H@N team deliver rapid improvements to support doctors in training
The quality of the Hospital at Night (H@N) service including experience of doctors in training at the Cumberland Infirmary has undergone a complete transformation following significant improvements by the Hospital at Night (H@N) team.
It has led to the General Medical Council (GMC) removing the Trust’s Hospital at Night Service from enhanced monitoring following a positive recommendation by Health Education England North East (HEENE) after a recent assessment of our performance.
In January 2020, the GMC formally received concerns about the experience of doctors in training particularly in relation to handover processes and supervision for trainees overnight. In their latest assessment, HEE NE are now holding up the rapid improvements as a model that other trusts can aspire to.
The rapid turnaround has been driven by the Hospital at Night team with changes including:
- Strengthened clinical leadership and team structure tailored to the needs of the hospital overnight
- The development of a Hospital at Night Handbook to help incoming doctors understand their role within the service; how to access advice and facilities to help them work more effectively and feel supported
- The introduction of a Hospital at Night Safety Huddle which has greatly improved team working and communication by uniting the wider night team
- The development of simulation training to promote best team working practices and address human factors
- The H@N practitioners have integrated with the doctors to provide an invaluable step-wise improvement in workload, experience and education
- Better oversight of the rota to ensure early identification which has resulted in more consistently safe staffing levels at night
- Embedded clinical governance arrangements and serious incident training for the team
Gage Willox is a junior doctor and he explained how the changes have really supported him:
“When I first started as a foundation doctor I was pretty terrified of night shift because there is this feeling that you are going to be a bit more on your own, and actually at the start of my shift meeting the hospital at night team and just knowing that there was some extra skilled pairs of hands who I could go to with any queries and who I could go to in order to draw on their experience was really reassuring thing for a junior doctor.”
Dr Jen Hoye, formerly Adam, said: 
"This has been a huge team effort, and I’m so proud of the changes we have made to support our trainees. We’ve achieved it through teamwork, collaboration, commitment and hard work.”
Daniel Sherret is an assistant practitioner with the hospital at night team, he 
says the improvements have made a difference to whole team and most importantly patients:
“It has made a phenomenal difference to staff especially junior doctors but the wider nursing staff and nursing students as well. I think everybody especially patients have benefitted from the hospital at night developments that we have managed to put in place through a lot of hard work and determination.”
Professor Sam Dearman, Deputy Medical Director for Professional Standards said:
“I can’t speak highly enough of the work undertaken, driven forward by the hospital at night team. The way they have worked together to implement the changes required has truly demonstrated our values, our NCIC way and I really hope this experience is shared across the organisation and an inspiration to others. Whilst this has certainly been a team effort and I recognise the excellence of our doctors in training as well as Ali Clarke, Daniel Sherret, Gage Willox, Katie Vandepeear, Sarah Jackson, Jacky Harvey, Mr John Wayman and many others I do need to recognise and commend Dr Hoye for working so hard and leading so well in such a high stakes situation so early in her Consultant career which no doubt has been daunting. It has been my privilege to do this important work with you all.”
Lyn Simpson, Chief Executive said:
"The Trust was placed into enhanced monitoring by the GMC just as I arrived in post and I’m delighted that through the hard work of everyone involved we have turned this service round. Our doctors now have access to a first class model as they start their careers and the changes will enhance patient safety. This is how we do things at NCIC, it has been a real team effort and the changes have resulted in a better experience for our patients and a better place for everyone to work.”
A video with Gage, Daniel and Jen explains the improvements, how they were acheived and the difference it has made to the team and patients.