71 Developing the hospital at night service at queen elizabeth hospital – an example of effective junior doctor leadership. (12th November 2018)

• Record Type: Journal Article
• Authors: Maguire, James; Eyres, Ruth; Simms, Jacqui; Younus, Osman; Rogers, Tony; Harding, Juliette; Doni-Kwame, Mercy
• Is Part Of: BMJ leader. Volume 2(2018)Supplement 1
• Page Start: A29
• Page End: A29
• Publication Date: 2018-11-12
• Subjects: Medical personnel -- Periodicals; Leadership -- Periodicals; Medicine -- Practice -- Management -- Periodicals; Health services administration -- Periodicals; 610.68
• DOI: 10.1136/leader-2018-FMLM.69
• Languages: English
• ISSNs: 2398-631X

Abstract

Abstract : The Hospital at Night (H@N) model is an established system of providing clinical care overnight. 1 Queen Elizabeth Hospital is a busy district general hospital in South East London. The H@N project was started in 2017 by a multidisciplinary working group which has delivered interventions using PDSA (Plan, Do, Study, Act) quality improvement methodology. 2 Intervention 1 – January 2017: Regular H@N meetings became standard practice; bringing together medical, outreach and site manager teams. Intervention 2 – February 2017: Introduction of structured checklist; location changed to site manager's office; '10 min warning' bleep introduced to signal meeting start. An audit demonstrated reduction in the average handover duration (figure 1). Intervention 3 – June 2017: Checklist modified to include information on hospital state. Trust-wide policy document created. Further audit demonstrated the improvements in handover duration were maintained and the handover checklist was consistently used (figure 2). Intervention 4 – June 2018: Invitation extended for other specialties to attend; meeting time changed to encourage attendance; 'Bleep filtering' by site managers to reduce junior doctor workload. Informal feedback is that these changes have adversely affected the meeting flow and not improved speciality attendance. Further interventions are planned. Lessons learned: Junior doctor leadership: Junior doctors have been key to the project and their experiences from different departments are behind the innovations. The project has provided them with experience in quality improvement and in drafting policy. Multi-disciplinary working group: Each member brings a different insight and has allowed interventions to be bolder. Staff engagement has been challenging and team members have needed to develop and utilise their leadership skills. Promoting 'on the ground' leadership: The bleep filtering system was designed to use the knowledge and leadership skills of senior staff to more effectively utilise their staff and has given them an insight into development needs.