One week on from Agents for Change

A week is, so they say, a long time in politics, and at the moment in medical politics, even 24hrs seems to bring new developments. So it seems like a month since the #agents4change conference in London, but actually only 6 days. 

This weekend I'm on night shift so have had a rest day today, after working days earlier in the week. Whilst still enthused by what I heard,asteroids weekend, I am challenged tonight by the thought' what have you done about it?'. In reality, nothing. 

This initially sounds negative, but sometimes the mountain seems huge and needs breaking down a bit. What I have done is started to read, again, Better by Atul Gawande, one in his series of books. Whilst not finished it yet, one theme has struck me repeatedly thus far, and it's not new to me, to anyone. It is the concept that you need to measure something before you can improve it.

This seems initially obvious, and thereafter a complication. Obvious because if course we all love bar charts showing a huge leap in compliance with a checklist or reduction in central catheter infections after our intervention, and simultaneous complicated because some things, some of the really important things in healthcare, don't fit nicely into any medical scale. Does me taking time to introduce myself and my colleague to the patient alter their care in a way we can assign a numerical value to? Possibly not, but it matters, at least as much as the reduced central line infection rate, sometimes even more. 

So it could be said that I have been biding my time.  I have also been reading the blog of my current health board. This has been very interesting. Some posts are people talking about their current initiatives, some and guest posts from senior medical and nursing staff in NHS Scotland, clearly syndicated to many similar blogs.  But the ones which have struck home the most have been the reflective, personal, even self critical and painful blog posts by staff who are involved in complaints management and demonstrate a keen desire to improve the quality of the care we provide to our patients, not just in terms of accurate diagnosis, rapid treatment and symptoms management, but also in terms of communication with patients and families, recognition of deteriorating patients, and good handovers between teams. 

This has given me much to think about, and some names of people to contact to look at using the remaining 3 months of this rotation to look at some areas and see what quality improvement intervention I could work on which could have a meaningful, measurable and lasting impact in the care of patients here.