Quality Improvement Fellows 2008/9

Dr Carol Peden has been a Consultant in Anaesthesia and Critical Care Medicine for fourteen years at the Royal United Hospital Bath providing anaesthesia for trauma and emergency surgery, major vascular surgery and opthalmic surgery.  As a Critical care consultant she looks after patients recovering from major surgery or requiring organ support to survive severe illness. 

Carol began her medical training at Edinburgh University Medical School and then completed her specialist training in Anaesthesia and Critical Care Medicine in the South West and London.  She was a Medical Research Council Research Fellowship at the Hammersmith Hospital and Royal Postgraduate Medical School London, performing research into critically ill patients, especially infants, using magnetic resonance.  This research lead to a Doctorate in Medicine (MD) awarded in 1996. 

As part of her Quality Improvement Fellowship, Carol will look at ways of improving care for high risk patients having emergency surgery, particularly the elderly. 1.3 million general surgical in-patient procedures are performed each year in the UK, 25,000 of these patients die. 

Emergency patients, particularly the elderly, have not been the focus of recent developments in the NHS which tend to concentrate on elective surgery.  However, interested doctors have identified three main approaches to improving outcome in high risk surgical patients – better preoperative assessment, intra-operative cardiovascular optimisation and better targeted postoperative care.  Adoption of evidence based practice in these areas has been poor.  As part of her work, Carol hopes to identify key areas of change which could be easily implemented, where more research needs to be done, what system processes can be improved and what would influence doctors and other healthcare workers to change practice in this poorly served group of patients.

Carol also has an ongoing interest in managing patients requiring anaesthesia or sedation outside the operating theatre.  She co-authored “Radiology for Anaesthesia and Intensive Care”, which was highly commended as a textbook by the British Medical Association in 2003 and is currently going into a second edition.  She was also an organiser of the regional exam course for trainee anaesthetists for ten years and is a Final Fellowship examiner for the Royal College of Anaesthetists.  Continuing her interest in pharmacology and therapeutics and she has been a researcher for major drug trials. Carol has chaired her local drug and therapeutics committee and sat on the regional prescribing group which manages the drug formulary for over half a million people.

Brian has a background in General Practice having been a GP in the West of Scotland for almost 10 years during which he was a founder member of an out-of-hours service, REMS. REMS operated using telephone based nurse triage, standardised protocols and later developed to use an electronic record.

He was appointed Medical Director of NHS 24 in 2001, which provides a Scotland-wide telephone based triage and health advice service for Scotland’s 5.1 million people.

In 2005, Brian undertook a one year secondment with Information Services Division (ISD), where he chaired the working group on the development of the Secondary Uses Service (SUS). In January 2007, he took up a new position as Clinical Director for eHealth across NHS National Services Scotland (NSS). NHS NSS provides a range of ‘common’ services across NHS Scotland, including national information technologies, information analytical services, legal services and national blood transfusion services.

His new position involves responsibility for establishing key elements of clinical governance, quality and patient safety within eHealth developments delivered by NHS NSS.

As part of his Quality Improvement Fellowship, Brian will develop this interest in the role of technologies in supporting reliability and evidence-based care. In his own words Brian is passionate about ‘making it easy to do the right thing’ and believes that technologies must support this principle.

He is keen to learn as much as possible from the Institute for Healthcare Improvement (IHI) to develop his understanding of the role technology has played in quality improvement settings in the US and further afield. Through his fellowship and existing knowledge of the technologies in place and planned across NHS Scotland, Brian believes he can contribute more effectively to service improvement across Scotland, and beyond.

Brian was a member of the NHS Scotland eHealth Strategy Board from 2003-2005 . As a member of the National Advisory Committee for the Scottish Patient Safety Alliance he is committed to ensuring that eHealth plays its part in improving patient safety.

He continues in clinical practice with a regular session in General Practice in Glasgow which allows a healthy mix of the planning world and real world!

Joanne Watson is the clinical lead Consultant in Diabetes and Endocrinology at Taunton and Somerset NHS Trust. In this time she has built up a strong team ethos within the department which has expanded on all fronts, introduced new therapies and services. Strong links have been forged across the county in both Primary and Secondary Care with the vision of improving care for all in Somerset.

Joanne Watson trained at St. Thomas’s Hospital (UMDS) and graduated in 1991.  After house jobs in London and Canterbury, she worked at Southampton University Hospitals for her Senior House Officer rotation in medicine.  Until her first medical registrar she had been planning a career in Clinical Oncology. However, she soon became interested in specialising in diabetes and endocrinology.

Joanne completed her specialist training by working in the Princess Margaret Hospital, Swindon, the Queen Alexandra Hospital, Portsmouth and the Royal Bournemouth Hospital as well before going back to Southampton University Hospitals.  She was awarded her Doctor of Medicine degree in 2002, having secured her consultant position at Musgrove Park Hospital, Taunton in Somerset the previous year.

As part of her Quality Improvement Fellowship, Joanne will work on her own specialist interest –  increasing patient involvement in the commissioning of diabetes care. Joanne’s goal is to make patient-centred diabetes care a reality in the NHS. She hopes that her Fellowship will further develop her skills in leading service change as part of a mulit-disciplinary team so she can make begin making a difference on her return to the UK. To help her do this, Joanne believes that the Harvard Clinical Effectiveness Course and work experience at the Institute for Healthcare Improvement will offer a unique opportunity to tap into expertise in the US on how to improve and measure processes in healthcare.

Joanne has also worked as a research registrar as a NovoNordisk Medical Trust Fellow working at the Royal Bournemouth Hospital with Dr David Kerr as her supervisor.  Her research centred around hypoglycaemia and in particular, the way caffeine affects responses to this.