Kate: I'm Kate Arrow, an educational lead on the scottish quality and safety fellowship, and I'm here today with Jon and Lynsey, who have both completed the fellowship in the last couple of years, and both come to us from NHS Borders. So, Jon, do you want to tell us a wee bit about yourself? Jon: Yes. So, yeah, I'm Jon Antrobus, one of the anesthetics and intensive care consultants here in the Borders. So I was on cohort 13 of the fellowship, so that was probably. I think that was 2021. I think that wasn't a few years ago now, isn't it? And so I've always done quality improvement, or tried to, and found that sometimes it landed and sometimes it just didn't work. And I got to the point of being quite frustrated by it, not understanding why my projects weren't working. And it was actually our quality director suggested to me, I'd not really heard of the fellowship before. I think there were a couple of people in the department had done it, but I didn't know very much about it and she suggested that I should maybe have a look at. And so applied and managed to get in and it's been a bit of a kind of life changing moment for me, it really has. But anyways, that's my experience. And then Lindsay was. Lynsey: Yeah, so I'm Lynsey, I'm the senior charge nurse in the intensive care unit at Borders general as well, and I applied for the fellowship at the same time as Jon, but he nicked my place, so I went on it. I was cohort 14, which was the one after Jon, and when I applied, bit similar to Jon, I'd done a few qi things, but not really knowing what I was doing. It was more I was doing it and people were having to follow rather than me doing it properly. So I wanted to learn how to do it properly, learn the methodology. And Jon not rubbing it in my face, but sent me loads of messages and loads of pictures of residentials and then it was an absolute marvel when I was applying and really helped me, so I was really keen to get on and I was so excited. Jon: Wasn't. Yeah, you put your heart and soul into that. Lynsey: Yeah, I did. I know there's not many nurses that have done it and I think it's something that would be of real value to the nursing profession when we make up quite a lot of the percentage of health care. And I think we should be driving QI from the bottom up and nurses. Jon: Could be leading and should quality improvement work and giving guys like you the ability to put you into leadership roles like this and mentoring models and role models for other nurses. That's fantastic. We should be doing more of that, for sure. Lynsey: Yeah. Kate: And quite often it's the nurses who are like the steady presence on the ward, aren't they? Whereas the doctors maybe move around a lot. Lynsey: Yeah. I think from my project that I'd done on the fellowship, it was basically shift in culture, wasn't it? In a very department, from medical led to nurse led, because, as you say, we are the constant in the unit and they've really driven the project forward and it's been a huge success and really changed our practice. Jon: It's a springboard to do other things. It really has been. Kate: So, had you worked together on QI before you started the fellowship, or was it very. Jon: No, but, I mean. But subsequently, I think it's worked really well, because, obviously, we've both now got a bit of QI leadership training, and so between the two of us, it means on the unit now that we can really cover all bases, that anything that we do on the intensive care has to be multidisciplinary. There is no improvement project that is purely medical or purely nursing. And so, as we all know that the success for an improvement project lies in motivating and engaging the staff to do it. And it's not really about data and charts, it's about getting everyone to understand where the benefit is. And so we can kind of double team it, then, can't we? And you can speak to the nursing staff and I can speak to the medical staff, and between the two of us, we can make some pretty good changes, I think. Lynsey: Yeah. Kate: So, a lot of people who have come to me asking about the fellowship have really focused on the Qi part of it. But what did you expect and how did it compare the content of the program? Lynsey: Well, I did think it'll be all quality improvement stuff, and I thought, was it going to be lots of data? Which, as we know, isn't my strong point, but I can read a chart now, which is good, I think, for me, the communication aspects, the leading teams, through change, learning about behaviors and influencing certain behaviors, especially in such a challenging system at the moment, one of the other things that I really enjoyed was the design. So the design thinking and actually the chat that Ali Walker gave on her redesigning the theatres and the sick kids kind of inspired us. So we redone our relatives room off the back of her talk, which was really good. And Jon and I paired up and made a welcome board for outside our unit. But we'd done it by engaging the staff, we sent them out a staff survey so we could make our own values and our own vision for our unit. So it wasn't just corporate words. So that was a huge thing that we took from that and it's been really recognized throughout the organization for other people to get a board similar. So that was a great success. And the staff, it's their words on the board as well as the corporate values, it has got our staff values on it, which I think means a lot to the staff. Jon: Really good for engaging the team as well. It was really cool. Kate: Sorry, Jon, you go for it. Jon: No, I was just going to say, I was just going to give my perspective if that was okay. And for me, I really like the charts and the data and that sort of stuff. And that's my happy space a little bit. And it's not everyone's boat. I just do all her charts. But for me, actually, it was about learning the language of improvement a little bit. And actually for me that was really powerful and understanding all starting on the elevator pitch thing. Right. And actually if you want to get people on board with you, knowing that you got to use different language for different people. And so if you're going to put a clinical context on something, use talk about mortality and improvement and that sort of thing. If you want to speak to managers and get money for things and get resource, then you got to frame it slightly differently. And actually that was pivotal for me. It really was. And then using that then allows you to get people on board and unlock things a lot more easily just understanding what it is that people want to hear from you and asking the right questions. So for me, actually, that was by far one of the biggest benefits. More than the charts, even though I love the charts. Kate: Yeah, like kind of influencing up as well. And do you think has that kind of your knowledge and inspiration? Like, I know we've got a fellow from borders this year, but do you think that what the work you've done in ICU is kind of, is it spreading? Is it rippling out to the side to other? Lynsey: We've just finished a wee tech project as well, so we've made a huge difference with our treatment escalation plan, certainly from an ITU point of view. And I know it's an organization thing to try and get that up and running throughout, so it's just about driving it, but there's no really much scope for a lot out with resources, so it's just getting the buy in from elsewhere. I have been lucky enough to do some teaching with the newly qualified nurses, which I loved, and I've done the Mr. Potato head, which was great. And we're hopefully going to do that with the team just to show them, like PDSA in a fun way. Jon: On the back of the fellowship, I've been lucky enough to have a new role as well, which is clinical lead for college improvement for the health board, which has been absolutely fascinating and because it involves lots, lots of different departments that I've never worked in before, psychiatry and primary care and all these people. So I get to be involved with everyone else's projects. So it is kind of like unsticking other people's projects or managing bigger projects and that sort of thing. So actually, kind of my reach has spread a little bit, which is great. The other thing we've been doing is a really big piece of work in theaters about. We've used the kind of joy and work framework from the IHI to try and improve morale and improve people's well being, but on the back of that, trying to improve efficiency through theatre as well. So it's been a massive project, but there's been loads of learning and so we've taken some of the learning from that and we're spreading that across the organization as well. The priest of inquiry joint work framework is now being rolled out across labor ward, for example, and there's a couple of other units that have been interested in picking that up. So we've just been doing some mentoring of those sort of projects as actually the reach does definitely spread out to other departments. Lynsey: We've started doing the learning from excellence. I don't know if you've probably heard of it, Kate. Yeah, we put it out to the staff what they would prefer. We did used to have like an online version, but it wasn't really working. So we made little cards up for just giving staff some positive feedback. At the end of a know, it takes two minutes and we've got a post box put up in the unit, which has been great. So people are loving getting their feedback as well. And I think I've joined the leadership council, which is a new nursing council and organization, and I think there's some scope to hopefully spread that throughout the hospital as well. So that's good. Kate: That's amazing, because it just shows you that if you go to people with an idea, quite often they don't think it's doable, but you show that it can be done in a small area, especially in a nice small board like you're in, where people are quite v
