Kate: Today we have with us Shobhan Thakore, who is our clinical lead for the Scottish Quality and Safety Fellowship. Welcome, Shobhan, do you want to tell us a little bit more about yourself?

Shobhan: Yeah. Hello. My name is Shobhan. I am clinical lead fellowship program and we're about to start recruitment for Cohort 15. I started as lead in cohort nine. I'm an emergency physician by trade and I did the fellowship back in cohort seven, which was like 2014, I think.

Kate: And how did the fellowship different now to when you did it?

Shobhan: I think we've just evolved it so it is different compared to when I did it in 2015. We've brought in some different elements, I would say, compared to what was done before. We've got more formal content around human factors and ergonomics than we did. And some of the service design and design kind of thinking element within the fellowship program didn't exist when I was there. So that's a whole new area within the program that really, I think, really helps us to engage with users of services in a different way. So really thinking about the user journey as well as just the kind of traditional QI process map approach to things.

Kate: What brought you to the fellowship then?

Shobhan: Back in 2014, I had been clinical lead for emergency medicine for quite a while. Felt like I was doing improvement work, didn't really have the quality improvement methods, didn't really have the improvement language, but was trying to improve the way processes worked in the department. And I think I got an invite to go to one of the quality improvement forums, which was in Paris in 2013, and I was quite a little bit skeptical about quality improvement and patient safety. It seemed like there's a lot of zealots and there's a bit of special language and stuff for it, but I thought, I am trying to improve things and I'm trying to do stuff in the department, so let's go to the improvement forum. We had things to display in a poster, so went there, and then whilst I was there, I met the cohort that was on the program, so that was cohort six and spent a bit of time with them, which was really excellent. And we got to hear about their projects, got to hear about what they were learning. And at that point I thought that really resonates with what I'm trying to do and trying to kind of just gently change things in the department or oversee change in the department and improve things in the department. So at that point I thought that this is the kind of course, that would give me some skills in how to change things in the health service. So that's where the kind of real interest sparked for the fellowship program itself.

Kate: And what did you expect from the fellowship and then how did it compare to that?

Shobhan: I guess the thing I expected, which is knowledge and skill that certainly delivered on that that I expected. I guess the things that I wasn't expecting was a bit outside of just the pure QI technical skills. So it really opened my eyes to things like began to open my eyes to things like human factors and how we all interact with one another and how that's important and how we interact with our environment. It really opened my eyes around the leadership and skills around the leadership. How do you engage with people? How do you appreciate the differences in the room and how do you start to see them as opportunities and not just hindrances? And how do you make sure you don't lose all your energy when you face the first bit of resistance to any sort? And how it's not really about changing other people. It's about maybe how you change yourself and how you change your own messaging and really properly reflect on what other people are telling you. Because actually, what they're saying, if they disagree with you, is potentially really valuable and needs to be built into your change. That bit was really unexpected learning and the other bit that was really unexpected was just the connections and just the kind of network within just within our cohort was amazing. Just it was really good, really kind of uplifting, to be honest, to be in a room at these residentials where you're just with people who are looking to improve things and have a really kind of positive outlook, and it didn't really matter where you came from. And making friends with somebody who works in paediatric ICU is a very different environment to me, but was so easy because we had the common interest of what just wanting to improve. And that's true of all the different people in the room. So there's 30 odd of us in the room from different backgrounds. Really great to have people from Scandinavia there. We had Norway and Denmark and the Northern Irish were there as well. And just that learning from different systems and different approaches was brilliant.

Kate: I think that's been a theme with everyone I've spoken to. That's been the surprising part that they didn't expect was the kind of human element to it as well as the tools. And you mentioned that there were international fellows and what does that bring to the program, do you think?

Shobhan: I think it just brings different ways of thinking about the same issues that we've had been leading the program. We have a constant stream of banes and Norwegians and Northern Irish. They're kind of core and we've been able to visit them as well as them come to us. I've had invites to go to Norway and meet clinicians there and it's just been interesting to see how they run their pathways. Now it doesn't mean to say that everything they do is better than everything we do or it's all achievable, we'd structure our systems differently. But it's interesting to see and it just stimulates different ideas. We've also had people from Canada and from New Zealand whilst I've been leading the program. And it is, I guess, thinking about the experience from Sarah from New Zealand and her project was all about how they are trying to engage with the Maori community with a clinical problem that they had. And it's just interesting to hear how they did that and how they kind of engage with a community that were not engaging with healthcare in the way that we expect people to engage with health care and how that cultural difference is recognized and how they do things to try and address that difference. I think even though we don't have a large Mallory community in the UK, we have communities who are not engaging with health care and so there are things we can learn. So I think the value is huge in just that international group.

Kate: Yeah, I think for me, like speaking to particularly some of the people from Norway and Canada about how their approach to rural health has been incredibly eye opening and probably that's a two way street, isn't it? They've had their eyes open to the way we do things here in Scotland. After you did the fellowship, how did it affect you professionally?

Shobhan: So I went back, to emergency medicine. I've done the fellowship and I guess I found myself on various committees and things where things were being discussed and I started to fix myself. Well, we could use improvement techniques for some of these larger system problems. We have an improvement academy in Tayside and starting to think, well, there's real opportunity to use that resource which was already being used, but this is how I would see it being used and having some clinical leadership around that would be important. So I guess long story short is I kept saying things about improvement at various meetings and then off the back of that Tayside adopted something called the clinically led model in 2018 and around that time they advertised the role for an Associate Medical director in quality management. And I played and I was successful in that. So I guess what's done for me is that I now have a different role which may be a bit more strategic within the organization and how we use it improvement expertise to help operational teams. Because it's the operational teams actually have the ideas and it's them that actually need to do the improvement. But if we can support that with some time for improvement advisors or improvement support and help them use the right methods, then it just adds robustness to the change that they're trying to do.

Kate: Cool. So, final question, what is one thing you now believe that if you'd said it to Shoban Prefellowship, you wouldn't have believed in some way that your thinking has completely changed?

Shobhan: So I would say that the thing that has changed for me is all around. I would say the big thing that's changed for me is the importance of place on us being person centered in our practice as opposed to just how do we kind of make for efficient processes, how do we ask clinicians to make their processes efficient? Instead of that is how do you blend that with what people actually need and what adds value to the individuals who are passing through the pathways that we are developing? So I think the big thing that's changed for me is around design thinking, actually. And it's about the influence of using the other half of your brain to think a bit more. I mean, creative is one way of putting it, but just to think a bit more from the kind of aspects or the kind of place of being a patient in the system or somebody, a person in their family sort of coming through the system. And I think that design thinking has made me look at things completely differently. On the first program, I often speak about my mother's experience of healthcare, actually turning that into applying some tools to try and improve other people's experience of healthcare by thinking of it from their point of view and say, using things like the kind of user journeys and empathy mapping, all this kind of thing. That's been completely different for me. That's been a massive shift in how I think. And actually, I think if we could do that more effectively, we would reduce a huge amount of waste that occurs in the health