Medicine 2019: Evolving systems

Day 2 of the RCP’s Medicine 2019 annual conference included a fascinating session on evolving systems chaired by Professor Dame Jane Dacre, former president of the RCP.

The session opened with Baroness Dido Harding, chair of NHS Improvement, who talked about diversity in the NHS.

Baroness Harding outlined why building an inclusive culture in the NHS matters:

  • it drives improvement which means a better outcome for our patients – there is lots of evidence for this
  • people do a better job if they can be themselves rather than pretending to be someone they’re not
  • we can’t afford not to be – the NHS is the largest employer in the country and we need more staff.

Why it is so hard to be inclusive? It’s easier and very human to enjoy working with people who are like us. We all make judgements about people in the first 30 seconds after meeting them and however much we think we are not biased, we are.

Baroness Harding then asked ‘what can we do’? She explained that:

  • role models really matter – how senior people in the NHS behave is crucial. It is also vital that you can see someone who looks like you
  • ‘micro behaviours’ are important and make a difference, eg not talking over someone in a meeting
  • physicians can play a crucial role in ensuring inclusivity in the NHS.

Dr Felix Jackson, founder and medical director of medDigital and medCrowd, gave a presentation on instant messaging in healthcare. He explained that instant messaging is an essential tool for doctors and other health professionals to use at work and that laws and regulations apply to the use of messaging technologies.

Half a million NHS staff use consumer messaging apps such as WhatsApp to communicate with colleagues at work. The benefits are: It’s simple, quick to use and most people have it on their phone. Emojis such as a thumbs up or smiley can also be useful and quick.

The downsides however, are a lack of security, non-compliance with required standards, easy to send to the wrong contact and open to misunderstanding, images stored on your device may end up in the cloud if they are not deleted.

NHS guidance on social media says that patient and sensitive information should not be used on WhatsApp. But this was followed by further guidance that it can be used in certain circumstances, ie if your organisation does not provide a suitable alternative.

Unfortunately, 2.43% of NHS staff have been disciplined for non-compliant use. Doctors should therefore learn how to use messaging apps compliantly to protect patients’ confidential information.

Doctors can protect data by keeping their devices secure, using a password or biometric lock with a short lock out time, adding a password to the app as well, keeping notifications hidden, choosing a messenger that complies with required standards, minimising identifiable information and ensuring that photos are deleted.

He was followed by Dr Binita Kane, a consultant respiratory physician at Manchester University Foundation Trust, whose presentation focused on quality improvement (QI) and sustainability.

She explored the importance of using QI methodology, followed by a whistle-stop tour of QI theory and an outline of the RCP QI Programme.

Dr Kane explained that QI is the use of methods and tools to continuously improve quality of care and outcomes for patients – if you can’t measure it, you can’t improve it. It gives a structured framework for sustainable change.

Studying processes will often reveal what needs to change in order to make improvements. Having a clear aim is crucial and this should be time-specific and measurable.

The RCP QI Programme aims to make QI accessible to all doctors and is supported by a faculty of experts.

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