The Helping Our Teams Transform (HOTT) Programme at Imperial College Healthcare Trust is a blended learning programme that aims to improve team performance through human factors education, simulation training, in-situ coaching, and facilitated conversations – something we call ‘HOTT Conversations’.
We had just spent about two months running these sessions for the thrombectomy team. It was now time to finish the programme with a patient focussed HOTT Conversation. We had about 20 team members from the multidisciplinary team present for the lunch hour session – stroke doctors, interventional radiologists, radiographers, nurses and anaesthetists.
We chose to use a User Experience Fishbowl, adapted for the virtual format. The two facilitators and our lay partner kept cameras on and aimed to create as natural a conversation as we could with Mo (the patient) and Aalia (his wife). The brief was to “pretend you are all having tea in somebody’s living room”. Everybody else had cameras off and were listening.
Mo proceeded to describe the events of the 9 February 2021. He was in his house when he suddenly collapsed to the ground. Aalia found him a few minutes later and phoned an ambulance, which arrived quickly. She remained calm in the presence of her 3-year-old son, who she quickly shuttled into his room. She said, “he was not scared, and he was well behaved, but he knew something serious was happening as he kept really quiet in his room for a whole hour.”
She remembers with clarity, that the paramedics asked what time Mo “dropped”, and then looked at each other and said, “there is time.” This gave her hope. She didn’t cry until Mo had left in the ambulance and her son had been dropped off at school.
She received a phone call not long afterwards from the hospital. A doctor explained that they were going to perform a thrombectomy procedure. She told them to do everything they had to save her husband.
He remembers going to sleep with the anaesthetic and waking up surrounded by people in masks.
Mo could not speak but was aware of all that was happening around him. He remembers going to sleep with the anaesthetic and waking up surrounded by people in masks. He doesn’t remember any faces but made a good recovery and was discharged after three days.
It was strange to return home, where nothing had changed, but everything had changed. Over subsequent months, Mo recovered physically but started acting more withdrawn. He was a refugee, and the stroke had unlocked a part of his brain where he had previously stored other traumas in his life. His psychological recovery is ongoing.
If you could meet the people who saved your life 12 months later, what would you say? Mo said, “Thank you. The team looking after me, they were angels. I have been close to death before, but this time, I could taste death. I am grateful to be here, for my four-year-old boy.”
There were some tears in the outer fishbowl and the last 20 minutes of the 60-minute session were spent with staff expressing how hearing this story had reminded them of why they do this job. One stroke physician commented that their stroke support group was disbanded since the pandemic, but Mo’s experience highlighted the importance of them re-starting this.
All in all, it was an hour well spent. We felt privileged to hear this story of courage, despair, kindness and humanity. A 15-minute procedure brought a father back to life, and it is my hope that this 60-minute conversation helps the thrombectomy team remember the value of what they do.
Here are five steps on how you can do something similar:
- Identify a patient who is willing to contribute an hour of their time to tell their story. Invite their family to join the conversation.
- Agree a time that suits them – lunchtime worked well for us.
- Identify the clinical staff members who cared for the patient and invite them to come along.
- Invite other members of the team – anybody who is interested is welcome to observe.
- Follow the structure for User Experience Fishbowl, making sure the “inner circle” comprises facilitators who ask good open questions. We invited a lay partner to tip the balance of people in the conversation in favour of the non healthcare professionals. Lay partners often see gems that we do not.
- Staff can find this a scary prospect, especially if the patient had a suboptimal experience. Reassure them that most patients willing to engage in this way are wanting to share in the context of facilitating learning.
- Having somebody with a friendly phone voice explain the concept to the patient beforehand is useful. It also helps to run through the digital platform beforehand as some patients (such as ours) have never used this before.
- Just do it! Thank us later.
This story is shared with permission, though names have been changed.