Excellence reporting in a major trauma network

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This guest blog post is from Dr Anna Greenwood, Anaesthetic Speciality Registrar and previous Major Trauma Leadership Fellow.

http://www.nyhtraumanetwork.nhs.uk

Introducing Excellence Reporting to a Major Trauma Network

Over the past 8 months the North Yorkshire & Humberside Major Trauma Network has introduced the concept of Excellence Reporting across three Acute Hospital Trusts.  The initial Quality Improvement PDSA cycles resulted in an online form emailed to the Network in recognition of what staff perceived as excellent care both clinically and in supporting that work.  There have been many examples of peer support, and our ‘five minute appreciate inquiry’ has allowed us to share ideas such as the use of a red badges to identify staff trained in TILS (Trauma Intermediate Life Support), to sharing ideas between sites about identifying elderly ‘silver’ Trauma Patients, who come in with less easily recognised Major Trauma. We have recognised and shared ideas for improved care and national audit data collection, and most notably recognised the great work of a non clinical staff member who identified an acutely unwell patient, allowing for prompt and potentially life saving care.  

The challenges of introducing the concept across six hospital sites and including care from road side through the ED, to theatre, ICU, wards and rehab has included sharing information, identifying those reported as excellent and influencing different practices across the Trusts.  This all benefitted from the committed individuals who attended monthly Network meetings across the region and disseminated the ideas back, and the hard working staff who recognised the brilliance of Dr Plunket’s original idea.

The next exciting development is the introduction of a ‘cloud’ web based reporting system at the Hull & East Yorkshire Hospitals NHS Trust.  Through collaboration between senior Management, Safety Teams, IT, the Communications team, and clinicians on the shop floor we have started to establish the first wards for PDSA cycles before a trust wide launch in June with the launch of the new intranet system.  The aim here is to join up the great work the Trust is already doing in recognising great practice, and its well developed and successful Communications team, with well-established safety teams to launch a quick & easy to fill in form that both reflects the great work going on, but also has a formal structure in place to feed this back and take on the learning points.  We are using the name ‘greatix’ and thank the Leicester team for sharing their practice.  I look forward to sharing these next steps in future, and would like to recognise the fantastic culture amongst the already established Excellence Reporting teams across the country who have shared their experiences and ideas so that we have more chance of success.

Dr Anna Greenwood

http://www.nyhtraumanetwork.nhs.uk

 

 

Lessons from excellence in trauma leadership

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My name is Chris Turner and I am a consultant in emergency medicine.

In the transfer window of 2011 I found myself with the quite unexpected opportunity of joining the team at University Hospitals of Coventry and Warwickshire. This was both exciting and simultaneously daunting; exciting because UHCW was in the process of becoming one of the 3 West Midlands adult Major Trauma Centres, daunting because it came with a reputation for excellence which I wasn’t at all sure I could live up to. As the starting date approached I became a little more anxious. Surely they wouldn’t be all that good? After all we had all had similar training and all had the same post graduate exams and life support courses.

Anyhow, the day came when I started. I settled down into the miasma of new systems and became lost in the process of learning a new job. That is, until the trauma call went out. Fortunately, I was not running the call and as such was able to watch. I settled against the back wall, happy that my lack of height would be a further defense to exposing myself as a charlatan in resus, whilst secretly hoping that I might recognise the process and feel that it was not out of reach.

What I saw was far worse than I had imagined.

Gary Ward walked in, took control of his team, ensured everyone knew their role, was happy with it and felt able to contribute. He then delivered text-book trauma leadership, creating, at its core, a small oasis of calm in the otherwise frenetic environment of a busy resus. Dialogue flowed back and forth, team members were addressed by name and there was consistent clarity of purpose. The patient had their primary survey and initial workup in less than 10 minutes, making it into the CT scanner in less than 12. I was horrified, this wasn’t just good- this was outstanding.

I decided that I would watch a few more traumas being run; after all, Gary came with a reputation for excellence and perhaps I could find someone with a more realistic level to aspire to. The next person I watched was Caroline Leech. Once more I stood in the background and watched as, in a slightly different style, another masterclass in initial trauma management was delivered. Over the next few days and weeks I watched as Rob Simpson, Louise Woolrich-Burt, Jim Davidson and others each brought their own style to the basics of ATLS/ETC to create what felt like amazing teams from groups of disparate individuals. They did this rapidly, succinctly and in a way that allowed the whole team to feel valued. The sense of being out of my league only grew.

At some point, I realised that there were things that each was doing that appeared to help the team to come together. From discussing with the trauma team leaders however, it was also clear that they were not quite sure how they did it “It’s just my style” and “I just do it how I do it” being amongst the replies I received when I asked about this.

Just asking the leaders wasn’t going to get the answers I was looking for. So, working alongside Dr Amy Randle (then an ACCS trainee), we developed an anonymised qualitative questionnaire that was distributed to members of the multi-disciplinary trauma teams. We asked what they liked, what they didn’t like and whom they thought was the best trauma team leader. We received over 100 replies and they are summarised below.

Positive attributes:

positive

Negative attributes:

negative

It may seem odd, but seeing this written down has been a great help. It has provided a structure to consider our behaviours and to think about the atmosphere we create in real time. But we did much more with this- we used it to form part of our peer review process and have had collective discussions so that everyone can learn from each other. By describing both the good and the bad we have given clarity to the behaviours that encourage and inhibit excellence.

And the best trauma team leaders?

Well, Gary Ward :garyand Caroline Leech:carolineBut now we know their secrets…

Chris Turner, April 2016

chris