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First up in Q’s new series of member interviews is anaesthetist Carloyn Johnston (see her Q profile page), who is leading trust-wide improvements at St George’s University Hospitals NHS Foundation Trust. She shares the inspirations and experiences of her improvement journey – as well as a request for help around QI improvements to help her Trust’s current DOLS (deprivation of liberty safeguards) and MCA (Mental Capacity Act) training and awareness.

Carolyn Johnston

How – and why? –  did you first get involved in improvement; and what has been your journey since then?
I’ve always had an enthusiasm for thinking about how I could do things better.  My first son had a significant health problem when he was born, and it was a real shock to the system to see the NHS from the patient perspective and I saw so much that could and should be changed.  So took a year out of my training as an anaesthetic registrar to do a Darzi fellowship (a year working with a trust leadership team on improvement projects).  I thought I would mainly learn about project management, but it was really all about meeting people, making connections and learning, so I really loved it and I knew from then I would have a significant improvement role along with my clinical work.

What most inspires you professionally?
I can think of so many role models that were really important to me during my training.  Now that I am a consultant and I’m teaching more, it is really exciting to see others learn; see the penny drop when they learn about making iterative change or think about how to influence behaviour change. It’s simple stuff but I know it makes a real change to how they tackle improving the service in the future.

I wasn’t sure where to start on [DOLS and MCA], so I am hoping the Q community can help me with some examples of what has worked well for them (or even learning from what hasn’t worked!)

Can you share a hard-won lesson you’ve learnt about what makes for a successful (or unsuccessful) improvement project.
My biggest lesson was about who ‘owns’ the project.  I am thinking about some of the things I did on my year as a Darzi fellow which weren’t sustained after I left. It can be a brilliant idea, but if you don’t collaborate and work with the whole team, it won’t be sustainable. It’s not just a project, it’s a long-term change in they way we are going to do things. I think that is particularly true for doctors in training who will move on to another post on rotation: if the improvement isn’t owned by the whole team, it won’t last after you are gone.

What change could we make that would do most to embed continuous improvement in health and care?
I think we need to teach some basic improvement principles to everyone, and then we have to really work hard to make collaboration easier. More time for clinical and non-clinical staff to work or learn together, and an expectation that all change will involve wide consultation and engagement. And that everyone knows if they see something in their work that could improve, they absolutely have the permission and support to just crack on and change it.

it’s really helpful to spend time with people who have many of the same ambitions, and experience the same frustrations, as me!

Why did you join Q?
I can see the benefits of sharing and spreading improvement learning, it’s so important.  But also for resilience – it can be quite tough trying to make changes, and so it’s really helpful to spend time with people who have many of the same ambitions, and experience the same frustrations, as me!

What new connections (and collaborations) have you made as a result of joining the Q community – and what have you learnt so far?
I’ve met lots of new people with similar interests at the Q events, I’ve learnt a lot from casual conversations with fellow members over coffee and lunch, as well as from the excellent speakers at the events.  I’ve done a few Q ‘Randomised Coffee Trials’ too.  That was different in that we had more time and focus to chat.  I’ve been able to connect with members working on areas that colleagues in my trust have asked for help with – such as sepsis and peri-operative safety.  I think this can really increase our capacity to do QI locally, as it will really increase the knowledge pool we have to work from.

if the improvement isn’t owned by the whole team, it won’t last after you are gone

Can you tell us about something you’re currently working on – that Q members might be able to contribute to
I’ve got lots of things on the go at the moment! Our trust would like to improve our DOLS (deprivation of liberty safeguards) and MCA (Mental Capacity Act) training and awareness and asked for some QI input. I wasn’t sure where to start on that, so I am hoping the Q community can help me with some examples of what has worked well for them (or even learning from what hasn’t worked!).

Coming next: Hilda Campbell (COPE Scotland)

You can follow Carolyn on Twitter: @DrCJohn

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