An outstanding approach to putting patients first

Dr George Findlay is Medical Director at Western Sussex Hospitals NHS Foundation Trust. He graduated from the Health Foundation’s GenerationQ fellowship programme in 2012. We spoke to him about how he’s using the leadership and quality improvement skills he gained to share learning and support others to improve patient care.

What did you value about being part of the Health Foundation’s GenerationQ programme?

I was involved in quality improvement work in my last role at Cardiff & Vale University Health Board, and I’ve always also had a strong interest in clinical leadership. When I found the GenerationQ programme, which combines real learning in quality improvement with the leadership behaviours to make the best of that, it really interested me.

One of the biggest things was that it made me re-evaluate my clinical leadership, and also changed my outlook. Within a year of completing the programme I moved on from Cardiff and took on my current role at West Sussex. GenerationQ certainly contributed to having the skills and confidence to take a step in a new direction.

And have you gone on to use those skills at West Sussex?

I’ve been able to use all my quality improvement and leadership skills – the whole board really bought into using improvement methodologies and I’m really proud to have been part of that.

Last year the CQC rated us as one of very few ‘outstanding’ trusts. This success is in large part down to the continuous improvement tools and techniques I learned, which have become the way we run the trust. We call it our Patient First programme.

What’s involved in Patient First?

Broadly it’s about two big ideas.

One is that everybody holds the baton for improvement. Too often people say, ‘That’s a problem. Somebody should fix it.’ Here the mantra is, ‘That’s a problem. How can I help fix it?’

The other is that little everyday things are important. Big transformational programmes can take a long time to show results. Instead, we focus on daily problem solving in wards. If each ward is working on improving just three things each day, that adds up to a huge amount of effort. We take each ward through a 4-month coaching programme on identifying waste and fixing day-to-day issues.

How successful is it with people who work at the trust?

Initially, there was some cynicism about giving over time to an improvement huddle (where every ward, for 15 minutes a day, pauses and works on the problems of the last 24 hours). But soon the cynics were real converts, saying ‘I can’t believe how much better this makes things – how much time we’ve freed up, how much happier people working here are, and the patients too’.

That’s why we call it Patient First, because the whole reason we work in hospitals is to put patients first. It’s about unblocking things that get in the way of that.

That idea really resonates with staff.The results of our staff survey improved this year in all areas and staff engagement scores are going up continuously.

How can this make a real difference to patients?

Our work on critical care discharge is a great example. In intensive care units across the country there are often long delays in discharging patients to a ward when they’re ready.

This year we resolved to fix this using our improvement skills. We got the data and the teams involved and we ran a project to map the processes. We came up with the top three things that could influence a critical care discharge and used our improvement skills accordingly.

Within a year we’ve reduced our delay in critical care discharge from very high levels to almost zero, and we’re the only critical care unit in the country that met our quality commissioning target of reducing delays in discharges. That’s had a huge effect on many patients.

How are you now spreading knowledge?

To spread knowledge more widely to other trusts, we host our ‘Outstanding visits’ programme four or five times a year. It’s aimed at senior and mid-level people and we spend a day talking through our Patient First programme. We include visits to the clinical areas so they can see staff, improvement huddles, and how we run projects.

So, what’s the next big challenge?

Following the success we’ve had here, as of 1 April 2017, our management team took on responsibility for Brighton and Sussex University Hospitals NHS Trust, which was placed in special measures and has real cultural and leadership challenges.

It’s a big challenge – supporting an organisation the Care Quality Commission rated as inadequate – but we firmly believe we can use improvement methodologies and a change in leadership behaviours to help them on their improvement journey.