In June 2023, the West of England Imaging Network held a launch event, introducing a new approach to facilitating and supporting transformation projects.
Becky Nichols, clinical lead radiographer in MRI at Yeovil District Hospital, Somerset NHS Foundation Trust, attended the West of England Imaging Network (WoEIN) event.
She explained that the event covered many topics, including using quality improvement techniques and coaching to promote culture change and sustainability.
Gold standard in MRI
By Becky Nichols
The first project undertaken by the network, sponsored by Cathy Walsh (lead radiographer, WoEIN) and led by Megan Wilkins (quality programme lead, WoEIN) was to look at the current provision of MR imaging in the emergency Cauda Equina Syndrome (CES) pathway within the network area.
The aim of the project was to provide evidence of the current state of provision of MRI for emergency CES, identify obstacles to improvement and look at opportunities for workflow redesign.
This would then be brought together in a standardised pathway and recommendations made to the providers within the Network geography to support business cases for service improvement and to reduce variation.
Perhaps the most innovative feature was the emphasis on the process being led by those who work within the pathway.
Project participants were MR radiographers who had a working knowledge of the process on a daily basis and quality leads, to assist in embedding quality improvement methodology within the process.
This is a topic that has generated much discussion nationally following the GIRFT Speciality report for Spinal Services in 2019, the HSIB review in 2021 and publication of GIRFT National CES guidelines in 2023 which set the gold standard of providing 24 hour access to MRI for emergency patients with potential CES.
Initial phases
The initial phase of the project consisted of a series of workshops for the project participants, led by Vafa Taleban (Personal Revolution Online).
These focussed on culture change, by raising participants awareness of their own values, identity, purpose, preferences and unconscious biases.
Strategies were provided to enhance communication and build new behaviours aligned with the core values identified.
Quality improvement
Participants were also introduced to quality improvement (QI) techniques to assist with data collection and analysis, with the support of NHS England (SW). This included methods to measure and display data collected, and the opportunity to complete Quality, Service Improvement and Redesign (QSIR) Fundamentals.
Feedback from radiographer participants was that they had gained skills in quality improvement, had the opportunity to network with staff from different hospitals, making good connections and long term friendships.
Personal development coaching helped build confidence, self belief and self awareness and it was felt there was a noticeable positive change in work and home life.
‘Refreshing and intense’
One participant stated: “It was a really great programme to be involved in, especially making connections with radiology within and outside of my trust. I found the Culture Workshops both refreshing and intense. They were a great enabler for the programme as well as my own personal development, providing invaluable insights into myself which has improved my wellbeing and effectiveness.”
There was an overall feeling amongst participants of greater confidence and empowerment, to allow polite challenge and the ability to speak out and have a voice to contribute on a local, regional and national scale.
The greater understanding of the techniques of QI and the connections made between QI leads and radiographers are now being utilised on other quality projects within radiology departments.
Optimising pathways
For the second phase of the project, participants were then joined by subject matter experts and representatives who worked in all parts of the patient pathway, from primary care, acute care, interface services, through to imaging and reporting of scans.
The group participated in a three- day Kaizen event, facilitated by Chris Kinvig of Lean Six Sigma, where the entire pathway was process mapped and opportunities for optimisation identified.
At the end of the three days, it was possible to document the current situation, reach agreement on the ideal patient pathway, identify future workstreams and look at improvements required across the region.
The ongoing work streams are each led by a participant from the Kaizen event and include:
- Training and education of both MR radiographers and those that use the services of MRI departments,
- Promoting the use of existing MR safety e-learning
- Developing preliminary clinical evaluation e-learning modules that can be shared nationally
- Clinical Governance and effectiveness covering variation in referral and reporting processes
- IT systems
- Scanning protocols
- Methods for recording audit and performance measurement
- Strategic workforce planning – looking at variation across the network in reporting services and availability of radiographers to scan
Whilst work is continuing on these workstreams, it is hoped that similar formats and methodology will be used on future network projects following the success of this project.
(Image: Sitting Left to right - Becky Nichols, Vafa Taleban – Course facilitator, Poornima Ravichandran.
Standing back row left to right - Megan Wilkins (WoEIN Quality Programme Lead), Ross Cook, Marie Little, Kristy Fraser, Cathy Walsh (WoEIN Lead Radiographer))