ESTABLISHING BEST PRACTICE

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ESTABLISHING BEST PRACTICE

• EMPOWERING STAFF, ENABLING PATIENTS
• Dr.Neil Graham
• Milton Keynes General (NHS) Trust

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• THE ENTROPY OF THE UNIVERSE TENDS TO A
  MAXIMUM
• ANYTHING THAT CAN GO WRONG, WILL GO WRONG!
• IF IT AINT BROKE, DONT FIX IT

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MUTUALLY COMPATIBLE?

• HOW DO WE (RADIOLOGISTS/ CONSULTANTS) KNOW
  WHATS WORKING OR NOT?
• certainly not by sitting in our offices!

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PREVIOUS STRUCTURE

• DIRECTORATE MEETINGS (MONTHLY)
• all Radiologists/Business Manager/ Departmental
  Superintendent
• (e.g. All Consultants/High Level Managers)

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DEPARTMENTAL MEETINGS (MONTHLY)

• Intended to be multi-disciplinary but dominated
  by Radiographers/Nurses
• Therefore other staff groups voted with feet
• Disenfranchised
• Disillusioned
• Recruitment and Retention

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DEPARTMENTAL MEETINGS (MONTHLY)

• Much too much work per person
• Resentment of other groups working practices
• Many unresolved issues
• No forum for airing views
• No mechanism for effecting change

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MUCH WORK WITHIN DEPARTMENT WITH OTHER
PROFESSIONALS(e.g. RADIOGRAPHERS AND NURSES)

• CHANGING ROLES
• RADIOGRAPHERS Bariums, IV (IVU, Venograms,
  Scan Contrast)
• Ultrasound - Protocols
• Reporting - A E (Appendicular, Axial
• Triaging Requests - Protocol
• Other - Dacros, Sialograms, Salps,
  MCUs?

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CHANGING ROLES

• Consequences Shift, not expansion, of role
• Require Helper (Communication,
  Admin - other nontech aspects
  of role).

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CHANGING ROLES

• NURSES Production of protocols
• Organisation of Care
• Pre-Assessment
• Monitoring/Drug Administration
• Post Procedure Liaison/Discharge
• Starting consent training

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CHANGING ROLES

• RADIOLOGISTS Continue hands-on delivery
  intervention,
• complex ultrasound etc.
• Manage service in others
• Appropriate delegation.

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CHANGING ROLES

• i.e. Much boundary shifting between
  professional groups in determining best
• ways of delivering care
• but
• other staff groups have had a relatively weak
  voice in determining departmental policy,
  strategy, and tactics.

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DOG AND QUAC

• DEPARTMENTAL OPERATIONAL GROUP
• 2 Radiologists (Rotating)
• 1 Senior Manager - Deputy Superintendent/Business
  Manager
• 5 Section Heads
• 1 Senior Sister
• 1 Head Porter

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DOG AND QUAC

• DEPARTMENTAL OPERATIONAL GROUP
• 1 Senior Helper
• 1 Office Manger
• In attendance 1 Secretary for minutes and
  communication.
• i.e. Relatively high level group.

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DOG AND QUAC

• QUALITY ASSURANCE COMMITTEE
• 1 Radiologist (Me)
• 1 Deputy Superintendent - Listen to feedback
• 3 Basic Grade (Senior II Radiographers)
• 1 Staff Nurse
• 1 Secretary
• 1 Porter

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DOG AND QUAC

• QUALITY ASSURANCE COMMITTEE
• 1 Helper
• 1 Front Office Staff
• 1 Film Library
• In attendance 1 secretary for minutes and
  communication

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DIRECTORATE(POLICY/STRATEGY)

• I
• I
• DOG (STRATEGY/TACTICS)
• I
• I
• DEPARTMENTAL ltltltltltltltltltltltltltltltltltltltltQUAC
• MEETING gtgtgtgtgtgtgtgtgtgtgtgtgtgtgtgtgtgt(ALL STAFF GROUPS
• I
• TACTICS/OPERATIONAL

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VERY ENLIGHTENING!

• Particularly for Radiologists and Senior
  Management!
• Identified Major Problems/Blocks to work
  flow.
• - unreported films etc.

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VERY ENLIGHTENING!

• Problems in Implementing Policies
• - Lifting
• - Old films
• - Triaging
• - Acceptance Criteria

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TANGIBLE RESULTS

• Improved communication with clinical staff
• - whole department behind issue not just one
  person whingeing
• e.g. Lifting
• Improve throughput of films - No old film wait

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TANGIBLE RESULTS

• Rotation of Radiologists thru DOG
• - eyes opened to impact of working
  practices
• - punches not pulled
• - Some initial reluctance to speak up
• - Radiologists willingness to attend
  varies!

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TANGIBLE RESULTS

• Senior Managers can find this difficult!
• - Hierarchical mind set
• - One-way communication
• - Defensive posturing
• - Behind-the-scenes manipulation
• - Confronted publicly in meetings.

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TANGIBLE RESULTS

• Improved Protocols
• - e.g. CT - Pre-protocols allow efficient
  throughput
• - Barium Protocols Evolved
• - Portering protocols more explicit
• - Empowerment of non-professional staff
  groups - not yet complete!

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TANGIBLE RESULTS

• Appropriate Delegation
• - each task performed by best person
• - training needs
• - PDPs
• - Appraisal - Now implementing for
  Consultants
• - 1st PDPs in place
• - 1st helpers accepted onto assistant
• practitioner training programme.

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AUDIT (ON-GOING)

• Prelim results - Equivalent Standards
• - no increase in complications
• - good patient acceptance ( decrease in stress)
• - improved non-medic job satisfaction
• - new groups very well received - things have
  changed for the better
• - better work handling
• - enhanced inter-group communication
• - directorate solidarity

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AUDITS (ON -GOING)

• Naming and Shaming
• - threat sufficient so far!
• - audit results will be open
• - multi-disciplinary the rule

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AUDITS (ON-GOING)

• Incident/Near Miss Reporting
• - evolving
• - more reports - mechanism for change too
  slow
• - patterns emerge with multiple inputs.

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CONCLUSIONS

• BUILD YOUR TEAM
• - Dont ignore any Group
• - PDPs for all
• - Develop potential
• - Delegate to grass roots
• - Listen, Listen, Listen!

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CONCLUSIONS

• DITCH TERRITORIALITY/DEFENSIVENESS
• - Engender trust
• - Be present (Im not too good at this)
• - Be available
• - Be involved
• - Support innovation/change

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CONCLUSIONS

• KEEP WHAT WORKS
• - No change for changes sake
• - Get evidence
• - Audit discomfort
• - Implement results
• - Use to inform business planning

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CONCLUSIONS

• DONT EXPECT TO BE POPULAR
• - Change is difficult for all
• - Support colleagues but inappropriate
  practice must change
• - Tough love
• - Trumpet successes
• - Encourage feedback
• - Support re-grading etc.

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