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.