Could you be the next Clinical Lead for our neonatal improvement programme? – Colin Peters

Posted on November 16, 2021

As Colin Peters leaves us as Clinical Lead for our organisation’s neonatal improvement work after five years, in this blog he describes the rewards of the role of clinical lead and how he made the role work alongside his day job.

Interesting, rewarding and enjoyable. After five years as the Neonatal Clinical Lead for Healthcare Improvement Scotland, that’s how I would describe the role. Now that I’ve moved on from the role and I reflect on the time with the organisation’s Scottish Patient Safety Programme, I feel grateful for the tremendous support of the team and the engagement of neonatal teams from around Scotland in order to deliver improvements.

There have been lots of highlights during the five years, but I particularly enjoyed the learning sessions where we had such engagement from everyone involved: nurses, midwives, doctors, improvement advisors and more. Post-it notes and marker pens were the order of the day with roaming microphones and ideas aplenty.

While I’ll miss being in the role, it does mean that there is a fantastic opportunity waiting for someone to take up the mantle of Neonatal Clinical Lead.

The role of the MCQIC Neonatal Clinical Lead

So what does the role of Neonatal Clinical Lead entail? First up, the role is essentially for one day a week, so you undertake the role alongside your clinical duties within your NHS board.

The key responsibility is to provide clinical direction to the neonatal improvement work of the organisation. This includes identifying new areas of work and ensuring that existing areas are up to date. Here it’s important to seek new ideas from around the UK and abroad, as well as draw on recent publications, national guidelines and evidence.

Within the role, you get to visit each NHS board to provide support, share ideas, motivate and inspire. I really enjoyed these as I inevitably came away with a new idea or reflection on something that could be developed.

The importance of collaboration and leadership

Working collaboratively with Midwifery and Obstetric Leads and NHS board teams on measures that sit across the whole MCQIC programme, is a vital part of what the clinical lead will do. In my view, improvement in neonatal outcomes depends on improvements in obstetrics and midwifery. The collaborative work on the Preterm Perinatal Wellbeing Package was a fine example of working across teams to come up with a message for everyone caring for a woman delivering prematurely and her baby.

Leadership is another key element of the role, for example, leading sessions at Scotland-wide meetings. These are really interesting sessions with a fair bit of work involved to put together an engaging presentation / session that leaves the delegates inspired to go back to their NHS boards with ideas and a motivation to improve.

You will also develop and participate in regular webinars. These are now more familiar to us all and although talking to your own screen, hoping that there are people out there, is strange, the responses and conversations are really rewarding.

The Clinical Lead for Neonatal will also contribute to national networks and groups. In my time I’ve worked with the Scottish Perinatal Network, the MANDALS group and Clevermed. Strengthening these relationships have ensured that we’ve been able to take consistent approaches across Scotland and avoided duplication of effort.

I’ve found the support from the project officers to be excellent, and I’ve put many of their ideas into practice. Moreover, the support from the Senior Improvement Advisor has been really helpful. I felt that I wanted to come out with more than just having worked one day a week, so I completed the Scottish Improvement Leader course. The new lead may have some particular area or skill that they want to develop.

Ways of working

I tended to work flexibly, especially in the virtual world which now exists on Teams. Before the pandemic I’d work in Delta House (Glasgow) or Gyle Square (Edinburgh) some days, site visits on other days and at home on some days. Sometimes I’d work whole days, on others it would be broken up across a week trying to average one day a week.

And what advice to my successor as Clinical Lead for Neonatal? There is lots of support from all teams within Healthcare Improvement Scotland, so don’t worry about the practical matters of the job. Enjoy, laugh, and don’t be afraid to voice your opinion. Make the role your own.

Colin Peters is Consultant Neonatologist in Greater Glasgow & Clyde and is the former Clinical Lead for Neonatal for Healthcare Improvement Scotland.

Visit NHSScotland to see the list of current job vacancies.

Categories: Uncategorized

Tagged: impact campaign

Long COVID: a new challenge in managing uncertainty – Scott Jamieson

Posted on November 11, 2021

Dundee-based GP Scott Jamieson explains his experience in diagnosing patients with Long COVID and his contributions toward the creation of the now updated Long COVID clinical guideline, which will play a key role in assisting doctors to diagnose and treat Long COVID.

In general practice we are very accustomed to managing uncertainty. We teach GP trainees that this is not only when we don’t know immediately know what a diagnosis is, nor how to define it, but also when we are unsure how to treat it.

The key to managing uncertainty is sharing decision making. Where there is uncertainty, there is nothing more important than to share management. Demonstrating empathy to understand the condition from the patient’s perspective is key. But, with COVID-19 disease, we were in new territory.

In the UK alone, the ONS reports 1.2 million people as of November 2021 who have reported symptoms of Long COVID ongoing for more than 4 weeks after COVID-19 infection. Of these, over 65% report it impacts on day-to-day activities with 55% reporting fatigue as their most common symptom.

As we come to have a better understanding of the symptoms ongoing after COVID-19 infection, it has become apparent that the new or continued symptoms is a separate condition all together. The term ‘Long COVID’ is commonly used to describe signs and symptoms that continue or develop after acute COVID-19.

The importance of the guideline

It is important in unknown waters to endeavour to chart a path and update that course as evidence emerges to inform the best route. In Long COVID, as with any severe illness, GPs will continue to have a critical role in navigating uncertainty and excluding other causes of symptoms.

Symptoms ongoing after COVID-19 disease are fairly indiscriminate in different patients I see. There are some groups more likely to be affected – females, more deprived backgrounds, even healthcare workers – but those differences are not great.

Any person getting COVID-19 be those with mild or with severe symptoms in hospital can develop ongoing symptoms thereafter. It is likely this isn’t a ‘syndrome’ per se with a unifying mechanism. Each symptom potentially has a different cause, and with a lack of clear direction in how to manage the symptoms, I utilise ‘the COVID-19 rapid guideline: managing the long-term effects of COVID-19’, to help navigate the challenges of each symptom. People have had to stop their usual work, reduced normal daily activities or struggled more with their mental health: it’s not easy but thankfully for most the recovery is progressive and steady.

A unified approach

Collaborating with my Royal College of General Practitioners (RCGP) counterparts in London, as the RCGP Scotland Executive Officer (Quality Improvement) and sitting on the Scottish Intercollegiate Guidelines Network (SIGN) Council, we were mindful that there were moves both north and south of the border to consider a guideline on managing the breadth of ongoing symptoms after COVID-19 infection.

However, with a lack of strong evidence on effective treatments, these guidelines were likely to heavily depend upon consensus for treatments.

In the UK, we are lucky to have both SIGN and the National Institute for Health and Care Excellence (NICE) as expert organisations in guideline development.

As such, with my RCGP counterpart in England approaching NICE, I reached out to SIGN and the Clinical Cell at Scottish Government to suggest it would be best to have a single guideline to work from.

All parties agreed and the guideline developed from there. I continue to work alongside RCGP and SIGN in reviewing the guideline and I’m particularly excited to see the patient booklet to go alongside, which I know will be welcomed by patients and their family and friends.

It has been a pleasure to be involved in the collaboration of SIGN, RCGP and NICE to create a unified ‘living’ guideline on Long COVID. Beyond this, an implementation note was developed by the Scottish Government to support NHS boards to introduce the guideline effectively. We have a long way to go to ensure that we manage the uncertainties and find an effective path forward for those with Long COVID, but the revised guideline, the implementation note and the patient booklet are important steps in the right direction.

Visit SIGN’s website to access the revised guideline and patient booklet.

Scott Jamieson is a GP within NHS Tayside and a member of RCGP Scotland’s Scottish Council

Categories: COVID-19 blogs

Improving death certification standards during the pandemic – George Fernie

Posted on October 19, 2021

Our Medical Reviewer, George Fernie, explains how our Death Certification Review Service (DCRS) has helped the national response to the pandemic by advising doctors on the accurate recording of deaths.

In many respects, this year’s annual report has been difficult to write. It has felt slightly uncomfortable to be looking to celebrate how the Death Certification Review Service (DCRS) has been supporting the pandemic, when the reality is that we’re helping to improve the accurate recording of deaths which we sincerely wished had never needed to be reported.

However, one thing that we shouldn’t shy away from is the importance of DCRS in being able to support the response to the pandemic in meaningful ways.

It has been vital that death certificates have been completed correctly and that doctors have been given the proper advice to know how to record COVID-19, especially when there can be a range of other co-morbidities that may have impacted on an individual’s death. The evidence tells us that we’ve risen to the challenge and carried out our task effectively for the service.

The importance of improvements

DCRS sits within Healthcare Improvement Scotland. As a consequence, it’s right that improvement is at the heart of what our service does.

I’m proud to say that DCRS has seen sustained year-on-year improvement in the quality and accuracy of Medical Certificates of Cause of Death (MCCDs), and the progress achieved appears to have been maintained as we start to exit the worst of this unpredicted virus.

We continue to meet our legislative requirements to improve the quality and accuracy of MCCDs, giving the public confidence in the death registration process in Scotland; to inform public health information about causes of death in Scotland, supporting consistency in recording that will help resources to be directed to the best areas in a more timely way. In addition, we’ve seen continued improvement in the number of ‘not in order’ certificates across all NHS boards – despite the significant additional pressures placed upon certifying doctors and the team of medical reviewers during the pandemic especially. Moreover, all advance registration applications have been undertaken within 2 hours, which minimises any additional stress that might be caused to loved ones as a consequence of knowing that a review of the paperwork was to be carried out.

These improvements are down to the hard work and dedication of the DCRS team, but also to the doctors across the breadth of the country to show commitment to making sure that death certificates are accurate and meaningful.

Fulfilling our commitments

Each year we set goals for key areas that we wish to improve. Last year was no different, even though we were in the midst of the pandemic.

On top of the goals we set, in July we took the opportunity to reflect on our response to the pandemic and carried out an After Action Review which helped us to be prepared and positively respond to the second wave. We responded well, indeed, we identified why there was a difference between death rates from COVID-19 diagnosed clinically and those where there was a positive polymerase chain reaction (PCR) swab, taking into account a known ‘false-negative’ rate. In addition, we highlighted nosocomial (hospital acquired) infections and successfully used the Antimicrobial Resistance and Healthcare Associated Infection (ARHAI) framework to categorise these. Furthermore, we worked with Scottish Fatalities Injuries Unit (SFIU) and the COVID Death Investigation team (CDIT) to ensure accuracy and promote public reassurance.

Unexpected developments

Although we would not have planned to do so in a pandemic situation, through necessity the service migrated IT systems and relocated staff (although at the moment the full team continue to work from home). Within seven months we have successfully introduced a new electronic case management and telephony system which has allowed the service to work with greater efficiency, in a more focused manner and benefits all stakeholders in the death registration process.

The pandemic and our team

Like the rest of society, the staff of DCRS experienced all the varied consequences of COVID-19 where many of us were tested for the virus, a number contracted the virus and, some like myself, lost a frail family member, all whilst viewing real-time data of the deaths that were occurring in front of us. Whilst this was nothing like the impact on those in the frontline of the NHS, we have had to learn to live very differently in both our personal and professional lives. We were fortunate enough to come through this experience physically unscathed as a team, but are very much aware of the consequences due to our direct knowledge of what had happened.

I cannot thank my team enough for pulling together during an incredibly difficult time where I believe we made a meaningful contribution to the NHS in Scotland – their commitment and sensitivity at a time of national emergency was outstanding.

George Fernie is Senior Medical Reviewer with Healthcare Improvement Scotland.

More information

Read the latest Death Certification Review Service Annual Report.

Categories: COVID-19 blogs, DCRS

Learning from the death of every child – Dr Alison Rennie

Posted on September 28, 2021

From 1 October 2021, Healthcare Improvement Scotland and the Care Inspectorate will be collecting national data on the deaths of every single child in Scotland to age 18, or 26 if receiving continuing care or aftercare. Dr Alison Rennie, Consultant Paediatrician and Clinical Director of Community Paediatrics at NHS Greater Glasgow and Clyde, and the National Clinical Lead for the implementation of the National Hub for Reviewing and Learning from Child Deaths, explains why this work is important and how we will make a difference.

During my 30 year career as a children’s doctor, I have seen children who died from neurological conditions, congenital disorders, prematurity, malignancies, infections, trauma, neglect and abuse. Each one stays with you. I have also witnessed exciting developments in treatments for conditions such a Spinal Muscular Atrophy, once previously universally fatal, and now hopefully curable. However, it is disappointing to note that Scotland still has a higher mortality rate for under 18s than any other Western European country, with over 300 children and young people dying every year. It is estimated that around a quarter of those deaths could be prevented. How can we make a difference? What can we learn and how can we change?

With no national system to support reviews into those deaths or to share national learning, there has been variation across services and across Scotland as to the quality of reviews and even whether reviews are carried out at all.

However, that is all about to change: from 1 October, the health and social care system in Scotland will work collaboratively to reduce avoidable deaths of children and young people by reviewing every death to inform the redesign of pathways and services, or to recommend legislative change. This includes the deaths of all live born children up to the date of their 18th birthday, or 26th birthday for care leavers who are in receipt of aftercare or continuing care at the time of their death.

Where death is inevitable, we aim to improve this process for children, families and carers by learning from quality reviews.

How this work is coordinated

In response to a request from the Scottish Government, Healthcare Improvement Scotland, in collaboration with the Care Inspectorate, set up the National Hub for reviewing and learning from the circumstances surrounding the deaths of all children and young people in Scotland.

The National Hub brings together representatives from across health and social care to develop quality guidance and develop a core data set to help services implement the methodology and to learn from each other’s experiences.

We also established an expert advisory group with representatives from health and social care as well as other agencies such as Police Scotland, the Procurator Fiscal and third sector organisations for their specialist advice around child bereavement.

The National Hub also channels learning from all over the UK to help reduce preventable deaths.

Next steps

We’re working with National Records of Scotland (NRS) to develop a notification system for receiving data regarding the deaths of children and young people and we’ll directly collect national data from health and social care partnerships across Scotland from 1 October. Once we have enough data, the National Hub will assess how the methodology has been adopted nationally and identify important learning about preventable deaths of children and young people. All of this will feed into an annual report to share what we have learned over the previous year. We will highlight areas for change, and recognise aspects of good practice.

I hope that this exciting development is our opportunity to make a change to Scotland’s grim mortality data for children and young people. Can we make Scotland the best country to grow up in and one in which you are less likely to die before adulthood? I am proud to be part of the National Hub and join my many colleagues who will be using the Hub’s guidance to conduct quality reviews, share learning and change outcomes. Through working together in this way, we hope to make a tangible, positive difference to the lives and deaths of children and young people as well as the families and carers surrounding them. They deserve nothing less.

Dr Alison Rennie is a consultant community paediatrician in NHS GGC with a special interest in children with complex disability. Her background of working with vulnerable families, and her experience in significant case reviews led to her interest in understanding and learning from deaths in childhood. She is seconded to Healthcare Improvement Scotland as national clinical lead for the National Hub for Reviewing and Learning from Child Deaths.

Follow Alison @AlisonRennie7 and follow the National Hub at @online_his using #CDRNationalHub

Find out more

Read our guidance, download resources and find out more about our work on the Healthcare Improvement Scotland website.

You can also get in touch with the National Hub team at his.cdrnationalhub@nhs.scot

Categories: Uncategorized

A week in the life of an improvement advisor – variety and making a difference – Leanne Marshall-Wood

Posted on September 20, 2021

In our latest blog, Leanne Marshall-Wood explains what she enjoys about the role of improvement advisor and what her typical week might look like. She explains how variety, plus making a difference, are at the centre of each working week.

I’m a people person. Without a doubt that’s a vital requirement to be an improvement advisor with Healthcare Improvement Scotland. Building relationships with teams and individuals in NHS boards and Health and Social Care Partnerships (HSCPs) all over Scotland is a key part of what we do. It’s those relationships that become the foundation to bring about the improvements to the care that people receive, whether in NHS or social care settings.

So without a doubt the best thing for me about the job is the amount of different people I get to work with and to see how the building of effective relationships leads to vital changes that make a difference for real people.

My own improvement journey

Where I am now in my career is because of where I started out.

I’ve worked in NHS Scotland since 2009. In fact, I started my career in this organisation as an admin officer in what was then known as the Scottish Patient Safety Programme. The organisation supported and encouraged me to grow and develop. I became a project officer for our organisation’s work to support improvements in primary care, before moving to NHS Greater Glasgow and Clyde to become an improvement coordinator.

So when I saw that Healthcare Improvement Scotland were advertising for an improvement advisor in the Living Well in Communities team, I immediately wanted to apply and go back to where my own improvement journey began!

Making a difference

At the moment I’m working on the Hospital at Home programme, which supports NHS boards and HSCPs across Scotland to develop and deliver Hospital at Home services. This has been a rewarding programme to be part of, as it provides an opportunity for people to be treated in their own home where possible, which is important to people at all times, but especially throughout the COVID-19 pandemic. Knowing that the support your team provides has contributed to the development of Hospital at Home across Scotland gives a real sense of achievement that your working day has made a real difference. It’s great speaking to teams about their services and how they might improve – every single person we work with is so passionate about the role of Hospital at Home and the difference it makes to patients, and its brilliant being able to share that message.

Getting into the detail

There are lots of opportunities to get involved in different things across the Improvement hub (ihub), which is the main part of our organisation where improvement advisors work and where the improvement programmes take place. The ihub is a really friendly directorate, and I’ve met lots of colleagues I don’t normally work with on a day-to-day basis – even since we’ve been working in a much more virtual way as a consequence of the pandemic.

My role is varied – so if that’s something that you like, then this is a great role to have. There isn’t really such a thing as an average week for me!

As an idea of what the role involves, here are some of the activities I’ve been involved in over the past week:

Delivery of online quality improvement training: a priority across Healthcare Improvement Scotland is to ensure as many staff as possible have a foundation level understanding of quality improvement. I am lucky enough to be part of the group that are delivering this training to a wide range of staff across the organisation.
Hospital at Home: A large part of my week has been spent meeting with the teams who are developing and delivering Hospital at Home services across NHS Scotland. The format of this varies from team to team, and can be anything from being part of a steering group, facilitating process mapping and stakeholder engagement sessions, or regular catch-ups with teams to discuss progress, any challenges and provide any support I can.
Delivery of a national learning system: one of the key elements of the Hospital at Home work is the delivery of a learning system to share learning, good practice and challenges. This includes planning and hosting networking sessions and drop in sessions, building and facilitating an online community for Hospital at Home teams, developing and sharing resources and planning and recording a series of podcasts. This is one of my favourite parts of my current role.
Developing a national infrastructure for Hospital at Home: this involves providing a measurement toolkit to teams to share activity on services while working with other national organisations to provide a sustainable process for this in the future, and working with colleagues across Scotland to address challenges around workforce, including competency frameworks and training requirements.

All in all, a varied, busy role with a great deal of personal satisfaction at its heart. But most importantly of all, I get to do it in a brilliant team and in an organisation that has always supported me to grow and to improve – I get the chance to improve as well as helping others to improve. It’s a perfect combination.

Leanne Marshall-Wood is an Improvement Advisor with Healthcare Improvement Scotland.

More information

To find out more about Hospital At Home, visit: https://ihub.scot/project-toolkits/hospital-at-home/hospital-at-home/

Visit NHSScotland to see the list of current job vacancies.

Categories: ihub

The importance of teamwork and continuous improvement in maternity care – Professor Alan Cameron

Posted on September 17, 2021

To mark World Patient Safety Day, Professor Alan Cameron gives his reflections on safety in maternity care. Alan is Clinical Lead for Obstetrics with Healthcare Improvement Scotland.

In maternity care, safety is all about the safe delivery of a baby and a healthy mother. These cannot be achieved without a team working together effectively. The team involved can consist of midwifery, obstetric and neonatal staff – and, depending on the complexity of a pregnancy, specialist midwives and subspecialists in maternal fetal medicine may also be involved.

A good example of where combined care is needed is when a mum to be has diabetes. Here, input is required from specialist midwives, maternal fetal medicine consultants, diabetic specialist nurses, diabetes consultants and dieticians. All of these staff need to work together to make sure mum and baby are as healthy as possible.

The Essentials of Safe Care

To support teams in maternity services to work together to deliver safe care the SPSP team recently developed the Essentials of Safe Care. This is an evidence-based package of guidance and support designed to enable health care professionals to deliver safe care. Embedding the Essentials of Safe Care provides an opportunity to accelerate the sharing of learning and improvement within and between teams in maternity services.

The importance of continuous improvement

Despite tremendous efforts of all clinical staff who care for pregnant mums and their babies, there are still a small number of families who experience a poor outcome in their pregnancies.

This can be either the devastating loss of a baby after 24 weeks, a stillbirth, or the loss of a newborn baby in the first 28 days of its life, a neonatal death. Also distressing for families is where a baby requires intensive care in a neonatal unit due to complications arising before or during labour. In addition, some mums may require high dependency care following the delivery of their baby. The most common reason for this is post-partum haemorrhage, which is severe blood loss after childbirth.

Although the rates of these complications are thankfully very low there remains a need for all staff involved in maternity care to practice safe care, using a multitude of guidelines and tools developed by SPSP MCQIC and recognised bodies such as the Royal College of Obstetricians and Gynaecologists (RCOG) and Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK (MBRRACE-UK).

To support safety in pregnancy and childbirth, Healthcare Improvement Scotland has developed various packages of support using Quality Improvement (QI) to aid staff working in maternity care to reduce the rate of stillbirth and post-partum haemorrhage (PPH). These include resources to help reduce stillbirth and the four stage approach to recognising, responding to and managing PPH.

Although the guidelines and tools have been created specifically for Scotland, we know that they will be of use to maternity care staff across the world. In fact, we already know that our work in Scotland has international interest. To mark World Patient Safety Day and its focus on maternity care, I’d encourage those involved in maternity care across the world to learn from our work and to share it as widely as possible, so that all babies and mothers can benefit.

The work that we do at Healthcare Improvement Scotland is work that I I continue to be very proud of to be part of. We’ve achieved many successes and it’s great to be part of a team with the knowledge and expertise to continue to make more improvements for babies and mothers across Scotland.

Professor Alan Cameron is Clinical Lead for Obstetrics with Healthcare Improvement Scotland.

More information

More examples of the work of SPSP MCQIC and resources to help make maternity care as safe as possible are available on our website: www.ihub.scot/spsp.

Categories: ihub

How quality improvement has supported improvements in maternal and newborn care in Scotland – Angela Cunningham

Posted on September 15, 2021

Angela Cunningham is our Midwifery Clinical Lead for our organisation. Angela has practised as a midwife for over 38 years in both Scotland and England. In this blog Angela explains how quality improvement has supported real changes for mothers and babies in Scotland.

When I first entered the world of midwifery as a student in 1981 it was accepted that things didn’t always go as planned. It was a high risk area of work, we did our best but sometimes things just went wrong!

Now, 38 years later, I was delighted when I heard that ‘safe maternal and newborn care’ was going to be the theme of the World Health Organisation (WHO) patient safety day on 17 September 2021. It really made my year. I know that may sound strange, however, improved safety and care are what I’ve aspired to throughout my midwifery career. Safe and respectful childbirth should be the right of every woman.

Improved outcomes

In Scotland through the Scottish Patient Safety Programme Maternity and Children’s Quality Improvement Collaborative (SPSP MCQIC) we have worked hard to improve outcomes for babies, children and mothers. Our work in the area of stillbirth is recognised as world leading. From the inception of the programme in 2013, MCQIC has supported NHS boards to understand their local data and introduce changes to support efforts to reduce stillbirth rates. Don’t get me wrong, we still have lots of work to do. However, as the Midwifery Clinical Lead I am really proud to be part of a programme which has helped services make changes which mean more mothers taking their healthy babies home to start a new family.

The introduction of the Scottish Patient Safety Programme gave maternity staff the opportunity to run small tests of change through the Model for Improvement and Plan Do Study Act (PDSA) process. These incremental changes have had a major impact on outcomes, giving staff permission to make changes which have improved outcomes for families across Scotland. Applying Quality Improvement (QI) methodology has helped to develop a consistent approach to service delivery at local and national level. It has improved communication between teams and more importantly improved the quality of the care and advice given to women and families. When I speak to frontline staff I feel humble when they tell me stories of how QI is working in practice, how they are using it and the improved outcomes for women and families.

Engaging with the clinical community

When we started out on this quality improvement journey I asked myself how are we going to engage with the clinical community? How would they feel and would they be overwhelmed by what we were trying to achieve? The answer was and still is “one mother, one baby, one family” at a time. This is the message we delivered. Individual staff members in maternity services could see how they could make a difference and they have risen to the occasion.

Safety is paramount in maternity services. Across the world too many women and babies are still dying in pregnancy and childbirth. Many of those dying in pregnancy and childbirth are only children themselves. We all have a responsibility to do everything we can to keep them all safe. Highlighting this on 17 September is another step in the right direction. We are all still on this journey together.

Fast paced and making a difference

Working in Healthcare Improvement Scotland is fast-paced and exciting. I’m part of the team that supports continuous improvement and re-design services for the better in healthcare settings. My training with patients and clinicians gave me transferable skills in negotiation and communication so I can engage in discussions with the same clinicians I am working with now. The training, coaching and mentoring support that I have received since I started has been invaluable and it has helped me become more confident in my role. If you want to work in a fast-paced and exciting team where you can make a huge difference in improving healthcare services, becoming an improvement advisor is the first step towards that goal.

Angela Cunningham is our Midwifery Clinical Lead.

More information

More examples of the work of SPSP MCQIC and resources to help make maternity care as safe as possible are available on our website: www.ihub.scot.

Categories: ihub

A day in the life of an improvement advisor – Adeline Tan

Posted on September 13, 2021

Improvement advisors play an important role in raising the standard of health and social care. Here, Improvement Advisor Adeline Tan gives us an insight into a typical day.

As an Improvement Advisor working in the Primary Care Improvement Portfolio, I have responsibility for the Scottish Patient Safety Programme Medicines and Dentistry programmes. I also help improve Anticipatory Care Planning across Scotland. Working with senior leadership teams in NHS health boards and nationally with clinicians, administrators and patient representatives, I look at the gaps in the service and how to improve them using a Quality Improvement (QI) structured approach. A lot of this work is about creating the environment for change, developing the ideas for actions that will lead to improvement and enable local health and social care systems to develop the capacity and capability to implement improvement ideas.

From physio to facilitator – and beyond

My background is in physiotherapy and I am a registered musculoskeletal physiotherapist with over 20 years of clinical experience in Singapore and Scotland across acute and primary care settings. I wanted to be able to make an impact on programme management in national improvement programmes so I made the transition to a Quality Improvement Facilitator in NHS Lothian working in adverse events, primary care and acute care before joining Healthcare Improvement Scotland. Coming from a clinical perspective and having worked across secondary, primary care and private sector in both Singapore and UK, I have a deep understanding of the clinical landscape. The relationship skills I’m trained in are transferable from interacting with patients to interacting with clinicians. This enhances my work as an improvement advisor when building networks. Completing the NHS Education for Scotland’s Scottish Improvement Foundation Skills (SIFS) Programme and Scottish Improvement Leader (ScIL) Programme, gave me the QI technical skills and leadership skills to enable me to work as an improvement advisor.

No two days the same – especially in lockdown

My work day and week varies. No two days are the same. I can be engaging with internal staff like our communications team or with external partners from Scottish Government, social care and Health Boards. I might be working with my team on project management for programme planning one day and then delivering and facilitating face to face learning sessions to external partners and their teams the next. I have to be quick in responding to the fast changing needs of Primary Care services. I used to travel all over Scotland to support and facilitate learning workshops before the lockdown, but that had changed to virtual learning workshops since.

During lockdown, I had to rapidly develop my IT skills to allow us to move into the virtual working as well as delivering our improvement support to the healthcare teams in Primary Care. That meant training in virtual facilitation to support my colleagues and the healthcare teams. Planning a virtual facilitation session consists of communicating and negotiating with all internal and external staff involved and lots of practice with my project team to get it working seamlessly. During learning sessions, I use skills like QI technical tools like Driver Diagrams, process mapping and fishbone diagram and Liberating Structure facilitation tools as a form of communication with the participants to make them fun and interactive.

The aspect of my job that I thrive in is interacting with different clinicians and management staff to develop programmes. I also enjoy coaching and mentoring people from NHS or third sector organisations on quality improvement methodology.

Fast paced and making a difference

Adeline Tan is an Improvement Advisor in Primary Care Improvement Portfolio.

More information

Find out more about our Primary Care improvement work: https://ihub.scot/improvement-programmes/primary-care/

Visit NHSScotland to see the list of current job vacancies.

Categories: ihub

Keeping sight of what’s important – Scott Hamilton

Posted on September 7, 2021

Prior to the pandemic, Scott Hamilton, Improvement Advisor with our Acute Care Portfolio, had perfect vision. A year and a half later and everything has changed. Scott explains how a routine eye test indicated an untreatable condition.

I used to pride myself on my 20/20 vision – even boasted about how far I could see.

My training is as a nurse and I stepped back to the NHS frontline to support the efforts during the first wave of the COVID-19 pandemic. I returned to Healthcare Improvement Scotland in late June 2020 and to homeworking for the first time in my career. Having worked on a COVID-19 ward I realised that my unhealthy lifestyle was putting me at risk if I contracted the virus. I was overweight and very inactive. This had been exacerbated by homeworking and the stresses of the pandemic in general. In January 2021 I took action. I started eating better and in March, for the first time in a long time, I started running. Now I can run…a long way!

In May this year I went for my 2-yearly eye test. I knew my sight had deteriorated during lockdown and I routinely felt exhausted with the ‘screen time’ and my eyes felt really heavy. Little did I expect that I would be diagnosed with early onset age related macular degeneration and to be told that it has no cure!

Macular degeneration – the facts

Every day, around 300 people are diagnosed with macular disease. It’s the biggest cause of sight loss in the UK. Macular disease is cruel and isolating. It steals your sight, your independence, and your ability to do the things you love.

And yet, despite the devastating impact of macular disease, little is known about its causes and there is still no cure. Today, more and more people are being diagnosed with macular disease. In fact, the number of people living with the condition is set to double in the next 20 years. It is set to be the next major public health crisis — far more people with macular disease than dementia.

How does this affect me?

At the moment I can still see. However, low and bright light situations are really difficult and don’t ask me to read what’s on the menu if I don’t have my glasses! Psychologically it’s challenging knowing that over time I am going to significantly lose my central vision. It really brings it home how much you can take your ability to see for granted. I joined the Macular Society after doing a Google search to find out more information – their support and information have been tremendous.

At the moment it’s all about small adjustments and doing all I can to slow the progression. This means that my healthy living needs to become a permanent fixture as good nutrition, blood pressure control and regular exercise can have an effect on how quickly the disease progresses.

Practically, it means doing a weekly test monitoring for any significant deterioration with an Amsler grid that’s stuck to our oven, using my glasses with their blue light filter and edge to edge prescription, being more aware of using my sunglasses (ironic in Scotland!) and managing my screen time in general. I should probably also mention that my wife, Elaine, reads the restaurant menus for me!

The future

There is only one way to beat Macular Disease for good. More research must be funded, until we find a cure, or find treatments that stop it in its tracks.

In June Elaine (personal coach as well as my wife!) talked me into doing the Scottish Half Marathon after doing 10k…at a stroll! When I looked on the Half Marathon website I realised I could raise some money for the Macular Society whilst achieving something I didn’t think would be possible back in January. The pandemic has hit charities hard and the money they have available to fund critical research has been hit hard. They have difficult decisions to make over the next few years. The Macular Society have promised that any money I raise will go straight into their research funds.

I am excited to be doing the Scottish Half Marathon on the 19^th of September 2021. I am the fittest I have ever been in my life but most of all…I love running!

Scott Hamilton is an Improvement Advisor with the Acute Care Portfolio of our ihub.

More information

You can support Scott on his JustGiving page

More information from Macular Society

Categories: COVID-19 blogs, ihub

Move to improve – Benjamin McElwee

Posted on September 6, 2021

In our latest blog, Benjamin McElwee explains how the varied role of being an improvement advisor with Healthcare Improvement Scotland has allowed him to improve health and social care in a wide range of ways.

When 90% of healthcare interactions begin and end in primary care, it is a setting with tremendous opportunities for improving population health and delivering on the early intervention and prevention agenda. This is what drew me to the role of improvement advisor in the ihub in the first place.

Before I joined Healthcare Improvement Scotland’s ihub, I worked in the third sector first as a care provider and then in a range of national roles influencing policy and practice. Whilst working for a mental health charity, I had the opportunity to engage more directly with clinicians and care providers and became particularly interested in the ways to affect practice change at the point of care.

I graduated from the Scottish Improvement Leader Programme whilst still working in the third sector, which enhanced my understanding of and passion for quality improvement. The ihub seemed a natural place to further develop and apply these skills.

A varied role where you can bring your strengths

Working within the ihub’s Primary Care Improvement Portfolio, I had the opportunity to support a variety of work across the whole breadth of health and social care in Scotland. I’ve supported a network of people involved in the redesign of primary care services in their local area to share learning and explore solutions to common challenges. I’ve helped GP practices to triage tasks and navigate people accessing care so they are seen by the right person at the right time in the right place. Working in partnership with colleagues at NHS Education for Scotland (NES), I developed a faculty of professionals (mostly clinical) with expertise in primary care to provide subject matter expertise and support the delivery of the Primary Care Improvement Portfolio’s work. I’ve also worked with the Royal College of General Practitioners, Scottish Government and NES to co-ordinate the primary care learning system and the delivery of webinars and resources.

Applying and developing a range of skills to a multitude of topics

During my time with the primary care team my work touched on a diverse range of topics including person-centred care planning, different approaches to supporting long-term conditions, telehealth and remote monitoring, medicines in primary care and whole systems approaches.

As well as the variety of topics, the role provides ample opportunities to develop a portfolio of skills beyond quality improvement. This could be through facilitating workshops with clinicians, running focus groups, interviewing people accessing care, engaging with other organisations to collaborate, developing business cases for new pieces of work or supporting the development and delivery of communication strategies.

Due to COVID-19, I also saw the adaptability of colleagues, as the organisation temporarily reconfigured itself to provide more responsive support to the system. During this time I supported the use of a video consulting service within primary care and maternity services, engaging directly with administrative, clinical and support staff to do so.

Improving from the inside as well as the outside

Working within the ihub also provides the opportunity to use quality improvement tools to support internal work both within the portfolio and across the organisation, with a variety of groups looking at internal improvement in areas such as organisational culture, digital ways of working, health and wellbeing, and internal processes. It offers the chance to work with people with a wealth of experience within the organisation, people who have quite often worked across multiple different parts of Healthcare Improvement Scotland, thus exposing you to different working styles, views, capabilities and expertise that can support your development.

Indeed, it is through the generosity of colleagues sharing their experience, expertise and insights that I was able to develop within the primary care team to take on a new role with the Value Management Collaborative as a Senior Improvement Advisor.

For anyone looking to make a difference to health and care in Scotland whilst also developing professionally, a role as an improvement advisor could be for you.

Benjamin McElwee is an Improvement Advisor within our Primary Care Improvement Portfolio.

More information

Find out more about our Primary Care improvement work: https://ihub.scot/improvement-programmes/primary-care/

Visit NHSScotland to see the list of current job vacancies.

Categories: COVID-19 blogs, ihub