Neil Mesher

The Quest for the Holy GrailReport from the 5th National Conference for Radiology Managers, 14 May 2015

Richard Evans

Achieving quality, safety and investment for your radiology serviceThe theme of this year’s conference was reflected on by Neil Mesher, the Managing Director of Phillips Healthcare UK in his welcome to delegates.

“We don’t need more top-down changes in the NHS,” he said. “But we are increasingly expected to respond to local needs. I want to see power given back to the healthcare providers and plans to accelerate patient-centred healthcare.”

Each year the conference has grown and this year’s was no different with a record number of delegates - including representatives from overseas - packed into a new London

venue, which Richard Evans, the Society’s CEO, observed was just a hundred yards away from where he started his career at University College Hospital.

Neil and Richard welcomed delegates to a conference that featured presentations by Trevor Dale of Atrainability, Tim Cooper of the Care Quality Commission, Sarah Woolley from Mid-Staffs, Dr Stephen Davies of Medica and Professor Erika Denton, the National Clinical Director for Diagnostics.

There were also case studies from Dr Peter Rowlands, a radiologist at the Royal Liverpool; Alanna Marvin, Radiology Operations Manager, Susan Farell, Lead Superintendent, and Kirsty Belcher, IR Superintendent, all from Ashford and St Peter’s.

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…was how Sarah Woolley described her experiences as a radiographer at the former Mid Staffs Trust.

Speaking to a hushed audience at the National Conference for Radiology Managers, some of whom later admitted that her experiences had brought them close to tears, Sarah related the events that led to the hospital becoming notorious for low standards of care.

“Stafford hospital is my local hospital. I live in Stafford. My children were born at the hospital. All the radiographers there live locally and are passionate about the services we provide to the local community,” she said.

Following numerous investigations and inquiries including the now famous Francis Report, in 2013 the trust was dissolved and merged the following year with another to create the University Hospitals of North Midlands.

“Imagine how you would feel if the headlines that were written about Mid Staffs were about your local hospital,” Sarah asked the audience of 300 managers.

“Imagine how you would feel if you were a member of staff at that hospital.

“We knew there were issues but we could not respond to the headlines, many of which were untrue. For the record, there were no vases on the wards,” Sarah said, a reference to allegations that patients had to drink from flower displays.

“Yes, there were problems,” she said, “But our focus as a department was to put the patient first and we continued to do so. I have the pleasure of working with a dedicated and passionate team,” Sarah continued.

“My message to managers is to listen to and support your staff. They are the people who will get you through the bad times. Ours was one of the departments where recruitment and retention was not an issue. The whole team trusted and supported one another, inside and outside work.

“Belief was our strongest point. A belief in what we did and in doing the right thing. We stood by the decisions we made.”

Sarah Woolley

“Shock, sorrow, shame and frustration…”

KAREN SMITH, SCoR President and Radiographer at Hull & East Yorkshire Hospitals: I can’t begin to say how important Sarah’s (Woolley) talk was and how it made me feel. It must have been so traumatic for the staff and their families. The way that the radiographers - our members - carried on says a great deal about their spirit and professionalism.

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This was the controversial motion put to the audience and it sparked a passionate discussion.

Speakers for the proposal: Dr Peter Cavanagh, a radiologist at Taunton and Somerset, and Jean Grubb, Professional Lead for Radiology at North Cumbria, and those against: Dr Charles Niehaus, Group Chief Medical Officer at Alliance Medical and Peter Sharpe, CEO of Cobalt, all spoke eloquently.

Peter Cavanagh got a particularly warm reception and almost single-handedly swung the debate in his favour when he declared, “Plain film reporting should be undertaken by radiographers.”

Both sides of the argument acknowledged that there has been a steady increase in imaging activity but that the UK performs a relatively lower number of CT and MRI scans compared with many other countries. Radiologist and radiographer numbers have not grown in line with demand and the number of patients waiting six to 12 weeks for scans has grown. What they couldn’t agree on is how these issues should be resolved.

The argument by those against the motion is that other countries such as Italy, Switzerland and Belgium make their

radiology resources work harder than the UK and that more can be squeezed out of the current capacity by changing how resources are managed and used. Better use should be made of private sector partnerships, as well as the development of new models to meet demand in the community.

Those arguing that radiology services need more resources, talked about the limits on workforce, facilities and finance. The only way to move forward is yet more efficiencies and initiatives such as lean working, skill mix, cost saving and benchmarking and these have already been done to death.

The audience agreed that ‘There is no further capacity in radiology for cost saving’.

‘There is no further capacity in radiology

for cost saving’

The panel responds to delegates’ questions. Left to right: Peter Sharpe, Dr Charles Niehaus, Jean Grubb and Dr Peter Cavanagh.

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This was the clear message from Tim Cooper, Head of Hospital Inspection at the Care Quality Commission (CQC).

“We are committed to driving up standards of care,” he said. “We ask are outcomes as good as they can be and are you working to make them better? However, we want to make the experience of an inspection as positive as we can because we want departments to learn and be encouraged about what they are doing well. There is a lot of good practice.

“The radiology department is a key focus of an inspection because nine out of 10 patients see a radiographer,” he continued. “We are recruiting radiographers to inspection teams because they know what to look for and they understand the pressures departments have.”

The Imaging Services Accreditation Scheme (ISAS) has been approved as an official information source to support CQC inspections. “A key reason why we recognised ISAS is because it involves patients and takes account of their needs and views,” Tim said.

“We are on the side of the patient”

Tim Cooper

SARAH WHITTAKER, Imaging Manager, BMI: The debate was brilliant. Also Tim Cooper’s CQC presentation was very interesting, particularly because the inspection findings can be used to help a department develop and to provide better services.

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Trevor Dale, Managing Director of Atrainability, gave advice about understanding the obstacles junior staff face when they feel they should raise concerns, and the challenges for managers heeding advice when under pressure.

Trevor cited his experience in the airline industry, where evidence suggests that 90 per cent of accidents occur when a senior officer is controlling the plane. Often, someone has raised concerns but has been ignored.

“Situations like this are also applicable in healthcare,” he said. “The onus is on managers to realise that staff are the safety net to avoiding a serious untoward incident, and to listen to advice no matter how obvious it seems.”

“We need to get away from the term ‘whistleblowing’ and what is attached to that word. It’s not about that, it’s about professionals trying to do their best,” he said.

Trevor stressed the importance of identifying and removing high risk situations from the workplace. “Interruptions and distractions are a big risk in healthcare,” he said. “They are dangerous situations because you can’t truly multi-task. You need to be able to politely say ‘not now please’ and fully concentrate on your work.”

Another piece of advice offered by Trevor was to make sure to break the monotony of frequently occurring tasks. He referenced airport security scanning attendants, who change tasks as often as every 20 minutes to make sure they remain focussed. “The human brain is not designed to do monotonous tasks,” he said. “It doesn’t matter how good you are, you will make some mistakes because our attention system is fundamentally flawed.”

He concluded that it was key to establish a culture of shared communication. One technique

Trevor Dale

suggested was to hold a short briefing at the end of each day to discuss one thing staff did well, what they could do more of, and something they could do less of.

“We need to get away from the term whistleblowing”

TRUPTI PATEL, CT Superintendent, Royal Brompton Hospital: The great thing about this event is comparing with what other departments are doing. Trevor Dales’ presentation was brilliant; raising concerns is a difficult issue to tackle. The NHS is about treading carefully but the culture is starting to change.

Left to right: Juliette Tennant, Imaging Manager, BMI; Kathryn Griffiths, Assistant Imaging Manager, Royal Brompton Hospital; Trupti Patel, CT Superintendent, Royal Brompton Hospital.

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is transformational change to the current way of delivering healthcare,” said Professor Erica Denton, the National Clinical Director for Diagnostics, NHS England in a wide ranging talk that looked at what the challenges are over the next five years.

“We used to think in terms of ‘transactional change’ such as ‘doing things better’,” Erika said. “Now we think of ‘transformational change’ or ‘doing better things’. To illustrate the point she quoted Albert Einstein: ‘You can’t solve a problem by using the same thinking that created it’.

Amongst all the negative publicity of a ‘service in crisis’, Erika pointed out that the NHS has achieved a lot in recent years: “It is ranked the number 1 healthcare system in the world; more than two-thirds of the UK public believe the NHS ‘works well’; cancer survival is at its highest ever; operation waiting lists are down - many from 18 months to 18 weeks; early deaths from heart disease are down over 40 per cent; there are 160,000 more nurses, doctors and clinicians; and single sex wards have been implemented.”

She continued: “We are delivering more care. Since 2009, each day 4000 more people are being seen in A&E; 3,000 more are admitted to

hospital; 22,000 more have outpatient appointments; 10,000 more tests are performed; 17,000 more people are seeing a dentist; and 3,000 more are having their eyes tested.”

Erika talked of how new technologies and treatments, as well as new ways of delivering care are making this possible but this is against the financial challenge of a funding gap in 2020/21 projected to be £30bn.

“We are looking at multi-specialty community providers,” she said. “These include greater scale and scope of services to dissolve traditional boundaries between primary and secondary care, targeted services for patients with complex ongoing needs, new ways of offering care, and making the most of digital technologies, new skills and roles.

“The workforce is not just about numbers,” Erika continued. “Across diagnostics there is increasing pressure from new technology and increasing demand. One-third of people who work in radiology now are set to retire by 2022. More clinicians, especially radiologists, need to be trained.”

And she returned to the theme of her presentation at last year’s conference: the value of and need for seven-day-a-week, 24/7 diagnostics.

“The solution to the equation of:

Demographics + Patient/public expectations + Quality

Money

Transformational change to delivering health care

Erika Denton

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Alanna Marvin, Operations Manager at Ashford and St Peter’s Hospital’s Trust said that the 10 year MES contract supporting a equipment replacement programme, room refurbishment, servicing and enabling works, has seen the department undergo a “rapid change”.

“The majority of our equipment has been replaced, all of our general rooms are DR, and all of our mobiles are DR as well, which has made a huge difference,” she said. In addition, the new equipment and working environment boosted staff morale, making for a “very happy radiology department.”

Alanna explained that the trust did not want to rest on its laurels, but continue to make improvements and maximise the efficiency of the new technology. “We knew we had the best technology provided by Philips, we knew we had the best people, but we needed the best processes to go with that,” she said.

Over the last year, the trust has been working with Philips on a service improvement programme, a process which has involved half-day masterclasses with all members of the department. Kirsty Belcher, IR Superintendent Radiographer at the trust, said: “We wanted to engage the whole team and empower everybody, and it allowed us to introduce a culture of continuing service improvement.”

Working with a managed equipment service

At the podium is Alanna Marvin, with Kirsty Belcher (centre) and Susan Farell, all from Ashford and St Peter’s Hospitals NHS Foundation Trust.

Peter Rowlands

SHEILA HASSAN, SCoR President-elect and Lead Radiographer at Guy’s and St Thomas’ NHS Foundation Trust: the managed equipment services and outsourcing case studies were great. To hear the experience of a small trust like Ashford and St Peter’s was excellent. Erika Denton, as usual, spoke with such passion and clarity. It has been a wonderful day and opportunity to hear first hand the latest thinking, as well as talking to members and understanding what are the issues they are facing.

“Make things easier and make us work smarter”Dr Peter Rowlands, Consultant Interventional Radiologist at Royal Liverpool University Hospital, talked about how a group of trusts in Cheshire and Merseyside had got together to roll out a new multi-site PACS.

Peter outlined the challenges the trusts faced with their old set-up, with no image sharing, different identifiers for each organisation and image transfers which involved a lot of manual work.

“Patient journeys were complex. If a patient had cancer for example, they may be seen at three hospitals and the images were never in the right place at the right time,” he said.

Peter explained that there had been huge improvements: “Everybody loves it because now the images are there when they are needed. MDTs are better with reports and images available online, not having the previous images available is now a rare occurrence and there has been a big reduction in IEP usage,” he said.

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All the presentations from the conference are at www.philips-events.co.uk/NCRM2015

You can register for the 2016 event - provisional date 12 May - at www.philips-events.co.uk/NCRMregistration

Stephen Davies

STEVE HERRING, SCoR Vice-President and Senior Clinical Reporting Radiographer at Maidstone & Tunbridge Wells NHS Trust: Sarah Woolley (Mid Staffs) had me almost in tears! What an experience for her and all the staff. The conference venue is excellent and the exhibition area is a great improvement on previous years. Delegates can talk to a range of equipment and service providers in one place.

EMILY TARRANT, Unit Manager, Guildford Diagnostic Imaging: I have attended all five of these conferences and everyone has been excellent. For a manager who is in the private sector (Alliance Medical) it is interesting to find out what is happening in the NHS.

Assuring quality outsourcingDr Stephen Davies, Medical Director at Medica, stressed that underpinning any outsourcing approach should be a focus on patient care and service delivery, citing the ISAS recommendations that patients should: ‘have the reassurance that the imaging services central to their core pathway are operating to a high quality standard’.

Stephen said there were crucial learning points for departments which could be picked up by teleradiology services: “It gives me the opportunity to look at trends. We all have natural variation in performance, but when that moves outside an anticipated range, we need to start asking questions,” he said.

He gave the example of one clinician who had a dip in performance and after investigation of the data it showed this was due to distractions that were arising during his reporting time. “So now we’ve built a portal so that messages are stored and saved so radiologists can access them when they need to. It was a simple problem but only came out because of the audit of the data,” Stephen said.

“Outsourced radiology will form part of a balanced approach to service delivery. There are gaps in the service, and I think that outsourcing is a way of bridging them.”