It’s Your Call - Episode 3 transcript Junior doctor Sofia Nilsson calls Simon Steddon, acting Chief Operating Officer to talk about the 7 measures of safer, faster care.

Simon: Hello.

Sofia: Hello my name is Sofia Nilsson, I’m one of the junior doctors working in general medicine at St Thomas’.

Simon: Hello Sofia, how are you finding general medicine?

Sofia: Oh well, it’s stressful and sometimes a bit difficult but it’s also a lot of fun and I’m learning a lot.

Simon: And how are you finding Guy’s and St Thomas’?

Sofia: Oh it’s a lovely hospital, I really like it.

Simon: How long have you been with us?

Sofia: For about 6 months. I did liaison psychiatry prior to this.

Simon: So a big change for you. Well I hope you’re enjoying it.

Sofia: Yes I am. I am.

Simon: How can I help you Sofia?

Sofia: I’m calling to ask you a few questions about the 7 steps to safer, faster care.

Simon: Oh yes.

Sofia: Could you just tell me a little bit more about it?

Simon: Well I suppose the reason that we’ve put these measures in place is that we know despite the efforts of our clinical teams some of our patients are unfortunately experiencing some unacceptable and potentially avoidable delays - particularly when they are trying to access urgent care. And we all believe that we can deliver high quality excellent clinical care that we’re very proud of at Guy’s and St Thomas’ and in some cases we’re falling a bit short of that. So that’s why we’ve pulled together the 7 measures of safer, faster care and all they really represent Sofia is just a more standardised and timely approach to ward decision making. There’s nothing complicated as you’ve probably seen yourself. They’re just clinical common sense.

Sofia: Yes.

Simon: What they’re designed to do is just to bring those important decisions that you have to make on the ward every day, particularly around sicker patients and patients who are maybe able to go home – just bringing those decisions earlier in the day so that any barriers to the care of those patients can be removed. Sofia: OK. I see. So what does this mean for the staff actually working on the wards?

Simon: I think fundamentally if you’re working on the ward it’s being aware that the care of those emergency patients isn’t just something that the team in the emergency department are responsible for. That we all have a responsibility to think about those patients. And if you think in any one day often between 400 and 450 patients attend our emergency department, so it’s a busy stretched department. You know yourself, you’ve worked down there, I suspect you’ve been on take [on-call].

Sofia: Yes, yes absolutely.

Simon: So if you’re working on the ward you have to take the view that there are many of those patients who would benefit from the excellent ward care that you’re able to give. So to be able to get those patients through the emergency department and into other parts of the hospital into an appropriate bed where they can be cared for represents good clinical care. On a practical level on the ward it means that what we’ve asked people to do is to ensure the Board round is completed by 10 o’clock in the morning and that all the relevant staff on the ward contribute to that Board round - so the nurse in charge, the doctors who are about to do a ward round. If barriers are encountered on the wards that are going to interfere with the care of a patient, that those are escalated. Sometimes they’re escalated within the ward so that a more senior member of staff can deal with them. Sometimes it might be that you need help beyond the ward so it might be that you need some specialist input or you need pharmacy to help you in a particular way. So that’s fundamentally what we’ve asked the ward staff to do.

Sofia: OK. And what about the staff in clinical specialties?

Simon: All of these measures are designed to help flow through the hospital. So flow from the front door of the emergency department through to our general wards but also to our specialty wards. So flow isn’t just important for general wards. We have a very high demand on our specialty services and it’s important that we can see patients in the specialties in a timely way and get them to appropriate beds in a timely way. There’s also that specialties can support the emergency department particularly, say for example if you were working in a specialty and one of your patients, as one way into your service, attends the emergency department. You can help the emergency department to see them and to get them to a specialty bed quicker.

Sofia: OK.

Simon: If you’re doing specialty ward rounds and you have a referral from a general medical ward where they need your advice and opinion or perhaps advice and follow up, that you give that in a timely way. And occasionally it may well mean that actually you physically go down to the emergency department and see how you can help when they are experiencing a very busy or particularly difficult period. This is about the whole of the Trust seeing the emergency department as something that is important to them. It doesn’t matter whether you’re an emergency physician, if you’re Sofia as a junior doctor doing general medicine, or you’re a specialty consultant or junior doctor, that we all see that care of emergency patients as just as important.

Sofia: Yes, absolutely. OK and how about non-clinical staff, how can they help with faster, safer care?

Simon: So I’ve never really liked the term non-clinical staff because we all contribute to clinical care, that’s why we work in a hospital and are proud to work in a hospital. So I think the support of all staff on these initiatives is really crucial and really valuable. And it doesn’t matter whether you’re working in clinical administration as a secretary or a ward clerk or you’re a pharmacy technician, it doesn’t matter. How you prioritise your work and how you view your work as part of the overall work of the organisation is really really important. So we think everybody has a contribution to make, it doesn’t matter what role they’re sat in. And to be aware of the richness of the work that goes on across the entire Trust.

Sofia: OK. So I wasn’t aware of this myself until a few days ago but I was just wondering is there anywhere you can find information about this that’s not on the website?

Simon: We’ve asked the directorate teams to display a poster that summarises the faster safer care. To display that in both clinical and non- clinical areas and encourage staff to ask questions when they see that poster. We’re also trying to roll it out face to face and you can expect to see me or one of my team at one of your meetings soon to tell you about it face to face because we think that’s really important. We believe in this, we don’t think it’s something that we just want to send an email about out. This is something that we want to tell people about through Team Briefing, we want people to read about it and ask questions and we want to come to the forums that you attend and have a discussion about it.

Sofia: Yes that sounds really good. OK well that was all I wanted to ask.

Simon: Sofia it was really nice to talk to you.

Sofia: Yes you too.

Simon: And I hope you continue to enjoy general medicine. I hope it’s not too stressful. It is very busy though isn’t it?

Sofia: It is busy but it’s not too stressful.

Simon: Thanks for calling and thanks for all the work you do on take and on the general medical wards. We appreciate it.

Sofia: Thank you. Thanks for your time.

Simon: Cheers Sofia, bye.

Sofia: Bye.