How did you first get involved in improvement, and what has been your journey since then?
Looking back on my professional career, I guess that I have been involved in ‘improvement’ continually in all the roles I have held. Although at the time, it was more of a case of ‘doing and developing’ the job I was involved with!
Having worked in, and then ran an NHS high street dental practice for 25 years, probably the first improvement project was for my patients. This was based on moving from a rationale of ‘treatment based’ dentistry to one of ‘prevention orientation’.
When I qualified in 1981, dentistry was still focused on filling cavities or extracting teeth – which was productive, but at the same time gutty and exhausting. Then I started to attend courses that exposed me to a more holistic approach to health care; looking at a proactive approach to educating all my patients to take ownership of their own dental health.
I recognised that this couldn’t be achieved with policy change or regimented enforcement, but needed a culture change, firstly within me and my team, based on understanding of an end goal: healthier mouths and less decay/better gum health. And secondly, cultural change within my existing patient base, who historically expected a dentist to, well, do dentistry!
The lessons learned then, of taking the team as well as patients on a journey, became the basis of how I approached developing improvement projects in the further roles that I held, as a dental lecturer and educator working for Health Education England, as well as supporting, developing and teaching a mentor course for all members of the dental team.
For me, improvement needs to be based on sharing a common goal, providing the structure to make this happen, reflection and feedback as the process progresses, and ultimately a willingness to want to see change happen.
What most inspires you professionally?
In my current role as a patient representative for the Centre for Perioperative Care (CPOC) I am very fortunate to be surrounded by people who understand just what ‘patient centred care’ really means and put it into practice within their health care roles every day. This reinforces what I believe is central to improving UK health care – valuing patients’ views, their expectations and individual needs, so that once we listen to and understand patients, we can support them in making the right decision for themselves in the care that they need.
I experience this everyday in my role at CPOC and quite simply, that is my greatest inspiration.
Can you share a hard-won lesson you’ve learnt about what makes for a successful (or unsuccessful) improvement project?
When I started out developing programs for dental health education, it was from a position of ‘I have an idea, I think everybody needs this idea, I am going to use my skills, education and knowledge to change the perspective of health care by this idea, and it is going to make a huge difference’.
Perhaps one of the most important (and most releasing) lessons I have learnt is that before I embark on a new improvement project, I must ask questions of those who are actually experiencing health care, not just the clinicians who ‘think’ they know the answers. We all know that co-design and co-production are vitally important, but I still speak to colleagues who get to the end of their project and realise that the patient voice has been left out of early planning and then at the end of the project, they recognise that they have devised a system that doesn’t meet the patients’ real needs. Tragic, but sadly not unusual.
What change could we make that would do most to embed continuous improvement in health and care?
Improved communication early on of the benefits to patient care that new improvement systems can offer and listening to feedback. Too often, change is initiated ‘top down’ without proper conversation with those who directly provide care.
Why did you join Q?
As a way to network with like minded people who are passionate about health care improvement and also to understand some of the different perspectives that make up the care landscape.
What new connections have you made as a result of joining the Q community – and what have you learnt so far?
The Special Interest Group that I co-convene, Perioperative Care – Prehabilitation, provides many opportunities of cross pollination with other passionate people in different health care settings. Having joined eight groups, I am equally challenged and inspired by the drive of others!
Can you tell us about something you’re currently working on that Q members might be able to get involved with?
We are currently developing a series of webinars that we would love other Q members to access and develop connections with us. These will be around the many aspects of prehabilitation and perioperative care that make up a patient’s journey from the moment surgery is contemplated through to full recovery.