The “909” club


This post is from my friend and colleague, Dr Barney Scholefield.  When lockdown became a reality, Barney had the brilliant idea of creating a daily on-line virutal meeting, with no agenda, for the staff in our department.  It’s a great example of “innovation in the time of COVID”.  As I often say to my colleagues, “909 is the best meeting of the day”.  AP

The ‘nine-o-nine’ virtual hug club

How do you provide a virtual hug in a locked-down world? On March 23rd the UK government announced the lockdown. Overnight society and workers were distanced. Working from home became the norm for most of us, with stricter self-isolation for the ’12 weekers’. The COVID19 pandemic had reached our doorstep and the paediatric intensive care unit (PICU) family, of which I am just one member of, was feeling the full impact. Fear, for what will be for our vulnerable patients, our wonderful staff, our precious families; willingness to help with the NHS’s battle plans in this pandemic; but uncertainty about pretty much everything else.

Out of this dust storm spawned many ideas. Mine was simply to set up a little group meeting: the 09:09 club. A daily, Monday to Friday, on-line videoconference. I joined the 300 million other users of Zoom to connect with around 60 paediatric intensive care consultants, medical trainees, advanced nurse practitioners and other members of the Birmingham Children’s Hospital PICU family.

So what did we talk about? Well that was the fun part – anything! At the beginning the only rule was connection and to check in with everyone. By 09:09 each morning I would see 15-25 familiar faces appear on my screen. Smiles, mad hair, tired post on-call eyes, tears, and the occasional face-licking dog. Children’s faces would pop up too, sometimes with muted intriguing looks, sometimes unmuted declarations of ‘I need a poo daddy!

But it was soon clear we had important topics to discuss. We needed to help our frontline PICU team and they needed us. The fear and uncertainty felt by all the team needed to be aired. Manifestations of stress, sleeplessness, risk of work exposure to COVID, maintaining safety and the thorny, complex, emotional issue of personal protective equipment (PPE). Absorbing the seemingly ever-changing Public Health England advice on level of PPE, our own hospital Trusts frequent communications and peoples own fears and concerns driven by a 24 hour, never ending social media driven monologue. The discussions sometimes exhausting, but nevertheless essential. Staff personal protection and well-being a fundamental basis of support that the team needed and 09:09 club tried to provide.

We had very sad and difficult news to share too. The death of health and social care workers from COVID19 had a numbing effect on us. Initially from hospitals in the region, but then the news got closer and closer until it was our own loved and admired family members. Offering bereavement support, sign-posting to help, allowing venting of anger and fear, all whilst the group watched each other’s faces, listening to responses and sensitively reaching out a hand, a chat room comment, or a post meeting message. But then the beauty of the 09:09 club kicked in and after a reflective pause, the topic could change to the pros and cons of the cancellation of this summer’s Love Island series due to the social distancing and the effect this would have on our diverse staff members. 09:09 trying to fulfil its role of providing both a hug and a laugh for anyone.

So why call it 09:09? Well I always knew that some would struggle with the IT barriers, zoom login challenges, dodgy home WiFi, microphone unmuting paralysis and of course some people are always late. So although advertised as a 9am meeting it was clear I needed to set a little allowance for some to roll up a bit late with their cup of tea, relaxed in the knowledge no one was judging them. This free reign at the beginning of the meeting was another compensation for the chaos around us, and well, the name just kind of stuck.

But in fact the 09:09 did start at 9am and those apparently insignificant 9 minutes revealed to me perhaps the most important of our vulnerabilities and to those of us who needed the 09:09 club the most. Those members whose daily routine was kick started by the club in the knowledge of socially connecting and keenly logging in as soon as possible. Pleased to see the first smile outside of their home and family circle. To feel needed, wanted, useful, hopeful and supportive and in return be looked after by others. The early joiners, the pre-09:09ers were an extra special bunch, they know who they were, and I was proud to be one of them.

The 09:09 club over the last 6 weeks has spawned many ideas, unravelled controversies, improved home working productivity and supported the frontline PICU activity. COVID19 disease affecting both adults and our paediatric ICU population needed understanding and untangling from the politics and emotion with science and evidence based medicine lessons. Complex issues with guidance on PPE were chewed around, action was delivered. Multiple versions of guidelines and standard operating procedures were drafted and shared, 3D visors were designed and printed, contacts with MPs and major hardware companies were made and equipment flowed into the NHS procurement chain to support our team. We had routes to communicate with the hospital Trust management and pandemic command team in their thinking and had the bravery to challenge and support. The 09:09 club became an ideas think tank to the problems that were affecting both life and death issues.

Then we had a sing-along. 30 faces on the screen, singing with their dogs and children to Olly Murs, you can dance with me tonight. Technically poor (not like the polished, edited youtube versions) but emotionally and memorably richer than can ever be described. Tears, dancing, singing, music. Connection at a level that started to repair the soul and allowed us to say that its ok to not be ok.

Oh, and then the weekly photo competition was born. Another little idea to allow us to share and link our family, pets, homes and our lives with each other. Talent and humour mixed together a Friday slideshow montage that could then be broadcast to the wider PICU team to spread as wide as possible the smiles and the 09:09 hug.

The 09:09 club meeting is owned by the members. Professionals, friends, colleagues, humans in need of a way of sharing a virtual hug and making a difference to the world. In our case the staff, patients and parents whose lives are entwined with the PICU at Birmingham Children’s Hospital. Created in crisis, the 09:09 clubs future is uncertain as we hopefully move out of lockdown. But there are two types of uncertainty; aleatory, the unpredictable dice-rolling uncertainty of what number will appear next. This one you can’t do much about except learn slowly to accept it exists and can’t be controlled. The other is epistemic uncertainty, this type can be learned and eventually controlled. Through knowledge, science, discovery, the uncertainty can be unravelled and start to be understood. The future uncertainty of the 09:09 club existence lies only in whether the alarm clock will be setup to join a zoom call login with colleagues or friends and not in whether a group of PICU professionals/friends, by connecting, can make a small difference to the world we live in.

By 10am each day the 09:09 meeting ends, but always with a wave and a smile, as people head off, hopefully a little bit stronger to face the reality of the day and the life we now live.

By Barney Scholefield.

On exnovation


I attended an excellent meeting in OLVG Hospital, Amsterdam recently. It was a convention of healthcare practitioners with an interest in LfE and safety-II. Delegates shared some presentations on LfE implementation and some related topics, including Appreciative Inquiry and joy in work. It was a stimulating and inspiring day, and as I reflected on what I had learnt, I became aware of a stream of thought about LfE and related endeavours: there is no single way to “do” LfE, Safety-II, appreciative inquiry or “joy”.  None of them is a panacea, and none should be ‘done’ in isolation. But they share a common thread of positivity: a kind of positivity that naturally emerges in a deficit-based culture. This type of positivity is not a highly energetic, celebratory force (although, I’m sure that sort of positivity has its place); it is a calming, warming, appreciative, nurturing sort of “everyday” positivity.

This thought has been with me for a while, just out of reach. But it started to take shape during the seminar while I listened to a lecture on exnovation, by Professor Mesman.

I first came across the term exnovation when I read Hollnagel’s “Safety-I to Safety-II”. It was listed, along with Appreciative Inquiry, as a methodology which may be used to facilitate safety-II. I confess that I never found the time to investigate further, and so I was pleased to find myself listening to a lecture on the subject.

I learned that exnovation is, in some respects, opposite to innovation. Where innovation may be considered to be the creation of novel improvements; exnovation is the process of improvements based on understanding current solutions within a system; many of which we don’t see because we take then for granted. Exnovation is a process to help us see what is right in front of us.

Exposing (or unmasking) these solutions, for the purpose of improvement, is the business of exnovation. Prof Mesman demonstrated how this can be done with in situ video ethnography. In other words – filming daily activities and then reviewing and analysing these videos in order to understand what is working.  The beauty of this approach is that the “solutions” or “recommendations” already exist and can be shared more widely.

Reports from the LfE initiative often focus on “everyday” excellence, and therefore, the potential to collaborate with the process of exnovation is worth further exploration. A vital part of exnovation is the recognition of something which works, and this is also the business of LfE. In both LfE and exnovation, the recognition of something good comes from the staff who are actually doing the work. This makes the process highly valid and relevant.

I returned to work inspired to see if I could turn my appreciative eye to some everyday excellence: something apparently mundane which I could learn from, or could share with colleagues. Whilst I was bemoaning the length of our ICU ward rounds, I noticed that a colleague routinely delegates certain tasks to team members during a ward round. This simple act saves vital time, minimises stress and inspires team members to engage with the round. Such a simple act is typical “everyday excellence” and I immediately adopted into it my practice.

Have you seen everyday excellence recently? Try actively looking for it, by watching your colleagues go about their work; and you might be pleasantly surprised about how much you learn.  Feel free to share examples (or other comments) below.


Moon shooting


I recently listened to this excellent podcast from radio 4: The Blame Game – 03/05/2016. I heard about various industries in which a blame culture is prevalent: health (midwifery), MI5, sports, politics and others. By the end I came to the conclusion that blame is never useful. It is not the same as accountability; blame is a cop out. It is fuelled by fear and an attempt to protect our own egos.  A culture of blame will stifle innovation,  promote self protection and lead to defensive behaviour driven by fear of reprimand and litigation.

A proposed solution is to create a ‘just’ culture: a culture where we acknowledge mistakes and learn from them, without apportioning blame. This sounds like a good idea in principle, but practical solutions to help us make the cultural switch are lacking.  Also, I can’t help feeling that we can do better.  It just seems a bit flat;  somewhat one dimensional.  Where’s the inspiration?  It feels like we’re heading for mediocrity, by trying to avoid things going badly.  Can’t we try to create something inspiring:  a culture where excellence is given its own status?  Can we not shoot for the moon?  If ‘blame culture’ is downright wrong, ‘just culture’ is safe and mediocre.  I would like to see a nurturing culture where excellence is routinely highlighted and appreciated;  where staff are motivated and their work is regularly celebrated;  where colleagues support each other;  where bullying is expelled and blue-sky thinking and dreaming about a good future is part of daily practice.

It might sound a bit far-fetched, but some days I think we’re almost there.