Talking: CLAHRC NWL 2013 Fellows Induction

Had a brilliant day today with the new group of CLAHRC NWL fellows.

There are people who class as service users (or whatever your preferred term is) as well as GPs, a midwife, managers, a physio and others – a really mixed group.  They all have different perspectives and they’re open minded and willing to listen and consider other people’s points of view.  I think this is going to be a really great group.

We did the game where you come up with 3 questions, and only 3 question, to ask of any improvement project.  And guess what – they invented (loosely) the Model for Improvement!  I love how this happens.   It’s really interesting to watch people see that whatever else this Model is based on, it’s certainly based in common sense.

“All models are wrong, but some are useful” – Deming

This group actually did a better job than many groups do when I do this exercise.  Most don’t think so much about how to know whether a change is an improvement.  But then, it occurred to me that they had a great session yesterday on measurement for improvement and statistical process control from Dr Alan Poots.  So that might explain it 🙂  Al, they may even have been listening to you.  The Rocket video shows that you can be systematic and document your tests of change with very few words – not a thesis in sight.

We also looked at process mapping.  Again, a really amazing job was done by all groups in mapping out the intricacies of the medicines administration process from the point the nurse arrives at the bedside to the point she leaves.  Lots of interesting points raised including:

• identifying where the knowledge in the group ran out about medication rounds and  controlled drugs – they would need to find more stakeholders
• not spotting a ‘check point’ (checking ID of patient) as a branching/decision point – possibly revealing an underlying assumption that it would be the right patient
• the need to check out (shadow) the process in reality as even in the ‘safety’ of a process mapping session people might not be prepared to admit the workarounds that really happen in practice

It was also interesting to hear that ‘do not disturb’ tabards which are so common now for medication rounds can be considered a problem by patients in difficulty who might not out call to a nurse who was wearing it.  A good point was made that if patients and staff had got together to design something to reduce interruptions a better solution might have been identified.

Next week they’ll be planning their projects.  That’s going to be really interesting.  Can’t wait.

And, they’re off to visit Jonkoping County Council’s health service soon.  I wish I was going with them…