We’ve got another insightful instalment of Meet the Trainer for you! Director of Clinical Governance Pamela Strange, a registered nurse educationalist, facilitator and trainer talks to us about interacting with patients and the changed landscape of healthcare since the pandemic. Read on to find out more!

(You can watch a short clip below from our interview)

Thank you very much for joining us to talk to talk a little bit about Miad Healthcare and your role there. Could you start by telling us a little bit about your experience and your background?

I’m a registered nurse and educationalist by background. I’ve worked all of my life in the NHS and I spent 10 years as a director of clinical governance in a very large London trust. I live in Dorset now but I travel for work all over the country.

Which courses do you lead at Miad Healthcare?

I work with Miad as a facilitator and trainer, mainly in the areas of clinical governance, which is quality improvement, patient safety and clinic audit. Particularly, I’m passionate about making sure that when things go wrong for patients that everybody learns from it. That we can examine everything that’s gone awry, put it right and learn from it for the future. Not just for ourselves, but for everyone.

I do webinar sessions and face to face sessions. I also do work with nurses that are coming into the UK to work in the health service which is a tremendously fun session. It’s great. Helping the nurses that are coming from overseas to understand what it’s like to live and work in Britain and to work in the NHS and give them some of the background of the very complex organisation that is the NHS.

What sort of challenges do you face with teaching overseas nurses and other medical practitioners when they come to England?

The overseas nurses are very eager to learn, to understand about the NHS, what they can bring to it and what opportunities they have to develop. I think Miad is fairly unique in delivering the course that we deliver, making it very tailored to the specific needs of the overseas clinical practitioners. In a nutshell, it gives them the structure of the NHS which is huge. What part the government and NHS England play, how it all works, where the funding comes from as well, because that’s a pretty unique situation. There is great focus on the structures and frameworks that help them to practice safely. 

A big part is understanding what it means when we say things because in Britain we don’t always say what we mean. It’s getting people to understand our colloquialisms if you like. It’s understanding our sense of humour, but also giving them the confidence as well to challenge, to be an advocate for the patient. Because sometimes it’s difficult. So we do work around that as well and we do a case study with them that says how would you handle this? They can ask as many questions as they like, it is fairly relaxed and really great fun and vey enjoyable for me and hopefully for them as well. The feedback is good.

How would you say the COVID pandemic has affected your training sessions?

What advice would you give to people in terms of having those conversations?

In the NHS we have what is called the duty of candour. We have to be open and honest with our patients when things have gone wrong. You need to be prepared and able to talk to patients or their relatives in a way that provides information in bite size pieces or an acceptable format for them to consider the information and ask questions. It will always depend on the situation. Explaining that the incident will be investigated fully and how the whole process of investigations is going to work on their behalf whilst making sure the patient has got the top quality care that they need and deserve.

But it’s also about making sure that through the clinical governance processes staff can learn. It’s also important that the patient or the relatives understand that and that they have contact with somebody to raise further questions.  Providing the support through the administrative processes that they need and the contact that they need and to make sure that they understand what’s happening. So it isn’t easy to, for example, break bad news and it does take skill and practice to do it.

It also important to remember that all doctors and clinicians need support. I think sometimes patients and the public generally run away with the idea that doctors and nurses should be absolutely perfect. We’re not, but it is invariably the systems and processes that we work in that let us down.

Every time there is an interaction it has a knock on effect on another system. It’s a very complex way of working and sometimes things do go wrong. Not because of an individual’s actions but because the systems and processes that we work in let us down. They need to be strengthened. They need to be made to work properly. All staff need understand how systems work and that’s where clinical governance and quality frameworks come into play. There is a great deal of work underway via the Patient Safety strategy to support all staff in providing the best care to patients.

Could you expand a little bit about the role quality improvement plays?

Quality improvement’s absolutely key in making sure that the services and the care that we deliver is as good as we can get it. Even if it’s only a small improvement, it’s an improvement that can be made. There are a whole different range of ways of looking at quality improvement, including some of the more obvious aspects like clinical audits. We do clinical audits to check that we’ve got everything where it should be, and we keep doing it again and again, to make sure that we are constantly improving.

When complaints come in or when patient incidents occur, whether they be serious incidents or not, we examine what’s happened in various ways and bring that into play into the quality improvement process to make sure that we change and we improve constantly.

That’s not just key for patients, it’s key for staff. Because when something does go wrong, staff feel terrible. Even when it is not their fault, which is nearly always. Nobody gets up in the morning and says “Hello patient, which is the most creative way I can mess your life up today”.  Things happen or go awry because there is a weakness in the systems and processes. We’ve got to make sure those are stronger and protect both patients and staff.

Do you feel that the perception of medical professionals from members of the public has changed post pandemic?

I think there’s two things here. I think Dr Google has a lot to answer for. It’s human nature that people will Google a condition or symptoms.  Google can lead to some really scary results that aren’t necessary. The patients will often bring that to the doctor or nurse and say this is what Dr Google says.

But actually, everybody’s individual. Everybody’s different and everything needs to be related to the individual.

Secondly, the pandemic has been particularly tough for staff in the NHS and it’s been horrendous for patients and relatives. It’s been a really difficult time. But staff in the NHS are really used to change. It never stands still, it’s changing constantly, but the pandemic not only meant that staff were dealing with some very, very difficult situations but also staff were moving around. They weren’t doing their normal specialty work. In some cases, they were supporting their colleagues to care for covid patients. It’s been a real challenge.

From working with colleagues and knowing many people within the NHS, I think we’re just seeing the outcome start to hit clinical staff. The challenges and the expectation of the public and what the waiting list is like at the moment. The public expect it to be sorted. The government expects it to be sorted. But actually, there are still patients with COVID. Staff are still working with those patients and doing exceptional work looking after COVID patients. There’s this real pull in both directions to make it work. So I think the public will forget the pandemic, quite rightly and I think it’ll take a little bit longer for the NHS to get through that hump. But it will survive and it will carry on it.

Staff have been through a lot, especially frontline staff. They’ve seen some terrible things. They’ve been through some terrible things and they’ve had to manage in that scenario. It’s been tough.

Have there been a lot of quality improvement conversations and focuses because of COVID as a result? Have you seen like a shift in the focus of quality improvement?

Good question. Yes, I think there has been a shift. There is a desire to get back to routine working and to get on with the work that everybody was trained to do from a specialty point of view. But I think certainly that some of the real frontline services, like the emergency departments, ITU, medical and respiratory specialities have taken on board the things they learnt through the pandemic and put that into their quality improvement programs. It’s learning how to keep the momentum going in very tough situations. There’s been very many good examples, fantastic examples, of how people have coped and managed and improvised.

Staff have learnt to think about quality improvement even more effectively in real time because there was no other way to work. Sometimes staff prior to the pandemic thought that quality improvement was something you do over there when they were not doing the day job. But it’s embedding all of those things into daily practice and daily thinking and not just giving it the wherewithal that says one person will do this. Everybody has to embrace all aspects of quality improvement to ensure change occurs. That includes management and administrative staff.

It’s not just quality improvement. Inpatient care needs to be clinically led by doctors and nurses by identifying where things need to be a little bit more equal or more developed. But it doesn’t mean to say that those people that are already frantic have to be developing, it can be developed by a whole range of people. It’s sharing the load and that’s one of the things the pandemic has certainly taught us.

Do you feel that the training that you offer helps inform medical practitioners about the right questions to ask and to think about improvements?

Yes, I do. I think Miad courses are really good. They have some fantastic trainers and facilitators who are really skilled in their fields and can support NHS staff, both in primary and secondary care, to let them question and reflect on the care they provide. It’s a developmental process whereby they have time and space to think about what it is they need to do within their areas, especially around leadership. I know there’s some fantastic work that goes on.

Are there any final points you’d like to make?

I find what I do an absolute privilege because I semi-retired from working full time in the NHS a few years ago and it’s really lovely to have the opportunity to continue working to support staff in the NHS, but also doing work like this to share experience and give something back to the NHS as well. I feel privileged to be able to work with the staff that I do in a role that I love and am passionate about.

It must be a very fulfilling role.

Absolutely. Everybody has a role to play. Play it to your best but also remember that things do go wrong. Let’s learn from them. It’s important that through clinical governance, quality and patient investigation frameworks that people don’t feel that they’re individually to blame, because that is so rare. It’s invariably because systems are weak, but because we are who we are, staff often feel “it’s my fault and I’m to blame” that’s not the case. We’ve got to get away from that. We’ve got to move to looking for quality improvement opportunities pro-actively as well as reactively.