ECG: Everybody Can Dance!

ECG: Everybody Can Dance!

Key contacts

Dance teacher/staff nurse/overall hero: Karelle Evans

Project coordinators: Guddi Singh, Avni Hindocha (pilot project)

Charity business development manager: Lindsay Wingate from EMD UK

Consultant champion: Dr Su Laurent 

Introduction

It is fair to say that morale amongst staff in the NHS is low; this can be backed up by both research and anecdotal evidence. There are a multitude of reasons including static pay and increasing workload but also a lack of feeling valued and happy at work. This, in combination with cuts to services which stretches staff even further contributes to morale and translates into nurses and other professionals leaving the NHS throughout the country. This effect was seen on our paediatric ward and an intervention was made using our own skill set, resources and required little financial support. We also hoped to improve the patient experience on our ward. Child obesity is on the rise and the hope was this intervention would encourage otherwise bored and bed-bound children to get up and move, including involving the high number of CAHMS inpatients who were admitted to our ward.

SMART objectives

A 10 week pilot in summer 2017 – weekly 30 minute dance sessions in the ward play room, led by our staff nurse and supported by a junior doctor.

Collection of feedback: demographic information, weekly forms about feelings before and after the class, and questionnaires for staff before and at the end of the pilot asking questions about their morale, working environment and patient safety concerns.

Aim:

  • To embed the sessions as part of the ward culture and weekly timetable
  • To collect feedback about the benefits of the classes and what could be done to improve it
  • To assess any changes in morale amongst staff, including assessing staff turnover rates

Progress made: What have you learned from doing this?

We ran a successful pilot project at Barnet Hospital with promising results, particularly from staff feedback.

A selection of results:

  • In answer to the question ‘Did you/your child enjoy the dance class today? (1= hated it, 10 = loved it) the average score was 9.3
  • In answer to the question ‘Do you feel this class has made a difference to you/your child’s stay? (1= no difference, 10= improved the stay significantly) the average score was 8.9

Feedback about feelings before and after the classes showed a marked improvement in mood, from an average score of 3.2 to 1.5 (1 being ‘I’m very happy’ and 6 being ‘I don’t feel good’)

 

Notable qualitative feedback:

‘There is a great spirit and atmosphere when people are dancing together’

‘It was fun, and nice to see the team dancing with the people they care for. It’s also good to move on the ward

‘Excellent – really made me happy & really enjoyed it’

‘It was really fun and enjoyable and lifted my mood and my spirits’

‘My son loved it and was so excited to dance with his doctors’

‘…warmed and encouraged by the class and the participation of those attending. Enjoyed it, bemused!  It was a positive bonding experience also it brought us into contact with professionals of all involved who saved ****’s life when he was a newborn so that was lovely and gave us a chance to thank him again 🙂 Thank you, what a great ideas for children, staff and families, for bonding of colleagues and an opportunity for staff to take a much needed healthy break from the hard and vital work they do…. ‘

‘Excellent – really made me happy & really enjoyed it’

 

Staff feedback:

  • In answer to the question ‘Do you think that staff morale within Barnet needs improvement? (1 = no it is fine, 10 = definitely) the average response was 7.5
  • In answer to the question ‘Do you think getting to know your colleagues better would improve your working relationship? (1 = no it is fine, 10 = yes this would help a lot) the average response was 7.9
  • 6/7 ticked the statement ‘Yes they are better‘ when asked ‘Do you think that stress levels in your workplace have changed? ‘
  • 7/7 said no when asked ‘Do you think patient safety has been compromised as a result of the dance sessions?
  • 7/7 said they thought that the dance sessions should continue

These responses were a genuine reflection of the informal and anecdotal feedback that was shared around the ward, and the consensus from the team was that the dance classes must continue.

 

We now also run sessions at the children’s outpatient departments at the Royal Free Hospital with good initial feedback. There are plans to take ECG to other hospitals including North Middlesex Hospital and beyond!

 

Learning points:

  • We need buy in from ALL stakeholders, and a consultant to fight our corner (healthy and safety, comms teams)
  • Very few materials are needed
  • Flexibility is key: dance was often switched to games depending on whether there was a need to ‘break the ice’ or many children with respiratory illnesses
  • Use fruit snacks to encourage healthy eating

What’s your take home message?

Introducing weekly dances classes are a simple and cheap intervention but can have wide-ranging positive effects on our wards. These can include improvements to both mental and physical health, staff morale and patient satisfaction and patient safety.

Resources?

  • A talented and enthusiastic teacher willing to make it work, no matter how busy the ward.
  • A safe space for dancing/activities (ward play rooms are perfect)
  • Sound system – a small bluetooth speaker works well
  • Ward champion – a doctor/nurse/staff member to help support the main teacher to advertise and encourage the sessions to become part of the ward culture, including negotiating with seniors to release staff for 30 minutes a week to get to the session.
  • Consultant champion – to fight your corner when it comes to PR/comms/health and safety
  • If your budget allows, some healthy fruit and drinks to have at the end of the class, and jugs of water during the session.
  • Support from a charity to help publicise the cause, fund any teaching courses, troubleshoot.
KSS Paediatrics ST1 Induction Pack

KSS Paediatrics ST1 Induction Pack

Key Contacts

Genevieve Booth, Paediatrics ST2 KSS (genevieve.booth@nhs.net)

KSS Paediatrics Trainee Committee (heksstrainees@gmail.com)

Introduction

Each year the KSS Paediatrics Trainee Committee designs and organises the induction day for new ST1s entering the deanery. For the first time in 2017 we decided to accompany the face to face induction with a written guide for our new starting ST1s, with information on as many aspects of training as possible, and a particular emphasis on what to expect and what to accomplish in ST1 – a challenging time for many trainees, especially those with limited experience and confidence in paediatrics. We wanted the guide to be optimistic, fun and simple to navigate and understand. Each year the induction pack is updated and expands, and will hopefully become more than an induction pack and mould into a trainee led guidance document for paediatric trainees at all levels within KSS.

SMART Objectives

Chiefly our objective was to create a thorough guide to starting a career in paediatrics within KSS, that would adequately prepare and reassure new starting ST1s and serve as a future reference point for frequently asked questions. We wanted the guide to be flexible enough to update and expand in future with current working links to useful resources. We specifically wanted the guide to feel and sound as though it was coming from other trainees, and to be based on experience as well as dry facts. The guide would have to be readable, encouraging and humorous.

We were going to measure the guide’s success on the feedback we received, and whether there are still questions unanswered by it.

The project was always attainable as there are so many resources (both written, and in our colleagues’ experiences and wisdom) available to paediatric trainees; it’s just a matter of taking the time to put those resources together in one place and making them accessible.

Relevance to paediatric ST1s was always paramount, but we hope that as the induction pack evolves, it can be expanded to have relevance to all paediatric trainees within KSS, and that the information within it may form an integral part of our trainee led website (currently in development).

The clear deadline for the ST1 induction pack was in time for the ST1 induction – and the same is true of the updated version we are producing this year!

Progress

The 2017 Induction Pack was well received by those trainees who read it. We were given lots of informal positive feedback on its readability and the usefulness of the content. I’ve learnt such a lot about the structure of training and processes that occur within KSS school of paediatrics from putting it together, and that knowledge has helped me in my role within the committee when answering queries from trainees of all levels. It has also given us a great starting point for the content of the KSS paediatrics trainee website which is in development.

The main learning point is that we need to disseminate the induction pack more, and continue to share and make it accessible throughout the year. Otherwise it risks being lost amongst a dozen other documents handed out at induction. With the 2018 update we will be sharing on social media, and incorporating the information into a website which will hopefully reach a wider readership that can actively engage with its development. As expected, with another year of changes to the administration within the deanery we have plenty to update in the 2018 version; as well as brand new sections.

Take Home Message

Trainees can create valuable and flexible resources for one another that may be shorter, easier and more fun to read than official “top down” resources and documents. Creating resources for one another generates a sense of community and mentorship that is good for the morale of those disseminating the guidance as much as for those receiving it. With KSS deanery going through a very difficult transition period this year which has affected feedback, communication and administration; clear information that is easy to access is more important than ever for trainees.

Resources

RCPCH Website

KSS Paediatrics Trainees Website (in development)

KSS Paediatrics School Website

Postgraduate Training Gold Guide 2016

The collective experiences of the KSS Paediatrics Trainee Committee!

Holding Hands: Making a Difference to Junior Doctor Wellbeing Together

Holding Hands: Making a Difference to Junior Doctor Wellbeing Together

Key contacts

Magali Dubus (magali.dubus@nhs.net), Olatokunbo Sanwo (olatokunbo.sanwo@nhs.net) & Shaveta Mulla (shaveta.mulla1@nhs.net).

Introduction

Burn out is well documented among junior doctors, leading to physical and mental health issues. This contributes to long-term sickness from work, people choosing to leave medicine and most tragically some junior doctors choosing to end their lives. Various initiatives have been started to try to provide support to doctors who are struggling with professional or personal issues. Many deaneries offer counselling services and there are a number of national services that are offered free of charge such as the NHS Practitioner Health Programme [1]. As well as this online groups such as Tea and Empathy and Physician Mums Group UK (both Facebook groups) have been set up to give healthcare professionals an opportunity to access a supportive network of colleagues when times are tough. These are great resources to have available, however we felt there was a gap in support provided locally. Our aim was to start a face-to-face group for paediatric and neonatal junior doctors, with bleep free time (and a slice of cake), where there would be an open and supportive environment to discuss clinical and non- clinical problems and tricky situations people have found themselves in. The idea is that this would allow discussion between different trainees and a chance for everyone to put their heads together to come up with solutions for problems and also to provide support and a listening ear when it is needed. As well as this we thought it would be a great platform to celebrate how hard everyone works and to also use to meeting to discuss positive events that happened over the previous month. Holding Hands was born from this idea and continues to evolve to meet our aims with feedback from each meeting. 

SMART objectives

  1. To facilitate a safe and open environment for paediatric and neonatal junior doctors to discuss challenging situations (both clinical and non-clinical) in monthly bleep-free meetings.
  2. To provide a platform to promote excellence in the workplace and to encourage positive feedback to junior doctors within our meetings.
  3. To facilitate both sharing of potential solutions to issues between junior doctors and signposting to other support services when appropriate.

Progress made: What have you learned from doing this?

This has been a particularly wonderful project to be part of because of the unexpected tide of support both from consultants and from the junior doctors attending who have really positively contributed and made the sessions work in the interactive way in which they were planned to. This project is still in its infancy but we are collecting data on burnout experienced by junior doctors at the beginning of this project and will collect more towards the end of this current rotation to assess the impact these groups have.

What’s your take home message?

To be able to provide the excellent levels of care we want to provide to children and young people, we have a responsibility to look after the wellbeing of both ourselves and our colleagues. This initiative allows protected time and a structured platform for doing this.

Resources?

[1] http://php.nhs.uk

Bleep Culture QI project

Bleep Culture QI project

Key contacts

 gappleby@nhs.net, genna.sole@nhs.net, emilytitherington@gmail.com, Megan Joyce and Nicola Kirrane

With thanks to all of Mountain Ward for participating

Introduction

The bleep system has a long history of use in healthcare institutions for communication between teams.  However, poor bleep culture has been noted to result in delays in patient care and to negatively impact on outcomes in several different settings1, 2.  Furthermore, a number of studies have suggested that the system is now outdated, and that alternatives should be used for improved communication in hospital environments3, 4. Bleeps are a key means of communication between medical, nursing and therapy teams.  They are also used to make referrals between specialties, or for discussion of patients under joint care under several teams.  

Mountain ward is a 42-bed paediatric ward in the Evelina London Children’s Hospital, incorporating an 8-bed medical High Dependency Unit (HDU) and 4-bed surgical HDU area for children requiring high acuity care.  Many patients, including those not in HDU, have complex long-term health needs and require input from multiple different specialties during their admission. The ward team cares for patients under a wide range of specialties: general paediatrics, respiratory, infectious diseases, general surgery, ENT, vascular and plastics as well as outlying patients from other paediatric specialties. 

The majority of patients have input from the general paediatric team.  General Paediatric SHOs have responsibility for patients based on their location; with each SHO covering 1-2 ‘bays’ of the ward.  However, the ward is large and the doctor’s office is far from several of these bays, meaning that nurses mainly rely on bleeps to contact the doctor allocated to their bay.

Whilst working on Mountain ward, it became clear that there were several problems associated with the bleep system.  This was causing frustration and had the potential to negatively impact on patient care. 

In order to understand the challenges facing bleep communication on Mountain ward, an anonymous online survey was sent to both medical and nursing staff.  A total of 10 doctors and 13 nurses responded to the questionnaire (of around 300 staff on Mountain Global email address).  Quantitative data was obtained on bleep response rates and the frequency of mis-directed bleeps, and qualitative data obtained regarding staff satisfaction with the bleep system and their suggestions for improvement.

Baseline quantitative data (collected prospectively over 7 shifts) 

  • Bleeps were frequently directed to the incorrect team/team member during the daytime (40.3%, between 2-5 times per SHO per shift), this did not happen at night (0% of bleeps).
  • In addition, a proportion of bleeps were found to be repeated (10.3%) or unnecessary (10.3%) due to information already being available in patient records.
  • The evaluation of patient notes showed that a significant number of entries did not include clinicians’ contact details. This varied considerably by specialty, ranging from 27 to 100% of entries lacking appropriate contact information.

Baseline qualitative data

The anonymous survey demonstrated high levels of dissatisfaction with bleep communication amongst junior doctors, but reasonable satisfaction amongst nursing staff. Key issues related to confusion over how to contact the appropriate specialty as well as the correct general paediatric SHO allocated to a specific bay.  A number of additional barriers to excellent bleep communication were identified, as summarized in the fishbone diagram below (figure 1):Fishbone diagram (figure 1)

SMART objectives

The project aims were: 

  • to understand the issues affecting bleep communication on Mountain ward
  • to introduce interventions to improve the system, re-assessing their effect through repeated PDSA cycles.  
  1. All ward whiteboards to have designated space for ‘SHO of the day’ bleep number
  2. New bleep to be obtained to allow 3 SHO bleeps (2 per bay) as opposed to all calls going through a single bleep
  3. All entries in notes to include bleep number or contact information in the documentation

The proposed changes were discussed in handovers to gain medical and nursing team’s views on the new system, and adjustments made to the process accordingly.  A date was set to implement the new system, and information relayed to medical staff via email, along with a verbal reminder during ‘huddle’ handovers in the doctor’s office.  The matron and nurse-in-charge were also consulted for their views, and were informed of the planned changes too.      

PDSA cycle 1:

Following initiation of the whiteboard intervention, snapshot data was obtained.  This demonstrated that only 66% of boards had the correct number documented, and that one bay was lacking a whiteboard nearby.  A lack of pens was also noted to be limiting the use of whiteboards. 

PDSA cycle 2:

A new whiteboard was placed in a bay that lacked a nearby whiteboard, and new pens were obtained for all whiteboards.  To ensure that this intervention was sustainable, a request was placed for whiteboard pens to be re-ordered along with other ward stationary.  Additionally the pens were attached to magnets by string to avoid their use in other bays/areas and the bay number was attached at first to the pen and then to the lid to promote sustainability. These changes resulted in some improvement in uptake of the intervention, 100% of bays had whiteboard and pen with 85% of boards having correct General Paediatric bleep number documented.

PDSA cycle 3:

Following the implementation of the new bleep allocation system, it appeared that bleeps were not being received to one bleep when dialed from a ‘rogue’ telephone in the bay allocated to that bleep.  This had caused some frustration amongst the nursing staff, who thought their bleeps were being ignored and that the new system wasn’t working. 

To resolve this issue, the bleep allocations were changed so that the ‘rogue’ telephone was linked to a different bleep.  Information about the new system was also printed on the nurses’ handover sheet to better disseminate information to nursing and support staff.

PDSA cycle 4:

Feedback from the nursing staff regarding the updated bleep allocation system was subsequently generally positive, although some commented that it was taking some time for all staff to gain familiarity with the new arrangements.  Feedback from the general paediatric SHOs was encouraging, with significantly fewer concerns that one bleep holder was being overwhelmed by bleeps from the whole ward.

However, an unintended consequence was that bleeps that were only ‘live’ in-hours were being called out-of-hours. This lack of clarity as to when certain bleeps were active resulted in bleeps being mis-directed out of hours and posed a possible risk to patient safety.

PDSA cycle 5:

An A4 sheet was created with easy-to-use contact information for bleep holders across all specialties, incorporating details of which bleeps were ‘live’ at different times. This poster was circulated included in the junior doctors’ handover pack and plans were made to distribute to nursing staff as well (figure 2).

Who do you want to call bleep contact sheet Figure 2

Limitations

Several limitations were identified with respect to the collection of baseline data in this project.  Firstly, there was potential for missed documentation of bleeps (e.g. during a busy shift), and a degree of subjectivity was implicit in the assessment of a bleep’s ‘appropriateness’ by the receiving doctor. Several comments were made about the length or amount of information needed to be completed on the bleep collection form and often if people were busy they struggled to complete the form. Furthermore, as only a small percentage of the total workforce of the ward completed the online survey; therefore results may have reflected respondents who held particularly strong views about the bleep system at either extremity.

There was potential for bias in results due to the relatively small sample size of shifts where bleep data was recorded post interventions (e.g. due to day-to-day variation in total bleeps received) and also completion of the data collection form itself.

Equally an aim of documentation of bleep number in the notes didn’t have a particular PDSA action point assigned to it beyond a reminder to improve bleep documentation amongst the medical team. Further initiatives could have included: posters as reminders for people to enter their bleeps in the notes or an incentives approach.

Progress made: What have you learned from doing this?

Many things have been learnt from this project:

  1. Importance of setting out aims and objectives to ensure they are SMART can’t be emphasized enough at the beginning of the project.
  2. In the planning stage sometimes it is necessary to use surrogate markers of outcomes of what trying to measure.
  3. Success of a project depends on engagement by staff who are affected by the changes in the project and identification of key stakeholders is paramount. In this project this was achieved through liaising with ward matron, the nurse in charge and gathering the views of the ward itself through a survey and talking to people about their views.
    1. Equally having a willing core team involved in the project is good to keep the momentum.
  4. Some PDSA cycles may produce unexpected consequences e.g. bleeps still being considered ‘live’ out of hours and this means further actions need to be created that weren’t initially anticipated there is a need to be responsive to interventions.
  5. Sometimes it can be easy to ‘suggest an idea’ to solve the problem but by analyzing the problem in a PDSA way it demonstrates that the seduction of the solution should be avoided. For example a suggestion was ‘more phones in the Doctors’ office’ would help the situation; however, provision of an extra phone still wouldn’t help the person making the phone call know who to bleep.
  6. Recognition that improvement is an ongoing process and with this project still scope for improvement

What’s your take home message?

Bleep communication affects all members of staff on the ward, and therefore interventions to improve the system have significant potential to improve patient care and staff morale. 

Improving bleep culture is a multi-modal initiative and requires input from the ward as a whole to enable change to be achieved.  

Resources?

  1. Perceptions and attitudes of hospital staff toward paging system and the use of mobile phones. Haroon M1Yasin FEckel RWalker F. Int J Technol Assess Health Care.2010 Oct;26(4):377-81.
2.      Bleep Etiquette: An audit of hospital communication.  . Sciberras, J. Patterson, D MacDonald. Bone Joint J Aug 2013, 95-B (SUPP 31) 48;
  1. ‘Reaching the End of the page – Bleeping out bleeps’ Volkaerts and D.Guy (https://www.buildingbetterhealthcare.co.uk/technical/article_page/COMMENT_Reaching_the_end_of_the_page__bleeping_out_bleeps/87903)
  2. Mobile revolution: a requiem for bleeps? Martin G, Janardhanan P, Withers T, et al Postgraduate Medical Journal 2016;92:493-496.

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Child Health Promise website

Child Health Promise website

Motivation

A group of paediatric trainees realised that many quality improvement projects were taking place across the UK that could be duplicated in other settings if only people knew about them. Effort was being put in to develop ideas from scratch when maybe a team in a neighbouring area had already done a lot of the work and would be willing to share ideas and resources.

The idea was born to create a website to be a repository for quality improvement projects in child health across the UK within hospitals, schools and the voluntary sector.

Plan / SMART objectives

Specific: to create a website where professionals can register an account and create pages to showcase their projects and allow collaboration between teams working on similar ideas. A Child Health Festival will be organised as an RSM event with the top projects from the website given the opportunity to present their work at the festival.

Measurable: to have at least four projects registered with the site at the time of launch.

Achievable: the team has a background in medical education, quality improvement and web development. The resources of the Royal Society of Medicine can be drawn upon because Camilla is the RSM Darzi Fellow.

Responsibilities: Camilla and Hermione are the project leads. Camilla will be the point of contact at the RSM and will be looking for funding for hosting the website. Lee will be the web development lead. All team members to promote the idea within their clinical and academic teams and look for opportunities to publicise more widely.

Time bound: to launch the website by September 2017.  Timing for the Child Health Festival still to be decided.

Progress

As of 23rd August 2017 the website is in the final testing stages. Ideas for the Child Health Festival are being worked on. The team members are creating the initial projects on the site to demonstrate how it can work.