Challenges Flashcards
What are the current challenges for the trust?
Weston merger
Poor recruitment, low CQC rating
Closed x2 during Covid, ED permanently closed
Blending of leadership, governance processes, clinical teams, rotas, job plans
Palliative care merged first, haem due to formally merge within next 6 months
6th division, will get consumed into others
Be careful not to overwhelm BRI services
Unclear exactly what Weston will be used for ?robotics
Workforce fatigue
Recruitment and retention issues
Integrated care systems Unsure what it will look like Funding not agreed 7 Bristol Health Partners More joint working, collaborative working
Estate
Moving work offsite
BHOC extension
Covid recovery Sill ongoing - still taking beds, operational consequences, higher staff absences - Covid estimated to be respons=ible for 40% staff absence Non-urgent care/ diagnositc backlog, 2WW Surgery Training
New surgical hubs, community diagnostics
Balance of leadership time between Covid recovery and ICS
Government failure to address issues in Social care
Patient flow
Inability to discharge medically fit patients
Huge pressure on acute and emergnecy services - queuing ambulances
Properly funded transformational change
What are challenges in your specialty/ department?
Multicentric model of care for haemophilia in the south west
Virtual meeting useful but does not replace need for interpersonal connections, supplements
Clear leadership and communication streams
Positive feedback from other centres.
Newer consultants coming through value have regional expertise to call on/ particularly in paediatrics
similar set up in TTP
Has there been any benefits of the pandemic?
Digitalisation
Shone spotlight of healthcare inequalities
Showed that we can perform high quality clinica trials quickly - Recovery trial - rapid recruitment and analysis of complex study
New ways of working, added agility to workforce - remote working
Proven that we have exceptional workforce
Public pride in NHS - pushed up the political agenda
Sparkled significant research in thrombosis
VITT
Downsides of Covid?
Workforce fatigue Back log of elective work Lost contact with vulnerable, less connected people Resources diverted from innovation BAME workers disproportionately affected
How will integrated care systems affect your specialty?
Haemophilia comes from NHS E specialised services
CRG - NHS England clinical reference group, set up service specification for care of haemophilia patients and policies
Rest of it - not sure
Opportunities for working more closely with NBT
Personally: I am working in a very adaptable way - across teams and across sites
ICS
Legislation - health and care bill
Collaboration not competition
CCGs will be abolished and turned into ICS
5 year forward view - systems matter more than centres
Disagreed with a colleague?
STARR Truro - senior nurse Haemostasis plan for child Gained further information Pros and cons and current and new management options Diplomatic, non-judgement approach Revisited it Acting in best interests of patient
Brought about change:
Gained respect
Opened dialogue
Ignore the hierarchy
Start conversation
Escalate
Reflect, note for appraisal
Review guideline
Swindon - colleague, arriving late, regularly contacted regarding whereabouts
Laboratory concern regarding quality assurance/confidence in results
Quality control
Internal
External
Validation - automated equipment and computer systems
Policies and procedures - SOPs reviewed and updated
Review reagents, calibrators and controls
Used in accordance with manufacturers guidance
CE marked
Training and competency assessments
Incident and exception reporting
ISO.UKAS
Q pulse - documents, audit, non-conforimity
NEQAS
Reportable ranges
Extremes
Positive bias - capital
Negative bias - little
Deviation index
Abnormal results D/w manufacturer Review IQA ?Recalibrate Visit from engineer
Coefficient and variation: ration of SD to mean, measure of disperson
How do I cope with stress?
Proactive in seeking out guidance to avoid stress Recognising it Positive affirmations and breathing techniques Share problems with colleagues Review job plan Book holidays Time with F&F Gardening
Work / life balance Personal interests Support network Seek ways to bolster personal well being Strength - dedicated, absorbed, recognise it home with me Consultant - work flexibly Mechanisms for dealing with stress Leave throughout year
Prioritise ?Can we do things differently - patient pathway (eg general clinic), roles of team Emphasis on handover Use of MDT Not in a silo Pre clinic prep and follow up Support one another
Job entails IP/OP/ad hoc/urgent cover/teaching/service development/departmental meeting
Tell me about a time you disagreed with a patient?
Need for hydroxycarbamide
Informed decision making
Tell me about a patient you managed where things did not go to plan/poor leadership
Severe VWD, bleeding, no plan in place
Tell me about a time you made a mistake?
Requested and prescribed non-irradiated RBC D-7 to stem cell collecction
Against local guideline
Acting on guideline from previous trust
Review national guidance - D-5
BMT consultant/ data manager - discussion at next meeting
Acknowledged mistake
Rapid review of potential harm
Duty of candour - informed patient of error, risk of harm minimal.
In future, make sure I am using local protocols.
Non-escalation of patient with sickle cell crisis
New to hospital. Monday handover from long standing clinical fellow - sickle patient with chest infection, needing a bit of oxygen.
Intimidated by individual
Reviewed patient in the afternoon - medical outlier on surgical ward, became clear, sickle chest crisis - life threatening in young sickle patient, transfer to Oxford for red cell exchange.
Patient - expressing to the responsible team the seriousness of the situation and delegated some investigations whilst I made arrangements.
I called the consultant - informed of my assessment and plan to arrange urgent transfer to Oxford
Transferred, treated, discharged
Did not challenge the clinical fellow
Overestimated capability without having evidence to do so
Struggling to review - escalated to senior earlier.
Medical outliers
How would you set up a new service?
Define the problem/deficit
Estimate resources needed to address, what do we have already?
Think creatively - ICS
Stakeholders
Benchmarking - how do other centres do this?
Patient input
Staff input
Guideline, referral criteria, map out pathways
How we were going to assess performance and quality
Managers/finance
How to avoid bullying?
Ensure there is all culture where all members of the team are valued
Departmental needs to talk about workforce and their needs
Review workload for individuals - are there other ways of working
Encouraging less hierarchical relationships
Set strong policies
Tell me about a paper you recently read?
Concizumab phase 2 trial Haem B inhibs Evaluate efficacy Immunogenecity 8 patient HBwI Significant reduction in annualised bleed rate Safe, well tolerated, no SE
Twitter: Mike Makris
TXA in non-cardiac surgery, reduced bleeding without CV events
Drug companies
Be transparent
Recognise educational benefits - use judgement
Share what I have learnt with department
Declare all support to trust
