain our normal emergency pathway so that patients not involved in the incident would get the same high quality treatment.

Our surgical teams ensured that theatre space was available just in case urgent surgery was required, our critical care team started making extra space for poorly patients who might require the expert skills of our intensive care team.  Our supporting clinical functions like imaging and pathology were mobilised and in position and our quality improvement and specialist nurses were ready to support ED and the wards.

As our frontline teams started to prepare for the first casualties, our support staff were doing a superb job – it was all hands to the pump, our catering staff were delivering extra food to our discharge lounge, our portering team were on standby and our security team were ensuring our site and patients were protected from the inevitable glare from the media.  A small team were deployed to our helipad on the roof in the event of patients arriving by air ambulance.

And to our JustDoIt’ers – yep, our willing group of volunteers were also involved in our response today – they were simply brilliant, they added additional ‘oomph’ to their activities and really made a massive difference.

As the day progressed we dealt with the challenges swiftly, methodically and with patients at the centre.  We established something called ‘battle rhythm’ – this is a term used to ensure regular situation reports and updates are delivered throughout our organisation and to our partners, every 30 minutes we were receiving updates and continually adapting our approach to ensure that we dealt with casualties and ensured our patients in the rest of the hospital were safe.

After 5 hours we declared an end to the major incident, we entered the recovery phase, did a swift ‘hot’ debrief to identify immediate areas for learning  (a ‘cold’ debrief will take place in a few weeks) and then stood down all of our teams along with a MASSIVE thank you!

Later in the afternoon I took the opportunity to visit all of the patients we had received from the incident, I was humbled by some of the amazingly courageous and brave stories of those injured as a result of trying to help others, this was humankind at its best.  This was our team at their best.

Today it was an honour to serve our community. Caring, listening, learning and respecting

*********

Yesterday I asked a couple of colleagues if they would like to guest blog today, #RebootMedway is about a team so I thought it would be great for folk reading this blog to hear from others.

Julia our Principal Medicines Management Pharmacist (@MedsManPharm) kindly obliged, so the remainder of this blog is written by Julia, and I think you will agree it is #fabulous

Finding an Extra Gear 

“The best-laid schemes ‘o mice an’ men gang aft agley” Robert Burns

Yesterday evening, I planned to write another #RebootMedway blog, but was foiled by the Great Sewing-In of Name Labels before the first day of school (I know, I know, I’m a fool for getting the sew-in ones…).

Today, we planned to continue our #RebootMedway journey. So when a 130-vehicle RTC happened on the crossing to Sheppey at 0715 this morning, and a major incident was declared, you might imagine that that plan had to go on hold too.

In reality, because of #RebootMedway, we were in the best position we could possibly have been to respond:

• We were very well staffed; colleagues had actually cancelled days off to support the #reboot.
• We were already working with more hands-on operational coordination than we usually would.
• We were ahead of the game in terms of medicines reconciliation and one-stop dispensing thanks to everyone’s hard work earlier in the week, paving the way for speedy discharge prescriptions today.
• We’d #rebooted our use of IT, so had working printers, workstations-on-wheels and e-transcription sheets that we didn’t have the week before.
• We’d already planned for Pharmacy support to areas we don’t usually cover, so we weren’t spreading existing resources too thinly.
• The whole Pharmacy team was ready, willing and able to step-up, and did so without question, and without fuss.

All in all, we were in a position to send teams of pharmacists and technicians out to support areas such as the Admissions and Discharge Lounge, without feeling over-stretched, disorganised, or like we were compromising our service to other areas. The team pulled together; we felt busy, and there were some hectic periods and moments of stress, but we felt in control.

What if this had happened a few weeks ago? I’m confident we would have found that extra gear needed, and got the work done quickly and safely, but I am also pretty sure it would have been more difficult, more stressful, less smooth.

So the next question: what if it happens again next week, or the week after, when #RebootMedway is over?

I don’t have the answer to that yet…but we’re working on it.

To infinity, and beyond

I just knew that today was going to be a better day, yesterday was a bit ‘gritty’ and didn’t feel quite right, many of the team left feeling a bit despondent that the operational success of Monday hadn’t been achieved during the day – despite the day yielding lots of learning.

How did I know it was going to be a good day, firstly walking the dog at 5am I watched two magpies flying across the horizon (1 for sorrow, and 2 for joy) I am not superstitious but I took the opportunity to say good morning to both of them!  Secondly, irrespective of what happened yesterday it was day three of our discover journey and we already had two full days of learning under our belt which would ensure that we started the day better informed about what works and what doesn’t.  Thirdly, I was excited to be welcoming Jenni Middleton the Editor of the Nursing Times to be a JustDoIt’er to experience first-hand how our social movement experiment was beginning to deliver real benefits to our patients and staff.

Like the previous two days we started with a bacon butty (supplied by our great catering team), coffee and a briefing from the #RebootMedway team and an extra special ‘oomph’ from Denise our Chairman.  The morning briefings have started to have an almost party feel, I am still working on the gangnam style video for the end of the week – surprisingly volunteers have been slow to respond!  After a quick safety briefing and a few more explanations it was time to mobilise the troops.

As I have mentioned in my previous blogs our JustDoIt’ers have been fantastic, without their support, encouragement and sheer determination there would be no #RebootMedway.  I think it is fair to say that our JustDoIt’ers have JustDoneIt and are making a transformational impact in many different ways – to each and every one of you Thank you!

It is also worth mentioning that all of our support services are doing something a little bit different this week, our pharmacy team for example have been making a gargantuan effort, being creative with staffing, staff cancelling holiday to be part of #RebootMedway and a whole manner of changes to process which have meant a more responsive service to our patients and wards.

Jenni and I hot footed it to one of our elderly care wards where we met the team and immediately started helping with delivering the breakfasts.  There had been a couple of housekeeping issues overnight which were causing some consternation, but it wasn’t long before everything was sorted and our patients were making their requests for breakfast.

Working alongside our staff is the best bit about my job, it gives me the opportunity to not only participate in the delivery of care, but also to observe the delivery of care and think about ways of improving the experience for our patients.  Jenni did a great job at the toast and tea, but was less confident with the porridge – remedial action was taken and the porridge soon became edible!  After breakfast was served I was reminded about how the small things make a big difference, a simple task of making a bed turned into a therapeutic intervention, watched by the elderly lady we started having a conversation, much of which was about how appalling our hospital corners were, but it also gave me the opportunity to hear about her concerns, make sure she was eating and drinking enough and assess her mobility and cognitive function.  Doing the simple things makes a big difference, its ok to slow down and spend time – we deliver healthcare 24 hours a day, we don’t have to fit everything in between 9 and 5.

Connecting with our patients is really important, #RebootMedway for me has demonstrated above all else that focusing on our patients really does enable us to provide better care together.

Today I have also been reminded that unexpected conversations in corridors or over a cuppa can yield some truly exciting ideas – now that we have the #JDI mentality it would be fabulous to start seeing these ideas come to fruition.  Afternoon Tea with patients, relatives and staff was one idea I heard about today that really excited me, #TeamMedway has some of the most talented bakers I know – we need to harness this creativity and do something totally different.  We did something similar to celebrate the arrival of the royal baby (it was a fabulous success), why don’t we do it every week?

Many of our patients don’t have people visiting them – yet this week has shown us that we have the most amazingly talented support staff who have really enjoyed the opportunity to support our patients.

It has been a great day today, both personally and professionally and I think it is fair to say that the entire #RebootMedway team were feeling more confident and even more committed to getting it right.  The intelligence and insight over the past 48 hours has enabled the team to refine their approach, iron out problems and identify additional support required so as to ensure that the 107 issues raised since Monday were tackled and resolved – I am delighted to say that 84 issues have been resolved – wow!

During the last 48 hours the issues have been varied, here are just a few:

• IT equipment not working, printers that have been condemned and not replaced
• Patients waiting for tests
• Patients requiring medical reviews
• EDNs not being completed in a timely manner
• Poor availability of transport to take people home
• Lengthy assessment documentation required to assess eligibility for additional care once home
• Medical records being in multiple locations
• Light bulbs not working

The 1pm silver command meeting today was doubly exciting, not only were there tangible signs of improvement we also hosted the Nursing Times weekly #NTTwitchat there was a definite air of confidence and the whole team were buoyant and excited that the small incremental gains that had been achieved over the past few days were beginning to pick up pace.

The #NTTwitchat was a great opportunity to tell others about what we are doing, it should not be underestimated the level of interest (and love) that is being created within the social media networks – many suggested that the entire NHS should follow #TeamMedway and have a reboot, this really is something special and something we should be very proud of.  It is all too easy to dwell on recent reviews, reports and events – but what we are doing this week is our way of acknowledging where we have been and setting a new destiny – a destiny that can be shaped by all of us.

To the all-important highlights of the day (excited)

• Our partners continue to support us in the most incredible way (Medway CCG, KMPT and MCH) – thank you!
• Our pathology team have developed a central reception supported by two members of the team, so far there have been no backlogs this week (something we have struggled with for some time)
• There have been less escalation issues relating to medical reviews, equally there have been no issues relating to the timely completion of EDNs
• Of the 54 patients at the start of the week who no longer required hospital care, a fabulous 42 have been discharged either home with support or to a step down facility
• The system wide assessment process for ongoing health needs (we call this the INP) for the first time in 5 years has been shortened – it normally takes our nurses at least 3 hours to complete, today the new version was used and it took 30 minutes
• Our transport provider has agreed to provide a designated ambulance for our discharge lounge starting from tomorrow – this will mean our patients get a responsive service and our staff won’t be required to work late
• All of our medical and surgical assessment areas are open
• Our Clinical Decision Unit in ED was being used as an overflow from our medical assessment unit – we have reverted back to a CDU which will help our ED manage patient flow
• We are beginning to use our BOS system more robustly to better understand projected dates of discharge, this will help us plan each day
• Feedback from our medical records team has highlighted that our wards and medical secretaries are making every effort to ensure medical records are returned to our patient service centre.
• Our JDI’ers have been busy ensuring that medical records are tidy so that information can be accessed chronologically
• Despite having a poorly PAS today – our IT team have been brilliant and have developed a technical work around so that areas that need access have access
• We had 71 discharges today
• ED was described as looking and feeling ‘beautiful’
• The XXL #RebootMedway t-shirts have finally arrived!

Today has been the most amazing day.  Why to infinity, and beyond?  If I wanted to sum up today I really felt like we have turned a corner both operationally and culturally – I know culture takes many years to change, but today felt different there was an air of confidence that not only could we aim for infinity, we could probably start looking beyond.

I don’t doubt that the next few days will bring many more highs and lows, but we are building resilience in both our systems and processes and most importantly each other, its ok to fall and its ok to celebrate, so as Buzz Lightyear said “This isn’t flying, this is falling with style!

Until tomorrow, it’s to infinity, and beyond from me……..

Discovery

Our voyage of discovery has commenced, a voyage into unknown territory which is locally known as #RebootMedway a simple initiative to deliver a synchronised shock to our system in the hope that it will reset and operate within normal parameters.

Just like yesterday the day started with another group of fantastic volunteers, our own staff who both individually and collectively want to make a difference, we are calling this group of volunteers JustDoIt’ers or commonly known as the JDI Team. It goes without saying that without this group of individuals there would be no #RebootMedway – you have been simply fantastic, in fact one of our JDI’ers was described today as a “miracle in action”.

Just like all good West End shows the main characters are supported by a highly talented and committed team who ensure that the show continues despite any minor (or major) wardrobe malfunction. For us at #RebootMedway this is our silver command team who despite being housed in what felt like a sauna today have worked tirelessly to maintain pace, to listen, to learn and to eat their entire body weight in humbugs, chocolate and drum stick lollipops.

To be honest, everyone involved in #RebootMedway is doing a fabulous job, our Chief Executive commented at one of our earlier planning meetings that “if nothing else we will learn about how we work together” – so irrespective of performance we are learning about how we work together, the infrastructure needed to deliver exceptional care and most importantly how the patient is the focus of all that we do.

Gold command today was supported by Jason our Director of Strategy and Governance, given my excitement I just couldn’t keep away – so attending the 9.30 am silver command briefing was high on my priority – to sit observe and listen. Following the normal pleasantries and exchange of commentary and sweets we sharpened our focus and had an update on activity over night.

I think most people will agree that today has been slightly more challenging – but that’s ok!

When you embark on a journey of discovery there will be times of great joy and there will times of utter frustration, despite lots of great work yesterday our position this morning didn’t feel quite right – there were many reasons for this – not least a higher than expected number of poorly surgical patients who rightly needed our treatment and care and the realisation that every stone you overturn another three are hiding underneath – but that’s half the fun!

The principle aim of #RebootMedway is about understanding how we can reboot and design a better destiny with our patients. If anything, this week is entirely about discovery, it’s not about winning it’s about taking part so that we can sustain what we find during our discovery phase.

I have many reflections on today, the entire #TeamMedway want this to be a success, everyone is working hard to deliver the improvements we need – and it really is beginning to make a difference. This morning I was greeted by a wonderful car parking attendant, our estate team have been busy sprucing up our gardens and cleaning windows – it just feels different, these small things make a big difference to both patients and staff and should not be underestimated.

There are lots of highlights so far, here are just a few

• Our JDI Team have been visible and gratefully received by our ward teams
• 107 issues have been raised and 65 have been dealt with
• More patients have been moved to their correct speciality wards
• Our partners, in particular Medway CCG and Kent and Medway Partnership Trust have been amazing today and really helped us deliver a responsive service to our patients
• Our pharmacy team have miraculously expanded and are providing services and support that speed up the discharge process
• We have already identified the quick wins, we are now working on the difficult issues that really don’t help our staff
• Wearing the #RebootMedway t shirt has given our JDI Team permission to ‘JDI and some’
• The energy created throughout our organisation is palpable
• Our IT team have opened access to word press so that staff can read this blog at work!
• A real eureka moment for me and the team was when we realised that our BOS IT system could actually deliver more insight than we had first imagined – we need to exploit this system to help us operationally deliver a responsive service and help keep our patients safe

By our final briefing of the day, it was evident that the early wins of yesterday might not be replicated today, that said we achieved something incredible today – we learnt exactly as we expected, that resetting our system wasn’t going to be a quick fix and that this week would be about discovery so that we can design a better future.

What else have I learnt? (I used this list yesterday and I make no apologies for saying it again – the last point is an addition)

• I have learnt that with strength comes solidarity
• If you enable people to work together they will deliver better care together
• Everyone wants a piece of success and everyone wants to make a difference – during the day we enrolled more volunteers for the rest of the week
• When you have fun at work you deliver better results
• When you role model our values of caring, listening, learning and respecting you connect with one another and make friends
• To be an effective JDI’er you need passion not permission
• If you spend time to listen you hear the bright ideas
• Being courageous and brave can be ever so slightly scary – but with high support and high challenge we can take risks
• With a common focus #TeamMedway collectively rise to the challenge to deliver Better Care Together
• I am loving my job!
• I am proud to be a #TeamMedway nurse and to work with a great team

The day ended with a MASSIVE thank you to our JDI’ers from Jason and the now familiar doughnut dance (only kidding). Having said that I am now looking for volunteers to do a gangnam style parody for #RebootMedway – any takers?

Finally, I wanted to share a very special moment I had this evening. Walking back to my office with Denise our Chairman we both heard music coming from the chapel, this isn’t the first time I have heard the piano being played in the evening. On further inspection the piano was being played expertly by one of our junior doctors, we were quickly joined by a young man who quietly sat beside us.

In a softly spoken voice he asked us for a prayer as he was waiting for a blood test and was concerned that it might be bad news. I immediately offered to make contact with a Chaplain, but the young man just wanted company – so the three of us listened to the piano being played whilst I reflected on what the young man had said and on the events of the day. This moment was a wonderful leveller and reminded me why we are doing #RebootMedway to deliver the very best care to those we serve.

Until tomorrow, its more discovery (and reflection) from me……..

Press the button

I think it is fair to say that the #RebootMedway button has been well and truly pressed! We have delivered a synchronised shock and we are currently flipping from Atrial Fibrillation to sinus rhythm – the patient is feeling slightly better!

The day started with over 30 volunteers (back office staff from all walks of our organisation) queuing for their bacon butty with looks of anticipation, excitement, fear and shear wonderment in this thing called #RebootMedway

After a carefully and beautifully choreographed introduction and call to arms by our Chairman (@denise_harker) there was no turning back, the #RebootMedway team swung into action, there were briefing packs, walkie talkie radios, fairy dust, t-shirts and buckets full of encouragement for our intrepid volunteers who were about to join our wards, many of whom had never been on a ward but were willing to spend a day making a difference – and boy did they make a difference!

By the time of our first silver command briefing (Cabinet Office Briefing Room A) at 10 am we were fully into the swing of things, it was great to simply watch the silver command team working together to problem solve – it wasn’t long before flip chart papers were being stuck to walls (don’t tell estates) and the creativity started to flow. During the day over 100 issues were raised and logged – these came from a whole range of issues relating to both patients and how we support our ward teams with rapid back office capability, for example printers not working, patients not receiving their take home tablets on time, light bulbs needing replacing and the like.

I know it would be easy to be cynical and say that this should be normal operational activity – we agree! But sometimes, when an organisation is running so hot (i.e. bed occupancy of over 100%) it is difficult sometimes to have the headroom to enable the improvements you know need to be made – I am pleased to report that today we started our journey of discovery to build the headroom that will allow us to work with patients to design a better destiny!

By our second briefing of the day it was evident that something very special was starting to happen, our operational activity was starting to look more favourable when compared to any normal Monday – but in true NHS style it was far too early to celebrate, there was a job to be done and we needed to remain focused. Our JustDoIt’ers were beginning to make a big impact, the feedback from them and our wards was positive – we even had one complaint from a ward that they had not been allocated a JustDoIt’er, the benefit of having someone that could simply just do it was clearly evident.

During the day our team worked closely with our Medway CCG colleagues who joined us in silver command to help us with safe patient placement for those patients who no longer required hospital care. At the start of the day we had 54 patients who would be better served by having time in a step down facility before going home – I am SO excited to say that working together we secured discharges for 14 patients, 5 planned tomorrow with a further 7 awaiting a continuing health care decision, the impact of this on our ability to safely place our poorly patients is immeasurable – for us this is almost one ward that can be used to care for our sickest patients.

During the day I was very lucky to join the team on McCulloch Ward, Tracey their CSW had baked a #RebootMedway cake – it also gave me the opportunity to watch my nursing team in action during morning report. This is what I love about nursing, great nurses and care staff focused on delivering the very best for their patients – this is nursing at its best and I am proud that they are my nurses and care staff. I should also report that the cake tasted flippin amazing, we have a bit of a reputation at #TeamMedway for enjoying the odd slice of cake, well today was no different!

As the afternoon was drawing to a close we had our last silver command briefing – so how did we do on day 1?

As at 4pm we had:

• 1 breach of the 4 hour quality standard in ED (since 8am)
• No issues with ambulance handover
• A reduced wait for majors
• The Medical Assessment Unit was open (the first time in months on a Monday)
• No escalation areas were open
• 46 discharges from surgery (50% above expected activity)
• 26 discharges from medicine (50% above expected activity)
• 11 medical patients repatriated to their speciality ward ‘right place’
• 6 surgical patients repatriated to their speciality ward ‘right place’
• We had identified improvements in our leg ulcer pathway which could be changed this week

Whilst early days, I think it is fair to say that the entire #RebootMedway team were pleased with the performance of day 1 – it is certainly a good platform upon which to build for the next 5 days where we shall giving even more ‘oomph’ to our improvement plans.

What have I learnt so far?

• I have learnt that with strength comes solidarity
• If you enable people to work together they will deliver better care together
• Everyone wants a piece of success and everyone wants to make a difference – during the day we enrolled more volunteers for the rest of the week
• When you have fun at work you deliver better results
• When you role model our values of caring, listening, learning and respecting you connect with one another and make friends
• To be an effective JDI’er you need passion not permission
• If you spend time to listen you hear the bright ideas
• Being courageous and brave can be ever so slightly scary – but with high support and high challenge we can take risks
• With a common focus #TeamMedway collectively rise to the challenge to deliver Better Care Together
• I am loving my job!

The final act of the day as gold commander was to gather the JDI’ers to thank them and the team for all their hard work and to replenish their sugar reserves with a mountain of doughnuts!

Back to my cardiac patient analogy, we have delivered the synchronised shock to convert the abnormal heart rhythm to a normal rhythm, as any good coronary care nurse will tell you there needs to be a period of intensive monitoring to ensure stability of the cardiac rhythm and lots of reassurance.

Until tomorrow, its intensive monitoring and reassurance from me……..

Ctrl – Alt – Delete or #RebootMedway

Tomorrow is an important day for #TeamMedway for six days we shall be rebooting.

Like any computer, sometimes you need to ‘turn it off and back on again’ – I can almost hear you say “that’s what my IT team always say” – well more often than not the characteristically expected response usually works (for me anyway).

For those cardiac nurses amongst us, imagine a patient in atrial fibrillation who is haemodynamically unstable requiring a cardioversion, a synchronised shock will help set the abnormal electrical rhythm back into sinus – hopefully with the patient feeling much better.

Here at Medway Maritime Hospital our bed occupancy has been running at over 100% for a number of months, despite lots of hard work by our fantastic ED Team the 95% ED 4 hour quality standard has not been achieved and patients have been telling us that their experience of the emergency pathway wasn’t good – we all recognise this is not good enough for the people of Medway and surrounding areas so we needed to think creatively.

#RebootMedway is our very own synchronised shock or ‘turn it off and back on again’. Clearly no hospital can shut its doors for a few days whilst we reboot – so our fantastic staff have come up with a package of measures that we hope will deliver a step change in both quality for our patients and operational performance.

Whilst we would like to claim originality for this fabulous idea, we can’t – a number of organisations around the country have already tried this approach and they have been very successful, for example earlier this year Cambridge University Hospitals NHS FT had the ‘Perfect January’ and the Royal United Hospital in Bath had ‘Spring to Green’. We are hugely grateful to both organisations who have freely shared their highs and lows and helped our project team design a programme that has really captured the imagination of our organisation.

The Team led by Sarah, Susan and Tracy started planning for #RebootMedway about 5 weeks ago – this really is a social movement for change, one of the great things about #TeamMedway is the energy and enthusiasm for putting patients first and coming up with the right ideas to make a difference.

#RebootMedway is as much about a synchronised shock as it is about an opportunity for our whole organisation to collaborate and provide a real ‘oomph’ to put us on a better path. The NHS Change Day was a wonderful example whereby NHS staff committed to doing 1 thing differently, over the next six days we will be doing lots of things differently – having courage and being brave. If something doesn’t work – then find another way – and if that doesn’t work then find another way! Keith McNeil the Chief Executive at Addenbrooke’s often talked about the number of iterative ideas it took to get human kind on the moon – try, try, try and try some more.

We have over 170 back office volunteers who for one week are prepared to do something different, to have the courage to help find a different way – we are calling these good folk JustDoIt’ers who will support our frontline teams at ward and department level to do non-nursing and clinical tasks that sometimes create obstacles to first class patient care and experience. All non-essential meetings have been cancelled and emails are being discouraged.

A Gold command will be established and led by an Executive Director each day. All our partners are assisting and we have volunteers joining us during the week, Jenni Middleton Editor of the Nursing Times will also be part of the JustDoIt’ers Team.

What does #RebootMedway mean for our patients?

• The care we provide will be even more responsive and tailored to your needs.
• We will deliver safe, high quality care and an excellent experience.
• The entire hospital and all of our staff (including management and administrators) will be focused on supporting our wards and clinical departments.
• We want to continually improve the services we provide, so we will ensure we listen to your suggestions.

What does this mean for our staff?

• Enable us to deliver Better Care Together.
• Our patients are the focus of everything we do – right patient, right bed, first time.
• Releasing clinical staff from non-essential tasks to focus on clinical duties.
• Support services providing a rapid response service to clinical departments.
• Providing non-clinical staff the opportunity to be based in a clinical area to provide fresh eyes and feedback themes to the command centre.
• Working differently with clear support to make that happen.
• Empower you to – just do it!

During the week we shall be measuring a range of indicators to demonstrate improvement, but being brave and courageous can sometimes mean that we won’t get certain elements right – but often most of the fun is in the trying and we certainly intend to have fun this week. If nothing else the six days for #RebootMedway will provide valuable insight into how we work together and how our organisation can do the little things that make a big difference for our patients.

Since I joined Medway NHS FT just over two months ago I have continually encouraged everyone to simply #JDI bright ideas need enabling and cultivating, #RebootMedway is one such example that has captured the organisation from top to bottom and end to end, this really is the creative #TeamMedway at its best!

So, tomorrow I am the gold commander for day 1 – whilst I have a fairly flexible brief it will be about visibility, trouble shooting, ensuring our teams are thanked for their hard work, doughnut delivery and lots of love!

Until tomorrow, charging at 360j……..

Its OK to raise concerns

It’s been a while since I have written a blog, often when you write a blog, you do so because you have something important or interesting to say – but not entirely sure who to say it too.

This morning on my way to work I was listening to BBC Radio Kent, the headline news was that one of my nurses in our emergency department had raised concerns anonymously with the BBC about low staffing, poor morale, poor patient experience and a lack of support for staff.

So given the concerns were raised anonymously, this blog is for you – in the hope that you will read this and feel comfortable in the future to raise your concerns in person, I know it can be difficult but together we can secure the improvements we both want to deliver better care to our patients.

Raising concerns is an important part of our professional responsibilities as registered nurses and midwives, had I had the opportunity to meet with you in person I would have thanked you – thanked you for advocating for patients and ensuring that the things you have highlighted are raised and dealt with in an open and transparent way. Importantly I would have taken the opportunity to find a way of working together to address the concerns you have raised.

I know on a day to day basis both individually and collectively the ED team do their utmost to secure the best for the patients in their care, the environment isn’t great and I know having worked alongside some of the nursing team in ED the environment is in need of a refresh.

That aside there is lots going on to improve the environment and patient and staff experience, here are just a few things that are being developed and will be coming on stream in the coming weeks:

• The new pod has arrived outside of ED and will be used to house our new STAR process, this is a rapid assessment process led by senior nurses, doctors and paramedics to ensure that patients get the right treatment from the start
• We have recruited additional ED Consultants to ensure our medical teams are led by the most qualified and best doctors
• We have recruited additional senior nursing staff to ensure there are experienced nurses to care for patients and lead our nursing and care team
• Plans are being made to redesign the internal space of our ED so that patients get a better experience and staff have a more conducive working environment
• Through the Big Conversation the ED team have implemented a ‘Star of the Month’ – it has been an honour to present the last two sets of awards to a nurse and a doctor who have been nominated by the team for exceptional delivery of care and leadership
• In a few weeks we shall be launching ‘Reboot Medway’ a fabulous opportunity to reboot and ensure the whole organisation is focused on the urgent care pathway and delivering great care for our patients
• We have been working with the CCG and other health and social care partners in Medway to ensure that those patients who are ready to be discharged from hospital but require additional support before going home have a suitable facility to go to – this will take a little bit of time to come on stream, but once it does it will create additional beds – which means our hospital beds can be used for those who are sick
• With support from Medway Community Health and Medway Council we have integrated our discharge planning team, this will aid better communication and ensure all organisations are focused on enabling patients to be discharged swiftly
• I would like to consider how we develop nursing roles for example introducing a Consultant Nurse in Emergency Care – these will be a great opportunities to develop nursing practice and ensure that our patients receive care from highly skilled and experienced nurses
• With all this work going on I recognise that we haven’t done as well as what we should of in letting you and your colleagues know what the plans are – so we are making amends and setting up some ED briefings and are committed to doing this regularly so that you know what is going on and most importantly can contribute to the exciting developments

I know on the shop floor you are having to deal with very real issues and it might feel like there is no light at the end of the tunnel, please be assured I and those I work with are committed to helping you deliver the very best care for our patients.

Whenever anyone raises concerns either in person or anonymously I always seek to question myself, am I an accessible leader? Am I open? Do I actively seek feedback? Do I live our values of listening, learning, respecting and caring? Do I really embrace a high support and high challenge focus on performance? I guess the test of accountability comes from my team and most importantly our patients.

I would like to think I am an authentic leader, my benchmark of quality is the commitment to deliver and to enable my nurses and midwives to provide care that those I love would be proud of – I recognise my role is to ensure that the team have the right tools for the job.

So it really is OK to raise concerns, come and talk to me and lets work together to make the improvements we all want for our patients.

#TeamMedway

How would I fix the NHS?

What I want as a user of health care  is for the NHS to deliver a service that is

• Harm free
• Delay free; and
• Complaint free

 

For our patients

• We must listen and act on their experiences – real time
• Encourage shared decision making with patients and their families – they are part of the team
• Deliver a responsive and consistently high quality service that focuses equally on the quality of treatment and the quality of care
• And most importantly we must ensure that all patients accessing the NHS are treated with dignity, empathy, kindness and respect

 

To deliver this we need to

• Listen to our staff and recognise that they are our first line of defence in relation to quality of care
• Ensure that change is delivered by frontline teams at the bedside
• Strengthen our leadership capability at every level – but particularly our senior sisters and charge nurses
• Work to deliver a culture of high support and high challenge
• We need to develop the thank you habit
• Recognise that quality of care improvement is essentially a multi-disciplinary activity involving a collaboration between doctors, nurses, therapists, managers and patients
• Reduce the bureaucracy and paper work (although much of it is needed to evidence the care we give) 
• We need to be held to account for our actions and have the courage to speak up
• We need to have a difficult debate about our expectations of the NHS and what it can deliver

 

And for me as a leader of nurses and midwives it is about

• Building pride in our profession and giving patients confidence
• Being a role model for the behaviours of kindness and compassion
• Enable my nurses and midwives to deliver kind and compassionate care
• Have an unrelenting focus on high quality care and being open to challenge
• Remaining true to the reason why I came into this profession – which was to make a difference

OK, so it’s not 290 recommendations – but simply its about being a great nurse and having patients at the heart of all I do.