Dr Dominique Allwood is currently Medical Director of the NHS Nightingale Hospital London. In ‘normal’ times she is Deputy Director of Strategy and Improvement at Imperial College Healthcare NHS Trust, and Assistant Director of Improvement at The Health Foundation. She describes what has happened in one of the temporary COVID-19 hospitals and what lessons she will take forward for the future.
This is Dr Allwood’s second time at NHS Nightingale Hospital London. “The first time I was here I lead the quality and learning work, and ImproveWell was integral to that,” she explains. “Back then, we asked organisations around London to help send staff to support the ICU model. This time we’ve used a rehab, step-down intermediate-care model and we’ve largely been filling positions and vacancies through bank, locum and agency staff so we don’t draw heavily on the London trusts who are already under a lot of pressure.”
But bringing together a diverse workforce and patients from different trusts in this way has been challenging. “Irrespective of where you work in the NHS, there’s a different way of doing things. All the patients that are referred here come with a different set of referral notes, different discharge plans, different arrangements that they’ll be going back to and. Variation is also very obvious in terms of how staff practice, what they’ve been trained to do and what they’re used to, so all of that proves to be quite a complex challenge when you’re delivering care in a temporary setting.” Gathering this information as well as keeping on top of areas where things could be improved was a huge job, but one that the ImproveWell solution has been able to support.
“We’ve had to think carefully and gather insights and data from our staff around their work experience and the environment in which they’re working; their welfare; the quality of care which they’re providing; and then we’ve needed to triangulate that with other data to help us understand our baseline where we can improve.”
“There have been a whole range of approaches in training and onboarding – to bring staff all up to the same sort of standards and competencies – but it’s a complex challenge to try and step up very quickly amongst a group of people who have quite different needs, so trying to identify those needs from the off has been key.”
Shaking up the system
Nobody in the health system was left unaffected by the pandemic in terms of working structure. And the whole operation has been challenged by the transient nature of the staff. “I have been acutely aware that people have had to move into places and settings that they wouldn’t ordinarily be working in, in roles that they’ve not done before, alongside teams that they’re new to working with. On a number of levels that’s daunting for them personally but also from an organisational perspective, making sure that people have enough support and training to be able to do those roles really well. They now have in-depth understanding of what it’s like to work in a different role and we’ve heard lots of feedback from people saying that that’s been really powerful.” Some recruits from outside the NHS are now looking into joining up full-time.
The crucial thing that has made it all fall into place has been a commitment to learning. “This is where that ethos of learning comes in, it’s really important in helping us improve staff and patient experience. We were really keen from the start that we bring in a big culture of learning. Partly that was due to being in a pandemic and not knowing much about COVID-19 back in early 2020, and partly due to standing up a hospital in a conference centre setting and trying to understand how we’re going to learn and improve. You don’t often get the chance to set up an organisation from scratch and one of the best things you can do is integrate a learning system or learning-organisation approach at the outset.”
New learnings influencing new understanding
In the past, learning hasn’t always captured been in a very systematic way within the health service, Dr Allwood admits. “We often wait year on year for an annual staff survey. We’re not very good at collecting insights from staff and we’re also not necessarily very good at closing the loop and acting on them – or doing so very quickly. Our learning system helped us to do things real-time in 24-hour cycles.”
By collecting data on the ground via the ImproveWell app, the small quality and learning team were able to get the information directly to the relevant decision makers be that the ward, specialist disciplinary forums or an operational group, for example. That worked from small to large issues – staff were empowered to action the easy wins, and where there were more significant changes such as changing the criteria around admission, a more formalised and clinical reference group made the decisions.
Creating a whole new role
During the process, the team identified that they needed to recruit for a whole new role. The Bedside Learning Co-ordinator (BLC) role is a voluntary one based on the trauma nurse co-ordinator role in the army. “It was really important in helping us to identify things that people felt we needed to fix, improve or change.” Embedded on the wards, these key staff watched what was working and what wasn’t, then fed back in real time via the ImproveWell solution. It involved monitoring everything from the working environment, staff welfare, the practice, the clinical effectiveness and the processes. The role is really important in helping to support the gathering of data to close the loop. “These are all my ‘learners in residence’,” Dr Allwood explains.
Figure 1: The role of the Bedside Learning Co-ordinator (BLC). *Matrons are senior nurse providing clinical leadership to the ward team alongside the lead consultant. **A rota is a system for planning the staffing for different duties for the ward over a set time period.
“We’re able to do that double loop learning of looking at insights and collating those alongside incidents of risk and other pieces of data. It’s really exciting to be part of that approach and has been amazing to see it in action. I think quite a few trusts around London have now adopted the BLC role.
“We’ve stress-tested it through some of the hardest times that we could, and it’s worked really well. Getting staff insight out and acting on it in real time was always going to be a challenge for the NHS, whether we’re in a pandemic or not, but what these roles have shown us is that we can do that really fast and in under really pressured circumstances. If we can do it then, we can definitely do it in ‘normal times’.”
To read Dr Allwood’s co-authored article about the BLC role in the BMJ, click here.
Read more about the use of the ImproveWell solution at NHS Nightingale London.
Engage to Improve with ImproveWell
ImproveWell is a digital solution that helps healthcare organisations in the NHS and beyond achieve their improvement and staff engagement goals. With it’s smartphone app and intelligent data dashboard, ImproveWell empowers teams to:
Give staff a voice, track workforce wellbeing and drive a culture of connectedness.
Gather instant feedback & learning 24/7. Plus create a funnel of staff-generated improvement ideas.
Empower local leadership, cross-collaborate, and drive data-driven decisions.
‘ImproveWell has been embedded into our learning system with complete ease… it’s given us the ability to analyse the data and put it into the right people’s hands to make changes and improvements – whatever level that’s at. It’s provided a really systematic, rigorous and fast way in which to understand the insights of our users and how we then put change into practice.’
Dr Dominique Allwood, Medical Director, NHS Nightingale Hospital, London