Michelle Clarke, Director of Nursing and Quality: What does improvement mean to me?

Michelle Clarke is Director of Nursing and Quality at Worcestershire Health and Care NHS Trust, a community and mental health care trust.

Michelle explains her interest in health care improvement and why she will be attending our improvement conference on Thursday.

I trained as a nurse in the 1980s at a time when patients stayed in hospital far longer than they do now and the environment was different. The throughput is far quicker now - which is the correct response because the home is where patients best recover - but that is a real challenge because the support is often just not there. There’s also been significant demographic changes in family life; the extended families of different generations either living nearby or in the same house has diminished. Improvement is needed in how we deliver care partly because of these changes.

In my organisation I’m involved in quality and organisational process improvements, which are not distinctly separate from each other.

How are we engaging with patients?

We’re having a real targeted focus on reducing avoidable pressure ulcers. I’m a district nurse by profession and you see a lot more patients with pressure ulcers in the community. Treatments have changed since the 1980s and the key thing now is around educating the patients, making sure they are more engaged with preventing pressure ulcers in the first place. 

Patients as well as treatments have changed and they are now less likely to take it as a given what the doctors and nurses tell them; it is more about co-production with the patient. When we talk to our patient engagement group, they are telling us to show pictures of pressure ulcers to patients, to show the seriousness of it which is often not realised. 

How are we working to improve patient flow?

We are working on improvement in how we get patients more seamlessly through the system. For example, a few years ago a patient flow access system was set up to co-ordinate discharge more effectively, however, it has had the unintended consequence of actually slowing the flow in many respects because all patients are referred through it. We are looking at how we can speed up the process by having more direct referrals from the appropriate health professionals but still keeping the patients that do need to go through this system.

When I attend Thursday’s conference and am asked what sort of support NHS Improvement could provide, I want to say that I find independent improvement facilitators extremely useful, people who can come in and act as a check and challenge. We’re really busy in our day jobs and so it’s really useful to have someone who can take information away, put it in charts and so on, and get the actions out of you so that we can get on and implement them. 

What we don’t want NHS Improvement to be doing though is telling us to do lots of things in a way in which we lose the valuable time we have. We do have busy jobs and sometimes we feel that can be forgotten.
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What do I want to get out of the inspiring improvement conference?

At the conference, I want to further my knowledge of quality improvement and see what I can take back to my organisation and share, but also critically, to share across my STP area.

When I think about what I would like to achieve in the next year, I would say firstly it is to reduce avoidable pressure ulcers, to have implemented new methods of quality improvement and it feels a bit strange to be saying this, to have challenged the systems and processes which we’ve become used to and to show how this has led to improvements.

I try to focus on rebel engagement, where you just get on and do things. In the past there has been a culture where there are lots of teams out there working who always need to go higher up the management chain to get approvals. This can be endless and often ends up with good ideas going untried.

I say that if you think something’s a good idea, and you are assured it's safe, just get on and do it. This is about changing the culture.

Follow up with Michelle after the event

What were the highlights of the day?

My favourite part of the day was the world café sharing session led by Helen Bevan. This gave us all the opportunity to discuss topics that would allow others to join in, debate and come up with new ideas. I think it is extremely reassuring to discover and discuss shared frustrations with colleagues from over the country who are doing similar things but who you’ve never met. Just sharing is very therapeutic but we were also discussing solutions. 

One example is that whilst there is national guidance on classifications of pressure ulcers, everyone has a slightly different interpretation of this - I suppose that is down to us all being individuals. 

What were the main points/speeches which struck you afterwards?

My favourite lines of the day were: 'Have the guts to say stop if it’s just not working' and 'Get closer to our staff, show leadership and hope, it’s part of our day job'.  

The speeches were interesting and although you’re not hearing anything particularly new, it is good to hear the emphasis on issues such as reminding us all in a health system we are very data driven, but that it is ultimately a people business whose overriding aim is to be better at providing care to people. 

I was pleased that all of the speakers wanted to move from micro management and to empower people but also be honest about the pressures which led to this not happening. 

Did anything give you any thoughts on specific quality improvement (QI) work you’d want to take up at your trust?

I particularly want to look more at the discharge and assess Aintree Model. I also want to focus on reducing the amount of paperwork we have so we can focus more on holistic assessments and recognising we have to work within our professional boundaries but not being over governed by bureaucracy.

How will you approach your colleagues with some of the improvement ideas that you have?

I’ve put a shout-out for quality improvement champions to get involved in improvement ideas and I am meeting with them shortly. 

What does improvement mean to you? Join in the conversation #improve365.

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