QUALIT Y IMP ROVEMENT


identifying problems, implementing solutions and empowering people at all levels to engage with and also lead the endeavours. The challenge facing the Trust encompassed their new protective hoods. How could all the surfaces of the hood, which includes a helmet, visor and neck cape, be decontaminated efficiently and effectively? After leaders framed the issue, small teams experimented with solutions using a PDSA method to resolve the problem. The problem was solved albeit in a complicated fashion. Both examples show how effective the methods for quality improvement can be, involving all those in the organisations, unlocking capacity for problem solving and energising their employees to achieve short and long-term goals.4 Other, and perhaps more familiar, examples of rapid change include the use of technological solutions.


Technological improvement Increases in the use of telehealth, both in acute care for outpatient assessments and in primary care for many patient exchanges with their GPs, has advanced the plan for technology immeasurably. Prior to COVID-19 the Royal National Orthopaedic Hospital (RNOH) was actively developing virtual clinics, in line with the NHS Long Term Plan regarding reduction


Focus on teamwork competencies


Encourage a climate of compassion


Make clear team purpose


Give clear objectives


in face-to-face outpatient appointments. Members of the Trust improvement team joined the COVID-19 team to support and facilitate a rapid response in the impending COVID-19 situation. Rapid implementation of both telephone and video virtual clinics was undertaken. Frequent use of PDSA cycles and team meetings, via teleconference, were held. A simple evaluation tool was used to ensure that the change would be sustainable post- COVID. Patient satisfaction scores were high for both forms of communication, telephone and via video. Some of the reasons for high satisfaction were given as: l The offer of an alternative to face-to-face


during the pandemic.


l Reduced travel times. l Reduced waiting times. l Reduced impact of travel on symptoms.5


Greenhalgh et al stated that organisational case studies have shown that implementing video consultations is a complex change that disrupts long established processes and routines. Some clinicians expressed concerns about technical and clinical quality, privacy, safety and accountability. However, randomised trials from non-COVID affected times, have shown that clinical consultations conducted through a video link tend to be associated with high satisfaction among patients and


In a crisis, our tendency is to focus on technical training, but we know the focus should be at least


as much, if not more, on teamwork competencies to help people to work together in new teams and challenging situations.


It’s really important to encourage a climate of compassion in our teams; compassionate support for each other, listening, understanding, empathising and helping each other, checking in with each other to make sure we’re okay.


It’s important to ensure that there is a simple and clear statement of the purpose of the team’s work that everyone understands, that’s repeatedly reaffirmed.


It’s critically important to ensure regular setting of 2 to 4 clear shared objectives for the team so that there are clear priorities and a clear understanding of what the objectives are.


Provide regular feedback Wherever possible, provide feedback and data on how well the team are achieving objectives. Clarify roles


Minimise hierarchy


Value everyone’s contribution


Regularly plan and review


Trust is key


Competition is disastrous


Develop shared responsibility


Figure 1 24 l WWW.CLINICALSERVICESJOURNAL.COM MAY 2021


Everyone needs to be clear about their role in the team and the roles of others. There must be a shared understanding of who is responsible for different types of knowledge and tasks during the work.


Particularly in multidisciplinary teams – we have to minimise hierarchy and boundaries between professionals so that we build trust. We build a valuing of everybody’s contribution.


A simple but effective way is by taking the time to have breaks together, to eat together. It makes a huge


difference to our ability to work together effectively and we know it makes a difference to the quality and outcomes of care.


In a critical care situation, this should be daily, maybe at the start and end of shifts and schedule longer


weekly reviews if possible. We know reviews are associated with higher levels of productivity, care quality, and staff wellbeing. Remember to review how the team communicates.


Build a climate of faith in each other’s benevolence, goodness, and compassion. Trust in the abilities and skills of fellow team members. Trust means that team members believe that a person will perform their duties.


Competition and conflict within teams and between teams is disastrous for patient care. Teams also have to work effectively with other teams in this crisis.


Build a shared responsibility for putting these principles into practice on a daily basis.


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