At the time, I wondered why she bothered. The patient had seen the surgeon in Outpatients where he had been given a 28-day supply prescription. ‘It’s important that you take these,’ said the surgeon. ‘The operation will have a greater chance of success if you do. I’ll write to your GP so he can arrange a repeat prescription.’ The patient took the prescription to the hospital pharmacy and handed it to the pharmacist with pink hair. She quickly returned with the box of tablets, but that was not all. She passed on some essential information. ‘Wait a couple of weeks and if you haven’t received a copy of a letter from the surgeon to your GP, then ring the GP. Ask him to contact the surgeon’s secretary to confirm that you need a repeat prescription of this drug and then the GP will set it up for you.’
After three weeks no letter had been received so the patient sent an e-request to the GP practice, repeating exactly what the pink-haired pharmacist had said. He checked his online GP record the next working day and the repeat prescription was there. (No letter from the surgeon was ever received).
Why did the lady with the pink hair pass on the details of what to do if the expected process doesn’t work? She may have read about the need for healthcare to be more integrated and the setting up of the new Integrated Care Boards; she may have been trained in QI techniques; she may have been copying a colleague; or she may have worked out what to do based on the experience of a family member. Like a lot of people working in healthcare she had bothered to learn more about the working of the service than was strictly necessary for her job, and she couldn’t resist passing on to a patient what she had learnt ‘just in case’. This is what happens if you work in the NHS and are curious.
In the early days of my hospital career a surgeon asked me for the number of a particular type of operation he had done during the last year, with a throwaway comment that he didn’t expect the clinical coding would be good enough to identify the cases. The clinical coders were adamant that the coding would be correct but said I should talk to the community nurse who followed up those patients after discharge. I did and she told me how many cases she had seen in the last year. Her number matched that derived from the clinical coding, and I told the surgeon this. ‘Where does she get her numbers from?’ he asked. ‘She visits the ward the day after you’ve operated so she can identify the patients to see at home,’ I replied. ‘Well, I never knew that!’ That was when I realised the importance and power of curiosity. From that day the surgeon was a regular requestor of data analysis and never questioned its accuracy.
A recent paper in BMJ Quality and Safety1 covers the skills needed by frontline NHS staff to deliver quality improvement: While relational skills of communicating, motivating and leading are recognised as important, they are often omitted in QI training, which may partly explain why interviewees were unable to articulate where they learnt them; they seemed to have developed cumulatively through daily interaction in healthcare. These healthcare workers are operating as integrators of care within their organisation every day; some of them will also be integrators of care between other healthcare (and social care) organisations. Even if they don’t use the term ‘integrator’.
I have watched data analysts develop these relational skills, together with very detailed knowledge of the workings of the NHS, by asking questions of clinical coders, outpatient receptionists, appointments staff, medical secretaries, nurses and doctors. All these staff know something that is unique to their role. The job of the data analyst gets more rewarding the more curious she becomes about the healthcare ‘domain’. The hospital pharmacist had learnt something similar. She was curious, she is responsible for the impending operation having a greater chance of success and she is a healthcare integrator.
To be a good data analyst you need to be curious, but to be curious you don’t need to be a data analyst. And you don’t have to have pink hair.
1 Wright D, Gabbay J, Le May A. Determining the skills needed by frontline NHS staff to deliver quality improvement: findings from six case studies. BMJ Qual Saf 2021;0:1-12.
Note: The views and opinions expressed in this article are personal and are not necessarily those of Northumbria Healthcare NHS FT.
The NHS: observations of an Information Specialist 