Why Apply? Reflections on the Scottish Quality & Safety Fellowship (SQSF)

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 visible. I imagine that th

Kate: My name's Kate Arrow. I'm here for our second series of Why apply? Reflections on the Scottish quality and safety fellowship. And I'm delighted to welcome Dr Jude Marshall. So, Jude, what cohort were you of the fellowship? Jude: I was cohort twelve. So we've not quite finished yet. We finished in September 24. Kate: Nice. And tell us a wee bit about yourself. Jude: So, I am from Glasgow, I work as a GP in a practice in Glasgow, and I am also clinical lead for realistic medicine and I've gone on to do jobs as a clinical director as well in one of our HSCPs since the fellowship, I'm a mum, I've got three boys who are young, twelve, nine and seven, and two mad cats, and that's about me. Kate: How are your cats getting on with each other? Jude: Not very well. Yeah, not very well. They're at different ends of the house as we speak, having fought with each other for half an hour, as they do every morning in the midst of the school run. So it's great fun, yeah. Kate: In the background of your teams calls and what brought you to the fellowship? Jude: So I have to say that I had been aware of the fellowship for a number of years and had never really felt it was the right time for me. I think with my kids being a little bit younger and then with COVID it didn't feel like it was the right time to step away from the things that I was working on to do the scottish quality and safety fellowship or to apply for it. And then I think every year I saw it and I think it was like that cumulative effect. And when I did apply, I just thought, I think this is the right time for me. Things seem to be aligning for me in my work life and also things kids were at school and so it was getting a little bit easier at home. So I thought this might be for me. And to fuel that in myself, I looked at the website and saw some of the names of people who had done it before and started to contact lots of different people who'd done the fellowship. And they're all so giving of their time that they spent time with me on teams calls, just talking about what their experience had been, the benefits for them, how things had changed. And it really just cemented in my brain that this was for me. With every conversation and every team's call, I just became more and more convinced and actually uncovered lots of other people who'd done the fellowship. Through those conversations, people who were leading on things within our board, I was able to then contact them and speak to them. And everybody was very generous, and the things that they said to me just made me even more sure that this was for me. Kate: Yeah. Cool. So, for people who don't know a lot about the fellowship, can you just summarize the structure of what was. Jude: Yeah. So. Well, the application process is quite straightforward. You have to do your application form. It usually needs to be in for mid to end of March, depending on where your board is and how your board processes those applications. Then it gets sent into the scottish quality and safety fellowship for them to look at. And if you're successful, you'll be given an interview, which is, I think it was about between half an hour and 45 minutes. Mine was around the end of June. And this is just an opportunity for the people who are hosting the fellowship and some other people who've worked, done the fellowship to ask you some questions about yourself and hear about your journey and just to make sure that you're ready to do the fellowship, I guess. And if you're successful, then the fellowship starts. For us, it started in October, and it starts with a residential, which seems very daunting that you're going from your comfortable work life into a fellowship where you maybe don't know anybody, but it's such a welcoming environment. The people who run the fellowship, the people who support the fellowship, like Sally, are a great support in getting you to meet everybody and get to know each other. And that's really where the learning starts. You start with two residentials before Christmas, or certainly that's what we did then. We did some project surgeries in January, we did another residential in March, and then more project surgeries. For us, it was in April. This year, it's in May. And these are all opportunities for learning. Like, I felt that since I'd left university, other than studying for my fellowship, my membership exams, I hadn't really had the opportunity to do learning or to have time put aside for learning. And for me, that was the biggest kind of draw. And the thing I enjoyed the most was just having this time put aside away from home. So you're fully focused on the learning and just that opportunity to hear from worldwide experts as well as national experts, as well as the people who lead on the fellowship, who have done the fellowship from their experience, and lots of people you wouldn't have the opportunity to speak to or learn from, and you're also learning from each other. So we've got people in our cohort, we had people from Norway and Denmark, Northern Ireland and Scotland. So again, what an amazing opportunity to meet these people, build up your network if you're thinking in that kind of speak, but also make friends, hear about how things work elsewhere. I've certainly been inspired by a lot of the digital solutions that Scandinavia have. And, you know, you look on very with a lot of jealousy about the way that they can gather patient outcomes or patient experiences or communicate with patients through digital solutions. That seems a world away from what we're doing. But it's then helpful when you're having conversations at your board level or your HSep level or even at national level, to be able to say, look, this is done elsewhere. It's not impossible. These are the things that we might want to look at. So as well as having the network hearing about people who work in different countries and how different systems work, you also have a huge new group of friends. And I remember people saying that in advance, oh, you'll make a lot of friends, and thought, oh, gosh, that seems quite daunting. But it's absolutely true. One of your most vital things is your WhatsApp group, which, again, when people told me that, I thought, I don't need another WhatsApp group, but I absolutely do need this WhatsApp group. There's such a support, and I had a difficult time, work wise, during the year that I was doing the fellowship and the support from UK Ed Job and Julia and Sally, as well as the people who were in my cohort and maybe went and spoke to different people about how to handle different situations. We had some communication training from Kathy McDonald, and being able to go to her and ask for her advice about the situation that I was having at that time was just invaluable. And I am so, so grateful for the opportunity to have been part of the fellowship. It was life changing for me. I really enjoyed it. I loved the learning, I loved the network. I love the new group of friends that I've got and the opportunities that we were given as part of the year. Kate: Yeah, I think that's one of the things that I love about it as well, is that you go in and you've got all these people in different specialties who wouldn't normally meet or speak on a social level, that you might kind of communicate just about a patient or in a stressful situation, and you can really get such a greater understanding of what's involved in their lives and in that specialty just now and learn so much about kind of transferable skills. Jude: Absolutely great. And I don't think we do enough of that at the moment. In healthcare, I think during COVID we all kind of came together and we were all in it together. But as we've been recovering from COVID I feel like those relationships that we maybe started to build on have maybe fallen away a little bit. And actually, there's a lot at the moment. I think from my point of view, where we are all imagining what other people are doing and we don't understand how they're all working. And it becomes, when systems are under a lot of stress, it becomes really difficult to have an open mind about that. Other people are trying their best and they feel that this is the best way to work things. And I think being part of the fellowship just let you have those conversations with people. So I now am very aware that everybody's trying their best and everybody's a human being. Everybody deserves to be treated with respect and kindness. And not that I didn't do that before, but I think at certain times at the moment, we're all under so much pressure, work wise in your life. So everything seems under a lot of stress that actually knowing how other people work now and being able to ask people in different specialties or different roles through the fellowship network, how would you address this? I mean, I've certainly had lunches out with Christine, asking her about how she would handle certain situations, because it's an opportunity to ask, from your point of view, how do you see this problem? And is there a way that I can approach this within the area that I work in to try and make this a little bit better? Kate: Yeah, I think you talked about the project clinics, and I think from what, when I've spoken to colleagues who have been recommending the fellowship to sometimes the idea of having to have a project to go to the fellowship with was quite daunting. So did you find that, and what was your experience about the project side of it, doing an improvement project? Jude: So I think everybody is daunted by this, and I know why, but now having been through the fellowship, I totally get the idea behind it. So it's not to be a massive project. It doesn't need to be changing the way your board works or a massive thing. What you're trying to do is show that you've learned the skills of quality improvement, safety, leadership, change all those different things and trying to demonstrate it within a project. So it's actually a really goo

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