Realising Realistic Medicine: Chief Medical Officer for Scotland annual report 2015-2016 appendix

NHS Tayside

Initial thoughts

Realistic Medicine has come at a time where it fits closely with the vision of improvers and innovators within NHS Tayside.

What have we done so far?

Links between the NHS and local universities are close. At the early stage of postgraduate medical life, foundation doctors undergo inductions where the focus is on teams and the working environment. Foundation doctors are placed into a ward team and are asked to comment on support systems, skill sets and team working. During the first week of work doctors spend time with a staff member from the deanery and they meet again at the end of the first rotation. This aims to help junior doctors fit in with their teams. They also have a three-month window in which they must use the Datix system and reflect on a clinical incident using the Mayo Clinic tool, focusing on the impact on the patient and teams that the incident has had. This aims to embed person-centredness in their practice from an early stage. Data is analysed and fed back clinically. Improvement work then commences during the third rotation, with foundation doctors encouraged to come up with improvement innovations. One of the improvement areas doctors focus on is Realistic Medicine, for instance focusing on variation between teams.

The Academic Health Science Partnership ( AHSP) is also key in building on work related to Realistic Medicine. It has supported the development of a Quality Improvement ( QI) curriculum for medical staff with outputs including real-world improvement projects focusing on reduction of waste and variation in systems. Work is particularly advanced in Anaesthesia with QI teaching for trainees in Tayside currently testing a model based on a combination of elements described by Bill Lucas in Habits of an Improver combined with curriculum requirements from the Royal College of Anaesthetists. The overarching aim is to produce clinicians with the required mindset to be habitual Improvers and drivers of change- key components of Realistic Medicine. The powerful combination of QI expertise, strength in skills training and design is embedded in the AHSP architecture and has already delivered a number of successful projects with plans for further spread over the next and subsequent years.

Links between the NHS and Community in NHS Tayside are also strong, in particular with the creative arts. A number of events have been held looking at design thinking in the interpretation of Realistic Medicine, 'flipping the pyramid' and using design to improve person-centred care. This has led to NHS Tayside representation during a QI Connect Session focusing on innovation and design in Healthcare.

What next?

The academic foundation programme is also being developed to include improvement methodology as a specific area of academic focus, moving from the themes of research and teaching which have previously been in place.

A further phase of the QI and Safety work will develop inter-professional and cross sector 'paired learning' to promote clinical engagement and improve health and social care integration. This will combine QI and educational expertise with access to research support. Innovative work on implementation of Realistic Medicine in NHS Tayside will be supported through this process.

Final thoughts

Innovation - including involving partners from agencies outside the NHS - is crucial to achieving the aims of Realistic Medicine. Innovation for improvement is a key part of Realistic Medicine and using design principles in Quality Improvement is a way forward to achieving this. Links between the community and universities must be fostered and maintained.

NHS Tayside Foundation Doctors QI Programme Diagram.

Realistic medicine event in NHS Tayside alongside Open Change.