IoIC Live '16: The human torch
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Rachel Royall brought a real human touch to IoIC Live 2016 – by starting her presentation with the story of a tragic hospital death.


The death of pregnant mother, Maria, after a series of mistakes highlighted the challenges she faced when she took on the role of heading comms at Barking, Havering and Redbridge University Hospitals NHS Trust in Essex.

At a conference aimed at ‘humanising internal comms’, there couldn’t have been a more apt session.

Rachel outlined the trust’s transformation journey – from special measures to higher standards of safety for patients via a campaign to overcome a challenging track record on quality and a fear of open and honest communication among hospital staff.

“In a hospital we deal in life and death,” said Rachel, director of communications & marketing at the trust. “People can die if we get things wrong.”

The transformation started two years ago when the trust was put in special measures. She admitted it was a “troubled trust”, often making the wrong headlines on national and local newspapers.

“When I arrived, communications was not in a good state, it was very defensive and had become entrenched,” said Rachel.

Staff morale was also low and she illustrated this by saying when she asked a stroke doctor why no-one talked about how good care was for his patients, he replied: “It’s a bit like bragging about your kitchen when your house is falling down…”

Rachel launched a campaign focusing on areas highlighted as a concern by the Care Quality Commission.

“One of our biggest challenges was to get people to admit when mistakes are made,” she explained. “It’s also an emotional place – when people complain, you have to acknowledge what they’re going through.

“It’s a people business – in terms of the people we serve, their families and, of course, our staff.”

The patient safety campaign was aimed at all 6,500 staff, including doctors, nurses and healthcare assistants. It focused on six areas, with a month dedicated to each:

  • Duty of candour (speaking up, being open and honest)
  • Patient falls
  • Medicines management
  • Raising concerns
  • Better care records
  • Infection control

Each monthly campaign started with a patient safety memo (newsletter), backed up by posters and face-to-face meetings. Then, the end of each campaign was marked by a patient safety survey open to all staff to gather insight.

But it was tough. Rachel says: “In a busy hospital that has got challenges in relation to quality and safety, how do you cut through the busy-ness and noise to change culture around patient safety?

“We needed to challenge the status quo and make the workforce realise that quality and safety is everyone’s responsibility.”

The tools used were:

Patient safety memo (newsletter)

Each campaign started with the issue of a patient safety memo (newsletter) on the subject, e.g. patient falls. These were emailed and printed.

“Hospital staff are a mobile workforce and very busy, so handover was often the best time to catch them and talk about the memo,” said Rachel.

“In each case we also carried out ‘corridor conversations’ where quality & safety advisors from the Good Governance Institute went out and had conversations on the wards, often on night shifts.”

Posters

“We used animated versions of people and it’s fair to say they were Marmite – some people loved them, others hated them – but they definitely got noticed!” she added.

Twitter chats

The trust CEO holds a monthly Twitter chat and each safety campaign was incorporated into them.

Patient safety survey

At end of each monthly campaign a survey was disseminated to all staff – it consisted of one question so it was easy and quick to answer.

“They can also answer online via the trust intranet and they can do it in their own everyday language,” explained Rachel. “The data is then assessed using algorithms to pick out themes, so we can start to see what aspect of, say, patient falls might be of concern to the nursing staff.

“We got between 200 and 250 responses on each campaign. That’s given us some really rich data to work on, so for example we can better understand nurses’ attitudes to patient falls or keeping better care records.”

Safety summit

A weekly safety summit was introduced as part of the campaign. Chaired by the medical director, doctors, nurses and healthcare assistants have a cathartic conversation about something that has gone wrong at the trust.

They discuss the issue, share experiences and debate what can be done differently to prevent it in the future. The summit has become a permanent fixture – it started with about 10 staff attending, but now each meeting attracts about 80.

Impact

“I think we’ve managed to make big changes in attitude,” said Rachel. “For instance, reporting of falls went up 20% – which is actually a good thing. Recorded injuries through falls didn’t go up, but reports of near misses or falls without injury went from six to around 100. This is really useful because it will help us find out how we can prevent them.

“It’s about gathering insight. For example, a survey has asked staff how they perceived their role in falls. What role do they have in preventing falls? Trying to get them to think about their responsibility. I think that’s happened.”

The trust has now improved from ‘inadequate’ to ‘needs improvement’ and the maternity department has improved so dramatically it was chosen to front a national advertising campaign.

Rachel said the declared target was now to aim to be rated as ‘outstanding’ by the CQC. “A few years ago that would have been unthinkable,” said Rachel. “Now, we’re trying to get people to feel that one day it might happen.”
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