For anyone at the sharp end of NHS leadership, the COVID-19 pandemic has demanded a level of innovation and improvement heralded by many as ‘unprecedented’. As improvement leaders, we have been tasked to deliver more than ever before and many of us have turned our hand to tasks which would normally be delivered by others. For me, that has included establishing early COVID-19 testing, re-thinking the distribution of PPE and ensuring 4,000 staff were face fit tested for FFP3 masks.

Our service runs on goodwill, kindness and professionalism.

The North West Ambulance Service (NWAS) employs over 8,000 staff and volunteers. Every one of them is cherished as an individual, family member, crew mate and brew mate. Our service runs on goodwill, kindness and professionalism. In the last year, members of our NWAS family have been admitted to hospital, battling COVID in intensive care and three have sadly lost the fight. Each time our people become our patients you can feel the organisation holding its breath and wrapping its arms around these individuals, with their families and friends willing them back to health.

Implementing the ‘safe check system’

When we look back at how we have moved faster during COVID-19, we should never forget the importance and power of this collective will to protect one another. This week, at the national Improvement Directors Network, I was proud to showcase the work of one of our senior paramedics. Matt has led the design, testing and implementation of a bespoke set of ‘safe checks’ to ensure the basics are taken care of and checked every day. The ‘safe check system’ is a digital innovation which allows the crew on every vehicle to document checks, faults, equipment and medicine supplies. Any faults or missing stocks are automatically passed on to managers to resolve. Delays in resolution result in text reminders. His motivation is to ensure the basics are covered and to prevent harm to staff and patients. The system has been instrumental in ensuring that our increased COVID-19 incident numbers don’t overwhelm our ability to ‘keep pace’ with resilient equipment and vehicles. It has provided us with an opportunity to monitor in real time (Safety II) and created a psychological safety way beyond our expectations.

The system has been instrumental in ensuring that our increased COVID-19 incident numbers don’t overwhelm our ability to ‘keep pace’ with resilient equipment and vehicles.

So, what is special about this? The system was designed, tested and implemented in three months. A small hit team of innovators carried out over 200 tests of change (PDSA’s) in less than six weeks to devise the system, within four months it had been scaled across 200 vehicles in Cumbria and the full fleet of 600 vehicles within six months. With over 1 million checks carried out since its inception, the system is now simply ‘the way it is around here’ and no one seems to recall the battered old books that once remained partly completed on NWAS vehicles.

Little did we realize that a system like this could lead us to such insight into ‘improvement’. A clear sense of purpose, the leadership of an authentic clinician, the incubation of ideas, rigorous testing, rapid modification and a clear understanding of ‘why?’. Everett Rogers’ seminal book, Diffusion of Innovation describes the uptake of innovations through the lens of multiple agencies and hints at the unknown characteristics of disruptive global phenomenon, such as terrorism and the World Wide Web on the pace of diffusion. Wouldn’t it be fascinating to see what he would have made of the disruptive impact of the COVID-19 pandemic? I feel confident that if he looked at our experience he would be saying that the instincts of survival and protection have been, and continue to be, central to our accelerated improvement effort.