Tell us a little bit about yourself and your improvement journey

I’ve been a doctor since the late 1990s, working in palliative care since 2002, based in Dorset since 2006.

My journey in improvement began with Don Berwick’s Escape Fire, recommended to me on a management training course as a specialist registrar. His work continues to inspire me. I’ve learnt a lot since then, including through an excellent MOOC (Massive Open Online Course) from the Institute for Healthcare Improvement; reading; listening; watching; writing; sketchnoting; and mostly through thinking and doing.

Reflecting on the experiences of people in their last months of life – looking at their experiences end-to-end, rather than in just one setting – has helped me to recognise that we need to think and work differently if we’re going to ensure the best outcomes and experience for all.

I met one woman just a few days before she died; she was beautifully cared for at the hospice. But if you looked back several months, you could see that she’d been feeling ill for some time. Throughout those months she’d been treated for heart failure and reassured that her ankle swelling was improving and that she was losing weight, which were interpreted as signs that her heart failure treatment was working well. She became increasingly breathless though and was admitted via the emergency department to critical care, where she was found to have lung cancer. She was transferred from critical care to the hospice for the last few days of life.

It makes sense to me to understand quality end-to-end from the perspective of people and communities we support.

Standard audits of care in the last days of life would show “good practice” and no cause for concern. Her assessment and treatment in her last admission to hospital were swift, expert, compassionate. The boxes were ticked. And yet protocol-defined care did not serve this woman well. A fragmented health service focused on silos of disease did not serve this woman well. A focus on improving isolated processes or meeting targets did not serve this woman well.

It isn’t enough for us to become better and better at our own individual jobs, or even to create outstanding teams or services. People fall through the gaps. It makes sense to me to understand quality end-to-end from the perspective of people and communities we support.

Since July 2018 I’ve worked on “Results Through Relationships”, a collaboration between NHS England and Dorset Integrated Care System, with Easier Inc acting as a thinking partner. Through this work I’ve been collaborating with local and national colleagues to focus on what really matters to people and communities, helping them – and helping each other – to live and die well.

What first attracted you to Q?

I heard about Q from several colleagues whose work I admire, and enjoy connecting across our normal organisational boundaries.

What are you hoping to get out of Q?

Connecting with others who have the courage not only to recognise when things are not as any of us would like but also to invest time to focus on creating the conditions for better things to happen. Together we can rethink what public services could look like – bespoke by default, with healthy relationships, shared understanding, exploring and learning at their core.

Interested in Saskie’s story? 

Would you like to hear more about the “Results Through Relationships” collaboration, or perhaps Saskie’s illustrations have piqued your interest in Sketchnoting? Reach out to Saskie to find out more and welcome her to the community.