It takes a little bit of passion, maybe a spark and a lot of hard work to get something going in a system that values structure and protocol – safety and response being paramount. 

This is what ambulance colleagues from around the country gathered in Edinburgh to do on 15th May.

Harnessing a building desire to connect and share, stimulated through mutual work on #ProjectA, Andrew Parker (Scottish Ambulance Service, Interim convenor of Ambulance Q) approached the Q Community and Health Foundation about the possibility of sponsoring an initial event for ambulance service quality improvement leaders to come together to learn and share the work they are doing. You can read more about the background here.

High on the list of objectives was to determine if there was an inherent desire to establish an Ambulance Quality Improvement (QI) Network that could break across the geographical boundaries that exist within the service. The emerging thought was a professional network of QI Leads that could provide mutual support to each other and support improvement more broadly within the service. The Q Community agreed to support and sponsor this potential network.

With a number of contacts established through #ProjectA and the Q Community it was determined that the first ‘Ambulance Quality and Improvement’ network event would take place. A mix of improvement speakers and work undertaken by attendees aimed at understanding a little more of what was happening in the ambulance quality improvement world as well as the inherent need to test the appetite for forming the network. Never having organised such an event Andrew, drawing from the knowledge of those in his own organisation, also approached NHS Horizons, a team of NHSE improvement specialists that had been supporting #ProjectA for the previous 12 months – improving ambulance services through engaging frontline staff and ambulance services.

The first thing was to establish the ‘design team’ in order to make the day as successful as possible and to ensure it was able to meet the needs of a wide group of ambulance QI leaders. Soon the design team had come together with representation from Wales, Northern Ireland, Scotland, South West England, North East, and Yorkshire. A date and location were quickly settled upon but pulling the content of the day together took a number of virtual meetings, increasingly the design team putting their efforts into making the day as relevant, interesting and fun as possible. Key note speakers were sourced, technology tested (sort of – we’ll come to that later) and the work through the day planned. Eventually with NHS Horizons support - Andrew and the design team were happy that the day would work.

It is interesting to note that all the design was undertaken using virtual collaboration tools allowing the design team to connect as they needed with NHS Horizons taking the lead in facilitating the meetings to a conclusion. This meant that they did not have to ‘physically’ meet to plan the day. The use of virtual tools to connect for improvement is something the ambulance service are starting to blaze a trail with and designing this day through such methods being a case in point. Indeed increasingly ambulance QI leaders are starting to use virtual technology within their own geographies as a means of working and influence.

So on the 15th May over 40 people with an interest in QI for the ambulance service met at the Royal College of Surgeons in Edinburgh. They came from all over the country – a spread of people eager to learn from each other. As if knowing it was going to be a good day the sun shined brightly that morning and the venue was simply stunning. A good atmosphere ensued over the welcome tea and coffee aided undoubtedly by the beautiful ‘Baby L’ – yes we had a little one in the room, Sarah Williamson one of the QI leads from NI and founder member of the Ambulance Q network being on maternity leave but determined to support the event. You are never too young to get involved in ambulance quality improvement.

The day started with an introduction from Andrew – describing the need to capitalise on the connections that the QI leaders had made through #ProjectA, thanking the Q Community for their foresight in sponsoring the network meeting and asking the room to make this network a reality and “break out of our silos’. Twitter was available to all and encouraged use through the hashtag #AmbulanceQ. David Morgan (Quality Improvement Manager – North East Ambulance Service) then told the room we were going to try something completely new – Mentimeter – an online conference tool/app that collects real time data. There was a sense of nervousness in the room – the technology had never been tested, but “hey” Dave assured us all that part of being in QI was the desire to test and try new things. It worked though – data was collected on how far people had travelled, their thoughts for the day and importantly their twitter handles for future connections. A good start.

The connections piece for the morning was designed by Erin Payne (Yorkshire Ambulance Service) and involved a series of questions that encouraged participants to move around the room whilst finding out what united them in the quality improvement sphere of influence. We heard from new front line paramedics wanting to make a difference to people who had been delivering QI in ambulances for a number of years and sensed a need to break out and connect with others. We heard what motivates people to work in QI, the enablers that make the role joyful and of course the barriers that people find in scale and spreading change and innovation.

The morning then moved into the two key note addresses by Helen Bevan and Diane Ketley from NHS Horizons. Helen with her many years of leading improvement and change within the NHS quickly captured the room with the latest thoughts about how our approach to change and innovation also needs to change – driving connections (super connectors), recognising ‘New Power’ and breaking down the permission culture. The address was well received – sparking questions and continued discussion over tea and coffee. Diane then took the room through the difficulties of spread and scale of innovation and the complexities involved – the challenging of bridging ‘Islands of Innovation’.

Post lunch we moved to an unconference based on the feedback from the morning and the subjects that were important in allowing this network to crystallise and grow. The facilitator was a little worried – would the network be confident enough at this early stage for people to come forward to make a pitch and host a table? He needn’t have worried – 6 tables were quickly filled, impressively – two young, enthusiastic front line paramedics (Nathan and Ed) offering to host tables and the “wildcard” pitched immediately by Katherine from North West Ambulance Service. Discussion then flowed, feedback given to the rest of the room and a commitment from the design team for the day to take all the completed flip charts and consider next steps from a #AmbulanceQ perspective.

Late in the afternoon the room heard from Phil Kyle – offering to connect ambulance improvement leads into Academic Health Science Networks wherever he could whilst also promoting the wider work of the Q Community. Commitments were subsequently built by the room with regard to next steps and Steve Page (Director of Quality, Yorkshire Ambulance Service) offered to link the network through to the National Ambulance Directors Group for support, mutual work and sponsorship. Already the network are considering how they use this offer to be linked into the Quality, Governance and Risk Directors (QGARD) group thereby levering national support for their network.

The day was brought to a close by Erin Payne (Head of Quality Improvement for Yorkshire Ambulance Service). Erin has always been a passionate advocate of improvement and this shone through in her closing reflections.

“Why settle for being the best ambulance service in your patch when we could be the best ambulance service in the world?”

Says it all really.

POSTSCRIPT

The ambulance quality improvement network leaders have already had a discussion on the outcomes of the day. There is a desire to support the work of QGARD and the NASCQG, promote their own change and improvement work across each other (and the national groups such as QGARD, NASCQG and AACE), provide peer support to each other where needed (acting as sounding boards), share practice, and a commitment to an annual event for QI leaders (indeed the Welsh Ambulance Service are keen to host the next meeting of the Ambulance QI network). It is early days in the network’s establishment but there is plenty to build upon.

If you would like further information on the Q community and upcoming events:

https://q.health.org.uk/community/groups/ambulance-services-and-qi/

If you would like further information on the AHSN please see:

https://www.ahsnnetwork.com/