#ProjectA Interview with Nathan Steadman: Quality Improvement Fellowship – Yorkshire Ambulance Service NHS Trust

As part of the series of #ProjectA Improvement virtual meetings, Yorkshire Ambulance Head of QI Erin Payne presented an informative session on the QI Fellowship. Erin spoke about the QI fellowship structure and the benefits that were starting to accrue within the service. 

#ProjectA will be working with Erin and her team over the next few months in looking at ways to scale and spread the Fellowship and to further introduce it to #AmbulanceQ members. Watch this space for updates on the progress and a potential workshop in November. 

One of the graduates of the Yorkshire Ambulance QI fellowship is Nathan Steadman (pictured below). You may recall that back in July Nathan shared blog about his experience of taking part in the 2019 School for Change Agents cohort. We talked to Nathan about his journey on the Yorkshire Ambulance Service Quality Improvement Fellowship.

"I joined Yorkshire Ambulance Service on my 20th birthday as I took the leap moving from the big city of Birmingham to the not so big city of Hull. And what a leap it was. Who would have thought at the ages of 20 to 22 that I would have seen some of the things I saw. I learnt lessons about myself and life faster than anybody could ever teach.

"Three years on from working on a front-line ambulance I needed a new set of challenges, a new set of responsibilities and a different view on how the ambulance service works. I was fortunate to find the opportunity to apply for the second cohort of Quality Improvement Fellows within the Yorkshire Ambulance after seeing the wonderful foundations that the first cohort had created.

What is quality improvement?

"I once read that there is no single definition for quality improvement but instead is a systematic approach which uses specific techniques to improve quality.

"There are many things that I have already learnt in my short time in QI. One lesson being that every question generally leads to another. With that question generally being “Why?” which is something I touch upon a little later.

The fellowship

"At Yorkshire Ambulance Service we’re extremely lucky to be offered the opportunity to be involved in the Quality Improvement Fellowship. The fellowship was created in-line with the Trust's new 5 year QI strategy and allows us to start embedding quality improvement to all areas of the Trust.  The fellowship role is open to staff from every sector of the ambulance service from our Emergency Operations Centre, 111, frontline, Patient Transport Service and estates.

"The fellowship is offered as a part–time secondment alongside our substantive roles. Completing around 18.75 hours per week for each role. It’s a learning role with training as you go throughout your fellowship. 

"I was fortunate in being part of the second cohort as I had the first team of QI fellows, who had now become advisors, to bounce thoughts and ideas off. Acting as mentors they would steer me in the right direction but also question a lot of my decisions to make sure I fully understood what I was trying to achieve. We are also fortunate to have a Head of QI who is so passionate about improvement so that it’s difficult for it not to resonate to the fellows. 

"One of the most fantastic parts about being a QI Fellow here at Yorkshire Ambulance Service is that almost everybody within the Trust is bought into QI and change. Our executive management team offer a ‘no barriers approach’ to improvement which is vital when attempting new change ideas in such a large organisation.

Adapting 

"One of the most difficult parts of taking on this new role was adapting; adapting to my new set of responsibilities, expectations and freedom.

"Having worked on a front-line ambulance for a few years your sense of ‘freedom’ is somewhat restricted. I now no longer have to ask to go to the toilet between calls, be told when I can have my lunch break and asked when I’m going to be ready for more work.

"Having the freedom to manage your own diary, manage your projects while ensuring results, gives you a sense of freedom but also a profound sense of trust. 

Projects

"I’m sure that almost every person who works within the ambulance service possesses the great ability to question those around us. “Where exactly is the pain?” "Ambulance Service - Is the patient breathing?”. What many of us often lack is the ability to question ourselves. By stopping to question ourselves, gives us the ability to question others.

One of the biggest questions I ask myself is "why"?

"When I stopped to ask myself the question to why I do a task in a certain way; I often found that I was actually unsure of the answer. If I was able to find an answer I was then drawn to asking 'why' to my answer.

"I decided to focus my questions around a particular problem which we all see day-to-day within the ambulance service. Handover delays within Emergency Departments. With demand rising and resources becoming stretched further how much of an issue are handover delays becoming?

"By finding the problems associated with my questions I was now able to begin to prove some of the root causes associated with my project; but to actually prove a problem I needed something a little firmer than personal opinion.

This is where the magic of data comes in.

"One of the most wonderful parts of the fellowship is gaining the ability the see what happens behind the scenes within a large ambulance trust. It’s quite easy to just think of the ambulance service starting and ending with a big yellow van with two people dressed in green, when actually there are many fantastic departments working tirelessly to ensure that their role has a direct positive impact on providing world class patient care. 

"One of the most fascinating departments of all (After QI) is Business Intelligence; a department of wizards who are able to gather almost any data which you could possibly imagine. Data is wonderful for being able to evidence a problem but it also comes with its negatives. Too much data can often distract us away from where the problems actually lie and the wrong data could possibly prove that a problem isn’t actually a problem at all. Gathering the right data and the right amount is key to ensuring your project is aiming in the right direction.

“Without data you’re just another person with an opinion”

- W. Edwards Deming

Next Steps

Nathan would like you to think about what quality improvement is and what it means to you? Feel free to tweet your responses to @YAS_NathanielS using #ProjectA #QItime

Nathan has now identified a problem, proved the problem is actually a problem and now he needs to spend time understanding the problem itself.  Taking a risk trying to tackle such a large issue as handover delays is one that could possibly make his year as a Fellow or break it!

For more information regarding #ProjectA or the improvement virtual sessions (using a platform called Zoom) please don't hesitate to contact Lynsey Oates for further information.