As a recently appointed ( 2 years ago) band 7 senior charge nurse with in the Emergency department of the Royal Infirmary of Edinburgh, I looked at the position with excitement, nervousness and a niggling worry of “ I have so much to learn” When listening to my senior colleagues with words of wisdom I heard them but I did not listen.
In my first 6 months I took on a piece of work that was started many years before on process change within the department. This process change was to alter how the patients journey through our department happens, to improve the efficiency of how we work and in turn improve the quality of care given to those patients and improve the patient experience. It was successful but it did not reach the goal we wanted.
I was naive to think this time it would be different as I’m a band 7 now and change is part of my job and I can do it. I say naive as I had not appreciated how the previous process change had made people feel and how a plan to develop this idea could be received with scepticism.
I was not perturbed, although at times upset but as a band 7 with the British mentality of stiff upper lip and possible belligerence I wanted to be heard, listened to and to prove a point I knew was right.
Recipe for disaster?, I thought about how I could prove to my doubters that this could and would work if invested in?
A Proforma was created and key points of the patient journey decided. We would measure time to triage, time to analgesia, time to ecg, time to observations, time to care provider and destination of patient. Allison Todd from Quality Improvement came on board and made the figures come alive with graphs to show the improvements we made.
The key change in the process was to front-load assess the patients. Self-presenting patients to the ED who would historically end up in the majors side and delays in their assessment meant increased length of stay and with the 4-hour standard every second counts.
I then spoke with Sue Bagley the lead nurse practitioner who had been trialling similar tests of change with patients who arrived with minor injuries. The process she had and the data she and the team were producing had startling similarities to ours. It was good to see the Nurses in the department working with other professional groups and driving change.
The Department's Clinical Director was, at this time, managing to secure funding to add another 25 staff nurses and significantly increase the numbers of Consultants and ENPs in the ED. We also benefited from the year-long secondment from GSK of Andy Currie, who skillfully led us through a total departmental engagement process and 2-day long Kaizen event. This took our understanding of the opportunities for change within the ED to the next level, three on-going work streams for improvement were begun, and the One Patient Pathway was born.
The quality team asked if they could send in an abstract of the findings from the original piece of work to the Quality and Safety Forum who were holding a conference in Paris in April. It was accepted and will be published in the BMJ later this year.
I received funding from the Medic One trust and NHS Lothian and secured monies to pay for the conference while I paid for accommodation and flights.
I went to Paris with an excitement at what I would hear and was very proud ED RIE were being represented on the world stage.
I was however personally feeling the strain. My stress was at levels never previously experienced. Disillusioned. Totally overwhelmed.
I actually thought the time had come to leave the ED and or the NHS.
If I felt like this how were my staff feeling? I am one of their leaders I should be strong. But for my own mental health I thought I could no longer stay to help with the improvements. The feeling of failure was immense.
Then I heard Helen Bevan talk. She is the chief Transformational Officer for NHS Improvement and is actually inspirational. One of the sessions was around petcha kutcha a new style of presenting where there are 20 slides timed at 20 seconds each so no presentation is longer than 6 minutes 40 seconds. There were 6 people presenting their story of change and quality. These were normal NHS workers who had experienced a problem or saw an area of improvement and just did it. Michelle Mello one of the speakers first words were I am a proud nurse. Her "caremakers" idea had taken off. More and more NHS trusts were taking on the idea concentrating on the 6 Cs Care, Compassion, Courage, Commitment, Competence, Communication and this programme has helped staff turn their work around in improving quality and the patient experience in their work place whilst improving their own well being and work satisfaction.
It turned my negative feelings around.
I can make a difference to my staff.
I heard and saw many other items which I will report on when I speak to the staff in June about what other ED in the world are doing and how we could enhance what we do here using their practices. We are also as a workforce definitely on the right track. We have changed a great deal over the past couple of years and changed for the better. It is easy to forget how far we have come and how that is down to each and every one of us. We are part of a team working towards the same goal. High quality care for our patients with good working environment for the staff.
The key messages I would want to give to people
Be a proud nurse or HCP
Don’t lose your faith
You are valued - we need to tell each other that
We are part of a team which is evolving and by getting involved you might actually be able to help make a difference to your patients and staff.
There are opportunities out there - grab them with both hands - nothing in this world is handed to you on a plate.
Don’t be shy and speak up
Don’t just hear – listen.
Listen to your patients and work mates. Care for each other.