Joanne Hill, a Service Improvement Manger in the Cardiff and Vale University Health Board’s Improvement and Implementation (I&I) team, was deployed to the Health Board’s Surgery Clinical Board as part of its COVID-19 response. By working collaboratively to solve some of the biggest issues facing the Clinical Board, they managed to achieve extraordinary outcomes for patients during one of the most challenging periods for the health system.
As one of the largest healthcare organisations in the UK, Cardiff and Vale UHB’s the care delivered by the Health Board is managed internally by seven Clinical Boards: Medicine, Primary Care, Clinical Diagnostics and Therapies, Mental Health, Specialist Services, Children and Women’s, and Surgery.
The Clinical Boards each have a direct responsibility over the services they deliver and vary in size; some are even larger than other NHS organisations around the UK and comprised of thousands of members of staff. Therefore, making meaningful change in a system as complex as health can prove challenging, even at this level.
The advent of the COVID-19 pandemic required the organisation to be able to make decisions and radical change at immense pace at every level. To facilitate this within the Surgery Clinical Board, Joanne Hill from the central I&I team was deployed to surgery in March 2020 and has been fully embedded since.
Joanne said, “Being able to build my knowledge of how the Surgery Clinical Board works was so useful to my practice. I truly felt part of the team and was able to build trust within the team that the Health Board’s Improvement and Implementation team were there to help make things better, not to force top-down change.”
By being based in the surgery hub for the majority of the time, Joanne was able to build excellent relationships with the staff in both the management team and on the frontline, all of whom found her input and specific improvement expertise to be invaluable. Joanne was able to facilitate planning sessions, identifying who needed to be part of the discussion and ensuring they were present; assist in identifying barriers and strategizing how they would be overcome; define the major areas of the project and map the processes necessary to achieve their goals.
The partnership between the Surgery and I&I teams has been very successful and was fundamental to the establishment of surgical Green Zones, or the Protected Elective Surgical Unit (PESU), which allowed the UHB continue with both urgent and elective surgical procedures throughout the COVID-19 pandemic in the safest way possible.
To increase patient safety, the units have dedicated entrances and exits, and staff working in the green zones are required to remain in the dedicated zones for the entirety of their shift. In order to support staff in this endeavour, new staff areas, changing rooms and showers were constructed within these green zones. Any deliveries to the units are contactless using an ‘airlock’ door system.
Both the construction and the staff processes at the units in both the University Hospital of Wales and University Hospital Llandough had to be completed and agreed at an incredibly rapid pace, and having the principals of improvement and implementation at the heart of this project contributed significantly to its success.
Mike Bond, the Director of Operations for Surgery Clinical Board said, “It has been a huge team effort and we have no doubt that patients have benefited from this hard work. However, I truly believe without Joanne we would not have delivered the changes that span across the whole organisation. Her project management skills, ability to follow up on actions, engagement and leadership has been exceptional.”
Since its launch in March 2020, over 5,000 patients have undergone surgical procedures in PESU at Cardiff and Vale UHB and, to date there have been no hospital-acquired infections in the units. This amazing statistic extends beyond COVID-19 as there were also no cases of other diseases acquired in hospitals, such as C-Difficile and MRSA. In turn, this has led to fewer cancellations as there is better bed availability for patients following their surgery.
Following the initial success of PESU, the team attended the March 2021 Spread and Scale Academy with the vision of expanding this practice beyond the COVID-19 pandemic and sharing their learning with other health organisations across Wales and beyond.
Len Richard, Chief Executive of Cardiff and Vale UHB, said, “The work that has been undertaken between colleagues in the Surgery Clinical Board with the support of the Improvement and Implementation team has been phenomenal. It is a truly great example of what we can do when we work collaboratively across organisational boundaries and will act as a model of how we want to work as we look to redevelop our services as the system recovers from the COVID-19 pandemic.”
