Although insights from front-line staff are vital for informing improvement, health services often struggle to gather insights from staff systematically and create mechanisms that allow these to be acted upon. Whilst working at the NHS Nightingale Hospital London – a field hospital established to provide additional ventilated bed capacity for London’s patients with COVID-19 in 2020 – we created a role called the Bedside Learning Coordinator (BLC) to address this gap. The BLC systematically gathered insights from front-line workers to help reduce burden on staff and fed these up to decision – makers to triangulate with other data and help inform changes, making processes and care better.
After seeing first-hand the value of the role at the Nightingale, I saw a need to implement this at Barts Health NHS Trust during the second wave of the pandemic. Here are three differences I’ve observed this role making, helping to implement changes that really matter to staff and patients.
- Quantify problems
We implemented Bedside Learning Coordinatorsat the St Bartholomew’s Hospital Intensive Care Unit (ICU) and the Royal London Hospital COVID ICU. The reprioritisation of services and redeployment of staff across both ICUs meant staff were operating in new ways. The Bedside Learning Coordinator role became invaluable. During a six-week period, 625 issues and improvement ideas were identified at the Royal London and 250 from St Bartholomew’s Hospital. Sometimes the same problems were put forward again and again. This data helped to flag the issues with the unit’s leaders, in a systematic way, who could then react and institute rapid changes. This greatly improved the safety and effectiveness of the unit and improved staff experience and morale.
- Improve the efficiency of senior leadership
During episodes of rapid change or crisis, Bedside Learning Coordinators create a crucial source of key information. At Barts Health, while rapid escalation and ownership of issues allowed staff to have a clear pathway to communicate with senior leaders, the Bedside Learning Coordinator model also allowed the leaders to focus on making decisions around changes and solving the issues raised. This rich source of reliable intelligence meant that they can focus on instigating the changes required.
- Inspire creativity among staff
A huge benefit of this model is that Bedside Learning Coordinators can identify creative ideas from staff and provide a fresh pair of eyes on an issue. For example, at Barts a lot of COVID patients had issues with proptosis (eyes bulging) because of the proning and inflammation. One of the Bedside Learning Coordinators at the hospital (a consultant ophthalmologist working as a nursing assistant during the COVID wave) recognised this and suggested it would make much more sense for them to support patients with eye work, rather than working in the nursing assistant role. A new pathway was created from this one idea. Ophthalmologists stopped being assistants and started working as ophthalmologists seeing every patient, every day and focusing on eye care. A win for both the staff and patients that was only identified because someone at the bedside was given the mechanism needed to highlight their observation and suggestion to senior leaders.
Experience has shown me that, with senior management buy in, introducing the role of Bedside Learning Coordinators in a range of different settings can empower front-line staff, providing a voice independent from the team, enabling effective and rapid change. This role has relevance beyond COVID and has the potential to benefit both staff experience and patient care across hospitals.
UCLPartners was recently shortlisted with Barts Health NHS Trust for a HSJ Partnership award for the ‘Bedside Learning Coordinator Approach to Care Redesign’. Find out more here.