“It was about learning together where things go wrong,” explains Ian Moyle-Browning, Head of Nursing for Specialist Services and Surgery. “Following a series of ‘Wrong Site Never Events’ that occurred in the specialty, the team decided that on reflection we needed a deeper enquiry into all processes and pathways – to really examine the interdependencies and culture needed to support improvements. As part of this, we wanted to look at where the mistakes were being made, the practices and cultures within the department, and how the department could work to correct these mistakes moving forwards.”
It’s now been eleven months since the quality improvement plan was first put into place, and twelve months since the department declared its last Never Event.
“It’s fair to say the department has been through a journey of discovery,” Ian continues. “As a team we’ve now completed 80% of the initial quality improvement plan, having performed 128 of the 157 positive actions the department set out at the end of 2020.”
“The success of the plan so far is a result of the dedicated team working together. Through the implementation of the QI plan, we’ve seen small cycles of change and investment in new roles. We’ve also seen process redesign to provide the patient with safe, effective care, but also to provide colleagues with the resources and processes to make working within the department much safer too.”
Leanne Knapp, Unit Sister in Dermatology, adds: “There have been many changes in longstanding processes, which have been embraced by the team to ensure that the care we provide for our patients is of the highest standard, safe, and person centred. The investment in a full-time departmental Sister has allowed us the opportunity to really review the services we provide, and to support our colleagues to be able to feel competent and confident to provide care for our patients.”
Naomi Burden, Patient Safety Specialist and Lead for Safety Culture, adds: “The Dermatology team have been a pleasure to work with this past year, and they have transformed as a team. When we look to make improvements within patient care, we do this through considering all the parts in a system of work, but also the people delivering and receiving care to ensure that needs are met. A Never Event is a result of a system perhaps not working as well as it could, and by working together, the Dermatology team have improved quality and safety of care for those that need it.”