1. Dr Christopher Cousins & Dr Zeeshan Malik

2. Overview Background What TICKLE is Our vision How we achieve our vision Our current projects Future

3. Background: the problem… Francis and Tooke reports

4. Normalisation of poor care…

5. Targets, targets, targets!

6. Gap between management and junior staff

7. Only a minority participate in change

8. The problem with audits…

9. Lack of understanding of quality improvement ????

10. Our Response:

11. What is……..? A committee of trainee doctors at SRFT aiming to: 1.Improve understanding of patient safety and QI 2.Incentivise involvement in QI and provide a platform for presenting work 3.Improve engagement between trainees and seniors / managers 4.Develop understanding and experience of Clinical Leadership and Management

13. TICkLE Committee 7 trainees spanning grade and specialty Currently we consist: – 2 x FY1 – 2 X FY2 – 1 x CT1 Core surgical – 2 x ST3+, both medical specialties Backing from Salford Royal Foundation Trust – Official ‘terms of reference’ – Accountability: report to Trust executive board every 6 months

14. How we achieve our vision Quality Improvement Management & leadership TICK Online forum Drop in support sessions FY QI teaching programme Shadow a manager Coroner sign ups FY management teaching

15. How we achieve our vision FY management teaching Management afternoon in FY2 teaching -Senior clinical and non- clinical managers -Overview of management structure in hospital -Practical ‘management scenarios’ Plans for regional ‘Clinical Management day’ Management afternoon in FY2 teaching -Senior clinical and non- clinical managers -Overview of management structure in hospital -Practical ‘management scenarios’ Plans for regional ‘Clinical Management day’

16. How we achieve our vision FY QI teaching programme QI tutorials linked to Lessons learnt for FY2s Fundamentals of Patient Safety Model for Improvement Reliability Measurement Human factors Next step: embed QI teaching into FY programme QI tutorials linked to Lessons learnt for FY2s Fundamentals of Patient Safety Model for Improvement Reliability Measurement Human factors Next step: embed QI teaching into FY programme

17. Next step – Building a ‘Quality’ Foundation FY1 aims: – Develop a skill base in QI and audit – Deliver 1 project with support – Enter FY2 with core competencies in QI and audit FY2 aims: – Deliver 1 project independently – Develop knowledge / skills in leadership and coaching – Support FY1 colleagues – Ensure excellent “audit” section on speciality application forms

18. FY1 - Program Timeline (from 2013) JULY Introduce program and QI department to new FY1s SEPT 2 afternoon sessions – QI basics and develop own project JAN 2 afternoon sessions – Further QI teaching develop and discuss projects APRIL 2 afternoon sessions – QI teaching, discuss projects and measures JUNE Submit an abstract on the project undertaken JULY Top 3 abstracts awarded an oral presentation at Grand Round and all others printed as posters and displayed. Best abstract awarded prize and shield.

19. FY2 - Program Timeline (from 2014) SEPT 1 afternoon session – Coaching and mentoring skills – Encouraged to identify an FY1 and support them with their project JAN 1 afternoon session – Clinical leadership and management APRIL 1 afternoon session – Clinical coding and hospital finance JUNE Submit an abstract on the project undertaken JULY Top 3 abstracts awarded an oral presentation (10min) at Grand Round and all others presented as posters. Best abstract awarded prize. Carry out an audit / QI project using skills from FY1 ALL YEAR

20. How we achieve our vision TICK Online forum Drop in support sessions FY QI teaching programme Shadow a manager Coroner sign ups FY management teaching

21. How we achieve our vision TICK

22. TICK – ‘Trainees Improving Care’ Bi-monthly meetings Each focus on ‘Patient Safety Theme’ The structure Senior Clinician sets the scene Presentation of related historical ‘SUI’ 2 presentations of QI work by trainees Discussion

23. TICK – ‘Trainees Improving Care’ Participants rewarded :

24. TICK – ‘Trainees Improving Care’ Intended outcomes: – Increase engagement of trainees with management – Raise awareness of patient safety issues – Incentivise QI work Feedback so far very positive “Relevant, Appropriate and fantastic arrangement.” “great!”

25. 25 Dr Laura Derbyshire Dr Tony Shanahan Dr Saba Bokhari Dr Matthew Robinson Dr Emma Donaldson Dr Sara Barton Dr Roisin Haslett & the SRFT Foundation Programme

26. …Any Questions? Thank you for listening!

27. References 1.http://www.midstaffsinquiry.com/pressrelease.html 2.http://www.mmc.nhs.uk/news__events/latest_new s/implementing_the_tooke_report.aspx

28. How we achieve our vision TICK Online forum Drop in support sessions FY QI teaching programme Shadow a manager Coroner sign ups FY management teaching