In late February 2019 I attended two days of workshops led by NHS Education for Scotland (NES) as part of my participation in this year’s AHP Career Fellowship. After the second day I walked along the Clyde on an uncharacteristically warm Glasgow evening and took time to reflect on my learning across the workshops. I managed to snap a photo of the beautiful sky that evening and have reflected that in many ways, it symbolises the opportunities and learning journey that the fellowship has facilitated so far.
At the beginning of the year, the end point of my fellowship seemed a very distant prospect; maybe too ambitious and not ultimately achievable. I’m not sure I was even too clear about where the end point was. However, attending the NES workshops in February was the first time I built a little bridge in my mind; a bridge that would lead to many more: ultimately allowing me to navigate the course of combining improvement methodology with the implementation of a very practical and person centred project.
My fellowship focuses on supporting children who use Augmentative and Alternative Communication (AAC) systems within school. AAC means ways other than speech that people use to communicate; this includes anything from signing to computer based systems that generate voice output for their user. When supporting children to develop use of their AAC system in school, one of the most important factors is that they see their teaching staff using AAC too; we call this Aided Language Stimulation (ALgS) which is nicely explained in this video https://www.youtube.com/watch?v=flFNMky22-U. Achieving a school culture and ethos within which ALgS is integral, is the general aim of my fellowship.
The theoretical underpinning of this project is robust, with no shortage of positive case studies to share. However, taking time to learn about and reflect on improvement theory has increased my awareness about why these types of factors in any project will not be enough in isolation, to bring about change. During her presentation to us, June Wylie of Healthcare Improvement Scotland described the importance of capturing people’s ‘hearts and minds’ i.e. making change personal, meaningful, manageable and motivating. And so, I have begun to weave improvement theory approaches into my project, dipping in and out of texts and useful e-learning as I go, such as:
My project is now grounded in a Driver Diagram which keeps me focused on the outcomes I want to achieve and the change ideas that will help to make this happen; I have taken time to gather pre-intervention data and practised drawing up run diagrams so I can show the educators I am working with real time progress, and most importantly I can feel that I am helping to build a will for change. The joy of the fellowship is being given the luxury of time, which for me has translated into the opportunity to really listen to the educators I will be working with and to understand how their current system works. Through short, focused workshop sessions, I feel encouraged by the discussions around the table and comments like “I think this is really going to help, I can’t wait to start.”
When I read that one of the fellowship workshop presentations in February would focus on Digital Practice in healthcare I was unsure how relevant I would find the topic. I was generally sceptical of digital solutions and being a Speech and Language Therapist, I am conscious about the impact of our increasingly digital lives on the communication development of young children. However, our presenter Dr Lesley Holdsworth, captivated me with her enthusiasm and undeniably impressive examples of digital solutions improving healthcare on multiple fronts. She presented the notion that face to face care is not always best, that we must not assume that patients would rather access us directly, when in fact the opposite is often true. Along with June, she also made me think about the bigger picture: that any improvement project must demonstrate positive impact through multiple lenses. This has opened up my thinking significantly; I understand it is not sufficient for a patient to report a good outcome if I want my project to have wider impact. Patient experience is of course central to what I hope to achieve, but so is sustainability, potential to scale up and saving resources – these are new horizons for me to consider. Later this week, I am meeting with a member of our IT team to discuss how I might be able to recreate the workshops I have facilitated as part of the project digitally. Already, I am thinking about how my project might work in the future, considering how the same outcomes might be achieved in a different format. It all feels really exciting: visualising new horizons captured from different perspectives and learning as I cross new bridges along the way.
Deborah Little, Specialist Speech and Language Therapist
AHP Career Fellow 2019/2020