Podcast by Dr Kate Arrow on behalf of the SQSF Leadership Team
Why Apply? Reflections on the Scottish Quality & Safety Fellowship (SQSF)
In this short series, we hear from SQSF Fellows, past and present, and hear their reflections on the programme.
Why Apply? Reflections on the Scottish Quality & Safety Fellowship (SQSF)
Latest episodes
14 March 2024
Dr Jon Antrobus & Lynsey Russell; The dream team
Kate: I'm Kate Arrow, an educational lead on the scottish quality and safety fellowship, and I'm here today with Jon and Lynsey, who have both completed the fellowship in the last couple of years, and both come to us from NHS Borders. So, Jon, do you want to tell us a wee bit about yourself?
Jon: Yes. So, yeah, I'm Jon Antrobus, one of the anesthetics and intensive care consultants here in the Borders. So I was on cohort 13 of the fellowship, so that was probably. I think that was 2021. I think that wasn't a few years ago now, isn't it? And so I've always done quality improvement, or tried to, and found that sometimes it landed and sometimes it just didn't work. And I got to the point of being quite frustrated by it, not understanding why my projects weren't working. And it was actually our quality director suggested to me, I'd not really heard of the fellowship before. I think there were a couple of people in the department had done it, but I didn't know very much about it and she suggested that I should maybe have a look at. And so applied and managed to get in and it's been a bit of a kind of life changing moment for me, it really has. But anyways, that's my experience. And then Lindsay was.
Lynsey: Yeah, so I'm Lynsey, I'm the senior charge nurse in the intensive care unit at Borders general as well, and I applied for the fellowship at the same time as Jon, but he nicked my place, so I went on it. I was cohort 14, which was the one after Jon, and when I applied, bit similar to Jon, I'd done a few qi things, but not really knowing what I was doing. It was more I was doing it and people were having to follow rather than me doing it properly. So I wanted to learn how to do it properly, learn the methodology. And Jon not rubbing it in my face, but sent me loads of messages and loads of pictures of residentials and then it was an absolute marvel when I was applying and really helped me, so I was really keen to get on and I was so excited.
Jon: Wasn't. Yeah, you put your heart and soul into that.
Lynsey: Yeah, I did. I know there's not many nurses that have done it and I think it's something that would be of real value to the nursing profession when we make up quite a lot of the percentage of health care. And I think we should be driving QI from the bottom up and nurses.
Jon: Could be leading and should quality improvement work and giving guys like you the ability to put you into leadership roles like this and mentoring models and role models for other nurses. That's fantastic. We should be doing more of that, for sure.
Lynsey: Yeah.
Kate: And quite often it's the nurses who are like the steady presence on the ward, aren't they? Whereas the doctors maybe move around a lot.
Lynsey: Yeah. I think from my project that I'd done on the fellowship, it was basically shift in culture, wasn't it? In a very department, from medical led to nurse led, because, as you say, we are the constant in the unit and they've really driven the project forward and it's been a huge success and really changed our practice.
Jon: It's a springboard to do other things. It really has been.
Kate: So, had you worked together on QI before you started the fellowship, or was it very.
Jon: No, but, I mean. But subsequently, I think it's worked really well, because, obviously, we've both now got a bit of QI leadership training, and so between the two of us, it means on the unit now that we can really cover all bases, that anything that we do on the intensive care has to be multidisciplinary. There is no improvement project that is purely medical or purely nursing. And so, as we all know that the success for an improvement project lies in motivating and engaging the staff to do it. And it's not really about data and charts, it's about getting everyone to understand where the benefit is. And so we can kind of double team it, then, can't we? And you can speak to the nursing staff and I can speak to the medical staff, and between the two of us, we can make some pretty good changes, I think.
Lynsey: Yeah.
Kate: So, a lot of people who have come to me asking about the fellowship have really focused on the Qi part of it. But what did you expect and how did it compare the content of the program?
Lynsey: Well, I did think it'll be all quality improvement stuff, and I thought, was it going to be lots of data? Which, as we know, isn't my strong point, but I can read a chart now, which is good, I think, for me, the communication aspects, the leading teams, through change, learning about behaviors and influencing certain behaviors, especially in such a challenging system at the moment, one of the other things that I really enjoyed was the design. So the design thinking and actually the chat that Ali Walker gave on her redesigning the theatres and the sick kids kind of inspired us. So we redone our relatives room off the back of her talk, which was really good. And Jon and I paired up and made a welcome board for outside our unit. But we'd done it by engaging the staff, we sent them out a staff survey so we could make our own values and our own vision for our unit. So it wasn't just corporate words. So that was a huge thing that we took from that and it's been really recognized throughout the organization for other people to get a board similar. So that was a great success. And the staff, it's their words on the board as well as the corporate values, it has got our staff values on it, which I think means a lot to the staff.
Jon: Really good for engaging the team as well. It was really cool.
Kate: Sorry, Jon, you go for it.
Jon: No, I was just going to say, I was just going to give my perspective if that was okay. And for me, I really like the charts and the data and that sort of stuff. And that's my happy space a little bit. And it's not everyone's boat. I just do all her charts. But for me, actually, it was about learning the language of improvement a little bit. And actually for me that was really powerful and understanding all starting on the elevator pitch thing. Right. And actually if you want to get people on board with you, knowing that you got to use different language for different people. And so if you're going to put a clinical context on something, use talk about mortality and improvement and that sort of thing. If you want to speak to managers and get money for things and get resource, then you got to frame it slightly differently. And actually that was pivotal for me. It really was. And then using that then allows you to get people on board and unlock things a lot more easily just understanding what it is that people want to hear from you and asking the right questions. So for me, actually, that was by far one of the biggest benefits. More than the charts, even though I love the charts.
Kate: Yeah, like kind of influencing up as well. And do you think has that kind of your knowledge and inspiration? Like, I know we've got a fellow from borders this year, but do you think that what the work you've done in ICU is kind of, is it spreading? Is it rippling out to the side to other?
Lynsey: We've just finished a wee tech project as well, so we've made a huge difference with our treatment escalation plan, certainly from an ITU point of view. And I know it's an organization thing to try and get that up and running throughout, so it's just about driving it, but there's no really much scope for a lot out with resources, so it's just getting the buy in from elsewhere. I have been lucky enough to do some teaching with the newly qualified nurses, which I loved, and I've done the Mr. Potato head, which was great. And we're hopefully going to do that with the team just to show them, like PDSA in a fun way.
Jon: On the back of the fellowship, I've been lucky enough to have a new role as well, which is clinical lead for college improvement for the health board, which has been absolutely fascinating and because it involves lots, lots of different departments that I've never worked in before, psychiatry and primary care and all these people. So I get to be involved with everyone else's projects. So it is kind of like unsticking other people's projects or managing bigger projects and that sort of thing. So actually, kind of my reach has spread a little bit, which is great. The other thing we've been doing is a really big piece of work in theaters about. We've used the kind of joy and work framework from the IHI to try and improve morale and improve people's well being, but on the back of that, trying to improve efficiency through theatre as well. So it's been a massive project, but there's been loads of learning and so we've taken some of the learning from that and we're spreading that across the organization as well. The priest of inquiry joint work framework is now being rolled out across labor ward, for example, and there's a couple of other units that have been interested in picking that up. So we've just been doing some mentoring of those sort of projects as actually the reach does definitely spread out to other departments.
Lynsey: We've started doing the learning from excellence. I don't know if you've probably heard of it, Kate. Yeah, we put it out to the staff what they would prefer. We did used to have like an online version, but it wasn't really working. So we made little cards up for just giving staff some positive feedback. At the end of a know, it takes two minutes and we've got a post box put up in the unit, which has been great. So people are loving getting their feedback as well. And I think I've joined the leadership council, which is a new nursing council and organization, and I think there's some scope to hopefully spread that throughout the hospital as well. So that's good.
Kate: That's amazing, because it just shows you that if you go to people with an idea, quite often they don't think it's doable, but you show that it can be done in a small area, especially in a nice small board like you're in, where people are quite visible. I imagine that things spread quite quickly. That's amazing. And then going back to the kind of application process, how did you find that, the application process for the fellowship?
Lynsey: I think Jon probably found my process more stressful.
Jon: That's a fair point.
Lynsey: Yeah. I was just so determined to get on. I just wanted my application to be.
Jon: Oh, you were so driven for that.
Lynsey: I don't think I've ever been as driven for anything in my life was to get a place on the fellowship.
Jon: Don't think anyone deserved that more than you, though. I think the amount of work you.
Lynsey: Put into that, I was so excited.
Kate: because it's quite a lengthy application. I think you said that not a lot of nurses have done the fellowship. And so, yeah, it'd be good to hear your thoughts and advice on the application.
Lynsey: I was really lucky because you've done a podcast with Louise Bell from what she worked in one, one eight at the time. And one of my really good friends had told me that Louise had done it and I reached out to her and she was brilliant as well and was like, oh, go for it, we need more nurses. We need to get the nurses on board. So she was great and Jon was great. So I was really lucky that I had that support. But I think if any nurse wanted to do know, just to ask other nurses and obviously people they know, but I think it would be such a valuable thing, as I said, for the nursing voice to come through and I would advise anyone that was thinking about it just to go for it because it honestly is so rewarding and I learned so much. And I think the way that I lead the team has probably changed slightly. But also we've been lucky enough. We had Kathy McDonald and I think everybody would say that Kathy was absolutely amazing, but we've been lucky enough to have her down with us and go have a session with my senior team. So it's been great for their communication as.
Kate: Yeah, Kathy does the kind of difficult conversations and overcoming conflict work.
Lynsey: Yeah. But I think she's one of those influential speakers that you could have 8 hours offer and still want more.
Kate: I know. She's phenomenal, isn't she? She remembers everyone's name in the room.
Lynsey: I know.
Jon: Yeah.
Lynsey: We were all just incredible, isn't she? But definitely anybody that's thinking about applying, just go for it because it is life changing. It has been definitely cool.
Kate: And then the other thing that I find people talk about and get nervous about is the project. And our current cohort just now are a bit in the slump with their project and they're worrying about it? Have you got any advice about that? I know that people's projects sometimes change through the year, but how did you get on with your actual project?
Jon: So it's difficult to know how to select a project, isn't it? I think, because I think the feeling is, I felt when I started the fellowship that actually the standards were going to be very high and the expectation was going to be very high, and it was quite intimidating the first day when you go in and there's all the piles of books on the desk, all the reading and things like that, and you meet your cohort for all the first time, not really knowing who they are or what their backgrounds are and am I going to be enough? Can I do it and can I keep up and things? And actually, one of the big surprises for me was actually everyone that does it are all very normal people and they're all very nice, and there's not a kind of massive competition to be better than everybody else in the room or anything like that. And everyone's projects are just normal projects. And so I've mentored a couple of people now through the fellowship, and I've mentored Lindsay and I'm mentoring somebody in cohort 16. And I think my recommendation would be to actually just pick a small and easy project because a lot of people, I think, try to pick things that are too big. And having seen them over a couple of cohorts now end up whippling them down over the course of the cohort to try and simplify them. And actually, I hope I haven't got the wrong end of the stick here, but it feels like that the project is really just a vehicle for you to learn the tricks of the trade and the tools. Right. So it's not like a big thing that you need to do to graduate. It's not something you get examined on or anything like that. It's just a means of learning quality improvement and doesn't have to be a big thing. And that's how you end up getting stuck then, isn't it, with having a project that's far too big and it becomes unwieldy and you can't complete it. And so that would be my tip, is just think small and then make it smaller.
Kate: Yeah. And something that you're kind of passionate about, I suppose, but you're totally right. I think a lot of people end up kind of making their projects smaller, but there's always that fear that everyone else's projects are going more smoothly than yours. But actually, the nature of healthcare is so complex. And that's almost part of the learning, isn't it? It's like one step forward, two steps back. You think you're going in this direction, you're going to have to go this other direction, and that's all fine and it's all learning and nothing's ever going to be complete and finished, is it? It's always just a stepping stone to the next thing.
Jon: Exactly. And that's the thing, isn't it? I mean, these projects are always part of something bigger, aren't they? And actually your aim of what you want to achieve overall might be big, but the way to achieve that is in lots of small steps, isn't it? I think by breaking a big thing.
Lynsey: Down into small, because mine was a lot bigger and John said, Linz, you need to think about this because that is a massive project. And then we just whittled it down to one part of a bigger project and it has made a big difference for the bigger picture. So, yeah, definitely keep it small and.
Jon: Simple and that's the expectation. Nobody's expecting you to change the universe in one project.
Kate: Yeah. And it's amazing. Some of the projects are similar. We've got an ICU consultant who's doing one on sedation holds. So suddenly your network. Yeah, we need to link you, actually, because that network kind of grows and you can learn those experiences.
Lynsey: Yeah. Well, I found that obviously on our last residential, when Cohort 13 came to do our last day, I spoke to a couple of other ICU consultants and actually shared the project with one of them and then I've shared it with St. John's as well now. So that's good that you find a network, but it's also you've got your cohort, but it branches into other cohorts and it keeps going. So you have your own wee group, don't you? So, no, it's definitely great for networking as well.
Kate: Yeah. And all these people just get to use your building blocks and rather than square one.
Lynsey: Absolutely.
Kate: And as part of the fellowship, you get to do a study trip. John, tell us what you did for your.
Jon: See, my study trip, I could talk for hours. So how long have you got? I've got my slideshow ready. It's the opportunity of a lifetime, isn't it, really? And actually the opportunity to go and study something that is important to you and you feel passionate about, but given relatively free rein to go and do it. And I think looking out of the health care system, I think is good because going around and looking for ideas in healthcare is important, but sometimes you'd only get really good answers to questions by looking outside of the problem, don't you think? So I chose to go to NASA, and it was just the trip of a lifetime for me. It really was. And so I spent a week in NASA headquarters in Washington as the guest of the chief medical officer for NASA. So he was very kind and let me trail him around for a week. It was just an incredible experience, and it set me up with some really incredible people, some amazing opportunities, and they allowed me to travel to Kennedy Space center. And so I had a few days there and had a kind of backstage tour, and they showed me all the search and rescue facilities and all the launch facilities, astronaut facilities and all that sort of thing. And it was just incredible. Loads and loads of photos. What it did give me, though, is it gave me a lot of stuff about leadership and safety and valuing your colleagues and valuing the people in your team. And I spent a bit of time thinking about that and had distilled that down to a five point plan. And what I then did when I came back is that the health board here, the executive health board team, have a leadership pillar, and they've allowed me to go to their teaching and explain some of the things I found from NASA. And the board have been good enough to take those five points on and then agreed to try and then launch those across the 80 different clinical teams that we have here in the board. It's about visible leadership and engaging your team and valuing teams and that sort of thing. So there's a huge amount of good stuff that's come out of that in the kind of board level in the borders, which has been great.
Kate: Amazing. And what are you planning, Lynsey?
Lynsey: So I'm off to Los Angeles in May to go to Cedars Sinai hospital for four days. So we are going over. Stuart and I are going, and we're going to work with the leadership council over there. So they've obviously got magnet accreditation, which is a massive nursing leadership accreditation. And we're going to spend a day at the leadership council and learn from their leadership styles. I think it's very much non hierarchical, so it'll be great to bring that back here as well. And I'm going to spend a day in their intensive care unit as well, which I think is an intensive care tower block with 250 beds or something. So that'll be amazing to see the differences from our we district general. Absolutely. So I'm really looking forward to that. And then we're traveling to Boston to go to IHi for an afternoon and meeting some more of our cohort there. So that'll be.
Kate: Oh, brilliant. And so, on that note, tell me about the kind of the people that you met on the fellowship. Like, what have they brought to your life and practice, meeting these different people from different parts of Scotland and different specialties.
Lynsey: Well, I think for me, we had a great cohort. I've met some amazing people, both in Scotland and Ireland and all the scandinavian countries as well. And as you know, Christine and I have actually just been in Norway to stay with two of the fellows over. I know you should have just. It sounds cliche, but they really will be friends for life. I think if I've ever got an issue at work, they would probably be the first people I would turn to now, because I think you form such close bonds in such a short space of time, because you're both there for a common goal. You're all there because you want to make a difference and you seem to have the same mindset. You have your little groups, but I hit it off with so many and we've got such a lovely group. If you ever need advice or just friendship, or we meet up for drinks, it's been really good.
Kate: And are they people that you would have ever met?
Lynsey: No, absolutely not. I mean, one of them is a GP, one of them is a neurologist, one of them is a pediatrician. They're just everything. It's like from all scopes of practice that you meet people. But we were really lucky, I think, and that we did have a group that just gelled pretty much not from day one, because, as John says, you go in and you're like, oh, my God. And I think for me, I thought, oh, God, I'm a nurse. I'm never going to live up to the consultants in the room or whatever, but there's just no hierarchy in the room at all. Everybody's equals, and I think that's what's really special about it.
Jon: You find quite soon that the backgrounds just don't really matter.
Lynsey: Absolutely.
Jon: They don't have any relevance to anything that you do in the fellowship, do they? It's all just folks with a common goal, isn't it?
Lynsey: And everybody's keen to champion each other. We've got group chats and if somebody's done something good, they'll put it on and everybody will be like, it's just really nice. It's just a nice community to have.
Jon: The irish guys in our cohort are putting their own QI residential on this summer for us all to go over and meet up again. So that's going to be great.
Lynsey: And he's allowed a plus one.
Kate: Is Ruth Gray going to bring her amazing van of dreams? Do you know her? She was maybe the cohort before you. She was one of the fellows and she's got this incredible van that she drives around Northern Ireland, taking it to sort of festivals and events.
Lynsey: Yeah.
Kate: And she's got like a megaphone and you go in and you just shout your dream through the megaphone and it's all about bringing people together and spreading important messages. I'm sure she'll be at your.
Jon: Sounds like it.
Lynsey: Sounds like it, yeah.
Kate: That'll be phenomenal. Cool. Well, have you got any other final words of wisdom?
Lynsey: I want to do it all again.
Jon: I know. It was so sad, wasn't it? Coming to the end of it.
Lynsey: It was. I was sad on our last day. Yeah.
Jon: We were all kind of just moping. I can't believe this is. Know, it's. I think the nice thing about it is it's because the residentials, you spend a bit of time, as Lindsay said, with some really like minded people. Everyone's really positive. Everybody wants to change the world and make a difference. Sounds a bit kind of trite really. But you come out of the residentials just really turbocharged and actually, especially at the know, being able to come out with a bit of an energy boost is just such a great feeling. And we got to the end of it not really wanting it to end.
Lynsey: I think by the end. By the time your residential is over and you've been back at work for so long, you were ready to go back on your residential, weren't you? I think for the charge time you just needed charged again. And it really does charge you, doesn't it? So. No, we've got cohort 15 final residential data organized. So that's something that we'll need to get our heads together with.
Kate: Cohort.
Lynsey: Yeah. And John, you're there.
Jon: Yes, I will be looking forward to it. See my buddies.
Lynsey: Yeah.
Jon: Thank you for having us.
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25:50
01 February 2024
Dr Jude Marshall; Reflections from a GP
Kate: My name's Kate Arrow. I'm here for our second series of Why apply? Reflections on the Scottish quality and safety fellowship. And I'm delighted to welcome Dr Jude Marshall. So, Jude, what cohort were you of the fellowship?
Jude: I was cohort twelve. So we've not quite finished yet. We finished in September 24.
Kate: Nice. And tell us a wee bit about yourself.
Jude: So, I am from Glasgow, I work as a GP in a practice in Glasgow, and I am also clinical lead for realistic medicine and I've gone on to do jobs as a clinical director as well in one of our HSCPs since the fellowship, I'm a mum, I've got three boys who are young, twelve, nine and seven, and two mad cats, and that's about me.
Kate: How are your cats getting on with each other?
Jude: Not very well. Yeah, not very well. They're at different ends of the house as we speak, having fought with each other for half an hour, as they do every morning in the midst of the school run. So it's great fun, yeah.
Kate: In the background of your teams calls and what brought you to the fellowship?
Jude: So I have to say that I had been aware of the fellowship for a number of years and had never really felt it was the right time for me. I think with my kids being a little bit younger and then with COVID it didn't feel like it was the right time to step away from the things that I was working on to do the scottish quality and safety fellowship or to apply for it. And then I think every year I saw it and I think it was like that cumulative effect. And when I did apply, I just thought, I think this is the right time for me. Things seem to be aligning for me in my work life and also things kids were at school and so it was getting a little bit easier at home. So I thought this might be for me. And to fuel that in myself, I looked at the website and saw some of the names of people who had done it before and started to contact lots of different people who'd done the fellowship. And they're all so giving of their time that they spent time with me on teams calls, just talking about what their experience had been, the benefits for them, how things had changed. And it really just cemented in my brain that this was for me. With every conversation and every team's call, I just became more and more convinced and actually uncovered lots of other people who'd done the fellowship. Through those conversations, people who were leading on things within our board, I was able to then contact them and speak to them. And everybody was very generous, and the things that they said to me just made me even more sure that this was for me.
Kate: Yeah. Cool. So, for people who don't know a lot about the fellowship, can you just summarize the structure of what was.
Jude: Yeah. So. Well, the application process is quite straightforward. You have to do your application form. It usually needs to be in for mid to end of March, depending on where your board is and how your board processes those applications. Then it gets sent into the scottish quality and safety fellowship for them to look at. And if you're successful, you'll be given an interview, which is, I think it was about between half an hour and 45 minutes. Mine was around the end of June. And this is just an opportunity for the people who are hosting the fellowship and some other people who've worked, done the fellowship to ask you some questions about yourself and hear about your journey and just to make sure that you're ready to do the fellowship, I guess. And if you're successful, then the fellowship starts. For us, it started in October, and it starts with a residential, which seems very daunting that you're going from your comfortable work life into a fellowship where you maybe don't know anybody, but it's such a welcoming environment. The people who run the fellowship, the people who support the fellowship, like Sally, are a great support in getting you to meet everybody and get to know each other. And that's really where the learning starts. You start with two residentials before Christmas, or certainly that's what we did then. We did some project surgeries in January, we did another residential in March, and then more project surgeries. For us, it was in April. This year, it's in May. And these are all opportunities for learning. Like, I felt that since I'd left university, other than studying for my fellowship, my membership exams, I hadn't really had the opportunity to do learning or to have time put aside for learning. And for me, that was the biggest kind of draw. And the thing I enjoyed the most was just having this time put aside away from home. So you're fully focused on the learning and just that opportunity to hear from worldwide experts as well as national experts, as well as the people who lead on the fellowship, who have done the fellowship from their experience, and lots of people you wouldn't have the opportunity to speak to or learn from, and you're also learning from each other. So we've got people in our cohort, we had people from Norway and Denmark, Northern Ireland and Scotland. So again, what an amazing opportunity to meet these people, build up your network if you're thinking in that kind of speak, but also make friends, hear about how things work elsewhere. I've certainly been inspired by a lot of the digital solutions that Scandinavia have. And, you know, you look on very with a lot of jealousy about the way that they can gather patient outcomes or patient experiences or communicate with patients through digital solutions. That seems a world away from what we're doing. But it's then helpful when you're having conversations at your board level or your HSep level or even at national level, to be able to say, look, this is done elsewhere. It's not impossible. These are the things that we might want to look at. So as well as having the network hearing about people who work in different countries and how different systems work, you also have a huge new group of friends. And I remember people saying that in advance, oh, you'll make a lot of friends, and thought, oh, gosh, that seems quite daunting. But it's absolutely true. One of your most vital things is your WhatsApp group, which, again, when people told me that, I thought, I don't need another WhatsApp group, but I absolutely do need this WhatsApp group. There's such a support, and I had a difficult time, work wise, during the year that I was doing the fellowship and the support from UK Ed Job and Julia and Sally, as well as the people who were in my cohort and maybe went and spoke to different people about how to handle different situations. We had some communication training from Kathy McDonald, and being able to go to her and ask for her advice about the situation that I was having at that time was just invaluable. And I am so, so grateful for the opportunity to have been part of the fellowship. It was life changing for me. I really enjoyed it. I loved the learning, I loved the network. I love the new group of friends that I've got and the opportunities that we were given as part of the year.
Kate: Yeah, I think that's one of the things that I love about it as well, is that you go in and you've got all these people in different specialties who wouldn't normally meet or speak on a social level, that you might kind of communicate just about a patient or in a stressful situation, and you can really get such a greater understanding of what's involved in their lives and in that specialty just now and learn so much about kind of transferable skills.
Jude: Absolutely great. And I don't think we do enough of that at the moment. In healthcare, I think during COVID we all kind of came together and we were all in it together. But as we've been recovering from COVID I feel like those relationships that we maybe started to build on have maybe fallen away a little bit. And actually, there's a lot at the moment. I think from my point of view, where we are all imagining what other people are doing and we don't understand how they're all working. And it becomes, when systems are under a lot of stress, it becomes really difficult to have an open mind about that. Other people are trying their best and they feel that this is the best way to work things. And I think being part of the fellowship just let you have those conversations with people. So I now am very aware that everybody's trying their best and everybody's a human being. Everybody deserves to be treated with respect and kindness. And not that I didn't do that before, but I think at certain times at the moment, we're all under so much pressure, work wise in your life. So everything seems under a lot of stress that actually knowing how other people work now and being able to ask people in different specialties or different roles through the fellowship network, how would you address this? I mean, I've certainly had lunches out with Christine, asking her about how she would handle certain situations, because it's an opportunity to ask, from your point of view, how do you see this problem? And is there a way that I can approach this within the area that I work in to try and make this a little bit better?
Kate: Yeah, I think you talked about the project clinics, and I think from what, when I've spoken to colleagues who have been recommending the fellowship to sometimes the idea of having to have a project to go to the fellowship with was quite daunting. So did you find that, and what was your experience about the project side of it, doing an improvement project?
Jude: So I think everybody is daunted by this, and I know why, but now having been through the fellowship, I totally get the idea behind it. So it's not to be a massive project. It doesn't need to be changing the way your board works or a massive thing. What you're trying to do is show that you've learned the skills of quality improvement, safety, leadership, change all those different things and trying to demonstrate it within a project. So it's actually a really good way of demonstrating your learning. And I think, don't be daunted by it. I was thinking about projects anyway, and I think many people who are applying for the fellowship do have a project in mind that they want to do, but they worry if it's too big, too small. Have I done too much of this already? Have I not done enough of it already? But what I would say to people is, please don't let that put you off. Everybody gets there in the end. There's great support for it. And again, the project surgeries where you come along and you've got your kind of like the backbones of your project written and you're presenting it to a member of the faculty and also to other people who are within your groups, and you think, oh, gosh, how's this going to go? But it's another opportunity for you to talk about the work that you're doing and have other people's comments and inputs. And actually, I think it was one of the most valuable things that I did. Obviously, I think the way that I think, and I do try and change that and think from other points of view, but having somebody with a totally different head on looking at your project and commenting on it, oh, I learned so much from that. And I wouldn't be daunted again about doing it. I would see it as I can't wait to present at project surgeries because I'm going to have this opportunity to get some input from people who think differently to me, and maybe it'll make my project better.
Kate: Yeah, we get so hung up on not shading our ideas unless we think they're perfect, don't we, in healthcare? So it's quite good practice because I see it with the people who start, and they're quite like the people who are maybe presenting their project initially are quite anxious about it and apologetic for what stage it's at and everything, and then actually, once they've had their questions answered, and then once you get through to the people who have listened to some of the other projects and the confidence is building and you realize how much fun it is actually kind of just throwing ideas out in a safe space and hearing comments about them. And it's actually really enjoyable. But we're not very good at doing that in our professional here because we only get rewarded for having the right answers and being perfect at everything.
Jude: Not having it right first time is not a problem in the fellowship. That's the whole point, is that you're there to learn and you've got all these other people helping you. So that can only help to make your project as good as it can be. And listen, all the pro objects don't work, do they? You've got to learn so many factors.
Kate: Yeah.
Jude: And you learn so much when things don't go well that the next time you're doing it, you'll do it slightly differently. It's just an amazing opportunity.
Kate: Yeah, totally. So were there any surprises during your year or was it what you expected?
Jude: I don't know if there were surprises per se. I think the fact that you've got this friendship group, I couldn't have imagined how that would have been. But having done it, it's brilliant. I think I was probably surprised, although I knew that I was doing the three days of the residentials, I think I didn't quite appreciate how tiring that was because actually having long days of learning, whilst it's great, it is hard. And the only thing I would recommend is that if it was possible for you to have half a day in the next week or so just to go through your learning and almost consolidate it, because I think I probably felt a little bit guilty for having the time out to learn and then rushed straight back into work the next morning. And in hindsight, with the last residential, I did have a day off afterwards to give myself a chance to write down what I'd learned and specific things I wanted to follow up on or things to look at or people to speak to, and I would recommend that. But it's very difficult when you're already taking time away from your work. But even just a half day or an evening, just try and put it aside because there's so much to learn. And the thing is, it all goes in because then you'll be six months later talking to somebody about work that they're doing and you'll think, oh, I remember that session that I did on X, Y and Z. I know somebody who might be able to help, or maybe I can help you with that. So it does go in, but I think for me, I would have just liked a little bit more time to myself to consolidate before going back into family life and straight back into work. So I think I was surprised how probably tiring I found it because I hadn't had that chance to do that for so long.
Kate: And as a GP, how did you balance the residentials and your other work? Have you got advice around how to manage that?
Jude: So I think that this is probably one of the tough things about being a GP and applying for the fellowship. So if you work within a practice, you need to probably negotiate with the partners or if you're salaried with the management and the partners about you having this time away and it's really difficult. I've just said it's really tiring. So it's not like you can make up those three days really easily from being away. I guess the benefits to the practice going back are that you will have done training and quality improvement. You maybe would take on a role like the practice quality lead or the cluster quality lead within your local area, which would allow you to demonstrate all your skills and your learning. But it is difficult because there's no backfill for the time that you're away from your practice, so it probably needs a bit of negotiation. I was in a different situation and I was on a year away from my practice to work in a pilot of a new service in our HSCP. So the HSCP signed off all my forms and allowed me the time away. But this is definitely something as a GP, you would have to consider and make sure you thought about it or discuss with your partners in advance. Listen, it's had a huge, huge benefit for me and I think I am a different clinician, I'm a different person to work around, and I think the way I think about quality improvement now is of huge benefit to the people that are around about me. But it would be a big cost challenge, probably, because if you work for the NHS, say, if you were an acute physician working in the hospital, then the hospital or the board sponsor your time away, so it doesn't come as a financial cost to you. So this is just something to think about.
Kate: Yeah. There are other GPs who've done it who are in practice roles, so I suppose get in touch with the quality improvement people in ness and we could get you in touch with them to find out how they worked around that too.
Jude: I would say if you look at the number of GPs that have done it, it's probably a smaller percentage than you would imagine, because I think of these challenges. There was another GP on the cohort with me, but again, she worked for the HSCP in a community role, but I certainly know of partners who have done the fellowship as partners and so. Yeah, absolutely. Sally or the faculty would be able to give you information about these people and you can speak to them about how they managed.
Kate: Yeah, yeah.
Jude: Great.
Kate: So tell us what's happened? Like, what have you done with all your learning?
Jude: So what difference has it made for me? I remember people saying, oh, it'll change your life. And I thought, really, I don't think my life's that bad that I wanted to be changed, but it has. So I would say personally, for me, I feel more confident in my abilities I think I used to sit in rooms of people in leadership positions and think I can't speak the same way as them. I don't know what they're talking about, but having done the fellowship, I think I've definitely got the chat. I understand what people are talking about and I can contribute to these conversations where before I don't think I would always have contributed. So personally, I think it's made a big difference. It's allowed me to think that I am capable of doing other roles as well. So as well as working as a GP, I do have two leadership positions. So I'm clinical lead for realistic medicine, but also a clinical director now and again before the fellowship, I'm not sure that I would have thought that I could do that, but I'm really enjoying the challenge again, I'm learning all the time. I'm getting an awful lot from that and hopefully contributing well to the HSCP that I work in. So lots has changed and I think I really enjoy my job. I really enjoy the mixture that I've got now. It seems to suit me and kind of motivates me and I love helping other people. So when people are talking to me about the fellowship or if somebody drops in the fellowship, as somebody in the current cohort was standing on the side of a rugby pitch with my kids and she heard me talking about the fellowship and came over and said, are you talking about the scottish quality Safety fellowship? And I was like, yes, do you want me to give you my chat? And she had already got her place on the fellowship, but I was able to give her lots of discussions, so I'm always happy to talk about it and really inspired to watch other people on their journey through the fellowship as well. This year. It's been so lovely keeping in touch with the fellows from our area and hearing how they're getting on and meeting up with them. And as part of previous fellows, you'll be invited back to support the fellowship and talk about it as we are today. And I think that that's something when you've been lucky enough to have the experience of the fellowship that we should do to support other people who are coming along behind us and try and support them with their personal development and give them the opportunities that we've had.
Kate: Yeah. Oh, that's great. Oh, well, thank you so much for sharing your story. We're looking forward to hearing what you do next, Jude.
Jude: Thanks, Kate.
00:00
21:25
15 February 2023
Why Apply? Ida Waal Rømuld & Marit Lunde Dalen
Hear the Norwegian perspective on this international programme
00:00
12:55
26 January 2023
Why Apply? Shobhan Thakore
Kate: Today we have with us Shobhan Thakore, who is our clinical lead for the Scottish Quality and Safety Fellowship. Welcome, Shobhan, do you want to tell us a little bit more about yourself?
Shobhan: Yeah. Hello. My name is Shobhan. I am clinical lead fellowship program and we're about to start recruitment for Cohort 15. I started as lead in cohort nine. I'm an emergency physician by trade and I did the fellowship back in cohort seven, which was like 2014, I think.
Kate: And how did the fellowship different now to when you did it?
Shobhan: I think we've just evolved it so it is different compared to when I did it in 2015. We've brought in some different elements, I would say, compared to what was done before. We've got more formal content around human factors and ergonomics than we did. And some of the service design and design kind of thinking element within the fellowship program didn't exist when I was there. So that's a whole new area within the program that really, I think, really helps us to engage with users of services in a different way. So really thinking about the user journey as well as just the kind of traditional QI process map approach to things.
Kate: What brought you to the fellowship then?
Shobhan: Back in 2014, I had been clinical lead for emergency medicine for quite a while. Felt like I was doing improvement work, didn't really have the quality improvement methods, didn't really have the improvement language, but was trying to improve the way processes worked in the department. And I think I got an invite to go to one of the quality improvement forums, which was in Paris in 2013, and I was quite a little bit skeptical about quality improvement and patient safety. It seemed like there's a lot of zealots and there's a bit of special language and stuff for it, but I thought, I am trying to improve things and I'm trying to do stuff in the department, so let's go to the improvement forum. We had things to display in a poster, so went there, and then whilst I was there, I met the cohort that was on the program, so that was cohort six and spent a bit of time with them, which was really excellent. And we got to hear about their projects, got to hear about what they were learning. And at that point I thought that really resonates with what I'm trying to do and trying to kind of just gently change things in the department or oversee change in the department and improve things in the department. So at that point I thought that this is the kind of course, that would give me some skills in how to change things in the health service. So that's where the kind of real interest sparked for the fellowship program itself.
Kate: And what did you expect from the fellowship and then how did it compare to that?
Shobhan: I guess the thing I expected, which is knowledge and skill that certainly delivered on that that I expected. I guess the things that I wasn't expecting was a bit outside of just the pure QI technical skills. So it really opened my eyes to things like began to open my eyes to things like human factors and how we all interact with one another and how that's important and how we interact with our environment. It really opened my eyes around the leadership and skills around the leadership. How do you engage with people? How do you appreciate the differences in the room and how do you start to see them as opportunities and not just hindrances? And how do you make sure you don't lose all your energy when you face the first bit of resistance to any sort? And how it's not really about changing other people. It's about maybe how you change yourself and how you change your own messaging and really properly reflect on what other people are telling you. Because actually, what they're saying, if they disagree with you, is potentially really valuable and needs to be built into your change. That bit was really unexpected learning and the other bit that was really unexpected was just the connections and just the kind of network within just within our cohort was amazing. Just it was really good, really kind of uplifting, to be honest, to be in a room at these residentials where you're just with people who are looking to improve things and have a really kind of positive outlook, and it didn't really matter where you came from. And making friends with somebody who works in paediatric ICU is a very different environment to me, but was so easy because we had the common interest of what just wanting to improve. And that's true of all the different people in the room. So there's 30 odd of us in the room from different backgrounds. Really great to have people from Scandinavia there. We had Norway and Denmark and the Northern Irish were there as well. And just that learning from different systems and different approaches was brilliant.
Kate: I think that's been a theme with everyone I've spoken to. That's been the surprising part that they didn't expect was the kind of human element to it as well as the tools. And you mentioned that there were international fellows and what does that bring to the program, do you think?
Shobhan: I think it just brings different ways of thinking about the same issues that we've had been leading the program. We have a constant stream of banes and Norwegians and Northern Irish. They're kind of core and we've been able to visit them as well as them come to us. I've had invites to go to Norway and meet clinicians there and it's just been interesting to see how they run their pathways. Now it doesn't mean to say that everything they do is better than everything we do or it's all achievable, we'd structure our systems differently. But it's interesting to see and it just stimulates different ideas. We've also had people from Canada and from New Zealand whilst I've been leading the program. And it is, I guess, thinking about the experience from Sarah from New Zealand and her project was all about how they are trying to engage with the Maori community with a clinical problem that they had. And it's just interesting to hear how they did that and how they kind of engage with a community that were not engaging with healthcare in the way that we expect people to engage with health care and how that cultural difference is recognized and how they do things to try and address that difference. I think even though we don't have a large Mallory community in the UK, we have communities who are not engaging with health care and so there are things we can learn. So I think the value is huge in just that international group.
Kate: Yeah, I think for me, like speaking to particularly some of the people from Norway and Canada about how their approach to rural health has been incredibly eye opening and probably that's a two way street, isn't it? They've had their eyes open to the way we do things here in Scotland. After you did the fellowship, how did it affect you professionally?
Shobhan: So I went back, to emergency medicine. I've done the fellowship and I guess I found myself on various committees and things where things were being discussed and I started to fix myself. Well, we could use improvement techniques for some of these larger system problems. We have an improvement academy in Tayside and starting to think, well, there's real opportunity to use that resource which was already being used, but this is how I would see it being used and having some clinical leadership around that would be important. So I guess long story short is I kept saying things about improvement at various meetings and then off the back of that Tayside adopted something called the clinically led model in 2018 and around that time they advertised the role for an Associate Medical director in quality management. And I played and I was successful in that. So I guess what's done for me is that I now have a different role which may be a bit more strategic within the organization and how we use it improvement expertise to help operational teams. Because it's the operational teams actually have the ideas and it's them that actually need to do the improvement. But if we can support that with some time for improvement advisors or improvement support and help them use the right methods, then it just adds robustness to the change that they're trying to do.
Kate: Cool. So, final question, what is one thing you now believe that if you'd said it to Shoban Prefellowship, you wouldn't have believed in some way that your thinking has completely changed?
Shobhan: So I would say that the thing that has changed for me is all around. I would say the big thing that's changed for me is the importance of place on us being person centered in our practice as opposed to just how do we kind of make for efficient processes, how do we ask clinicians to make their processes efficient? Instead of that is how do you blend that with what people actually need and what adds value to the individuals who are passing through the pathways that we are developing? So I think the big thing that's changed for me is around design thinking, actually. And it's about the influence of using the other half of your brain to think a bit more. I mean, creative is one way of putting it, but just to think a bit more from the kind of aspects or the kind of place of being a patient in the system or somebody, a person in their family sort of coming through the system. And I think that design thinking has made me look at things completely differently. On the first program, I often speak about my mother's experience of healthcare, actually turning that into applying some tools to try and improve other people's experience of healthcare by thinking of it from their point of view and say, using things like the kind of user journeys and empathy mapping, all this kind of thing. That's been completely different for me. That's been a massive shift in how I think. And actually, I think if we could do that more effectively, we would reduce a huge amount of waste that occurs in the health service. Potentially reduce demand because we're empowering people to care for themselves.
Kate: Yeah, I totally agree to have a follow up about real estate medicine. Perfect segway?
Shobhan: Yes.
Kate: Great. Well, thanks so much for your time.
Shobhan: You're welcome.
00:00
12:52
25 January 2023
Why Apply? Louise O Dalaigh
Kate: Today we have Louise O Dalaigh, who works in Northern Ireland. And you are a fellow in Cohort eleven, is that right, Louise?
Louise: I was indeed. Kate. Yes. Cohort eleven.
Kate: Well, thanks so much for joining us. You're our first fellow from Northern Ireland that we've had to chat about their experience. So could you tell me a little bit about yourself?
Louise: Okay, so, my name is Louise. I'm currently working in one of the trusts in Northern Ireland, the Western Trust. So I started in health care over 30 years ago, first qualifying as a nurse, and have worked in various roles in the last few decades. Ward sister, mostly in acute care. I was a service manager for a number of years, and my current role is I'm the Qi lead for the Western Trust here in Northern Ireland.
Kate: Oh, great. And what brought you to the fellowship?
Louise: So what brought me to the fellowship? Well, it was a bit of a bumpy bump. I landed there not realizing what I had put myself in for, I suppose. I suppose my journey, how I got there was a couple of years beforehand, I had been on a journey for myself as a result of burnout, working in the NHS for a number of years and being a working mom, etc. And I had went and done, outside of work, a coaching course and got very involved in that and was really intrigued by it. My years as well as in health service, up into that, I was always involved in improvements. I was always kind of getting involved in new areas of where we can make improvements. Quite often. I often say that I kind of planted seeds, got to sapling, but never really yielded the fruit of the trees, if that makes sense.
Kate: So very common for everyone, I think.
Louise: Yeah. Just there was always so much more to kind of do, so kind of running on and trying to sort the next thing. So after I had done my coaching, I had got involved. I got in contact with a number of people, and one of which was a person that had done the fellowship. So it was from a previous cohort, and she had become like, a mentor and had introduced me to Qi methodology and made reference to it. And around that time, she had said, Why don't you apply for this? And I had no idea really what I was getting into. So ended up then making the application and getting a place successfully. So it kind of was a bit bumpy bump. But what really interested me was that around the improvement about getting a methodology to support, because quite often in the improvements that I've been involved in, how are we able to really demonstrate and articulate the longevity of and the sustainability of the improvements? Because quite often we made improvements and went on, and then maybe a number of years later, they fell back to where they were before. So that kind of methodology around it really interested me.
Kate: Yeah. Oh, great. What did you think that the fellowship would be and how did it compare in reality?
Louise: Well, I suppose I thought that it was going to be a program really about the quality improvement methodology, so all the data and the charts and just the whole science of it. But actually it was very different. It was very much about human behaviors, about the whole culture, about leadership, about being part of that kind of change agent. So the human behavior is part of it really did interest me. And probably when I think back, that's the bit that I kind of tended to really get so much from. But yeah, going into it, I kind of thought it was going to be very much around the improvement science.
Kate: Yeah. It's so eye opening, isn't it, when you start to try to understand the behaviors about why people behave a certain way or maybe aren't that keen on change or improvement and then the first time you kind of put it to work, how transformative it can be.
Louise: Yeah, absolutely. Absolutely. Yeah.
Kate: And what was your favorite part of it?
Louise: I suppose around that whole psychology of change and what was my favorite part of it as well was actually being in a program with a real diverse bunch of people that were very likeminded and each and every one of us in the cohort that I was I was part of cohort eleven. And each and every one of us in the cohort had our own stories of why we got there on the actual cohort. So that really togetherness and being part of a tribe, so to speak, that for various reasons, when we all exchanged stories, we had been involved in various improvements and we had had various challenges in our careers, et cetera. So actually I'm going to talk that tribalism of us all together and bouncing off each other and supporting each other is probably the best bit for me.
Kate: It's kind of the tribalism, the antitribalism from what you're used to at work, isn't it? Because we're so used to working in our silos and then to get that bigger picture of people across the system and from different countries, a lot of people have said is really inspiring. What was it like to bring it back to your practice, to put all that new learning into practice?
Louise: Yeah, I think one of the things I reflect on as well is about putting into practice was sometimes when you're in your own organization and your own teams, when you come into it with a curious mindset, it can be more challenging. So I think the thing that I brought back was increased confidence that actually yeah, this is okay to be really curious. Yeah. It's okay to always keep pushing and asking those curious questions. So I think that increased level of confidence is something I can kind of relate to that I brought back. I think that was kind of the main things. And again, also what I brought back was this increased knowledge around the methodology that I was able to apply to, projects that I was doing and improvements that I was doing. A mixture of both. And the other thing is an increased network. So we're a small area in Northern Ireland and the overall NHS population in the UK, so to speak. Actually having that network of people as well, to really understand and hear how people are doing things and the barriers that they face and the challenges they face is very, very similar. So that was really kind of I felt that really beneficial as well to bring back that. Yeah. At the time that I was doing the program, I was working within Ophthalmology and Optometry Services, and there was an Ophthalmologist on the program. So comparing stories of the challenges that we were facing at the time realized that they were and learning from each other. So that space of shared learning as well was huge.
Kate: Yeah, I work in quite a remote health board in the north of Scotland, and it's so lovely to go and be able to say, oh, well, they're trying this here, maybe we could adapt that. Or bringing new ideas from out with when you are a bit more like geographically isolated is so beneficial, isn't it? Tell me about how it's affected you professionally.
Louise: Yes, so professionally, when I came back after completing the fellowship, I realized that it was going to be really challenging for me to take what I had learned and use it in the role that I was doing at that time. So I made a conscious decision to apply for a job that was very, very different. It wasn't a career plan I had ever had, but at the time it seemed really the right thing to do because I found that it was going to be difficult to because the relentless nature of the job I was doing that, how was I going to be able to utilize and maximize these skills? Also, one of the things when I went for the fellowship interview around that time, I'd realized that probably I was about the halfway juncture of my career in the NHS. And I felt that I spent the first half of my career helping to make improve services for patients, et cetera. Whereas I had this strong sense of I want to spend the second half of my career helping people in the worked in health and social care to do that for patients. So I then applied for a post in the Qi team in the Trust and then successfully got that. And then that has led me to the post that I'm doing today. So now, as I say, as the Qi lead, I quite often say to people when people ask, what's your job? Well, I help people to make things better, I suppose, both personally and professionally. It's had a huge made a huge difference in both home and work life.
Kate: Yeah. And how have you found that transition to, like are you now nine to five, Monday to Friday?
Louise: On paper, yes, on paper, I think that's what we're supposed to be. But yeah, one of the biggest things for me was I didn't have to be part of an on call rotor, so that was one of the biggest factors. After a number of years, I've been on various on call rotors, so that was one thing. But yeah, I'm in a kind of no weekends.
Kate: Yeah. But these kind of roles are all consuming, aren't they? So you think about them day and night if an idea comes to you. But I think that's how work should be. It should be enjoyable and you look forward to it. And the NHS is a lot of people who have had difficult times recently with Burnout and everything we've been through with the Pandemic and even before that, and having a feeling that you kind of belong in a good team and you're contributing to something that you're really passionate about is so good, and then you just want to give more. But I think a lot of people don't feel that. But I think from speaking to other people about their experience of the fellowship, it's something that a lot of people, they feel like they've got that back after completing it.
Louise: Yeah, and absolutely. I think that was one of the things when I got involved with it first. And even part of the fellowship, even around that whole joy and work framework that actually people being involved in Qi gets them back, links them back to that purpose and passion of why they come into the roles in the beginning. So it really does have that kind of antidote to burn out. And that's where I wanted to be. I wanted to be helping people to shine the light towards that, to get them more involved. Because I suppose my own journey as well, I've been kind of dark for a few years, that actually, if I can help other people see the light of that sooner rather than later, that would be all kind of worthwhile.
Kate: Yeah, absolutely. I've been asking some of the other fellows, what is one thing you now believe that before the fellowship, the Louise before the fellowship would never have believed?
Louise: I think probably what comes to mind, maybe around impostor syndrome, before the fellowship, maybe I just thought that it was only certain people that had imposter syndrome. But one of the things is that everyone has it, everyone suffers with it from time to time, that we're all human. And during the fellowship, as I say, when we built that kind of trust within our cohort, and we shared stories that you really see that it doesn't matter whether what role you play, what discipline, et cetera, what professional body you belong to, that people do have periods of it, and actually, that's okay, that's kind of normal. So I think that kind of when I think back of before, I would have thought, oh, not certain people and, you know, myself, maybe, but yeah, maybe maybe around Imposter syndrome might be something that I wouldn't have believed that people experience and feel that as wide as people do.
Kate: Yeah, absolutely. And then when we do experience it, quite often, like, there's a moment where we're made to be humble again. And it usually happens just when you're getting confident with something and you think one of the surgeons at my work said told me about a story where he did not anticipate how big the surgery he was going to do and how long it would take. And he felt really silly at the end of the day when he'd overbooked the list. And I said, well, he's been a surgeon for 30 years. And I said, well, it's really such a good example to our junior colleagues that even when you've been in for 30 years, you can still get it wrong, and that's okay as long as you react in a safe and appropriate way. And he was like, yes. So everyone gets imposter syndrome. Definitely.
Louise: Yeah. And even adding to that, the whole concept of having psychological safe environments for people to air that and feel comfortable around, that is another, I suppose, huge learning that I took away from the fellowship, how important that is. I'd probably been exploring a little bit before I started the fellowship, but, yeah, that's another bit of it, is that that whole psychological safe space is really important. And for improvers that, they feel that they're open if they've got a wacky idea or that they have the safe space to be able to air it because quite often somebody's only dying to air it, but they just don't want to say it out loud.
Kate: Yeah, absolutely. Great. Well, have you got any advice or tips you want to share with anyone who's thinking about applying?
Louise: Yeah, I think anyone that's thinking of applying, talk to somebody that has been on the fellowship before. Link out, reach out to people, because if you're thinking of doing it, just go with it. Go with your gut and go for it. Because most people or any people I've spoken to that have done it have always felt the feedback is always it was so much better than they had ever anticipated. So probably for me, it's definitely in my career, it's the best program that I have ever completed, the fellowship program. So, yes, go with your gut and seek out people if you need to get that reinforced, but go for it.
Kate: Yeah, absolutely. Oh, well, thanks so much for talking about us today.
Louise: Thanks very much, Kate, for the opportunity.
00:00
16:02
22 January 2023
Why Apply? Clare Morrison
Kate: Today on why apply for the Scottish Quality and Safety Fellowship, we have Clare Morrison with us, who was a fellow on cohort 8 of the fellowship. So Clare, would you like to tell us a little bit about yourself?
Clare: Yeah, absolutely. So I was, as you say, a fellow back in cohort eight, which I think was 2016, which seems forever ago now, and you have caught me in between jobs. So up until yesterday, I was director for Scotland at the Royal Pharmaceutical Society, which is pharmacist professional leadership body, and I'm a pharmacist by profession. And then in a couple of days time I start my new job at Healthcare Improvement Scotland as director of Community engagement.
Kate: Great, that's very exciting. And what's your clinical background?
Clare: So I'm a pharmacist and I suppose where I was in the run up to the fellowship was I was working for NHS Highland. I was lead pharmacist in the north area. I had a particular interest in medicine safety, so I recently co created the medicine rule cards with a colleague and then also been involved with the Scottish Patient Safety Programs pharmacy in Primary Care pilot. And we'd applied as a board from NHS Highland to be a pilot site, which we then went on to do. And I think all of that kind of work so very much that focus on medicine safety and then leading into the world of quality improvement through the SPSP work gave me a taste of the future, I suppose, and where I decided I then wanted to head with my career into more of improvement world.
Kate: And what brought the fellowship to your attention then?
Clare: Completely working away at that pilot I just mentioned. So the SPSP pharmacy pilot and I was suddenly exposed to all these people who just spoke this new language and it was all quality improvement. And we got to go to events with other teams who'd been doing improvement for a while and had been involved with SPSP for much longer as well. And through that I met some of the fellows from that time and I also had some really inspirational people and it was part of a world that I realized I wanted to join and be part of. And I suppose thinking back to that time, there's two particular people who really did influence me and they were Jill Gillis, who was the lead at his for the SPSB primary care work, and Neil Houston, who was the clinical lead for SPSP work as well. I would never have even thought that I might have gotten to the fellowship were it not for the encouragement that they gave me at that time to apply for it. So I owe them a huge thanks.
Kate: Okay, that's a great little shout out. Perfect. What did you think it would be and how did it compare to that when you actually got onto the fellowship?
Clare: So I guess what I thought it would be would be a huge amount of learning, which it was. But what I wasn't prepared for was just how completely and utterly it changes the way that you think and it changes you kind of approach to all of the work you do from that moment on. And it really was life changing for me, without a doubt. And I know a lot of people say that about it, and people think, oh, how could that possibly be true? But it really was. And I suppose to illustrate that, I would say where I was before the fellowship, so I was completely part of a multidisciplinary team, but I was really focused on that kind of narrow niche of the pharmacy world and I don't think I really recognized in that more strategic way about pharmacies part in the bigger NHS system. And all my contacts and my networks were very kind of pharmacy based. And so through the fellowship, I really just had my eyes opened. I started to think about the whole system, and I became part of this just fabulous network of people who you can just call up and have a conversation with and think, really and help you understand things in ways that you could never have thought of before. So, yeah, the fellowship's life changing and I don't think I was expecting that.
Kate: Yeah, it's quite rare to get the opportunity, isn't it, to spend so much time in a non clinical, maybe less stressed environment with people from different disciplines and specialties.
Clare: Completely. And it is absolutely a luxury and it does feel quite time pressured at the time, like you're always trying to finish the work that you need to do in order to free up the days that you're going to go away and spend with them. But actually, to have that ability to disconnect from your day job and spend the time thinking and learning with other people is such a brilliant opportunity.
Kate: And was there a highlight for you or a particular bit of learning which you feel you carry with you?
Clare: Yeah, for sure. I would say the biggest kind of thing that the fellowship gave me was that understanding of co design and how we properly engage people in improvement. And I think if we're really honest, it's not something that we're great at. And when I think back to before the fellowship, I was really hot on evidence based medicine and on asking patients for views. So if ever I was doing a project, I would always have asked a patient to be part of that project team, but I didn't really do co design with them. And that kind of co design of involving people in helping you understand and develop services before you launch them, the testing of the services as you move into that development phase and then really involving people in an ongoing way of delivering that continuous improvement and as the service goes on and on and on. I don't think I did that before. And I think I really learned that through the fellowship. And I suppose connected with that is the proper listening. So not just asking for a view and sort of taking off that you've done engagement, but properly listening to people and then acting on what you hear. So, yeah, completely.
Kate: Yeah. I wonder if, obviously there is lots of amazing design content like teaching, on the fellowship. But I think a big part of that, being in that room with all these different people opening your eyes and giving you all these ideas and sharing their perspective on problems. It sort of, in itself, opens your eyes to the benefit of talking to more people, all the different stakeholders, patients listening to their ideas, even the kind of atmosphere itself that's created as well as the formal teaching, really.
Clare: 100% agree with you. 100% agree.
Kate: Great. How's it affected you professionally?
Clare: Like I said, the learning was life changing and the fellowship has been life changing as well in terms of the kind of the direction that my career has gone. So part of the fellowship, and again a real luxury, is the possibility of going on a study trip to learn something to bring back to Scotland. And at the time I was working for NHS Highland and I was really interested in improving access to pharmacy services in our most remote and rural areas. So I went to InterMountain Healthcare in Utah to see how they use tele-health in what is a far more rural setting than we have. So I came out from that and I proposed setting up a video consulting service and I got funding from the Health Foundation to do that. And at the end of that, the then Chief Executive Adventures Highland, Elaine Mead, came to see what we had done and she said, do you want to have a year and try and do this for outpatients? And that was the birth of what was the Caithness Tele health project at the time that went on to become Near Me. So I suppose her decision, her putting that trust in me, which is absolutely linked to the fellowship experience, started a new chapter of my life in which I was then working with that very much an improvement focus and I suppose then going on from that the development of near me all about everything that I'd learned through the fellowship. So the approach is to develop the service in terms of that continuous codesign I mentioned earlier, thinking about the whole system, to understand the problem, having a really clear structured approach to what we were doing. And I suppose my best anecdote about Near Me is how it got its name. So I said it was the Caithness telehealth project and we were using the system that underpins Near Me, which is Attend Anywhere and we were referring to it as AA. And I was sitting in a cold and freezing town hall in Wick and people said to me, well, we're just not going to use it because we're not using anything that's called AA. It's because the name is associated with Alcoholics Anonymous. I said to them, great. Well, okay, it's great to know that right now, at the beginning in the design phase of what you want to call it, and that night we came up with the name. So it was named by patients.
Kate: I never heard that before.
Clare: But it shows you the value, doesn't it, of engaging people properly in the development of services right from that beginning stage. It's just essential to do that.
Kate: Yeah, absolutely. Because you will know yourself that there's a lot of services cropping up that are all around frailty. And I've had similar conversations around frailty services and what people, older people, think of the word frailty, and they absolutely hate it. So I've had quite a lot of fun conversations with people asking, what would you rather that was called? And things like some people, one person said, well, I'd like it to be called the Age related Deterioration Service. It would be ARDS. And then that led on to, well, why don't we call it age related optimization? Why does it have to be all about deterioration, just about living your best life?
Clare: And I bet it's the fact that you've done the fellowship that enabled you to have conversations with people like that. That's what the fellowship does. It helps you to understand how important it is to have that involvement of people and to give people the opportunity to really talk properly and maybe to.
Kate: Understand that not all feedback is bad feedback, which often people presume because of your complaints. And that sometimes, if it is bad feedback, there's actually a way to positively respond to that and to use it to make things better.
Clare: Everything is an opportunity to improve, isn't it? Everything. Someone says there's something within that that you can use to improve.
Kate: Yeah. So what's one thing that you now believe? That if you'd said it to Clare pre sqfs, she would never have believed.
Clare: Oh, gosh, I think it is the transition from me before, which was that focus on evidence based medicine to actual, and I still believe in evidence based medicine, I should say, but to absolutely making sure that you've got people involved in improper co design. And I think without having that what we went on to do with Near Me. So obviously during the Pandemic, I worked for the Scottish Government as national Near Me lead to support its spread across the country. We wouldn't have been able to do that were it not for the fact that we've done all the codesign work before. There were other digital services that should have spread too, but didn't because that groundwork hadn't been done. So I think for me, that real understanding of how you have to engage with everybody. And I do think of it as a bit like a magic triangle of service, of a service. So you've got the service users, so that's the patients and the public and the family and everyone who uses a service, the service providers, which tends to be the health professionals involved, and then also the service enablers, and they're the third part of the magic triangle. And if you don't engage all three parts of that magic triangle in both the initial development service and then the ongoing continuous improvement of services, then they just don't work properly. So that's the real learning for me, I would say, is that that understanding of proper co design and coproduction going forward.
Kate: Well, that's great. I think the first time I met you, you were on stage with Jason Leitch and Derek Feeley at the Quality Forum in Glasgow.
Clare: Gosh. As I said before the fellowship, I would never have believed I would have been able to do that.
Kate: Yeah, I remember thinking, like, wow, you are a hero. That's so brave to stand up with two big characters like that and share your story.
Clare: It was the most petrifying thing I've ever done. And I suppose the secret to that was the preparation. So what you didn't see was the months of preparation that went into making sure that I was able to do that, but even then, it was still petrifying. So thank you.
Kate: Yeah, it was amazing. It was really good. Great. Well, have you got anything else you'd want to share or advice for anyone else who's thinking about going through the fellowship or applying?
Clare: I would say absolutely, go for it. It is just the most amazing opportunity. I never thought that my life would change and my career would go in the direction it has. And I know it is down to the fellowship as a result of that. And I'd also say that huge benefit of it opening up this network of fabulous people who just give you positivity and all of our jobs can be tough at times, but actually, when you have this network of other fellows that you can turn to across the cohort. So I love it when someone from another cohort calls me up or when I'm stuck on something, I might track someone down from another cohort, even if I didn't know them at the time or they didn't know me. And people are willing to talk and willing to be involved and it's just an amazing thing to be part of. So I would say go for it and don't be scared.
Kate: Oh, that's great. Cool. Well, on that note, actually, we have a Danish fellow this time who's looking at video consultations for breaking bad news about brain injury and brain cancer. And I said, you need to call on your Scottish Fellow family and learn a bit more about that.
Clare: So I'll need to work with them. And there was some really great work done in Highland, actually, by a team around how you can break news, bad news, but it has to be done in a really thoughtful and planned way. So absolutely. We could hook them up as well.
Kate: Yeah, let's do that. Cool. Great.
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