BOB in conversation with...Charlie Merrick, Senior Improvement Manager, NHS England & Improvement

Tuesday, December 15, 2020 |
Charlie Merrick

You’ve just started in your new role, tell me all about it!

I work within the National Patient Safety Team at NHSE&I in Manchester specifically leading on one of the five service improvement programmes - the maternity and neonatal programme. We have a clear set of deliverables, which involves reducing harm, pre-term and stillbirths amongst other things. We take direction from national strategy and then commission Academic Health Science Networks (AHSNs) to deliver the plans and work together to assess the quality of the applied interventions.

What was your journey into quality improvement? 

My introduction to the NHS was as a Band 5 Pathway Manager in Cardiology and then a role opened working in improvement at the Royal Free NHS Foundation Trust, which was funded by NHS Resolutions, the litigation authority of the NHS. I was given a list of things that were causing patient harm to go and work on to bring about meaningful and sustainable change in the areas of concern through positive changes. I spent three years in that role and was awarded the National Patient Safety Lead of the Year Runner Up and National Patient Safety Winner. In addition to a project looking at surgeries, assessing human factors, compliance and economics in line with the World Health Organization checklist, I was lucky to also work with Google Health, DeepMind. Our work on their Streams app, for people with acute kidney injury (AKI), was published in the prestigious Nature journal. Following that, I moved to East London NHS Foundation Trust, a mental health Trust where I did quite a bit of regulatory work. I then moved on to University Central London Hospital (UCLH) where I led a division for acute medicine and A&E using quality improvement (QI) methodologies, service redesign and programme management. From standing in operating theatres gathering front-line experience to bigger picture projects, I’ve really developed a passion for QI and in my new role I can see how I can make a really meaningful contribution. 

How does your role differ from being in a local-level role?

There’s a huge difference. At a national level, it’s a case of having a bank of stuff that we know works and presenting it as a delivery package. Some of it is about still being attached to ground level and I want to continue doing that, so people at a local level don’t just see us as being a group of people telling them what to do. My knowledge of QI methodologies is something I can bring to the table and hopefully help midwives, obstetricians and neonatologists to find ways to improve service delivery. So one example is that we all know checklists work, but the quality of those checklists is important - now I’m one of the people behind the development of them. 

How are you currently gathering best practice examples to then roll out across the trusts? 

There are numerous ways we gather examples. The big ones are the governing bodies or the associated colleges e.g. Royal College of Midwifery, Obstetrics etc. Then there is the National Institute Health Research (NIHR) which has dedicated teams focused on research and innovation to counter some of the big national problems through trialed and tested, peer-reviewed studies. We draw shortlists for our work based on review of all of this available information. 

How do QI and academia come together when developing national strategies? 

Historically the two have been quite disparate, with QI having a perception as a localised, softer way of improving services and care. However, the relationship between the two is improving. Research methods work and are very credible. With QI, it’s more fluid, whereas medicine is all about evidence-based interventions, which traditionally means drugs and clinical techniques. QI also looks at cultural behaviours. Pause for the gauze is a great example of a really successful intervention in surgery to prevent Never Events relating to retained foreign objects. The more we look to find sustainable solutions, the more QI is beginning to hold its own. Research will always be needed to find the interventions, drugs and devices that are going to last a long time. Marrying together research and QI will be reflective of the success that happens on both sides. 

How is learning shared across the NHS? Where do you go to look for information?

It really depends on where you are. At national level, I am focused on getting large data sets from the Royal Colleges etc. Whereas at a local level it would be at Trust or regional level, e.g. via the AHSNs.

How do you think COVID-19 will change the way that learning is shared? 

There are some parallels with Roger Bannister; he turned up and ran a mile in under four minutes, and then everyone was doing it. So it’s similar in that there are so many things whereby people said they couldn’t be done, but then when the pandemic hit they were happening within a matter of two weeks. Sustainability is the key - blockers and bureaucracy that were put in place previously need to be reviewed to make sure they don't re-emerge as we return to normal. There's a bit of a chasm between national and local level sharing and that needs to change. 

What interested you in getting involved with BOB?

Serendipity! A very good colleague of mine, Siri, was supporting the development of BOB and she got me involved. I was instantly engaged following a first meeting with Siri and Marc (BOB co-founder), I reeled off for ages about the deficit of a learning/connective system that shares intelligence, insights and stories as there is a huge market for it and so it was music to my ears that BOB was in the making. Ever since that first meeting I have continued to be involved through several discussions and workshops. From what I saw through the development process, and what I see outwardly on the likes of LinkedIn, it’s so evident that BOB fills a very vacant gap around sharing and collaborating. 

As a BOB Champion I very much believe in the aspirations for the platform. I think the NHS is burdened with useless tech, but I certainly don’t feel like this is one of them. I’ve got no vested interest in it, I’m not a shareholder, so this is just my honest opinion. It’s got a really good application to it and I think it could drive some really meaningful storytelling and sharing, which will support people to take forward good ideas. The equation is quite simple; shared learning, leading to someone taking on board that learning, could help a patient to receive better care and lead to improved outcomes. That’s worth all the money in the world. 

What have you been reading or listening to lately that’s inspired you? 

A BBC podcast called 13 Minutes to the Moon, which is all about the lead up to the landing on the moon. The average age of team at NASA was just 27 and it was a really diverse workforce. What comes through loud and clear is that when a challenge came up, it was never a case of ‘it can’t be done’ instead it was all about ‘this is difficult, but how can we do it’. It’s all about that receptiveness to want to do a task. A lot of these challenges are difficult, but they can be done. Of course we need seniority and grounding, but the young can-do attitude and diversity within NASA in the 1960s is something we can all learn from. Highly recommended listening!

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