Chief Executive’s Message – Friday 27 September
September 27, 2019
I suspect we all go into our first Unity weekend with a degree of apprehension, but also I would hope a huge sense of pride and achievement about what we have achieved together since this time last week. I want to pay tribute to everyone working so very hard to make sense of the new system, and I know that our green t-shirted coaches – floorwalkers, super users and digital champions – have made a real difference in most parts of the Trust. There is a right way and a wrong way to use the system, which is operational in over 70,000 hospitals worldwide, and we need to use our second week of the Go Live fortnight to make sure that the best way is understood across your team.
I will continue to send some ideas and reflections out each day. I want to balance clarity on expectations and advice with recognition that this is an improvement journey and we will make mistakes. There is, and must be, no attempt to brush under the carpet challenges or difficulties, and at the same time we need to be vocal about what the system lets us do now: A drug round in half the time (both on D27 and D11!); easy access to order, view and endorse results; a clear look at GP records; single location access to reports from physiology departments; electronic requesting of portering support etc. etc.
My message this week truly is not about IT. My strongest sense from this last week has been the team working and organisational spirit that has been on display from bottom to “top” of our Trust. The whole purpose of the investment of time, energy, and money into a new system was to break down barriers and silos between functions. I think on that ambition we have made a fabulous start. What better time to make sure you know the risk reporting arrangements where you work. What better time to see your line manager at their best trying to motivate and engage. And the experience has shown us the passion that all of us of have for patient care and to do our best. A nurse of forty years told me she now enjoyed coming to work – the camaraderie was inspiring.
This Trust has a very exciting future. In two and a half years’ time we re-organise acute care to create a single centre at Midland Met. We separate ‘hot’ and ‘cold’ diagnostics. We develop multi-specialty acute care teams and change our hospital at night model. We move to a genuine seven day emergency service model. As we move through the Unity journey we need to reflect on what it teaches us about that huge reorganisation, what we would do the same way, and what we would do differently. I know, for example, of colleagues who have become incredibly engaged with Unity this last ten days, and wish they had leant in sooner. Equally, I think it is fair to say that some information about the impact of the new ways of working was itself belated and we need to consider how we enter 2022 immensely clear of the pathways and work patterns that we will take to the new hospital. November’s respiratory reconfiguration, and the changes that creates for gastroenterology and for haematology is the latest step in that journey, and there may be other changes as we countdown.
Of course, over the next year over 700 new staff will join us. They will have missed the excitement and difficulties of this fortnight. They will come cold to Unity, just wanting it to work for their patients and their work. That challenges us to think carefully at a local level and at whole Trust level about how we induct people and involve them before and as they start. You will know that Year One retention is not always our strongest suit as a Trust. We need in your team to understand that challenge and build on the good practice we have in patches across our directorates. Corporate induction will only ever be a tee-up for a local welcome that is not just warm but detailed and ongoing.
A number of colleagues have contacted me this week about next steps on Unity. There is time to finalise and formalise that in the weeks ahead, running after we are certain about walking. The big step is to meet our Optimisation challenge across the Trust, in every team, and through each individual’s use of the system. That is the job of the next six months and will dominate our coaching work. Of course there is scope to adapt the system, with priority given to safety issues, and then to teams best meeting that optimisation challenge. But Deva Situnayake was right to highlight to me, as others have done, that some of our clinical processes are exposed by the automation of Unity, and we need to find support to make changes to those processes this side of Christmas: Specialist opinions for example must be part of how Unity works, just as it does for other requesting.
The circumstance of Unity has made sure that people speak up. The simplicity of ext 4050, the immediacy of super users, the energy of our hub teams, has generated a real capability to raise issues and in most cases have them solved. That confidence to raise concerns and spirit of rapid solution is one that we want to try and “bottle”. There has been thought to the design of how we have organised ourselves to make that effective, commitment in the way that corporate functions have worked for and with ‘end users’, and a strong desire to communicate wisely as we go along. There are by-products from the programme that we can keep going – much better data on staffing gaps for example, real familiarity between key managers and the nooks and crannies of services, first name conversations without job titles, and decent stock levels!
Inevitably a number of patients have contacted me to raise issues about either slower access to care or concerns about corridor care, which I certainly share. I know teams have worked hard locally to both reassure and to explain what is going on. One or two instances have arisen of patients overhearing comments better made in private – our anxieties should be discussed, shared and addressed where they can be (thank you to those doctors in training raising queries via IR1s for example), but it must be wrong to tell patients directly or in their hearing in such a way that alarms them about the safety of their loved ones’ care. To be clear that is not about spin or media management, that is about wellbeing for those in need. If at any point you have a safety concern, raise it and it will be tackled. Unity solves problems we have had for years but it raises new problems we did not have, or in some cases know we had, before. All of us have a common purpose and I think that the last week has made that just a little bit clearer than we realised.
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