Author: Dr. Hannah Zhu
Foundation year doctor
I heard about PIPSQC through the quality improvement (QI) grapevine and it seemed to be finally exactly what I was looking for – QI specific to paediatrics! PIPSQC’s international speakers and workshops very much exceeded my expectations and this conference gave me exactly the boost of inspiration and ideas I needed. Here’s a snapshot...
Our illustrious chair, Peter Lachman, introduced the day by reminding us of the unique paediatric patient safety considerations that make PIPSQC so important. Children are fundamentally different to adults due to size and physiology ranging from neonates to teenagers, drug dosing is much more complex (weight dependent), children present with different pathologies and children rely on adults for care. In our workshops, we shared our experiences in hospitals with predominantly adult patients, where unique paediatric considerations are not always taken into consideration. These hospitals often do not have the resources or expertise to deal with some paediatric problems. It can be very challenging and time-consuming to transfer children to tertiary centres with the necessary resources. This particularly resonated with me following a case of a baby with pyloric stenosis who waited 3 unnecessary days in a district general hospital, waiting for a surgical bed at the local tertiary hospital, whereas he would have been operated on immediately if he had been referred there directly.
Handover and escalation were particularly topical. A big risk area that Phil Debenham identified is the synthesis of information in preparation for handover. Current audits often focus only on the handover itself (SBAR, IPASS), rather than the preparation time, which is fundamental to what is communicated during handover. It was very interesting to view a video of a typical handover prior to intervention – the junior doctor typing frantically (possibly updating the handover sheet and doing discharge letters at the same time), multiple interruptions, doctors having a chat amongst themselves, people arriving late and not concentrating. Just like with communication skills training in medical school, it would be really eye-opening for us to video and analyse our own handovers.
Matt Scanlon’s systems analysis talk stated the environment, organisation, tools & technology, tasks and people are all interdependent and interactions between these components are essential. This ties in to Stephen Muething’s outline of Cincinnati Children’s Hospital’s journey from chaos to reliability, where process design, reliability culture and human factors integration are all synergistic in optimizing outcomes.
One idea that stood out was Trey Coffey’s account of daily improvement ‘huddles’ around an ‘improvement board’. This is a simple, cost effective and allows everyone working in a team to identify areas for improvement, prioritise and implement solutions. As a junior doctor on understaffed wards, I saw system failures and inconsistent care almost on a daily basis. The challenge here is to turn these experiences into opportunities for improvement and follow through, which I’m doing through auditing and improving handovers. However this is only the tip of the iceberg and even this has been difficult this year due to time pressure, lack of continuity/support and bureaucratic inertia. The best way of sustaining QI is to develop people to solve problems and improve performance, since behaviour drives culture. Thus, changing culture needs to target everyone with both a ‘top down’ and ‘bottom up’ approach to motivating patient-centred QI behaviour.
I’m a big believer in engaging students and junior doctors early in patient safety and quality improvement. I look back on my days as a medical student and realise how much time I had back then relative to now. Students represent an underused resource within QI. If students are taught to recognise QI as a cornerstone of effective patient care, they will become clinicians who do so and take their colleagues with them. My student experience as leader of the Cambridge University Paediatric Society and IHI Open School Cambridge has shown that, with encouragement and support, students will work together and engage in QI, thus changing behaviour and culture of healthcare.
This is why I’m very excited to be the newest PIPSQC Ambassador, reaching out to anyone in paediatric training or thinking about paediatrics as a career.