Looking to the Future – it’s that Time of Year by @fionacmcqueen

Firstly, many thanks to Derek for holding the fort with my blog. His rubbish ending was intriguing, that’s for sure.

For me this was a week of looking to the future and planning for what that brings to us. Whatever happens, there’s no doubt it will be different; so a really important task for all of us is to get our heads out of the sand or out of wishing for the past, and fully embracing our future. It’s easy for us to cling to what we’re used to; our old routines; our old relationships; just are we’re used to.

And often, the just as we’re used to isn’t that great.

The 2020 Vision

So, with a Board workshop on Tuesday where we were looking to beyond 2020; and the Scottish Executive Nurse Directors discussing how we best organise ourselves to deliver the 2020 vision, and beyond on Friday; my focus has been on what we need to do today to make sure we are prepared for tomorrow.

The remainder of my week was spent catching up with the team, welcoming the Healthcare Improvement Scotland team who were here to learn about how we are caring for older people; and reviewing nursing numbers to prepare for next year and what we are needing to submit to the NHS Board with regards to additional nursing numbers.

On Tuesday the HIS team spent the day with us reviewing what we do to care for older people in acute hospitals. They left at the end of the day letting us know they were pleased with the progress we’re making, but what was particularly pleasing was the informal feedback on how impressed the team had been by the commitment and professionalism of our staff.

And not to be left out, at the other end of the age spectrum, the midwifery service were audited on Wednesday with respect to the standards of midwifery supervision. Again, a glowing report, with the Midwifery Officer who was leading the inspection (on behalf of the NMC) letting us know how impressed she was with our supervisors and what they are doing to protect the safety of women and their babies. Innovation, improvement, and learning from best practice.

There’s no doubt being able to reflect on what we do is crucial if we are to improve our services.

Back to the Future

So, back to looking at the future. With public sector finances being incredibly tight; public concerns about safety and lack of compassionate care; and the introduction of integration of health and social care; it’s going to require a real focus on what’s important and a relentless pursuit of excellence, if the professions are to continue to meet the needs of our communities.

There’s no doubt that the increased demand for our services is putting pressure on our services that requires a combination of additional resources, and a radical look at the way we deliver care.

The inquiry into the Vale of Leven will be published on 24^th November, so there’s going to be a frenzy of interest in the unnecessary deaths and have we learned the lessons?

And we have to ask ourselves, what steps have we taken to make sure that care is not only good, but excellent? Do we tolerate poor standards?

Why do people not always wash their hands? Why are our infection rates not the best they can be? What is it that stops us from providing excellence in care for every patient every time?

Leadership

Leadership is going to be key- from all of us – keeping the people we care for at the centre of everything we do, and being open to new ideas in the pursuit of excellence. Our Senior Charge Nurses and Team Leaders are crucial to this; often being the lynch pin between the people we care for and the rest of the organisation, so the results of the Stress Survey of ‘Band 7s’ indicating there were additional levels of stress – over and above what could be expected for people in similar jobs, means the planning to support health and well being of all our staff is going to be fundamental to ensuring excellence in care is deliverer.

Holding onto our values

The future of health and social care in Scotland is going to be different.

The regulatory framework for nurses and midwives is also going to be different. So as we hunker down to face a blustery winter, we need to hold on to our values and our aspirations to provide excellence in care for every person every time.

Great beginning – rubbish ending by @dtbarron

A positive start

I had a really interesting and varied week, although the end of it was rubbish – before I get to that though, the week started really positively.

Along with Iona Colvin (Director, North H&SC Partnership) I visited wards 1D & 1E in Crosshouse. I was interested in seeing how ward 1E is getting on with the new whiteboard system they are using. The system is different than the one being used across the rest of the hospital, primarily as the information needs are different.

I was disappointed that we were in ward 1D a day too early, on Tuesday they got their new medicines trolley. As part of the Scottish Patient Safety Programme, Mental Health the ward are working on the safe medicines management workstream, the new trolley is to help them work towards individual self administration of medication.

Tuesday morning started off with confusion, I turned up for a meeting that had been postponed, it was just that the message hadn’t been passed on to me by the meeting organiser. I have to confess, there’s a little bit of me that smiled inside – it’s not that you don’t want to meet with people, but a wee unexpected extra hour of ‘free’ time doesn’t happen very often and is occasionally welcomed.

SISTER Thomson – a role model for many

Tuesday afternoon was a happy, sad occasion as we bid farewell to Carolynne Thomson, Senior Charge Nurse in Glenrosa Ward, Ailsa Hospital; Carolynne is retiring after more than 30 years of exceptional service within mental health services here in Ayrshire.

On Tuesday afternoon there was a wee (well rather large actually) party for Carolynne. Services users, families and staff came together to say how much we appreciated Carolynne’s input over many years. Carolynne is a nurse whose core approach was of person centred, compassionate care.

She was an undoubted role model for many new, current and aspiring nurses, we all wish her well for her future.  The picture attached is Margaret presenting Carolynne with flowers and a gift – you may remember Margaret who feature in ‘The Sorcerers Apprentice’ as she insisted on making tea for the John, Iona and I.

Expert by experience

Wednesday afternoon saw me in Edinburgh for the Dementia Standards in Hospital – Implementation and Monitoring Group. One thing that stayed with me was a comment Agnes made (supported by Henry) – our approach in Scotland is to have representative of people that use our services and their carers at meetings and groups that create, shape and monitor policies, it’s core to how we do things, it’s in our DNA.

I was surprised to hear of so many other countries where this simply doesn’t happen.

Surely the lived experience as a carer or someone who has dementia brings an expertise by experience, while being different than that of professional expertise, it is every bit as relevant?

Wednesday night was exceptional for me. George Nish, Senior Charge Nurse, Ailsa Hospital invited me to his graduation from the School of Social Entrepreneurs. I was in awe of people who had started small projects which addressed social inclusion within a small business environment – few, if any, are going to be rich; however the element of inclusion, of reducing inequalities for people with different abilities was spirit raising. More information can be found via the link: http://www.the-sse.org/about-us

Best wishes to George and the Acorn Furniture Workshop on whatever the future holds in relation to being a social enterprise (BTW if you want garden furniture, benches, tables etc have a wee look at what they produce at the furniture workshop, it’s awesome).

Mandatory and Statutory Training

Thursday started off with the North H&SC Partnership Management Team meeting. It’s an exciting time, there’s lots to be done to shape our new organisation, while at the same time ensuring we continue to deliver and develop our current services.

Following the meeting I visited Pavilions 1 & 2 with Iona Colvin and Andy Swanson (Senior Nurse, Elderly Mental Health Services). It was useful for me to see the link between some of the things we had been taking about at the national Dementia meeting with what is happening locally. It was of course more useful just getting to spend some time with staff hearing what things are like from their perspective – I did ask about progress with MAST (Mandatory and Statutory Training), just dropped that in here in case the Chief Exec reads this blog, it will get me some brownie points!! #maybe.

Friday started off with a planning meeting, in Glasgow, for the Mental Health Nurses Boards leads meeting on 5^th November – it’s going to be a busy meeting!

A rubbish ending

The end to my week however was rubbish, although I think it’s more correctly call ‘waste’ and how we manage it. Having been to the kitchen I wanted to understand how other aspect of our core systems operate. I guess there are few letters of thanks or Christmas cards sent to this team of dedicated people, but without them our hospitals cannot function – patients don’t get transported from A&E, samples don’t get to the labs for testing, linen doesn’t get delivered to wards, theatres grind to a halt with no instruments.

Twice daily our laundry gets delivered – ever wondered how this all happens? The systems and processes here are as important to patient care as the systems/process and people who are front facing in care delivery.

Here’s a happy picture for you – Christmas has come early for Derek – new custom designed trolleys which improve the efficiency and safety of his team when transporting stores, equipment and waste from one end of the hospital to the other, especially now that building for better care construction has started – it blocks of the previous loading bay at the labs side of the hospital.

Did you know – I didn’t – that paper towels shouldn’t go into these bins?

Did you know when we put the right waste into the right bin it can save us money? For example, a paper cup with residual coffee or tea put into a bin is contaminated waste, whereas the same cup, if it is emptied before putting it in the same bin is recyclable and costs us a third of the price to dispose of.

It might just be rubbish to you and I, but to others it’s a hidden role that everyone relies on, usually without knowing it.

I’d just like to say thanks to all these unsung heroes without whom we cannot deliver the exceptional, person centred care we aspire to in NHS Ayrshire & Arran.

Derek Barron (@dtbarron) is Associate Nurse Director, Mental Health Services and Lead Nurse, North Ayrshire Health & Social Care Partnership.

Next week Professor McQueen is back in charge of her blog.

Times are changing – and so are we by @fionacmcqueen

Staff at the centre 

This week, when reflecting on my blog, I decided to pick through my week with staff at the centre of my reflections rather than patients.

That’s not to say I’ve moved from my belief we need to put the patient and their loved ones at the centre of every decision we make. On the contrary. However this week I decided to challenge my thoughts of ‘talk patient, act staff’ and see how that looked from my perspective this week.

The NHS Board on Monday had a typical agenda of patient story, and Quality first.

Reflecting on the meeting from the perspective of staff, whilst there were no direct discussions focussing exclusively on staff, it’s clear to me that staff are changing; not only in what they are doing but in how we do it.

 The Patient Experience paper highlighted improvements that have been made by staff who listened to feedback from patients and their families; and an update from Billy McClean on the AHP delivery plan highlighted successful changes in care delivery from an OT and physiotherapy perspective; bringing improved outcomes for patients.

The wait times paper that Liz Moore presented to the Board again highlighted how hard staff are working to provide good access to our services.

Tommy on Tour

For me there was a quick transfer from Ayrshire College (Ayr Campus) once the Board meeting had finished over to UWS to be filmed for the DVD that’s being made about Tommy on Tour.

Other than the phobia of seeing myself on film, it was a lovely relaxed session.

And again, as well as being able to reflect on the impact that Tommy has had on all of us; the many pledges that staff have made to make changes brought home to me how committed we are to changing what we do to improve our care in general, and in particular, for people with dementia.

Staff support

I presented Peer Support Guidelines to Corporate Management Team (CMT) on Tuesday, which happily were approved. This is an approach that we’ve been developing over a number of years, through Roddy McNidder’s enthusiasm.

It’s taken from how we support staff through critical incidents, and gives members of teams skills to be a listening ear and be able to support colleagues in day to day work. Something that most of us do most of the time over a cup of tea, or in the passing; but is a method of providing background low level support to help staff well being and resilience.

In our ever changing world it’s so important to provide support for staff to keep up resilience and well being, so was great to have CMT support on this. One of the other papers I presented was the results of the In Patient Experience survey.

An interesting, but disappointing finding was that a significant number of patients are reporting that doctors and nurses are continuing to talk in front of patients as though the patient isn’t there. This is incredibly disappointing given our commitment to person centred care; and a few days later I witnessed this in action.

As I was walking through the main corridor in Ayr Hospital I noticed a man in a wheelchair being pushed by a qualified practitioner, accompanied by a support worker; both talking away as though they were pushing a shopping trolley in a local supermarket. I fully accept that at times it can be difficult to excellent care. However this was such a good example of staff centred care over patient centred care; it made my heart sink. What do we need to do to make sure all staff put patients at the centre of care at all times

How we assure high quality care for our patients by a system of accreditation, is an area of work we’re taking forwards with NHS Lanarkshire and NHS Greater Glasgow & Clyde, and on Thursday we met to review the good progress we’re making.

As we move forward towards revalidation for Nurses and Midwives, it’s going to be increasingly important that we evidence high quality care and I’m looking forwards to how we can take this system forwards.

Flying Start

And finally, Friday finished off my week really focussing on staff. Meetings with Ann Gow and Derek Barron focussed on the workforce tools and what additional investment would be required to support staff to provide safe care; and then one of my favourite jobs; attending a Flying Start Ceremony.

This is where we set aside an hour or so to present practitioners with their certificate of completion of Flying Start and mark all the hard work that they have put in to consolidating their practice, and also all the hard work that their SCNs or Team Leaders have put in to provide them with the support they need. And of course an opportunity for me to thank our team of PEFs who quietly get on with their work and make such a difference to supporting both undergraduates and also our newly qualified practitioners.

Well done Flying Start completers; keep up the good work; and hopefully see you at another Flying Start ceremony, but this time as a mentor.

Reflection

So, how would I rate myself on looking at things from a staff perspective this week? Well, if I’m being honest, not as highly as I would have thought. If we are truly going to provide a person centred service, then we need to focus on how best to support staff to do this. It’s clear from my week that we expect a lot from staff; both in terms of how hard people work, but also in terms of how we need to change to provide sustainable, person centred care. Hopefully people will have completed the staff survey and that will give us further information on what action we need to take.

Please let me know what you think.

So, on behalf of all the patients who use our service, to staff who do extra ordinary work everyday. Thank you very much.

Next week I’ll be on leave so will leave you in the capable hands of Derek Barron, Associate Nurse Director for Mental Health

Improving Care From a Living Room by @fionacmcqueen

MAST

A mixed and varied week this week from corporate and governance meetings, to an incredibly moving session with parents, to a very satisfying phone call on Friday afternoon.

Monday saw my week being kicked off attending a session on what we now fondly refer to as MAST. Mandatory and Statutory Training as John Burns clearly articulated, is essential to patient and staff well being; so why aren’t we doing it?

Well I suspect the list is endless;

• don’t have time,
• no places on the course,
• course cancelled because other people didn’t turn up

(boring) not my main area of interest………..

but now, the direction is clear.

If we are to be a learning organisation and truly put people at the centre of what we are doing, everybody needs to be appropriately trained and developed, which includes the minimum training and education we need to do our job.

That’s not to say we don’t also need higher level development – because we do.

Responding to feedback

I followed on the learning theme at Area Partnership Forum where I was pleased to have full support to take forwards discussions on how we best support staff to respond to feedback from patients when things go wrong, so that we can learn and improve without the staff member feeling downheartnered or criticised. This was an area highlighted to me by one of the Unison stewards, so I’m looking forwards to the discussions bearing fruit and moving forwards.

Routine Healthcare Governance and Integrated Health Steering Group (where the health reps on the partnership boards get together to check we’re taking forwards the health aspects within partnerships the same way across Ayrshire) took up my Tuesday uneventfully.

Attention Deficit Hyperactivity Disorder

On Wednesday I had one of these blow you away moments when I listened to a young man with ADHD talk to an audience about what it’s like to have ADHD and what it’s been like growing up in Ayrshire. Carol Cartwright, the nurse who supports children and parents with ADHD has been instrumental in setting up the ADHD Alliance Ayrshire which is a parent support group. It’s a real and shining example of how to coproduce services.

Improving care from her living room

The first conference took place on Wednesday and I’d been invited to say a few opening remarks. As the Scottish Health Council were running a national event on ‘Stronger Voices’ I had only intended to say my bit and then excuse myself up to Glasgow. However after opening the conference, the atmosphere was so compelling I stayed to listen to Carol, Jack’s mum, talk about what it’s been like for her as a mum of a boy with ADHD. In front of an audience, mainly of parents going through the same journey, she told us about her life with Jack; including how care was improved form her living room – when Carol came to Jack rather than expecting Jack to conform to our bureaucratic services.

Jack at this point had got cold feet and decided he wasn’t speaking, but listening to his mum, he then decided he would speak after all. This young 18 year old student, talked about what it was like to feel broken, and excluded from society. He talked about how it felt after he had lost his temper and how frustrating it was. Most of all he talked about his pain and anguish at not being able to control his emotions, and his pain and anguish from being bad and broken (his view). He was a joy to behold and an inspiration to all of us in so many ways.

If I needed to be reminded of how important involving service users in shaping services, Wednesday was it. From angry parents at breaking point, to parents whose lives have been transformed by our services; a fantastic session and well done and thank you to the team who put it on, and continue to support our families and young people in Ayrshire.

Healthcare scientists

The improving services from a different perspective theme continued on Friday when I had a session with some of our Healthcare Scientists. Healthcare Scientists are such an integral part of a quality, person centred service that makes a real difference to peoples’ lives. Many times unnoticed (it’s usually the doctor or nurse who gets thanked for the prompt diagnosis and news that there is no recurrence of cancer rather than the histopathology team), and often life changing (the physicist who makes the cochlear implant work and the child can hear for this first time in their lives) our healthcare scientists are a fantastic asset to our services and we discussed how we can showcase their work, as well as plan for the future of their services.

Integrated Joint Boards

The phone call that made me smile on Friday afternoon was with a Scottish Government Colleague who was discussing how the Scottish Nurse Directors can work with the team at government who are working on integration of health and social care. He let me know that now there will be a requirement for the Joint Boards to have a nurse at their Board meeting. This is something the nurse directors in Scotland have been concerned about for some time, as we were concerned that with nobody accountable for professional standards of care around the table, then there was a risk that the quality of care delivered to our patients may not have been all that it could be.

Clarity of understanding

So, another week passes, and the importance of relationships; with people and their loved ones; as well as with and between staff; has never been clearer to me in how we deliver excellence in care.

 

Sitting in an office can improve care by @fionacmcqueen

This week saw me quite removed from patient care and office based, with much of my work circling around policy and strategy; however not only is it central to the Nurse Director’s role, it’s essential if we’re to keep building improvements in care and to support practitioners to care for patients and improve health, whatever the future holds.

Professorial lecture

My inaugural professorial lecture had been haunting me all last weekend, as I was presenting it on Monday afternoon at the Ayr Campus of UWS.  However, like most things I approach with trepidation, I thoroughly enjoyed it and it helped move our partnership with the university forwards, a nudge, with a mix of undergraduates, lecturers and NHS staff having the opportunity to meet and discuss ways we can improve care.

Issues such as how we support undergraduates to feedback on their learning experience and care provided within their placement areas, and how we can work in partnership with the university to bring evidence into practice so that we can provide excellence in care for every person every time, were just two of the areas I discussed over the very tempting lunch the university had arranged for us afterwards.

Institute of Healthcare Infection

Our strategic partnership with the university has helped Institutes to form and we directly support the Institute of Healthcare Acquired Infection as well as the Child and Maternal Health Institute. We also work with the university on development of programmes for undergraduates and I discussed how we can strengthen the selection of undergraduates into nurse education and make sure the clinical view is strong in that selection process.

The Francis Inquiry made recommendations about people who enter into nurse education having experience as a care assistant before entering. This is not something we are pursuing in Scotland, but we do need confidence that students who enter the profession have the potential to develop, deliver compassionate care, and also develop a real sense of professional values.

Governance 

At Corporate Management Team on Tuesday our main area for discussion was the integration scheme for the Integrated Joint Boards – which sets out how the new Health and Social Care Partnerships will work. Whilst that might appear on the face of it to be a bureaucratic exercise, we discussed how the NHS Staff Governance Standards and Healthcare Governance would be applied within the partnerships without overcomplicating matters (a thing the health service can be good at!). Thereby laying down conditions for the future to ensure staff can thrive and clinical services are delivered to a high standard.

The afternoon was spent, once again, reflecting on what happens when things don’t go to plan; from a relative’s perspective on poor experience, experienced by their partner; from a member of staff’s perspective on when they hadn’t been treated fairly; and finally from a patient’s perspective when the multi disciplinary team weren’t person centred and couldn’t respect that patient’s right to make decision about their care (in this case not to accept the treatment that was usually recommended).

Excellence in Care

When I get up in the morning, after having fed the dog, I usually have a quick look at what e-mails have come in overnight and check my diary for the day. Wednesday morning was no different; my routine tele-conference at 8.30 am about Scottish Executive Nurse Director business (where I would discuss the final arrangement for the session for the nurse directors we were organising for Thursday and Friday), and then in the afternoon there was a session on workforce with mainly the Senior Charge Nurses – which I was looking forwards to.

However I was incredibly touched to receive an e-mail from a senior nurse in Scotland who I’ve worked with over the last twenty years. She told me that her Mum had died in Crosshouse Hospital last week, and described care that was quite frankly, outstanding. Principally from a nursing perspective, but she described care from across the whole hospital, ending up that we had reminded us of why she came into the profession in the first place. It was obviously sad that she had lost her Mum, but wonderfully uplifting to hear about what happens almost all of the time within our wards and departments.

Shift patterns

A formal but informal session on nursing workforce on Wednesday afternoon was really interesting. We looked at what we considered to be the best way to agree principles of a safe and effective shift patterns for the organisation; as well as a look at what we had agreed at the summit last year and the progress we made.

There’s no doubt we’ve made some good progress in improving staffing levels, and speed of recruitment (with room for improvement of course), but discussing some continuing challenges with the SCNs at Ayr Hospital alerted me to some ongoing problems we have with secure safe staffing levels for our patients and I’m confident that we can agree a way forwards, in particular when our current round of internal moves have taken place.

The next ten years

Discussing the Allied Health Profession input into partnerships, and reviewing the progress we’ve made since our HIS inspection of care of older people in Ayr Hospital kept me busy on Thursday before I set off to Edinburgh to work with my Nurse Director colleagues from across Scotland and the Chief Nursing Officer on how we can lead the profession over the next ten years and what we need to concentrate on. Our thoughts are on Professionalism (including revalidation), Education(including a framework for post registration education), Workforce (in particular the aging workforce across Scotland), providing excellence in nursing care, as well as looking at the climate and context for the profession to thrive and develop.

All of this against our challenging socio economic climate, and a real desire to reduce health inequalities. Let me know what you would like to see taken forwards nationally to improve care locally.

Listen and learn by @fionacmcqueen

£1.5 million

An early Monday call to the Performance Governance Committee to report on the £1.5 million investment into nursing started my week. And whilst there have been significant reductions in the use of agency nursing, there appears to be a relentless need for additional bank staff; particularly nursing assistants. We’ll need a closer look at which wards have yet to have the establishment agreed, and at the moment the teams are looking at making sure staff have the opportunity to apply for posts across the organisation now that the additional staff are in post.

The trade unions have raised the issue of lack of availability of full time jobs for staff so that’s something we’ll discuss at the Nursing & Midwifery Workforce Group, as it’s clearly important to roster staff around the needs of the patients but equally to provide jobs that give staff the security of employment that they need.

We are the biggest employer in Ayrshire so it’s important that we take our place in the community as a good employer (remembering the difference in people’s health having a job makes).

Partnership working

Before attending the Partnership Conference in Irvine in the afternoon, I chaired a Leadership Oversight Group (LOG) to receive the final report of a Significant Adverse Event Review. This was the eighth Review we’ve called since the new process came into place; it’s always difficult when things go wrong for patients for both the staff concerned and also their loved ones. However it’s so important to be able to reflect and learn when things go wrong so that we can make changes to improve our systems and processes.

The Partnership conference in the afternoon heralded more focus on health and social care integration; at the conference when we discussed how we could work across Local Authorities and Health in engaging our staff and our staff side colleagues, and then the following day as a member of the South Ayrshire Shadow Integration Board.

The Board were really interested in hearing about the District Nursing service and recognise how important it is in securing the changes we need to see in our services. We then had a session on Self Directed Support, which at the moment is applicable when people need support via the social work services, and involves people organising their own care, in whatever way suits them. It’s a real step forwards in giving people control over their lives and services, but quite a shift in thinking for professionals who may be used to organising care for people in the way the professional thinks is right.

Professorial role

It it’s Wednesday it must be Hamilton. I had a routine meeting with Heather Simpson, Head of the School of Nursing & Midwifery at UWS so took the opportunity to meet a colleague from Scottish Government there to save them coming right through to Ayr. Erica has been to Boston as an IHI Fellow and now having returned is keen to work with the Scottish Executive Nurse Directors to see how we can make real improvements in care. We thought it could be really productive if she works with other nursing Fellows from across Scotland to see if we can develop policy that will help us across Scotland to improve care.

The importance of reflection

Last day of the week (always good to have a four day week) saw a day of reflecting on how we can make improvements, but from three different perspectives.

Distress

I met with a woman who has been really distressed by the poor care that we gave to her mum in the last few days before her mum’s death. Her mum died over a year ago and she still hasn’t been free to grieve and bring closure to her grief as she has been working through her complaint with us.

Meeting with the woman and her husband has helped me better understand what we need to do when poor care has been delivered; for instance senior manager (preferably clinician) intervention as soon as possible and early discussion with the team about what has gone wrong, and how we can really learn and improve.

Recognising the hurt and distress both patient and staff experience is also central to caring for everybody touched by the incident.

Learning

The second perspective on how we need to improve and learn was through a meeting with Dr Hans Hartung, who has recently returned from a year in Boston with the IHI. Those of you who know Hans will know how core person centred care is to his practice, and this has been further emphasised during his time away. I’m confident Hans will help us move along our journey of transformational change and was pleased when he let me know that coming back into the organisation he has noticed changes and improvements in what we’re doing and how we’re working to reach our goal of excellence in care for al of our patients.

Improvement

Finally I spent some time in the afternoon on a Patient Safety Leadership walk round. The visit was to the Ophthalmic Clinic in Ayr Hospital and Ann Kennedy talked me through some of the improvements to safety that had been made since the last visit (more seating for patients). However there are still some real challenges for the service in how to provide person centered care for all of our ophthalmic patients.

As it is a service that is able to do more and more for patients, and also a service where there is an increase in the number of older people in the community who need to use the service, there have been large demands for appointments and treatments.

This means there can be up to five consultants seeing patients and the area becomes very crowded, with clinic over runs being par for the course. So the challenge to the organisation is how we can build on the fantastic work the team are doing for patients and find ways to be able to provide an excellent service to all of our patients, without exhausting our staff in the process.

Staff survey

I can’t sign off my blog without mentioning how engaged the whole of Scotland has been in debating what’s important to them this week.

If only we could generate as much interest in the staff survey.

So, have you completed your survey, and have the rest of your team? Return rates are low, so please get on with encouraging everybody you know to make a difference to improving where they work.

Back to the Future Part II by @fionacmcqueen

Blowing my assumptions away

Over thirty years ago when I took up my first Staff Nurse post in the Institute of Neurological Sciences (nobody working there accepted they were part of the Southern general) I worked in a neurosurgical ward where most of the patients came from the Highlands. Two things about working there have stayed with me. Firstly, when talking to relatives about their loved one who was on a ventilator, we used to warn them that the head injury may well resolve but there was a risk that they might die from a pneumonia from being on the ventilator – come in Scottish Patient Safety Programme and blow my assumptions away – we’re now going years in Ayrshire without a ventilator acquired pneumonia.

And secondly, the other aspect that stays with me was the fact that since our patients came from the Highlands – so did their loved ones. So ‘visiting’ was from 10am until 8pm.

Going back, to deliver the future

Why then have we made so much progress on infection, but seem to have taken a backwards step for ‘visiting’? This was how I ended my week – having a discussion with Diane Graham about how our pilots for open visiting are going. Hence my going back so we can have our future. Diane and I discussed some of the concerns that nurses have; including how to tell the visitors it’s time to leave at the end of visiting.

A recent RCN Management Journal reported on a nurse’s experience of shadowing a family of someone who had chronic health problems, and the question this nurse posed at the end of her period was this; ‘Who are the real visitors within a ward?’ Our community nurses are very clear that they are the visitors in people’s houses when they go to deliver care.

The shadowing nurse was very clear at the end of her period of being with the family, that even in hospital; it was the nurses who were actually visiting the patient to deliver care. Their loved ones could only enhance the healing of the patient.

Now, I fully understand that society has changed, as have our hospitals.  However perhaps we do need to look at who is actually the real visitor and work in partnership with the families we care for.

• Yes, patients need to rest.
• Yes patients need to use the commode.
• And yes, patients need privacy and to leave the ward and go for tests.

However most families understand that. My challenge to all of us is to really look at what we do and open our hospitals and welcome our patients’ loved ones to be by their side. Whenever they need them.

 The challenge of resistance

Much of my week has been about catching up with people on a one to one basis and planning and organising. But Infection Control is worth a mention. I met with the team to discuss anti microbial prescribing and some of the challenges we have in not only meeting our HAI targets, but in the ever increasing challenge of resistance.

Later in the week I caught up with Professor Craig Williams, of the Institute of Healthcare Associated Infection, at UWS. The Institute was pump primed by NHS Ayrshire & Arran and is beginning to produce some good evidence that will help infection control. Brian talked to me about some of the potential exciting areas of research such as the impact of the environment on HAI, as well as increasing resistance. We also talked about how to better share some of the work form the Institute and agreed to have a briefing event early next year to share all of the Institutes’ work from the University – and how we can improve outcomes for patients.

 Staff survey (yes, again!)

And finally – how many of you and your teams have completed the staff survey?

– let me know if there are departments where all staff have completed theirs –

and do let me know what stops us welcoming visitors into our wards and departments more freely.

Back to the future by @fionacmcqueen

Survey and revalidation

I’ve done it! I’ve completed my staff survey – it didn’t take long- and was easy to fill in. Have you done yours? What will our response rate be?  What will our response rate be??.

As well as doing my staff survey, on Monday Chris Rodden had asked me to complete a questionnaire that is being tested to see if it will gather information to support revalidation. We’re looking for something that will cover all practitioners – and for me who is very removed from direct practice it was interesting to look at how I could evidence how I meet the code (and I think I did).

Another Edinburgh meeting (but this time as I know the people well having worked them for over a year now a teleconference sufficed); and we discussed the Safer Patient Programme and the difficulties we’re having nationally with measuring how many catheter associated urinary tract infections we have. The other measures such as falls, cardiac arrests.

Social Media

Mr Twitter himself, Derek Barron (@dtbarron) rounded off my Monday nicely; discussing mental health nursing numbers and the workforce tool, as well as seeing some impressive figures on how far reaching #nhsaaa has been through blogs and twitter.

Derek has been impressive in his leadership with this, initiating AyrshireHealth, encouraging the use of twitter, and of course helping me with this blog.

Back to the future

Tuesday was my Back to the Future moment when meeting with newly appointed Staff Nurses into the mental health service. Big congratulations to Pete Gilfedder and Lynne Murray for providing the leadership for this forum, to give newly appointed nurses space to learn, reflect and support each other in their first few months of being appointed. It’s always a pleasure to meet ‘real’ nurses! I’ve met a number of colleagues from mental health now over the past few weeks and it is quite unusual for the subject of FACE (the electronic record used within the mental health service) not to be brought up.

In this case, there was no exception to that rule and we discussed the ‘clunkiness’ of the system. And whilst electronic records have a real benefit, there is no doubt that the next iteration of FACE will be an improvement – so going to the future, it looks like the nursing record will be going back to easier evaluation and record keeping.

The debate with practitioners around FACE is fascinating. In terms of NMC standards for record keeping, the system supports practitioners to meet these standards in a way that colleagues with written records on the general side can only dream of. There’s no doubt that improvements can always be made to electronic systems, and Mark Fleming and his colleagues must be congratulated for their innovation, determination, and also in really listening to practitioners to shape the new system. Community colleagues reflected to me that they could send an update to their patients’ GPs immediately they had written their record.

Now if only we could replicate that for all communications with GPs.

Professionalism

An interesting opportunity to provide connections for Kirsty Darwent, the Vice Chair of the NHS Board – who also chairs the Healthcare Governance Committee and the Endowment Committee, happened on Thursday. Kirsty had asked if she could get out and about and see more of what’s happening within wards and departments so it was great that she could come with me on Thursday when I went up to A&E at Crosshouse and also 3E. Nursing workforce, person centred care, and patient flow were the main topics of our conversation and the professionalism of Theresa and Tracy, the SCNs, and the relentless nature of the work was easy to see. At the Endowments Committee in the morning we had been talking about the use of endowment funds to improve the relatives’ rooms, and also whether or not Dyson fans were really necessary! So it was good to be able to talk to a nurse on her way to give a patient a fan to make them more comfortable and also pop into the relatives’ room for 3F. Interestingly we also had a chance to talk to a woman whose mum was very poorly in 3F; she was very happy with the care her mum was receiving and grateful for all that everybody was doing for the family.

Green spaces

The Endowment Trustees Committee is probably a not so well known committee that oversees the use of endowment funds. This week we were delighted to receive a bid for more greening of our estate – which at the moment is mainly putting paths in and around Ayr and Ailsa.

The paths we currently have are being well used and we’ve benefitted from external funding as well. If you work on this site and haven’t yet taken a walk – please go and see what you think.

Reduce unemployment to improve patient care by @fionacmcqueen

Staff survey

Another week dominated by workforce and quality of care (that’s the way it should be) and dealing with it at both national and individual patient level is really intriguing.

However first things first; have you completed the Staff Survey?

Are you relentlessly nagging colleagues and team members to complete theirs?

As confession is good for the soul, I haven’t yet completed mine but by the next time I blog will have. It is so core to changing and improving our culture, we need to get as many people to have their say about our organisation as we can.

NHS Board meeting

Monday started with the NHS Board meeting at Greenwood Conference Centre in Irvine. The NHS Board is keen to be more accessible so is meeting in areas around the county – and often not in health venues. If you can, you should try to come along to a meeting and see what happens. A number of usual discussions took place; HAI; Patient Safety in Mental Health; Waiting Times; as well as a report on workforce.

We then had a wide ranging discussion on the conundrum of needing to keep an older workforce healthier and at work, with some of the real shortages of supply we have (just look at the number of bank nursing assistants we use); with the high unemployment rate of our young people.

As numbers of young people decrease, and our older workforce retire, it’s going to be important that we can recruit from a wide pool of people and also help young people get that all too important ‘experience’ to get them into the workplace and improve their life chances.

Saving a life

Taking the opportunity to save a life (my own) I decided to cycle into work on Tuesday. Because I’m out and about so much I rarely stay at the one base for the whole day, so a full day Corporate Management Team at Eglinton House gave me the opportunity to get on my bike and cycle to work. I was so proud of myself I wanted to take a selfie with me on my bike and post it on twitter, and also on my blog.

However the power of two teenage daughters means that all I have is a photo of my bike in my office as proof! Once over the falling off as I tried to get over a large kerb, and the chain coming off, I arrived at work feeling fantastic.

The exercise set me up for a full day meeting dominated by balancing waiting times, finance and quality.

Engaging our staff

Participating in Engaging our Staff with the team and preparing for the Workforce Summit in September filled my Wednesday. We had a Workforce Summit last year and agreed we should proactively recruit staff so that as one member of staff leaves, their replacement can be brought in right away rather than waiting for a lengthy period as we went through recruitment.

A year on, people have commented on the real difference getting replacement staff in time makes, and we have also invested £1.5million pounds in additional staff to bring wards up to staffing levels agreed in the workforce tools. I know there are still areas not covered by the tools but we are now looking at these areas, as well as mental health wards and community teams.

So the Summit this year will take a look back, and in particular concentrate on safe and effective shift patterns that can wrap around patients and families, as well as enhancing staff well being.

National policy

Thursday and Friday were mainly spent on national work and that’s where it’s good to see the connection of what is happening nationally with what we’re doing locally. And in particular, how what we do locally can affect national policy, which is why it’s important that people contribute to what’s happening in their teams.

I chair the Nurse Directors group (Scottish Executive Nurse Directors, SEND) and we meet each month with the Chief Nursing Officer, Ros Moore, who many of you will have met when she has visited Ayrshire.

This month we focussed on where we are with nursing numbers; the integration of Health and Social Care and how we make sure we can assure the quality of care within the partnerships; as well as nursing policy and what we need to do to secure excellence in nursing in the next decade.

Healthcare Scientists

Some colleagues have already developed Delivery Plans, and our colleagues the Healthcare Scientists have asked me to spend some time with them on how they contribute to excellence in care, sometimes in direct contact with patients, but on many occasions, by never setting eyes or hands on patients. They would be delighted to have comments on their delivery plan The key themes within the NDP are: Leadership for Change; Delivery of Integrated Services; Reducing costs and Improving Outcomes; Reducing Unnecessary Test and Interventions, Workforce Reprofiling /Competency Frameworks.

The complete document can be found at: http://www.scotland.gov.uk/Publications/2014/06/2844

Nobody listens ??

One area of discussion we had with the CNO and SEND was how can we assure the public (and ourselves) that we are delivering care safely. Some of you will know that we are looking at a model for accreditation with our Glasgow and Lanarkshire colleagues. We were able to share this with CNO/SEND and it’s likely that the local work we are doing will find its way into national policy.

So for those of you who doubt ‘nobody listens’; take note.

Always really pleased to get feedback on my blog – feel free to invite me to see what you get up to.

Talk Patients, Act Staff by @fionacmcqueen

Health and wellbeing

Without wishing to tempt fate, as I’m on call this weekend and am not anticipating there will be a large need for me at work, I’m writing my blog on Friday night and reflecting on another week closer to the Board’s target of All Patients Having a Good Healthcare Experience and no complaints – by the end of 2015. My week started and finished revolving around staff health and wellbeing, with many aspects of my work reminding me of how important healthy (mental and physical health) staff are, to high quality person centred care.

Staff Survey – Talk customer, act staff

In the early days of Virgin, Richard Branson used to say; ‘talk customer, act staff’; as he knew how important good staff experience was to excellent customer service. This has translated for me to; ‘talk patient, act staff’; if not literally, then metaphorically. All too often, we expect staff to deliver excellent care to people in hugely demanding situations, but fail to provide a healthy environment for them to deliver that care.

So with that thought, it is my aim, to walk into a meeting with my Nurse Director colleagues across Scotland, and announce that Ayrshire Nurses and Midwives had the highest return rate for the Staff Survey this year.

Last week Derek talked about the Staff Survey and how important it is for us to improve staff health and well being and making Ayrshire a fantastic place to work (and therefore a fantastic place to deliver excellence in care). So my challenge to every nurse and midwife in Ayrshire is – get filling in your staff survey (I’ll let you know when I’ve done mine) and nag your colleagues relentlessly to fill in theirs.

Now this week I met a number of staff who are unhappy. Do I mean that I want staff who are disgruntled with the organisation to fill in their surveys? Absolutely – the only way we can make improvements to our working environment in its widest sense, is for all of us to complete the survey and work on our action plans. Hopefully, many people will complete the survey and have positive responses; there’s only one way to find out. Hard copies and electronic copies are both available.

Back to the start of my week which started off with me visiting our Occupational Health Department to have some bloods taken as part of a staff health and well being initiative that we’re taking part in.

It’s good to see nurses providing care in all settings and for me to have time to catch up with how things are for our Occ Health team.

Health and Social Care

Integration of Health & Social Care again featured throughout my week; on Monday interviewing for the Head of Health & Community Care in the South Ayrshire Partnership; on Friday, with Billy McClean, talking about the opportunities to improve care, delivered by AHPS for people in partnerships; and on Tuesday through in Edinburgh. On Tuesday morning as the Chair of the Scottish Executive Nurse Directors (SEND), I was chairing, on behalf of the Chief Nursing Officer for Scotland,  the first meeting of the programme board for revalidation of nurses and midwives in Scotland. The NMC are likely to let us know what they’re proposals are for revalidation in September and it’s going to be important that we can implement the proposals safely and effectively. So the programme board will oversee how we roll this out across Scotland, and in particular, we reflected on how nurses within partnerships will have their professional practice supervised.

Of course, within Ayrshire, the partnerships have all agreed to have a Senior Nurse around the partnership table, but nationally we are continuing to lobby government to make this mandatory for all partnerships.

Ayrshirehealth blog

On the staff health theme, Derek had asked me to do a blog for Ayrshirehealth – which I did on physical health and wellbeing (Somebody has to change) and it was published on Wednesday, with loads of comments on how important it is – if not difficult. I also did a patient safety visit to Ward 1A on Wednesday, and those of you who are regulars to my blog know how much I enjoy visiting clinical areas, and the paediatric assessment area was no exception to this.

Excellence in care

Finally, Friday was a mix of a day. Finishing off discussions with the Clinical Nurse Managers (along with Liz Moore) about nursing budgets. Liz, as Director of Acute Services will say, ‘I expect you to keep within your budget, and roster safe levels of staff ‘. I will say, ‘I expect you to roster safe levels of staff and keep within your budget.’ In essence what we are saying is exactly the same, Liz has high expectations that staff will provide excellence in care, and I have high expectations that we will manage budgets effectively.

Excellence in care can only be delivered in a financially stable organisation and I do appreciate all the work that Senior Charge Nurses and managers are putting in to rostering safely and effectively.

Rostering annual leave smoothly throughout the year, and improving the health of our staff (as measured by reducing sickness absence) is making sure patients have the right level of staff available to care for them.

Personal Reflection – complaint

On Friday afternoon, I had an appointment with a woman, who was accompanied by her husband, who had not only received poor care from us, but whose complaint had been handled badly. The response had taken months and was also defensive. Over a period of time, we had exchanged letters, and the woman had compiled a report on where she saw the failings of our care delivery system and also our complaints system; which included my handling of the complaint. For some time she refused to meet with me as she felt I had been disrespectful in my handling of the response, been defensive, and not tried to see things from her perspective. On reflection I could see exactly what she meant. I was deeply saddened that my handling of her complaint had added to the distress that poor care had caused.

So with some apprehension, I met with the couple to hear their story. I was pleased to have the opportunity to let the lady know how sorry I was that we had let her down, myself included; but I was also moved when she talked to me about how she had been admitted as an emergency, received major surgery that had not only been unexpected, but had echoes of a procedure her grandmother had had years ago when the woman had been a young girl.

Respect her right to make decisions about her own health

I was so sad to hear of her desolation and isolation, and our lack of compassion in the days before and after surgery, and wished I could have walked the journey with her. Ironically, it was also for me a really uplifting meeting, as the woman was vibrant, full of life, insightful and a delight and inspiration to be with. She and her husband clearly articulated her journey through the system. If we had failed to fund a life saving drug, or failed to provide a hugely expensive piece of equipment, it may have been a different conversation.

But all that the woman was asking for was someone to listen to what she was saying, respect her right to make decisions about her own health, and respond in a professional compassionate manner. 

Breaking bad news in a compassionate caring manner; listening to what works for patients; because they do know their bodies better than we do; and of course saying…’hello Mrs Blogs, my name is Fiona, I’m the nurse looking after you today and I’ll be here until 8 o’clock. How are you today and what can I do for you?’ costs us nothing, but not doing it costs our patients, at times, a fortune in loss of confidence and fear.

I’ll continue to work on resolving the woman’s complaint and am heartened that she will work with us to support our ongoing learning and improvement.

Spiritual care

My week ended in picking up an e-mail from one of our staff nurses at Ayr Hospital who is really interested in spiritual care of patients – so important to whole person care. She has completed her Masters programme and as part of her research looked at spiritual care in acute settings.

In her e-mail to me she highlighted that there had been an unanticipated addition to the study around spiritual care for nurses……..and so my circle completes, caring for our staff will mean patients can be cared for safely, effectively and in a truly person centred way.