A story of two halves… key lessons learned on my PICH journey

I began my PICH journey with enthusiasm, but little experience of leading QI projects.

I firstly introduced a proforma to our ED to help standardise the acute care of wheezy children and improve the advice and education given at discharge. Several iterations of audit showed that we were making improvements to acute care and also discharge advice and education.

Following this, I noted that many patients referred to paediatrics from our  UCC were seen and sent home with few, if any, additional investigations and wanted to streamline patient care. I conducted a review of UCC referral data and identified that the most important thing we provided was additional time for observation and a second opinion. Relevant stakeholders were interested but the project ground to a halt with my break for maternity leave.

A period of enforced reflection (maternity leave!) and a personal experience of my own made me realise the power of acute ambulatory services in helping to avoid the disruption and disappointment of a prolonged hospital admission for a new baby.

Most recently I have worked on a project looking at the acceptability and feasibility of extending our hospital’s acute ambulatory homecare service to neonates. Aiming to learn from previous mistakes, I assembled a team, engaged in patient interviews and met with other relevant stakeholders early, conducted data auditing and have maintained communication with all interested parties as the project has progressed. We recently had the first neonatal referral to the service and expect on-going growth as the conversation continues.

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Lesson 1: Integrated services are patient centred: do not underestimate the value of early, patient involvement – if you do it too late you will have wasted valuable time in developing the kind of service that patients want

Lesson 2: Involve ALL relevant stakeholders early – be bold and get the word out about what you want to do; you will be surprised at the interest you receive and the support that comes with that

Lesson 3: Delivering change takes time and commitment – be patient, and remember your patient story as that will keep you going when things get tough

Lesson 4: The power of reflection – time away from the project helped me gain focus; all our mistakes are worthwhile if we learn from them

Lesson 5: Communication, communication, communication  – with everyone, at every level, it opens doors and helps you to identify your blind spots!

If I could do it all again…

Lacking confidence in how I would be received, when I began work for PICH, I launched myself into projects without adequately consulting local stakeholders or fully embracing the idea of patient co-design.

I spent valuable hours of my time beavering away on these projects, only to find I had more work to do once I finally met with relevant stakeholders and consulted with the wider team.  I felt as though I was working back to front – I was identifying the problem, not the children or families that we serve. And I was assembling my team far too late, when I could have done with their expertise and involvement from the beginning.

I was lucky to have an extended period of reflection (mat leave) half way through my PICH year. I tried to identify and learn from my earlier experiences that did not always deliver as I had hoped. As a result my final project has been easier and I would try to do these things again.

I identified an interested and influential consultant as a supervisor before starting work; I assembled a small team of interested junior doctors to help; and I met early with relevant colleagues to discuss the proposal. I communicated with all relevant team leads to inform them of our work. Once I knew the project had ‘legs’ I conducted patient interviews and collected data simultaneously.

Having not only my own, but also some other very powerful patient stories in mind as I worked on this final project really helped me to remain focussed and determined to see the project through.

I communicated with relevant stakeholders as the project progressed and am pleased to say the dialogue continues.