Clare Ashby is a nurse, working for Yorkshire Ambulance Service NHS Trust as its Head of Safety and Infection Prevention and Control Lead. She is a member of the Q community – one of the founding cohort – and is also involved with the Improvement Academy at the Yorkshire and Humber Academic Health Science Network (AHSN).

We spoke to Clare about quality improvement work in the ambulance service, the Q community, and how she plans to continue spreading quality improvement learning.

Reducing harm

As Head of Safety, Clare works with a team that reviews and investigates incidents involving patient and staff safety within the ambulance service. The learning from the team's investigations is communicated to people working at the front line in order to reduce incidents. The three most common harms identified by Clare’s team and experienced by people in the care of the ambulance service are falls, medicine errors and patient injury (bumps or scrapes sustained when staff are moving patients). Through communicating their learning, in 3 years Clare and her team have successfully reduced falls by 61%, medicine errors by over 50% and patient injuries by 25%.

Yorkshire Ambulance Service covers a large geographical area with over 60 ambulance sites, and its front-line staff are often out on calls. Clare has had to think carefully about how to communicate feedback on incidents to such a mobile workforce.

The team gives brief feedback every day using the NHS safety thermometer tool and creates infographics to share learning visually, for example to say ‘no harms today’ or ‘there was a fall today – this is what happened and this is the learning from it’. This approach is now also being strengthened through the use of safety huddles.

Clare says, ‘It has been really successful. The staff like the quick feedback and the immediacy of being able to say “this went wrong yesterday, let’s make sure it doesn’t happen today”. They like the idea of a harm-free care day. The constant feedback and learning, using very visual formats like the infographics, has really worked. With the safety huddles, we’re hoping that we can go even further, even faster, and reduce these harms even more.’

Learning during investigations

Clare’s and her team aim to take action on what they are learning from incidents as they investigate, as well as learning from situations where harm could have occurred, even if it did not.

Clare says, ‘We’re trying to be more active and proactive – a bit more like aviation or the building industry – and we’re using methods like the safety huddles to improve communication. We’re looking at getting everybody trained up in human factors (a scientific discipline that looks at how people interact with the system they work in, including the factors that influence their behaviour) and in how to recognise situations that might increase the likelihood of things going wrong. We want people to take action early to reduce the chance of more serious things happening. We’ve been really trying to focus on near-misses this year, with lots of training and awareness-raising of the importance of reporting incidents even when you believe that nobody has actually been harmed.’

Being part of the Q community

As part of the Q community, Clare worked on the recruitment of new members in her region. The number of Q members in Yorkshire and Humber shot up in May this year from 15 to nearly 150. The boost in numbers has enabled members to connect with groups based on their particular interests, such as human factors and positive deviance (the practice of looking at teams that are productive and working well, rather than only looking at what happens when things go wrong).

Being part of the Q community has also enabled Clare to connect with and learn from members in other parts of the UK. Clare says, ‘I recently went to the West of England AHSN Q group to take part in a coaching for quality improvement course. I went as a spy, really! I wanted to see how they are running it and whether we can run the same kind of course for the north of England. It was brilliant – I got a lot from that day personally and it’s given me a lot of ideas about how a coaching for quality improvement course might fit in the north.’

Supporting learning and development for others

There are five Q members within the Yorkshire Ambulance Service. The service also has a range of other improvement projects underway, including a project to transform the response to calls relating to older people who have fallen.

Clare is now working with her colleagues to develop the quality improvement skills of the Yorkshire Ambulance Service workforce – particularly people on the front line, but throughout the organisation.

‘Our head of quality improvement has been down to East London NHS Foundation Trust, which is a mental health trust. They’ve integrated quality improvement into everything they do, training people up in the same way, from receptionists to executives, and that’s enabled them to have this body of knowledge, this movement, which creates a tipping point in quality improvement. That’s what we’re starting to do now at Yorkshire Ambulance Service. We’ve got executive sign-up and we’ve just had our first group of trainees complete a bespoke quality improvement course developed by us and the Improvement Academy. We work really closely with the people working at the front line, to look at existing work, themes and learning from when things have gone wrong. We’re looking at how that fits with the improvements staff want to make, to make sure that we’re focusing on the right things.’

Q is an initiative connecting people who have improvement expertise across the UK to form a community – sharing ideas, enhancing skills and collaborating to make health and care better. The Q community is currently open for applications in Northern Ireland, East Midlands, Oxfordshire, Berkshire, Buckinghamshire and Milton Keynes, North West London and South London, closing on 11 September. Find out more on the Q website.