Weeknotes s05e32

7 min readSep 17, 2023

TL;DR: Visit to Catering team. CQC Report recognises NUH is improving. Progress on First Time Board CDIO programme.

[week ending 15/09/2023]

Who did you talk to outside of your organisation? Over the past few months I’ve been working with a few people on a First Time Board-Level CDIOs programme and our pilot session in October is now fast approaching. This week we had a session with some of the faculty (who will be providing content and delivering the material. I set out a skeleton slide deck a few weeks back, and have watched with increasing anxiety as it remained unchanged. However, we had a really great meeting where we did a full review of the agenda and make some positive changes that I think will mean the programme will be even better. We have a deadline for the next week for all the input to come in and then we’ll be able to send agendas out to the delegates. NHS Providers and Lou in particular have been tremendously helpful in helping confirm attendees and sort out the practicalities.

I had a call with Zakki from City of London Corporation. We were connected earlier this year by a mutual friend. He shared his brilliant articulation of their strategic consolidation and reduction of number of systems. This showed all 766 corporate systems, grouped by function and the strategic intent for each. In about a year that has been reduced by 43% to 432. I shared the diagram around to the Digital and Information leadership team as a model for us to use for the reduction in systems we are planning at NUH. It is interactions like this that strongly reinforce my view that widening your network and actively maintaining it, reaps dividends personally and professionally.

I joined the Digital pathfinders meeting, convened by Hillingdon Hospitals Trust. I was part of these meetings as we prepared for our new hospital build at Kettering, so it was good to get back into the cycle of meeting with NUH. I think this is one of the best national-level meetings I attend. I think it is due to everyone on the call having common aims and being at a similar position in their new hospital programme. I find the sessions are practical and inspiring and come away with a lot to think about.

What did you learn? This week was the Trust’s Equality Diversity and Inclusion Committee meeting. This Committee is a delegated from the Board and was constituted this year, so we are still working out a work plan and how to be most effective. This week the time planned was split into two; a workshop session on the three key items on the agenda and then the formal meeting. This worked really well as the workshop time gave more time and space for discussion, such that when we got to the formal bit, everyone was much more informed and involved in the decisions. I’m going to take that format forward into future meetings.

I joined the meeting of the Medicine divisional management team. I shared some of the emerging themes of the Digital and Information strategy and we talked particularly about the frustration about the large number of systems to use. The team had started to embrace the functions of Microsoft Teams and we talked about the features of Office 365 that everyone will soon have access to. There’s more to do I think in this area to signpost colleagues to some of the great training material available.

What did you enjoy? A big moment this week was the publication of the CQC report, following our inspection into Well Led and Maternity earlier this year, both of which have moved from Inadequate to Requires Improvement. There were a few opportunities this week to join an “Ask the Exec” session to talk about it. I joined one led by Michelle, which was emotional and uplifting as a workforce that have been under all kinds of scrutiny were able to take a moment to celebrate the Trust being recognised as improving by an external body, testament to the hard work they’ve been doing over the past few years.

Source: https://www.bbc.co.uk/news/uk-england-nottinghamshire-66785539

As part of my schedule to meet all the teams in Digital and Information, this week I met the Clinical Coding team. There were too many people on the call to go round the room and do introductions, but the team had been really organised and sent me a list of questions ahead of time, so we worked through those. A consistent theme was the variety of systems the team need to use, which align to the frustrations that come out when talking to clinicians. We also talked about the transformation of Clinical Coding at Kettering, which resulted in some considerable improvements and increased income.

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Jack and I got to spend some time with Trust catering team. Sue took us through the end to end process, from deliveries coming into the unit, to the prepared meals going out to the wards. The team deal wholly with patient meals (staff and visitor meals being managed by a third party). The team deal with 7,000 patient meals a day and manage 19 different menus, taking into account different nutritional, cultural and alergy needs, with 65% of the ingredients sourced locally. We saw how meals were cooked in batches ranging from 200 to 1,600 in size and then frozen and arranged for delivery and cooking on the wards in specialist ovens. The team do a brilliant job in quite constrained space, where the limited area means they can’t prepare meals too far in advance, so it takes a lot of careful planning and sequencing. I thought I’d had some insight into larger scale catering when making meals for 80 people as part of my role in scouting, but this was something else entirely. There’s a lot of work going into developing meals that work for a family and then scale out to 1000s at a time. For example, we saw a 213 litre vat of custard cooking away next to a similar volume of rice pudding. I came away from the visit with admiration of the team and the role they perform.

What did you achieve?

Gilbert, Bel and I had a conversation on the back of the Overseas working discussion document that Marc and I drafted. We agreed a broad approach that will now be worked into a policy.
We had a good Digital and Information strategy session, where we attempted to take the long list of things collected during all the various engagement sessions and then fleshed them out further in preparation for prioritisation against our new matrix.
I met with Richard and we went through in detail about his work leading NUH’s Global Health Partnerships and how he might approach programme planning on such wide ranging and long-term objectives. We talked through the high level objectives, which ones should be prioritised and a few planning approaches that he might take. We’re meeting again in a few weeks to see where he has got to.
Zoe and I met to complete her first appraisal. This was a good opportunity to talk in more detail about the first few months of Zoe’s role as CNIO at the Trust, where she’s made a great contribution so far.
It was Trust Board this week. One of the longest in my Board career, starting at 8:30 and finishing at 18:00. We started the open Board session with a powerful patient story from Sarah, where she described the circumstances where her baby, Thomas was stillborn, which was awful enough, but the experience of serious case review and inquest process that followed exacerbated her the pain and suffering, not least as in some meetings her partner was prevented from being with her. It was painful listening and we talked about what things have changed since. We also talked about the publication of the CQC report, our financial situation, winter planning and a Cath lab business case. After the private board session we normally have a visit by a team to give the Board a more informal insight into their work. This week was the maternity team, who shared their challenges with honesty and passion.
I met with Tim to talk about a student doctor project. We‘d discussed this earlier this year, about setting up a project for a student to look clinical impact due to slow machines/switching profiles. This will build on some of the already published literature and augmented by our data, will help inform the business case/justification for fully funded replacement programme.

What are you looking forward to next week?

Tour of Pathology
Information Asset Owner forum
The second Midlands Digital Health Skills Development Conference. Need to sort my presentation out asap!

Interesting Stuff read/consumed:

Towards a unified vision of nursing and midwifery documentation by NHS England. Really interesting and potentially powerful guidance. Good section on what people current say about documentation e.g. “nurses do not see the purpose of much of what they document but feel powerless to change this.” and “there is little standardisation of risk assessment tools within a care setting or across care settings. The impact of this is that the language used by nurses may have little or no meaning outside the organisation.”
What is MFA Bombing? at GCS Technologies.

Books finished this week: