Capturing staff insights and making improvements through Bedside Learning Coordinators
Challenge
Insights from front-line staff are vital for informing quality improvement. However, health services often struggle to gather insights from staff systematically.
Front-line healthcare staff with rich insights and ideas about how to improve patient care, workplace efficiency and staff well-being often lack time or power to enact change or make systemic change.
In contrast, senior hospital decision-makers can effect change, but often don’t have timely access to staff and patient insights to inform changes. Insights from patients and front-line staff are rarely routinely captured and when they are, they are often underexploited.
What we did
The Bedside Learning Coordinator (BLC) role was designed to capture staff insights and provide rapid feedback to leadership teams to inform decision-making and communicate changes with staff and support improvements. After seeing, first-hand, the value of the BLC role at the Nightingale, the model was subsequently introduced at Barts Health.
The role was initially implemented to support recovering Intensive Care Units (ICUs) and staff who were previously redeployed, to settle back into ‘normal’ working arrangements. Although the role didn’t prove as useful in this setting, staff reported finding the role empowering as it meant their voices were being listened to.
The role was subsequently re-introduced at both the St Bartholomew’s Hospital 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. BLCs were found to be invaluable to these services, both for staff support and in identifying many issues that needed to be improved. The model used by BLCs was a crucial safety and operational system that facilitated safe and effective care.
Impact/outcomes
- 875 issues were captured during wave 2, covering all areas of operations (625 issues and improvement ideas were identified at The Royal London and 250 from St Bartholomew’s Hospital).
- Improved safety and effectiveness of the unit and improved staff morale was observed as a result of issues being fed up to unit leaders so they could react and institute rapid changes.
- Leaders were able to focus on making decisions around changes and solving the issues raised, as the model was designed for efficiency
- The model allowed creative ideas from staff to be implemented. For example, a lot of people had issues with proptosis (eyes bulging) because of the proning and inflammation. One of the BLCs (a consultant ophthalmologist working as a nursing assistant during the COVID wave) recognised this and suggested it would make much more sense to ask them to support patients with eye work. A whole 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.
| Dr Lynne Barrass, Consultant and Helen Hewitt, Matron work in Adult Critical Care Unit at Barts Health NHS Trust where the BLC role was in use during winter 2021. At a time where the unit was facing substantial pressure, with nurse shortages and high levels of staff unfamiliar with the unit being expected to work there, they found the Bedside Learning Coordinator role invaluable. They told us: “Bedside Learning Coordinators are able to take objective viewpoint, making staff feel comfortable having candid and honest conversations versus discussions with their line manager. “The physical presence of Bedside Learning Coordinators on the units eliminated the need for time-consuming paperwork after a shift was completed and also enabled simultaneous verbal feedback of previous lessons learnt. “Taking on board the feedback from Bedside Learning Coordinators allowed us to focus new resources on the main areas of need, for example army cadets to help with manual handling/ proning/ restocking; Ophthalmologists to help with eye care; and maxillofacial/ dental to assist with mouth care.” |
The development team across UCLPartners and Barts Health have spoken about the BLC role at a number of national and international workshops and conferences to share learning and spread the idea. The BLC was featured in World Patient Safety Day activities in 2021 and has been featured as an exemplar by the global Institute of Healthcare Improvement and cited in a number of peer review publications.
In 2022, the BLC was shortlisted for an HSJ Partnership Award in the Most Effective Contribution to Clinical Redesign category.
Next steps
A number of NHS organisations across a range of wards and settings have successfully adopted the BLC role across the UCLPartners geography including Royal Free London NHS Foundation Trust, Mid and South Essex NHS Foundation Trust and more widely in the NHS. Basildon Hospital introduced the role into a range of settings including maternity. Over 90 issues were raised between May and September 2021 with over 70 of these successfully resolved.
UCLPartners was awarded a grant by the Health Foundation to support spread of learning and adoption across the wider NHS by developing a community of practice. This has been launched to enable sharing of experiences. Resources have also been developed including a BLC handbook, template of the role description, and an app to streamline capture of insights.