Posted by: ayrshirehealth | May 21, 2014

Nobody asked us by @trixieD67

Progress is impossible without change, and those who cannot change their minds cannot change anything”

George Bernard Shaw

Managing change

It’s been a year of change for me. Firstly, as a confirmed avoider of children, last May I found myself a first-time auntie, now looking forward every Friday to receiving weekly photos and videos of baby Talia as she grows up at an alarming rate. Since they live just north of London, it’s not so easy just to pop round and visit, and that’s quite stressful. I wondered how do we effectively manage major life and work change?Threat Opportunity

There has been a lot of significant change in NHS Ayrshire & Arran in the past few years. We have always had to manage conflicting priorities in the health service, but in 2014 patients are living longer but are frailer with multiple health issues, which modern medicine can manage more effectively than ever before.

These advances have associated (and rising) costs, and we are tasked with making efficiency savings whilst still managing patients within the new Treatment Time Guarantee.

Extending nursing roles

We have enhanced and extended nursing roles we’d never have imagined when I was a wee student at Ballochmyle.  Expectations of what we can do, from increasingly well-informed relatives, the Government and the media, have increased greatly.  We are under scrutiny from all of those groups, and we need to maintain public confidence and make sure the NHS is something to be proud of. We face constant change, evolution.  Yes, there is always some stress that goes along with all that, but it should be positive stress, because we know that the aim is to do the best we can for as many as we can. We learn to see change as less of a threat, more an opportunity to improve.

Now into my 27th year of nursing, I’ve seen three major periods of restructuring (and several small ones) in Ayrshire. I’m cautiously optimistic about the recent one. I’m not sure if it’s the change itself, if the new team seems more engaged with staff, or if I have changed my attitude towards it, perhaps both.

SPSPProblems arise when significant changes are made and those implementing them don’t communicate with those who are affected, we often hear “nobody asked us”. One example is the Scottish Patient Safety Programme (SPSP), an initiative to reduce mortality and harm to patients, which is working, and working well. However it was not implemented in our department without problems.

Traditionally the operating theatres were a bit isolated and unaffected by the wider changes in the health service. We were sheltered to a great extent – the surgery needed done a certain way, the anaesthetic was pretty predictable and practices were more or less standard. We needed set staffing numbers to run a list and roles were clear.

The potential to protect

In 2008, SPSP was introduced. All staff, nurses, surgeons and anaesthetists, wondered why we suddenly had to use checklists, have team “huddles” and “time-outs” before surgery, staff asked “what were we doing wrong before”. Surgical checklistIt wasn’t arrogance, and we hadn’t done anything “wrong”, there was a safer, better way with the potential to protect patients, and ensure the “holes in the Swiss Cheese” didn’t line up to cause harm.

There is always risk, always the possibility for error and potential to cause harm, because we are human and fallible. We have to make the system as safe as it possibly can be, and take human factors into account.

Nobody could argue with the premise, but a major issue in getting SPSP off the ground was staff engagement. Perhaps the wrong people were involved at the beginning, or there wasn’t enough discussion with clinical staff, but I was, I admit, cynical, “more tick-boxes” I thought.  CheeseI couldn’t pinpoint when, but I did some reading, (learned a lot about aviation safety which was interesting!), listened and gasped in despair at some of the problems NHS England had, and something clicked into place. There was no dubiety – this was a good thing to do.

The tide has turned and everyone is now on board with SPSP, it’s routine, worked seamlessly into practice, second nature. It was the intention to standardise how huddles were done across all theatres, that didn’t go so well. In the West of Scotland, mostly, we’re introverted. We don’t enjoy speaking up, we don’t like introducing ourselves, and that’s a big part of the huddle. With a bit of discussion and common sense, we settled upon a compromise. We ask “does everyone know each other” at the morning safety huddle, rather than the somewhat uncomfortable, “I’m Tracy Dalrymple, the Anaesthetic Sister and I’ll be assisting Doctor..…. today”. If there are any new staff or students, we do full introductions and that works well.

Embrace changeStaff are empowered to speak up far more than they were when I was a girl. It’s still daunting to challenge a doctor if you’re a junior nurse or an auxiliary, but to keep a patient as safe as possible, it’s encouraged, and supported. Even if you turn out to be wrong, it’s better to ask the silliest of questions than compromise patient care. Another major change, for the better.

Change management is a big subject, this is just a snapshot. I do enjoy change, if it has a purpose or benefit, I embrace it. Maybe I have a low boredom threshold, but I prefer to think I am proactive and appreciate that if there are problems to solve, there must be a solution out there and some of those will cause anxiety and resistance – and that’s not always a bad thing. DirectionThere’s always a period of adjustment & uncertainty, heels are dug-in, but ultimately if it’s handled well, we can make all great improvements in processes and services – we can make things better.

This week’s blog  was by @trixieD67 (Tracy Dalrymple) who is a Senior Charge Nurse in Anaesthetics in Crosshouse Hospital, NHS Ayrshire & Arran.

Further Reading-




  1. First blog I have read, enjoyable and makes sense.

  2. thanks tracey what inspiring comments well done to you and your team

  3. Thank you, my first ever blog, but a subject I could chat away about for a long time. I’m very lucky to help lead a great anaesthetic and theatre team who have been so supportive of a lot of changes and probably lots more to come in future!

  4. […] By ayrshirehealth […]

  5. The most simple thing can have such an impact on patient safety. Insparational read,thank you Tracy. I hope your thinking cascades….

  6. Wll done Tracy. Hopefully your positive outlook will continue to rub off on those around you.

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