<p>We chat to Clare Morrison, former Lead for NHS Near Me, newly appointed Director of Community Engagement at Healthcare Improvement Scotland, Pharmacist by background and Scottish Quality and Safety Fellow.  Hear about her incredible journey since Fellowship, the opportunities that have opened up and how co-design was key to the success of NHS Near Me.</p>

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.

Why Apply? Reflections on the Scottish Quality & Safety Fellowship (SQSF)

Why Apply? Clare Morrison