In the House of tomorrow

This blog first appeared in the Ayrshirehealth blog ahead of the Twitter chat I held on 24th May – as I said on the Twitter chat I welcome the views from across Scotland on the content of the nursing strategy we are currently developing.

This blog sees the start of my monthly blog series, which will be posted at the end of each month.  I look forward to sharing my thoughts with you and to hearing back from you.

Fiona

Follow me on Twitter – @Fionacmcqueen

The development of our national nursing strategy

‘for their souls dwell in the house of tomorrow, which you cannot visit, even in your dreams’…    

Although Gibran’s words were about parents and children, these words have resonance within me about the future of our profession.

We’ve come such a long way in recent decades, and made such a difference to people’s lives as a consequence of that.  If this growth and development is to continue, then I think our next Nursing Strategy (yet to be named) must prepare the profession to respond to the needs of our communities in a way that we’ve not yet experienced or thought of.

Who Would Have Thought?

Would Elsie Stephenson, who set up the first Nursing School (in Edinburgh) in a university have envisaged our all graduate profession and the impact our Nursing Schools and our new graduates across Scotland are making to reduced morbidity and mortality?

Would we have imagined that senior nurses – both clinicians and academics would have had such an impact on reduction in HAI?

Would we have imagined the Advanced Practice roles that many practitioners are now taking on, making sure that services to local communities continue to be safe and effective?

Would our predecessors be surprised that at Board level, Boards are talking about the delivery of compassionate care, and nurse staffing levels?

What I Know for Sure

I’m not sure that we could have foreseen any of the above, but what I know for sure, is that in 2030 if we are to continue to take our place in supporting communities to improve their health, and provide compassionate care, it is likely to be in a way that few us can imagine.  

But what I also know for sure is that we will be there supporting our communities, putting professionalism and compassion and the centre of all that we do.

There may well be new professional groups, but for sure we’ll be working in strengthened multi-disciplinary teams, supported by digital communication.

Reason for a Vision

And as I go around Scotland, I hear about amazing pieces of practice and leadership that has transformed care, so it is vital that we make the connections across our profession and build on where we have come from and put concrete plans in place to support the nurses of the future to be sure footed and competent, but also able to change and grow to ensure we continue to meet the needs of our communities.  It’s for that reason I think we need a coherent vision of what action we need to take in the coming years, to ensure nurses are prepared for the future.

The timing is right- we have a new government with high ambitions for the public sector, and health in particular; the implementation of the National Clinical Strategy, that has an overarching approach but based on a strengthen primary care and  equality of mental health with physical health.

There are high expectations of all professions in delivering out of hours care, as well as our other national strategies, but nursing in particular, being with people and their loved ones 24/7 do have a particular role to play.  That means making sure we create an environment where nurses can flourish and provide safe, effective person centred care becomes all the more essential.

We will have legislation to support safe levels of staffing, so we now need to create a vision that delivers not only the right number of nurses, but with the right skills.

Setting the direction is full of promise that there will be real and meaningful support of our current workforce from a post graduate education and development perspective; that will become all the more crucial if we are to prepare the profession for a future that will certainly be different.

Shaping the Vision

That’s why I think it’s important that the whole profession, as well as our communities can contribute to and shape that vision.  And just as we know that care delivery will be different, I’m keen to engage with the professions in a different way.

Whilst I think nothing can beat face to face conversations, as we had with our Future Conversations work; I’d like to build on that by publishing a regular blog so that I can share what is happening nationally and hopefully get feedback on that; 

hold twitter chats;

and as NHS Highland did last week – have Webinars to help every nurse in Scotland to have a part in shaping the future.

We have a real opportunity to shape our future; whatever role we carry out, we are all linked with a common purpose – to support people improve their health and deliver compassionate care.

Please look out for ways you can contribute to that future and let me know what you think.

Follow me on Twitter – @fionacmcqueen

(Professor Fiona McQueen), Chief Nursing Officer for Scotland, Scottish Government.

Two roads … I took the one less travelled by @fionacmcqueen

Two roads diverged in a wood, and  I –

I took the one less travelled

That quote from Robert Frost probably sums up how I felt about how I felt when I first started to post my blog. Coming from a generation that hasn’t embraced social media, with people being quick to criticise senior managers in the health service, I was thoughtful about laying myself bare for criticism.

That was, if anyone bothered to read my blogs.

And there is no doubt I wouldn’t have known where to start without the help and encouragement from Derek Barron (@dtbarron – albeit he comes from the same or dare I say an older generation from me!!). Derek, has single handedly been the catalyst for change across NHS Scotland when it comes to social media and nursing and midwifery.

In the beginning

So, without really having a view of what would happen, I penned the first of my blogs ‘From Boardroom to Bedside..’. The main purpose was to share my thoughts and feelings as the Board Nurse Director, and to try and narrow the gap between me and practising nurses and midwives, and get closer to patient care. I also thought that by writing an account of what I did for most of my working week, it would give people an insight into the role of the Nurse Director.

Saying my weekly blog was transformational to the way I did my job, is probably an exaggeration; however the response from colleagues who read my blog certainly affirmed what I was doing to improve care and helped generate dialogue.

Even if people didn’t necessarily post on the blog site, I was greatly encouraged by the feedback I received from staff I met when I was out and about. Mainly letting me know that the poor care I came across was how others had experienced things, and that helped me put steps in place to make improvements.

The end of the beginning

As regulars of this blog know, I have been on secondment as the Chief Nursing Officer. My secondment finishes at the end of May, so whilst my Associate Nurse Director colleagues have kept the spot warm, I’ve decided that, for the moment, I’ll not be having postings on this site, at least until the end of my secondment.

Extra-ordinary every day

What writing a blog helped me greatly with, was connecting my day to day work, with improving health or delivering care. It also gave me an opportunity to share some of the amazing work that nurses and midwives are doing on a day to day basis within Ayrshire. Extra-ordinary every day is certainly the main theme of what is happening; despite the popular press running stories that are so critical of our day to day work. Yes, there are certainly areas that need to be improved. Are we doing enough about that? No, I don’t think so.

On the week that the public inquiry into failings of care within the Vale of Leven Hospital, there were other reports published with some echoes of what had happened at the Vale. Most certainly, the recommendations of Lord McLean, had in many ways been overtaken by events.

However within the report, there were issues that I think are currently running within the shadows. Nurses not fully engaging with patients’ loved ones- when the nurses notes were removed so families couldn’t read them. Faeces under the nails of patients that had obviously been there for some time – and not as we so often like to say, ‘must just have happened before the relatives visited’.

 We need to do more

Other headline grabbers within the press; not enough nurses. Are we doing enough about that? Well, I think we’re taking action to address shortfalls; but I do think we need to do more to make sure staffing levels mirror patient need.

Some of the work that we’ve been doing locally with the tools, and also in some areas posting staffing levels on ward doors, are certainly putting us on the right road.

But collectively, I think we need to do more.

Within Ayrshire we are incredibly fortunate to have so many skilled and dedicated staff; pushing the boundaries within advanced practice; providing outstanding essential care for people on a day and daily basis; making sure laundry bags are tagged so that laundry workers are kept safe; smiling at the passing stranger in the corridor to help them feel at ease and welcome; and working tirelessly to provide outstanding care.

Thank you to all who work so tirelessly to deliver such good care. But how do we make sure this happens for every person, every time?

Listening

The one thing I think that would transform the care that we deliver to people is listen…… really listen; not just hear what suits us. We need to listen to staff who deliver care and make changes that support them to provide real excellence; but in particular, we need to listen to feedback from people who use our services…. and believe them.

….and that will make all the difference.

 

The twelfth day of Christmas by @angela_oneill1

A special time for all in our care

Well, here we are again in the last few days before Christmas and if you are anything like me you will be starting to feel the pressure of the many fun but tiring activities that the lead up to Christmas brings. The overwhelming need to make this a joyous time for all takes its toll and often we are left feeling that there are just not enough hours in the day.

Not only are our home lives busier with the extra chores and social occasions on normal ‘school nights’ but our working lives are filled with greater activity and an associated burning desire to make this a special time for all who come into our care.

As we go about our daily working lives we strive to make that little bit of difference and over the last few days I have been fortunate to witness many examples of our staff going that extra mile. Ranging from the very individual – the Health Care Assistant who took the time to crochet gloves and socks for a lady with very few possessions, to the excellent Multi Disciplinary Team effort to make sure that a very ill gentleman, with very specific needs, was safely discharged into the loving care of his family for what may be their last Christmas together.

Just two of the many examples of person centred care at its very best and at a time when we are personally and professionally stretched it is never more reassuring to see the effort and commitment of our remarkable staff.

A cracker of a day……

At this time of the year it is difficult to find that extra bit of time to reflect on the year that has just flown by, what we have done well, what we have learned and what we want to achieve in the next busy chapter of our working lives. Friday 12^th of December was a very special day for me as I got to do just that.

I spent the day with many of the professionals that I am proud to work with.

 A time for reflection…………

The day started with time to reflect on the outstanding work of Tommy Whitelaw (@tommyNtour). I attended the launch of the DVD which captures Tommy’s efforts for all to share.

Not only does Tommy remind us of the basic fundamentals of life but also of the importance that each and every small contribution makes – we can all make a difference and Tommy reminds us of this in a powerful and very moving way.

If you haven’t seen it please take five minutes and follow the link http://vimeo.com/110517142

Fiona McQueen said on Friday that she would remember Tommy’s message for the “remainder of her professional life” and I can only echo her words. I promise that it will be time well spent in the endless list of things that must be done.

A bright light is shining……

Next it was off to meet with one of our Nurse Consultants and an opportunity to reflect on the excellent work that has been done in Emergency Care over the last year or so. It is certainly exciting times and I have no doubt that the new Model of Care will bring many more benefits to the people of Ayrshire over the coming months and years. The shining steel frames and building sites cannot be missed but it is not the building that will make the difference.

The difference will be made by the people within it.

Our state of readiness is crucial and I know we have many teams and individuals ready to embrace this challenge with the same vigour and commitment that we see every day. I left Paula, in the knowledge that our staff are receiving the best quality training and education to support this transition and I look forward to working with all of our teams throughout the forthcoming months.

Sorry – no humbugs allowed……..

Another spring in my step and I was then off to meet with the Clinical Nurse Managers (CNMs), Senior Charge Nurses (SCNs) and Nurse Specialists in the first of our Cross Site Professional Meetings.

A time to really share our knowledge, identify our learning and decide what our priorities are for the forthcoming months.

An early Christmas present………

The session started with an excited SCN McLaughlin sharing her experience of a recent trip to Milan, where she went to learn more about the national approach to delirium. Lynn was clearly delighted that she had been afforded this opportunity but of course the importance of recognising excellent contribution cannot be overlooked. The obvious addition to her early Christmas present was the need to share her learning widely and today it was the turn of the wider senior nursing team.

We learned that Ayrshire is progressing well with the assessment and care of people who present with a delirium but that once again education is at the core of success. One for Derek Barron and I to share with the wider delirium group.

No surprise that Lynn did us proud and she represented NHS Ayrshire and Arran with the professionalism that is inherent within the SCN group.

All I want for Christmas………

Next we moved on to the tremendous work on falls prevention which SCN McRobbie and the team in Station 6 have grasped with great enthusiasm. An opportunity for Gail and the wider support team to share the excellent outcomes from the SPSI work that they have undertaken over the last few months. A new supported approach to falls prevention was shared and importantly the team were able to deliver the take home message that this approach works – an overall reduction in the number of falls and importantly no falls with harm in a 6 month period.

The SCNs would all like this on their Christmas wish list and the roll out programme will begin in earnest.

Time for coffee, mince pies and a quick catch up with our colleagues from across Ayrshire.

Next we moved on to the Vale of Leven Hospital Inquiry Report and I had the opportunity to share the 75 recommendations of this crucial report with the senior nursing team. Time was taken to reflect on where we are in relation to each of the recommendations and of course to think of those who did not receive the care that we aspire to each and every day.

It is clear that much progress has been made and we pledged to work together on the areas that require continuous assessment and improvement – the shape of 2015 has begun and there is no doubt that these basic fundamental requirements will continue to be at the fore front of improvement in care delivery.

The day was brought to an end with the opportunity to discuss the Care and Assurance Accreditation Tool (CAAS) which we are developing in partnership with our colleagues across the West of Scotland. This approach will provide us with a much needed performance assessment framework which offers SCNs the ability to demonstrate the standard of nursing care being delivered in each individual ward/team.

As a group we are excited by this approach and SCNs are keen to be able to evidence safe, effective and person centred care in one coherent way – they want to be able to provide assurance and evidence to support why they are proud of their wards. CAAS will offer this to all.

Continuous improvement

The priorities for 2015 are certainly taking shape and I look forward to working with you all to make this another year of ongoing continuous improvement.

All that remains is for me to wish you all a very happy and peaceful Christmas and of course my thoughts and heartfelt thanks to those who are working to care for our patients over the festive period.

This week’s blog was by @angela_oneill1 (Angela O’Neill) Associate Nurse Director, Acute Services, NHS Ayrshire & Arran

 

 

Changing relationships by @maidenturret

Good experiences

I am lucky that my job gives me the opportunity to interact with staff across NHS A&A and beyond. I have been reflecting on last week’s conversations and some of the challenges we collectively face at the moment.

Talking with colleagues in Acute Services I was struck by the increasing impact of constant fire fighting on the wellbeing and morale of staff. Indeed, it is testament to the resilience and values of the staff that the vast, vast majority of patients and their families have a good experience despite the challenges of patient flow!

Is it possible to reduce demand in the system? I think that there is potential to reduce demand and be more efficient by delivering person centred care. Let me give you a couple of examples.

Over medicalisation

I am a big fan of Atul Guwande and I was struck by some of the take home messages in his new book ‘Being Mortal’. Guwande argues that we have over medicalised death, where we approach the end of life as the well meaning need ‘to fix’ (for example the most common week of having surgery in your life is the last week of your life), rather than a focus on what the desires of the patient are and letting them control as much as possible their decisions about both major and mundane aspects of their lives.

Are they more interested in living longer or avoiding pain, for example?

Surely, it must be about a good life up to the point of death (rather than a good death – as I have talked about in the past). A more person centred approach to living life up to the point of death would avoid unnecessary interventions (as we know most resource are spent in the last year of someone’s life).

Why so many?

My second example comes from a conversation last week with a colleague whose father was newly diagnosed with a long term condition. A recent lung problem turned out to be a heart problem and following an acute episode of care the gentleman was discharged home for follow up.

He received four out-patient appointments from general medicine, respiratory and cardiology. He understandably asked why so many?

We know that the burden of treatment for people with long term conditions can be considerable and living with long term condition(s) is like a descending roller coaster. If we let people set their own priorities and goals, accessing flexible expert help when they need it (rather than routine review appointments) then there is potential to reduce demand. We need to build on the good anticipatory care work being progressed to date, making a more person centred approach the norm. Easy to say, but much harder to deliver!

Professionalism

Lastly, I wished to mention a couple of areas of service I had contact with last week. I was involved in a child protection case review (in my new add on role of interim Assistant Nurse Director for the south Health & Social Care Partnership) and I am genuinely impressed by the professionalism and dedication of all practitioners/clinicians involved in such a challenging area of practice.

On Friday I went to Kilmarnock prison (which is more difficult to get in than out!) to discuss complaints management processes with the team. They very much underestimated the great job they are doing to informally resolve issues as they are raised and we agreed a couple of actions that could improve their processes further.

It was also good to hear that the hardworking staff get to enjoy a delicious Christmas lunch for £2 – a perk of being behind bars!

This week’s blog was by Andrew Moore (@maidenturret), Assistant Nurse Director, NHS Ayrshire & Arran

Integration, AHP style by @billyahpd

Integration, Integration, Integration

Those of you who have been keeping an eye on the progress of the integration of health and social care locally will be aware that Allied Health Professionals (AHP) in NHS Ayrshire and Arran have recently moved to the South Health & Social Care Partnership continuing to deliver services across the whole of Ayrshire under a lead agency model. You may also be aware that AHPs are currently undertaking an options appraisal to determine the future management structure for AHPs as the partnerships become fully established and begin to mature.

The future’s bright, the future’s integration

There are a number of challenges when considering how we plan and manage services as we go forwards, not least because no-one is clear about what the future will look like and each model brings it’s own strengths and corresponding weaknesses.

This has been taxing me as Associate Director for AHPs and Heads of AHP Services for some time, so this week it has been refreshing to look at the same problem but through a very different lens.

Inequalities

This week I was interviewed to test out an inequalities self assessment questionnaire as part of a pilot. The questionnaire was designed to test how familiar individual clinicians, teams and service managers are with issues related to health inequalities and more importantly how we translate this knowledge into how we all go about our jobs.

As someone who feels passionately about addressing health inequalities I was comfortable answering questions about my understanding of the social determinants of health (how differences in housing, education, work, financial security etc. can affect the choice and control of an individual and their family and ultimately impact on their health, quality of life and life expectancy).

In my days as a Physiotherapist I could have easily demonstrated how I used this knowledge to ask specific questions, coach and signpost to make the best positive difference I could for that person in front of me. I worked hard as a clinician and service improvement lead to forge relationships with housing, employability and other agencies to make sure that I did all that I could to limit the negative impacts of the inequalities gap and tailor services to the needs of individuals and communities. Unfortunately, what I realised as I completed the questionnaire was that as I had moved into service planning my focus had changed.

When looking at the big picture I had switched my focus to equality of access and providing the best service across Ayrshire without considering the unique needs of specific communities. What the questionnaire made me realise was that the best service for one person or community is not the same for every person or community. How do we know what the best service is for any given community? How do we tailor services to meet individual and community needs?

Tough questions that none of us have answers to just yet.

Identifying the customer

The second important moment this week came on Wednesday when I joined the South Ayrshire Council team for a leadership engagement and development session. The session involved senior managers from across the council – housing, education, finance, social services, sport and leisure etc. We were split into groups to discuss how we would apply a self assessment tool which helped teams and services to evaluate how good their services are. The first part of that tool asked teams to identify their customers. Firstly teams were asked if they understood what their customers valued and secondly they were asked how the customers rate the services we deliver against those values. Again, challenging questions.

Do we really know what those who use our services value?

Do we measure and benchmark ourselves and our teams against those expectations?

How might this approach help us to tailor services to the needs of individuals and communities? How might this help us to tackle health inequalities? How might our services look if we did this better? Again, all tough questions, with no easy answers.

 Locality planning

This is where integration gets exciting. For the first time these questions are being asked and are being tackled by teams from across different specialties and sectors, all with the collective shared skills and resources to make a real difference.

This coupled with the strengthening of Locality Planning, where services will be planned and delivered at a more local level in partnership with communities means that the foundations are being set to enable us all to make a real positive difference to those individuals and communities we serve.

This week’s blog was by Billy McClean (@billyahpd), Associate Director for Allied Health Professionals, NHS Ayrshire & Arran.

In the footsteps of … by @poppletonp

Filling the shoes

It’s been an interesting week and an exciting one for me personally. On Tuesday I was appointed as Interim Nurse Director tasked with the job of filling Fiona McQueen’s shoes while she’s on secondment as Interim Chief Nursing Officer. For those who don’t know me, my background is in public health and community nursing and I’ve been the Associate Nurse Director for Primary Care and latterly Partnerships for the past five years.

My appointment came the day after the publication of the Vale of Level enquiry which will I’m sure shape much of the work we need to do during the six months of my secondment.

Without grandparents at Christmas.

On Monday evening I read the report and watched the accounts from affected families on the news. It was the wish of one relative in particular that no children should be without a grandparent at Christmas, as her were, due to poor standards in the very place that people go to for care. Much has changed since the outbreak which has vastly reduced the prevalence of” C Diff” in our hospitals including better monitoring and prescribing. I learned at Tuesday’s Infection Control Committee that we still need to remain vigilant with our use of antibiotics to get the rate down even further and prevent another rise.

A key feature of the report was standards of nursing care in the hospital including the fundamental aspects of care that, as Fiona has shared in the past, can remain even now in some areas and for some patients stubbornly difficult to change. The report cited a “catalogue of failures” some of which I see reflected still in complaints and inspections. A key challenge for me, the senior nursing team and the nurses on the wards and in our communities will be to ensure that all people coming into our services receive the right care first time. Work has been underway to achieve this and in most cases with most patients staff do a good job. None of us however would want to see another family without a loved one at Christmas because of poor care.

Person centred care

Wednesday and a meeting with John Burns our Chief Executive to discuss priorities in my new role – which will start today!!!. Needless to say the focus will remain as it has been under Fiona’s leadership on ensuring that people receive high quality, person centred and above all safe care. My big challenge in the next few days will be to cover my current role in the evolving Health and Social Care Partnerships to allow me to focus on the learning curve in my new one.

On Thursday afternoon I attended the South Ayrshire shadow integration board for a development session focusing on inequalities. Public Health colleagues highlighted the effect of inequalities on health and focused our thinking as a Board on what contributions partnerships could make to alleviate the effects. I left invigorated and enthused about the potential that Health and Social Care Partnerships have to improve the lives of the whole community and in particular those who are marginalised by poverty, addiction or increasingly by frailty and loneliness.

Need for consistent high standards

Friday and my first meeting with the other Executive Nurse Directors from across Scotland. Again the Vale report and the need for consistent high standards of care were central to discussions as was the formation of Health and social Care Partnerships. Reassuringly for me personally in my new role and for Nursing in Scotland Nurse Directors are committed to working together on these areas.

We discussed what could be done and what is already in progress across Scotland to support nurses and ultimately patients. Again I left full of enthusiasm for my new start next week.

Blogging

Now for the future- or the next few months at least- we’ve agreed that the Associate Nurse Directors will each share our thoughts and experiences in the weekly blog while Fiona and I both find our feet in our new roles. For me this will start first thing Monday morning with a meeting of the Health Board, becoming it seems a tradition on directors’ first days in role.

I look forward to an exciting and challenging time ahead in the knowledge that I am and have been supported by my senior Nursing and Director Colleagues and by all of our front line staff who strive every day to provide high quality care. After all-

“The power of one, if fearless and focused, is formidable, but the power of many working together is better.”

Gloria Macapagal Arroyo

This week’s blog  was by Ann Gow (@poppletonp), Interim Nurse Director, NHS Ayrshire & Arran

 

 

 

 

Compassionate care by @Aac946

Proud I work in NHS A&A

As the Associate Nurse Director for Women’s and Children’s services I am trying to fill big shoes by covering Fiona’s blog this week.

I am continuing Fiona’s theme of celebrating the many achievements we have made in A&A over the last few years of which we should be proud, not least in the area of SPSP.

As the Midwifery Clinical Lead on the MCQIC (Maternity and Children Quality Improvement Collaborative) I get to benchmark our services 1st hand against other Health Boards in Scotland.

I am always left proud I work for NHS Ayrshire & Arran knowing we are doing well.

That is not to say we do not have our issues and challenges, however collectively we are moving forward and changing patient care.

SPSP Learning Session

I had the pleasure of spending two days in Edinburgh on the 11th and 12th November at the SPSP learning session.

I met colleagues from England and America and I know there were others including Denmark  who were present, everyone I spoke to was amazed at what we have achieved in Scotland.

I tweeted more in two days than all my previous tweets added together, some were retweeted onto a wider ranging audience and so the message of our good work spreads.

I even added photo’s for the 1st time, thanks Derek for the encouragement to keep going till I got this right.

I was inspired to tweet by the level of enthusiasm and the air of excitement across all of the SPSP community.

The acknowledgement from Paul Gray (@PAG1962), Jason Leitch (@jasonleitch) and Brian Robson (@brobson3) to name but a few of the excellent work we are doing to improve outcomes for our service users was inspiring

Excellent work being shared

NHS Ayrshire & Arran were showcased in several of the presentations and it was really good to hear the excellent work being shared and commented on by colleagues from elsewhere in Scotland. The huddle introduced in University Hospital Ayr and University Hospital Crosshouse was one example of how working together we are improving communication and therefore  improving outcomes in Ayrshire.

We often do not appreciate how much we do that makes a difference, often we think that is just the job, and it is, however we do it to an exceptional level on many occasions.

Compassionate Care

The emphasis on compassionate care and a person centred approach was a key theme and took centre stage at the opening plenary. A very brave daughter stood up in front of 800+ professionals and told her fathers story. Once again it was based on the fact we did not listen to the people who knew him best. This was turned into a positive experience by  listening to the family and changing processes for future service users.

Our service users and their families are the best judges of the safety and quality of our services. They are the only people who experience the pathway of care in all its facets.  They know the number of hand offs they have had, the quantity of the missed information in the notes and the number of times they have to repeat themselves, this does not really inspire confidence.

What matters to you?

How often do we ask them , “what matters to you”? They and their relatives have the best information regarding their needs, as clinicians we need to tap into to this expertise, if we do we  are more likely to “get it right ” the first time.

I left exhausted after two intense days, sure in the knowledge we are making a difference.

Patient safety is a journey, not a destination and we are all on this journey together. Collectively we all have to be involved for remember next time it may be your family member or friend who comes into our care, how do you want them to be treated.

The people of Ayrshire & Arran trust us with their most treasured possessions, their family members, let us all ensure we do our bit to ensure that trust is not misplaced.

This week’s blog was by Angela Cunningham (@aac946) Associate Nurse Director, Women and Children’s Services, NHS Ayrshire & Arran.

It’s made my week by @dtbarron

Time to reflect

http://www.marcandangel.com

One of the great things about writing a blog is that it really makes you sit down and reflect on your week – what has gone well? What not so well? What have I learnt? What might I do differently next week.

Before exploring that a little I would of course like to say very best wishes to Fiona on her new role as Chief Nursing Officer, the very pinnacle of the profession for us as nurses and midwives here in Scotland. I’m sure all of you will share the sentiment of best wishes, I know she’ll do us proud.

At the bottom of the blog I’ve included a list of who will be writing the blog over the next few weeks until the end of the year

– I’m hoping that after that Fiona may take over writing her blog as CNO (we’ll have to wait and see).

Revalidation

On Monday I joined a teleconference meeting with the NMC (Nursing & Midwifery Council) and Scottish Government, the focus of the discussion was revalidation. We heard from Dr Katerina Kolyva, Director of Continuing Practice at the NMC on progress with revalidation, pilot site and next steps.

For Scotland, pilot sites will include NHS Tayside, University of Dundee and our three island boards (Orkney, Western Isles and Shetland). Early next year we need to consider our own preparation for revalidation here in NHSA&A, which will go live on 1^st January 2016.

Make a difference

Tuesday was the first of my outstanding days I had this week. As you know we have had Tommy Whitelaw (@tommyNtour) working with us here in Ayrshire, you can read a summary of the work so far on AthenA.

Over the past few moths we have been working on a DVD to capture what we’ve done and why we’ve done it – on Tuesday I saw the first cut of the film.

We’ve been working with UWS Media and Culture School and an independent film company Prancing Jack to produce the film and they done an incredible job of capturing our commitment – we’re launching the film on 12^th December, in the mean time click on the picture to see a short trailer.

We’d love to know your thoughts, please use the comments section of the blog to let us know what you think.

Integration

On Wednesday Iona Colvin, Director North H&SCP, met with the Mental Health Services joint management team to discuss integration and the timetable we are working towards. While integration opens up an exciting world of possibilities for us to deliver on our vision of improved health and wellbeing, it also creates uncertainty regarding next steps.

At a time of uncertainly it’s really helpful to hear our Director engaging directly with the senior team and asking them to share and cascade the information to their teams – here is a screenshot of the timetable.

Thursday was spent at a national meeting hosted by RCN Scotland discussing integration from the perspective of scrutiny and improvement – Healthcare Improvement Scotland and the Care Commission presented their vision and invited the audience to consider question they brought to the event. In the afternoon revalidation again featured as a topic of discussion, this is highly relevant within the context of integration given the role the ‘confirmer’ will have in a nurse or midwife revalidating.

It’s made my week

What a way to end my week! Firstly I attended an event at University of the West of Scotland hosted by Health Simpson (UWS Head of School) and Fiona McQueen. The event was an early exploring our collaborative outputs and impacts, what seemed clear was that there is far more going on than could be reasonable be capture in a morning.

It is however unmistakable that our strategic collaboration is making a difference – I’ve included a link to the presentation that Mick Fleming (Honorary Nurse Consultant/Senior Lecturer) and I did related to mental health collaborative outputs (click here)– I think the contribution to the literature from our teams is outstanding, I’m proud of them all.

It’s made my week! No, it’s not me saying that, it’s the Chief Executive John Burns, so what would make him say that?

I was on a leadership walkround in Elgin Ward, Ailsa Hospital with John Burns, CEO; Mrs Lesley Bowie, Non-executive Director and Angela Rowe, CIU  – Elgin Ward is our forensic rehabilitation ward.

We were listening to Senior Charge Nurse Jeanette Henderson, Community Forensic Team Leader Brian Hood and Clinical Nurse Manager Stuart McKenzie, we were looking at evidence of what they do, what they’ve done and hearing of where they want to take the service. Integration to them means the opportunity to do things differently, to building on their blended community/inpatient model wrapped round the person.

This poem was written to a member of staff by of of the service users who had been in Elgin Ward.

I was thrilled to hear about the flexible approach the staff adopt in wrapping care around the needs of their service users – it was awesome to hear that having created the conditions, the service users were indeed empowered to take ownership of their own journey of recovery.

Ladies of Alloway Church

Friday ended with two , and an email, which made me smile – firstly the email. William Lauder emailed me telling me about a donation of £830 from the ladies of Alloway Church, which they’d raised in their winter coffee mornings.

This is the third year in a row they have donated towards activities/equipment to be used for people within mental health services at Ailsa Hospital – thank you to everyone who has contributed towards a fantastic total of £2630 over the three years.

Engagement

Shortly after reading the email Michael Cavanagh and I met briefly to discuss the use of social media to engage our staff, to create safe spaces for discussion, to share learning as well as places to share general info more widely.

There are so many emerging examples of how we are learning to engage with our team and co-supporting each other, in addition to traditional approaches – The Delirium Facebook page, Andy Swanson’s EMH ‘thought for the week’ Facebook page, the twitter accounts @NHSaaaLibrary , @weepeoplechat , @eastayrshireOT , this blog and the ayrshirehealth blog to name but a few.

Wrapping up Friday was a meeting with Janice McAlister, Alzheimer Scotland Dementia Nurse Consultant – the focus of the meeting was to plan the launch event for the Tommy #makeadifference film launch on 12^th December

This week’s blog was by Derek T Barron (@dtbarron), Associate Nurse Director, Mental Health Services – Lead Nurse, North Ayrshire Health & Social Care Partnership

Bloggers coming next are:

24^th November – Angela Cunningham (@aac946)

1^st December – Ann Gow (@poppletonp)

8^th December – Billy McClean (@billyahpd)

15^th December – Andrew Moore (@maidenturret)

22^nd December – Angela O’Neill (@angela_oneill1)

29^th December – Diane Murray (@di962)

 

And now for something different…. by @fionacmcqueen

Sharing thoughts

Last week I blogged about leaving you for a period of time (yet to be determined) while I take up the post of Chief Nursing Officer at the Scottish Government, until they make a substantive appointment.

Whilst arrangements are still being finalised, it looks as though I’ll be taking up my new post over the next week, so this will definitely be my last blog for the time being.

I’m leaving to go on secondment, but not certain on when I will return. Whatever happens, things will be different, so I thought I would use this opportunity to share some thoughts on my time as Nurse Director here in Ayrshire.

in the beginning … 1998

When I arrived in Ayrshire almost 16 years ago, I was overwhelmed by the friendliness of staff and the real desire to do the right thing for patients. Sixteen years on I continue to be overwhelmed by that same desire to do the right things for patients and their loved ones; which is supported by some amazing improvements in care over the past few years.

Last year the Board reaffirmed its commitment to the NHS Scotland Quality Strategy and agreed to have an aim of excellence in care for every person every time by 2015. Whilst we are a good way towards this, I think there is some way to go.

Some of the improvements we still have to make will be supported by the establishment of the Health and Social Care Partnerships, others by the completion of the assessment units at our front doors.

However other improvements that can be made can be made by improvements that all of us can make within our current environments, right away.

How can I help you?

Poor attitude and communication continue to bother patients and their loved ones;

‘how can I help you’ could replace ‘who buzzed?’

A smile and a ‘hello my name is…’ could replace a grunt and a downward look at case notes.

A smile and ‘how can I help you’ could replace a huddle of nurses around the nurses’ station not acknowledging the worried relative.

A lot of improvements we have to make are about being human and compassionate in what we do, and I’m confident we can continue to build on the improvements that have been made in recent years.

A wonderful place to be

So what makes NHS Ayrshire & Arran the wonderful place that I believe it is? Well, the staff. The amazing care that people talk about and write to me about is truly humbling.

Over the years I’ve had letters outlining what makes me proud to be a nurse.

Whether it’s been about caring for a woman with alcoholic liver disease in her final weeks and supporting her teenage son and estranged husband;

or about the school nurse who kept a teenager at school and safe by her supportive interventions;

or about the CAMHS nurse who transformed a family’s life by the support they gave ;

or about the Health Visitor who supported a young mum in early days of motherhood;

or the member of staff care who kept a colleague at work; or the staff who supported a dearly loved mother to a peaceful death.

Amazing compassionate care

It is truly an honour to be a nurse and truly an honour to be the Nurse Director in NHSA&A. As a team, not only have we managed to deliver some amazing compassionate care, as a profession we have embraced working in a multi disciplinary team and supported the organisation to deliver real improvements in care, not only but most notably through the Patient Safety Programme.

Counting the gap between ventilator acquired pneumonia in years rather than days; seeing reductions in mortality and morbidity; and some outstanding reductions in healthcare acquired infection – and we all began to wash our hands!!!

Leadership across Scotland

Ayrshire nurses are not ones to sit back and wait for change to come to us. We just have to look at the leadership across Scotland our teams show; the palpable improvements we have made in mental health with a number of initiatives improving care across IPCU, in patients and community teams- as well as our approach to electronic record keeping; the sustainable services we are maintaining for the people of Ayrshire by having Advanced Nurse Practitioners and our Hospital at Night team to name a few.

And it’s not just nurses who rise to the challenge to improve care, our AHP colleagues are leading the way with the MSK pathway as well as the AHP Consultants who are taking their services to people to a new level.

Choppy waters

Across the NHS in Scotland there are choppy waters ahead; whether it’s the challenging financial times ahead; or our need to improve health; or our need to deliver care using highly specialised technology and medicines; or our ability to respond to our aging population with a reduced population of working age.

However I’ve no doubt that within NHS A&A we are ready and able to respond to these challenges, and I look forwards to leading the profession across Scotland, with all that I’ve learned here in Ayrshire close to my heart.

I have been truly humbled by people’s good wishes and genuine pleasure at my appointment – I’m sure that my appointment reflects the good work we’re doing here in Ayrshire & Arran.

Keep in touch

The Associate Nurse Directors have agreed to keep the keyboard warm until I return, and I’m hoping to be asked to provide a guest blog – either here or at AyrshireHealth.

Please keep in touch and let me know what you’d like to see from me as CNO. You know where to find me.

 

Saving lives from the library by @fionacmcqueen

Working together to do the right thing

A mixed and varied week again for me, against the hospitals being really busy and staff working flat out.

Monday was the annual planning event that the Chief Executive runs – funnily enough – every year. It’s a chance for the John and the Directors Team to spend time with the operational managers and professional leads, to focus on an area of the service with a view to having time to discuss, and also make plans to improve our services.

This year the event was at Dumfries House; which was a wonderful setting – and very cost effective as they are trying to encourage more use of the facilities and support the public sector by giving reduced rates.

This year’s event was called ‘Working together to do the right thing’ and John kicked off the day by urging us to examine what we do, and at all times, do the right thing for our patients and communities; no matter how hard that is.

Learning organisation

I had the privilege of presenting ‘Working together to become a learning organisation’…….. which as most of us know is really difficult. Learning from reflecting on our practice, and also when things go wrong is crucial to improving care; indeed I wonder if it’s the last major barrier we have in achieving excellence in care for every patient.

I used examples from the Patient opinion website of where patients had posted about care – good and bad – if you’ve not looked at Patient Opinion, take a couple of minutes to see what our patients are saying about us.

A lot of the postings are positive, and should encourage us to keep searching for improvements.

On the road – team meetings

As part of being out and about more, I asked my team to invite me to their team meetings so I could spend some time with the teams, for no other reason than to be with them and hear what’s on their minds. On Tuesday morning I popped in to meet with Chris Rodden and her team – mainly the Practice Education Facilitators and the librarians (@NHSAAALibrary).

Unfortunately I couldn’t stay for long, however I’m sure to go back as on arrival a freshly made bacon roll was waiting for me. (It would have been churlish for me to refuse). Our library managers bowled me over with their enthusiasm to really improve care by making it easy for clinical staff to access good evidence based information and proved to me that lives can be saved from a library.

Have a look at the services they provide- on Tuesday they were discussing how to put links directly onto the desk top to save clinical staff time (and divert them away from Wikipedia) when looking for information.

Infection control

This was a week for catching up with my direct reports and on Wednesday it was good to catch up with Bob Wilson. We discussed Healthcare Associated Infection and the improvements that are being made with respect to our infection rates; both Staphylococcus aureus Bacteremia and Clostridium difficult infection (CDI) rates are continuing to decrease, although constant vigilance is needed.

Some of our peripheral vascular catheter care is not as good as it can be, and prudent anti-microbial prescribing is going to be essential if we are to hold onto the improvements in CDI.

Complaints workshop

And finally Friday. I met with Andrew Moore to talk through the key issues he is dealing with and he fed back to me what had happened at the complaints workshops we had been running this week. It was really encouraging to hear how keen managers and clinicians are to embrace feedback and put all their energies in to resolving concerns as they arise – with the intention of dealing with concerns as early as possible so that they can be resolved – ideally there and then. The aim was to be able to resolve all concerns informally – so no need to get into formal letter writing – now that would be a success.

I also met with Heather Simpson from UWS to plan a seminar we’re having where we will look at the relationship between the university and the NHS, and see how we can build on the really good partnership we have to further improve care for our patients.

Chief Nursing Officer – Scotland

Moving back to Wednesday of this week, when I attended for interview for the post of interim Chief Nursing Officer at Scottish Government. I’m pleased to let you know that I was successful and will soon be going on secondment to take up the post. John will be moving immediately fill my post on a temporary basis until I return.

It’s a real honour to have the opportunity to lead the profession across Scotland at this turbulent time in the NHS and I’m confident that much of the good work we do here in Ayrshire contributed to my success.

I’ve been overwhelmed by people’s good wishes and will take a piece of Ayrshire with me to the government. So, this will be my penultimate weekly blog for a while, the Associate Nurse Directors will keep the space warm.

You know where I’ll be – so keep in touch.