Dr Gemma Crossingham, Consultant Anaesthetist at Plymouth Hospitals NHS Trust talks to us about using Appreciative Inquiry to improve safety at Derriford Hospital. Gemma is a participant on the Patient Safety Launch Pad and recently attended Appreciative Inquiry training organised in partnership with West Midlands Academic Health Science Network and Liverpool-based AI trainers Appreciating People.
“Back in December 2016, my colleague David Viira and I heard about the Learning from Excellence project at a local patient safety event and thought we’d like to bring the concept to Derriford Hospital. I was really keen to get on a course – and when we heard about an Appreciative Inquiry training course offered by the South West Patient Safety Collaborative, and went on it, we managed to use the skills the following week, which was brilliant!
The first thing we wanted to do was establish a system that thanked staff for their input. The first benefit we wanted to provide was learning about safety and learning from where things have gone well. We set about designing paper and electronic forms which could be used by people who wanted to report positive actions. Now the system works well, so that when a form has been completed the person who has nominated will get an email saying that their email has been read and action will be taken. The nominee will also get a copy of this email, which details word for word what this person has done to deserve recognition.
Now we have built up this element, we are including what we can learn from the incident as a result. The other thing we are trying to do is to build in a thematic element. If the nomination is particularly interesting, we will sometimes hold an Appreciative Inquiry, to get more depth on what it was that led to the positive outcome and how we can learn from this.
From when we set up the system until now we have received 420 reports! We now have the admin side set up, so we are sending nominees thank you cards, while also trying to focus on learning and thematic analysis.
The system has proved to be very popular at Derriford, with quite a few common nomination themes – such as receiving support from a colleague, which comes up a lot. We have found that this is really important and makes a huge difference. We’ve had people nominating colleagues for having a smile on their face while working under difficult circumstances, in fact, this consistently come through.
One really interesting case, was when a child came in for what was thought to be a routine operation. When the team realised it was a lot more complicated, the situation became intense, with a lot to do that the team weren’t prepared for. The outcome was really good and two nominations came out of this, so we carried out an Appreciative Inquiry. This showed that the staff were adaptable and worked across roles, they communicated well and managed to bring an overwhelming sense of calm to the situation. When we carried out the inquiry, we used a 5d model to find out what enabled them to stay calm and turn a potentially dangerous situation into one with a positive outcome. We are now learning and sharing this information so we can spread it across the organisation.
We are really pleased with how this is going and want to spread this across the trust – making sure that we’re not just saying thank you, but we’re identifying trends as well.
How we spread that ‘softer’ side will be interesting. We’ve had a really good collaboration with our Organisational Development team, particularly Claire Underdown, who was carrying out staff recognition work. They secured some funding to produce cards as up to 60% of staff are not reading emails. The feedback we’ve had is that people really like the cards.
We haven’t called our project Learning from Excellence, although this was our main motivator, we don’t want to just learn from excellence – we also want to say thank you, so this is why we’ve called the project to “Say thank you and learn from excellence”.
If you are interested in how you can apply a similar approach, please contact our team to get involved with you Patient Safety Collaborative. We have been working closely with New Devon CCG to support a local ‘Community of Practice’ that is focused on learning from excellence and sharing common themes from safety incidents. For more information contact firstname.lastname@example.org