Podcast | Improving Women’s Health Care

Episode Transcript

Better Never Stops | Improving Women’s Health Care | East and North Hertfordshire NHS Trust 

Chris Backous Thank you for joining us for Better Never Stops, our podcast for healthcare leaders and everyone committed to transforming healthcare. We interview leaders from our clients and partners around the world, as well as leaders right here in Seattle, who work to maintain a culture of continuous improvement at Virginia Mason Franciscan Health.

In each episode, we hope to explore a philosophy of “go see, ask why, and show respect.” My name is Chris Backous, and I'm an executive partner for transformation services at the Virginia Mason Institute. I'll be your host for this episode of Better Never Stops. On today's episode, we're going to be talking about maternity care and women's health at East and North Hertfordshire Teaching NHS Trust.

This past summer, I had the opportunity to work with the team on a 3P, or Production Preparation Process workshop, where we literally took a moment to rethink women's healthcare from the ground up. So at this time, the reason that we decided to use a 3P instead of a step forward incremental approach was that there's quite a bit of activity going on in the news regarding the state of maternal health and women's care in general.

And so we wanted to take a step back and say, "What could we do with this information and move the team at ENHTT forward in a new true north and actually allow them to deliver on their promise of providing the right care, at the right time, for the right reason, for all the patients in their community?"

Today, my guests are Amanda Rowley, director of midwifery and lead divisional director for women's and children's at East and North Hertfordshire, and Dr. Mona Modi, head of clinical services for women's and neonates at East and North Hertfordshire Teaching NHS Trust. Thank you both for joining us today.

I really appreciate getting a chance to reconnect after the 3P and see how things are going. So before we get into the work that we did this summer, I'd like to jump back in time just a little bit, and Amanda, can we start with you? I understand that when you first joined the trust in 2022, things were at a kind of a critical moment for midwifery.

Can you tell us a little bit about the state of the situation back then?

Amanda Rowley Yeah, of course, Chris. Thanks for inviting us to join you today. So I've worked at East and North Herts coming up for four years now, actually. It doesn't quite seem possible. But when I joined the trust, we were going through a very difficult time in maternity services.

We'd just had a regulatory review, a sort of standard regulatory review by the Care Quality Commission, who were unhappy with the quality of our services, both in terms of staffing levels, challenges with processes, pathways that were impacting on patient quality of care and also women's experience, and also impacting on staff experience as well.

So shortly after joining the organization, we embarked on an extensive quality improvement program, and I worked very, very closely with our fantastic chief nurse, Theresa Murphy, on this quality improvement program where we were leading fast-paced change. So it was lots of changes very quickly to meet regulatory timeframes.

We also entered into a national support program to help improve our services, so there was a lot of scrutiny. There was also additional support, but it was quite intense for quite a while, and sort of making sure that we were communicating with staff, giving that assurance that we needed, both at trust level and regional and national level was really important.

And it was... We did achieve an awful lot, but it felt a little bit sort of top-down, I would say, in its approach, if that makes sense, in that we were needing to sort of meet the demands of lots of regulators and stakeholders, and we didn't always consistently get it right with the messaging to staff and involving staff in the decisions that we were making.

But we have been on a significant journey over the last four years.

Chris Backous I remember the first time that I stepped out on the Gemba with you and met some of the team, and it became very clear to me this is absolutely about processes, not about people, because the people are some of the most caring, compassionate, and dedicated.

And I think what I saw was amazing people trying to do the best work with overcomplicated processes, waste, and barriers to overcome. I immediately felt their passion about making it better. So even though I think the pace you talked about was very intense, I think the passion to do the right things the right way was there.

And one of the most passionate people that I happened to meet was Mona. And so Mona, do you wanna tell us a little bit about your background and history and how we arrived with you participating in this amazing 3P?

Mona Modi Sure. Thank you, Chris. I have been with the trust for the last 14 years, and maternity has changed a lot in 14 years.

And I've sort of gone through lots of changes along my journey. I've also gone through a leadership journey, and right now I, as the head of clinical services, I can see that yes, we have had our challenges with our CQC, as Amanda mentioned. However, we have come out with a very collaborative work with our staff, and also embracing new ways of thinking, like what we are discussing today, and a new way of managing our problems.

The problem is not a problem, I think, if we have a way to, and I think VMI gave us that platform as to how to look at a look at something and transform it in a very systematic way.

Amanda Rowley Just to build on what Mona said, I mean, I think I've had my own personal journey with Virginia Mason.

I remember when I was first introduced to it and had the pleasure of meeting you first in Seattle, Chris. I was really struggling to process how I was going to understand and implement the amazing ideas I was hearing about and make it relevant in my service. I really struggled with that, but actually we've come on such a huge journey of now fully embracing the methodology.

So there's been our learning and growth as a service, but I think for Mona and I, there's also been that personal journey that we've both been on as we have tried and tested the methodology and the techniques and started to see the outputs. And we had already had the opportunity to do that before embarking on this 3P, which is something a bit different for both Mona and I, looking at things at this sort of scale.

Chris Backous I remember our conversation. I think it was in a corridor somewhere when I was on site working with teams with some other improvement. And I think we were in a conversation of, you know, it's so important to make this method your own, and we started talking about opportunities within maternity.

Because again, at that time, there was so much being talked about in the press and on the news and there were some real unfortunate things happening nationally. And we had talked about how can we best engage the team and really take control of the narrative and turn the negativity into an opportunity to make things better for patients in Hertfordshire.

So can you talk a little bit about why the 3P made sense when we talked about not taking an incremental step-by-step change process, but actually pausing and rethinking and developing a true agreed-upon true north with the 3P, and then working our way back to a step-by-step process of implementing to achieve that vision?

Amanda Rowley Yeah, absolutely. And I think the first thing is having had the experience of being involved in a rapid process improvement workshop and a couple of smaller Kaizen events, where you see that instant change, which is really meaningful to staff and to the service users that we want to improve our services for.

You realize that those events are really important, but they're one part of a jigsaw, and as you start to do more small improvement events, you start to see how it connects together. And that got us to thinking about our vision for the whole service. And we really... You know, we are a women's service.

We cover gynecology, women's services, maternity and neonatal care and that's outpatients and inpatients. So when we actually took the time to step back and look, we could see how things interlocked with each other. There's lots of codependencies. We're working within a limited infrastructure across specialties, across all of our services.

And the way to create the sort of vision for the future that we wanted was to look at those together and to really throw everything up in the air and think, "Okay, if we came from a sort of back to zero approach, how would we want to build this service?" So one of the important things was thinking about something we've spoken about, Chris, our sort of true north.

What are we really trying to achieve? And it was about that seamless, timely, women-centered care for every woman every time. But also thinking about women accessing care throughout their lifetime with us, and how do we, how do we get that right? And with those codependencies identified, it really made sense, while it seemed very big in its approach, to look at all of that together, to look at the longer term vision.

But along that way to look at what we call the low-hanging fruit or the sort of quick wins that we might be able to deliver in the short term around pathways and process while having that sort of strategic vision over where we want our services to be in 10 years' time.

Chris Backous Mona, I think I remember in our planning, we were talking so much about how the problem isn't that you weren't providing services to women and maternal services to women delivering, it was the experience wasn't a great experience. And in our original conversations, I know one of the transitions we really wanted to make for the team was from service centric to patient centric.

And Mona, I think that's where your passion really lit up in the planning, and it came through during the workshop. Do you wanna talk a little bit more about your experience?

Mona Modi Yeah. Thank you, Chris. Yes. First of all, over the last few years, maternity service and expectations have changed so much, both nationally from the national reports, but also from our patients.

They do expect us to do better and not just continue with our old ways. I don't think there's anything wrong with incremental changes within a system, but sometimes something like 3P gives us that permission to look at the whole thing from an holistic point of view, and also get a multidisciplinary team to come and look at it from different angles and give us a better option of how to manage.

So as Amanda said yes, we have done some smaller events, QI projects, as well as improvement projects. However, this was... we felt now that we were ready to embark onto something bigger. And, not because we wanted to do it bigger, but because I think honestly with the national reports, with the current maternity climate, this is what it demands us to do, is to look at our processes and pathways for our patients to improve their accessibility, safety And having a seamless service.

Chris Backous In addition to maternity services, one of the areas where, you know, to use your terms, we could do better, was in the care for women having gynecological surgery.

And could you both talk a little bit about what you saw as opportunities there?

Amanda Rowley So I think one of thechallenges we've had since COVID times, before COVID, we had our own gynecology ward, dedicated specialist staff. That wasn't possible during COVID, and we've not had our own inpatient ward since then.

So our gynecology patients are on a ward that sees multiple specialties. There's limited private spaces. Some of the surgeries, most of the surgeries and procedures for women, you know, are very sensitive, and it's just not a space that's conducive to supporting women's experience. We also, there's been a lot of sort of triangulation of different sources of information, and a lot of that has come from the users of our service, complaints around process pathway, administrative errors, delays, cancellations, really leading us to think about there are clear challenges in our pathways here, that if we can get that right, instead of spending our time responding to complaints, we can actually intervene and support these women to have the care and the experience that we all want them to have.

So that in itself is a massive efficiency while really improving our service for our women.

Mona Modi And from a clinician perspective, I feel like we felt a bit helpless because the processes were not supporting the good work that we actually want to do. And sometimes it does lead to also poor staff morale, and the complaints, responding to a complaint can sometimes knock confidence amongst clinicians as well.

So there were some unintended consequences for not having the processes right, for not having the dedicated ward, et cetera. So again, from gynecological point of view, it was very important that we look at the whole service with the 3P lens, and try and bring the obstetrics and gynecology service together.

Right now it's a bit fragmented in terms of even the geographical areas and where we deliver the service. Because we are, as obstetricians and gynecologists, one team, but the services are geographically divided, which does not help in providing that seamless service that we're talking about.

Amanda Rowley Well, on the first day of the 3P event, that just brought back to my mind the sort of ward manager from the inpatient wards.

And really, and she won't mind me saying this, I think she thought, "Oh gosh what am I doing here?" And, you know, "I'm with people that I don't know." And this is the ward manager for the wards where all of our gynecology patients are admitted to and cared for, but there wasn't that relationship and dynamic with the other people who support that service.

So even that, from that first day, you know, that was a massive step change and an improvement in the relationships that have been built as a result of the 3P event.

Chris Backous And I remember, you know, as a facilitator of these events, you can scan the room very quickly, and I noticed who's looking engaged and who's looking a bit disengaged.

And I found it interesting that I identified someone who seemed to be, I wouldn't say not engaged, but their body language was just showing either isolation or confusion, like, "Why am I here?" And I remember by the second day, the ward manager stepped forward and said, "You know, I'm so appreciative about being included."

And you think about what happened because of COVID, for all the right reasons we isolated that team. Unfortunately, we isolated the process away from the overall patient experience, and that then chance to kinda come back. I think the other thing that we did uniquely in this 3P which is always a chance to think outside the box.

That's what we call them, the outside-of-the-box workshops. When a step change or a step-by-step improvement isn't going to get us where we want to go maybe as quickly or as boldly as we want. And this, setting this new vision to help build a road map aligned to that vision was really our objective.

But we went back to zero. We took that zero-based approach. And I'm curious what your experience in preparing the team and engaging with the team. What happened when you presented this as kind of a, let's go back to zero, let's really think about this without any limitations, budgets, space, costs, but just what's the right thing to do?

What was the experience for both of you as you talked with others?

Amanda Rowley From my point of view, I'd say it was slightly mixed. There were some people who'd had the experience of previous Kaizen work, and they were absolutely, “right, you know, let's get started.” But for others, it was maybe their first experience of the methodology or their approach with skepticism or weren't sure why they were there.

We tried to approach that by making sure that the staff coming into the room were really prepared, but also you don't wanna take away some of the mystery. 'Cause actually when you discover what's possible from this type of work and just walking into the room and seeing when the penny drops and people are sort of, "Yeah, I understand why I'm here and what we're doing," you know, can't be underestimated.

So it's getting that balance right. And I think it's about having the right people in the room, really thinking about your stakeholders. And we had people from our estates and facilities team, 'cause a lot of this was about infrastructure, but we also had colleagues from primary care, so who worked in community services because a lot of this was about, “does all the care that we give need to be in the hospital?”

We talked a lot about a sort of left shift of, can we take services closer to where our service users are so that they can have care and diagnostic procedures closer to home? So it was thinking about all of that, planting the seeds, and Mona and I started off the week, we launched the week talking about a service user's perspective and trying, asking the staff to put themselves in the service user's shoes about what they might experience and the challenges they might face.

And actually that connection is built then quite rapidly, and they realize why they're here and what the purpose is and why we're asking them to come away from their day jobs and focus on a sort of future vision for the service.

Mona Modi And yeah, I had clinicians who have never been on a VMI journey and equally some that were, as Amanda said.

And it was quite exciting to see that some of my very junior colleagues and junior registrars who were equally, by the time they realized what it is, were so excited about being, first of all, so grateful that their voice was sort of included in this planning. I think as a junior registrar in NHS, your main is service provision and clinical activity.

This was something totally different for them, but equally, they realized their strength while going through that journey. And initially they had no idea, but as Amanda said, we gave them some, but we left some for them to discover themselves rather than giving them the whole tools of what to do and probably sometimes not get their perspective and rather they would put our perspective into their work.

So it was quite nice to have that combination of people, some who were experienced enough, while some who weren't but were excited to learn something new.

Amanda Rowley And just to add to that, the other important part, and I'd say I've learnt this as the more events I've done, is about the information and support you give to staff who are working in the clinical areas who may not have the opportunity to be directly involved in the events.

Because for some of them, they see staff being taken away from a high-pressured clinical area and given time to work on this. And it's about the impact in the clinical areas and how we share the purpose and the vision with them, and that they understand the reasons for it. Chris, I remember very early in our journey with Virginia Mason, you said to me, and I've always remembered it, "When you think, ‘have I got the time to do this?’, think, ‘can I afford not to?’"

And I absolutely understand and get that now in my core and it's about how I share that so that the staff working in the clinical areas and those that are involved directly in the improvement events hear that message and feel that as well. So that's been an important learning point for us and something that we really focus on with our improvement work.

Chris Backous Well, and I think about the timing of this event, because I believe it was Monday of the workshop that the Baroness report came out. And I remember you know, that people were feeling a bit defeated and deflated because the report basically said there's so much work to do. And I would say that the underlying message that came through the press was, if you were in need of maternity or women's health services in England, you should be concerned.

And we had a very lively discussion as a group of, you know, we can let that narrative play out, or we can take control of that narrative this week and do something with it. And the shift was there. And then thinking also about the three radical shifts of the NHS 10-year plan, from hospital to home and community, from analog to digital, and from illness to wellness and prevention.

Those are big leaps and it seemed to be the perfect storm of opportunity to bring people together. So what was it like from your perspective? That was my perspective. What were your perspectives?

Amanda Rowley So I think maternity has never been under such scrutiny. And I think it is challenging for staff who come to work every day to do their absolute best for women and babies and families.

So I think it's trying to turn that sort of negativity, a potential negativity around how it lands, what's in the media, and turn that into an opportunity and something positive. And I think the Baroness Amos report in particular is very forward-focused. It's about looking at things from a systems perspective and what, not just as a single organization, but across the NHS, across maternity services nationally, we can do differently to improve the quality of care and the experience of care for people using our service.

So I think it really was about turning that into an opportunity and it not just being, "Oh, we've got another national report," and, "Oh, there's, you know, there's more things in the news." How can we take what's in this but really use this as an opportunity to drive change, transformational change, on a large scale?

Mona Modi Yeah. I don't think it could have been better timed. Somehow it did fall quite well in the timeframe. It does help the staff to see as a team us moving forward with these kind of reports rather than having that grim... So in fairness as the report came, we were also trying to get the staff to think positively, to think for the changes that we are planning to do to our services.

So I think it couldn't have been better timed in terms of the 3P report. And as Amanda said, it is forward-thinking, and the 3P event was a very forward-thinking event where people explored what Baroness Amos report is about illness and wellness, hospital to home care. Those were all explored in this five-day event by our team, and that just shows how the ideas were already there within us.

We just needed the space to sort of think about it and plan this.

Amanda Rowley And a key theme that came through across those reports, it was about listening to women. How do we truly listen to women? And with this work, you know, it's very much patient-centered to patient-focused. So using all of that information that we've got from users of our service, where we've got it right and also where we haven't quite got it right, and using that to drive the improvements and giving staff that are delivering care in the clinical areas, the opportunity.

They understand their areas. They know they're full of ideas, but don't have the head space to be able to turn those into an opportunity and ideas for improvement. And I think Mona and I's roles were very much enabler, facilitator. Those are the sorts of words I try to keep in my mind. It's not for me to go in and fix all the problems, and one of the challenges I have with this work is taking a step back and allowing the staff to do it because I very much want to be in the thick of everything and doing the doing.

But actually, that's not Mona and I's role in this. It is about facilitating the staff who know their service, they know the women so well, to be able to come up with the ideas for the improvement.

Mona Modi I mean, they did 46 ideas in 30 minutes. That is just amazing. So it just shows that the ideas they can generate if they're given the right environment to think and talk about it and the freedom to talk about it.

Chris Backous Well, I, and you're both on the points about the importance of how leaders really enable. I often say the smartest people in the room are the people who are sitting here, because it's your processes, your patients, your spaces, your people, and it's your ideas. And, you know, we made no promises to fund things.

We made, made no promises to build things. We translated the week of activity. We paid for it with the currency of their ideas. We said, "Your ideas need to come forward, and we will find a way to turn those ideas into action at the right time, in the right moment of the journey." But having that true north was so important to define.

So you were able to come in at different times and check in on our progress. And from the day that you gave us your challenge and inspiration at the beginning to the first time you came in, what did you notice?

Amanda Rowley I noticed high energy. I noticed people not sitting and working with the people that they sat and worked with every day, but actually building those relationships and drawing on the ideas of others.

I noticed that the sky was the limit. There was no limit on people's thinking and what was possible, you know? I can't remember if it's by the end of the second day that somebody, who I didn't know had such a creative streak, had done the most beautiful hand-drawn infographic about everything to do with how they thought the service could be.

She'd brought together ideas from all the different groups and ideas that had been generated, with a lovely picture of a woman right at the center of it. And it really brought to life from very early in the week, the opportunities that were there, the vision, and the ideas of the people in the room.

And what these events, and this one in particular, can do for culture, I just don't think can be underestimated. These were almost, not different people, but they were different by Friday than the people who walked in on the Monday because of what they had shared together and the experience that they'd been through.

They were very tired, I think, but oh my goodness, what had they generated and created with with your support during that week.

Mona Modi I did notice a lot of appreciation about each other's viewpoints, about each other's talents. For example, the finance team, the estate team, they brought a new perspective to their discussion.

So like clinicians and appreciating how that links well with what their expertise are, and I thought that was amazing because they would never work with a, like as a clinician, it is not very common to work with estates and finance teams. So the appreciation and collaboration of ideas that we saw was amazing.

And I think, yes, I found high energy as well. I found enthusiasm. Even after day one, I met some of them as they were going home, and they were like, "Oh, it was just amazing. Fantastic start of a journey of thinking." Yeah, no, I think there was so much passion in that project.

Chris Backous Well, and Amanda, you used the word culture.

And Mona, you talked about the experience of the junior doctors, the junior registrars. And you think about how do you build a culture that looks forward and continues moving to a future vision, is by engaging the new participants in healthcare delivery in a vision for the future. You've now created a culture that continues to pursue a vision instead of just accept the reality.

And I think that what I noticed, I did a check back with the team on Tuesday morning. I said, "After yesterday's work where we really started back at zero, what do you think about the reports and the press and the media?" And the team said “We're in charge. We can either continue this narrative or we can change the narrative, and we can be an example for others.”

And I think that members of the team really felt strongly about that, that what we really need is examples of people who are actually doing the work, showing how the work can be made better by us. You know, it's bad processes but amazing people, so let's change the processes and make them as amazing as the people.

And they felt that very strongly, and I think when they shared on Friday their final report, the pride, and that this is what it could be, and I saw both of you, and you were just, you know, beaming. Or to use a Northeast UK term, chuffed

Mona Modi And our seniors, our trust presence was also quite significant, wasn't it? Our senior managers, they were quite encouraging to our staff as well.

Chris Backous Yeah. I think the hardest thing is when you're in leadership bearing the responsibility for organizational success to, in a sense, hand over the vision-making and really entrust your teams. And I want to applaud you both for, you know- trust the process and trust the people, because a great improvement strategy and roadmap and passionate people who do work every day together is just amazing.

And, you know, both of you have actually undergone your own training, and I think that showed in how you provoked the team. But let's talk about the vision. I mean, it's so exciting. So what were some of the things that really stood out for both of you with the vision and where it can lead you in the future?

Amanda Rowley I think there's, there's several work streams that have come out of this already that we're working on. One is that sort of left shift around how can we work better with our colleagues who work in primary care, the sort of community-led services around those services closer to home.

Another one was looking at how we can best use our existing infrastructure. Have we got the right services in the right place? How can we make things so that they feel more connected for women using our service, but also for our staff? So there's a lot of efficiencies that we identified around if we can co-locate certain services and the opportunities that would bring.

There were so many ideas. I mean, part of that sort of shift to community was, you know, could we, could we get a bus? What services could we put on a bus, and how could we take those to people's front door? And actually, at the start of the week, people were thinking, "Oh gosh, this is a really out there idea."

But actually having since taken that idea to our healthcare partnership, they're really interested in that idea, and actually it looks more achievable than we maybe thought. The other things are around recognizing just the change in our services. We've got more and more women having cesarean sections.

We're at about a 50% cesarean section rate now, and that doesn't look like it's changing. A lot of women have their labor induced in their pregnancy, so there's a lot more elective procedures. So there's opportunities - to create a community hub was one of the big ideas, and that definitely will be part of the longer term vision to achieve, and it will require significant financial investment.

But the key thing is we have a plan, and we're already working up the financial plan around that. So there isn't money at the moment, but if the money does come we will have a plan all worked up and ready to go. So, those were sort of some of the big things, but also looking at outpatient pathways that can really support our outpatient processes, not just about inpatient journeys.

Mona Modi Yeah, and as Amanda said... So obviously our center rally was to make sure that the women centered care and have seamless services. And there are some plans that probably may take longer, but at the moment, we are in that process of looking at some some easily achievable plans, easily achievable aims and targets so that even though we have all our business cases soon ready when money's available, we can clearly show our team that we've started working on it by looking at some easily achievable targets.

The big plan has been made. Now the work begins. We also, Amanda and I feel that it is very important to keep the momentum, so we were just recently discussing about how we keep our staff informed about what work we have started doing because sometimes it might not be possible to involve the whole team again, but at least they are kept in the loop as to what we've started doing from the plans that they have made.

Chris Backous That's such a good point, Mona, that awareness that, you know, we took a week to take a big leap. It was big moves. All week it was big moves, bold moves, moves that others may not have even thought about. You're the first to think about these things. And they make perfect sense, and that team leaving inspired the moves that you'll make as a result initially, especially with, you know, we have ideas and no funding and, you know, it's kind of implied in what you were both saying there, but those are powerful ideas, so when the funding comes, we're ready to go.

So it's almost like you've written the business case, you're just now waiting for the opportunity, that's exciting. But I think for the team to feel that this week was worth it, having a bit of movement. So we talk about a directed creativity cycle of attention. Pay attention to where you are, escape with new ideas, new vision, new thinking, and move.

And I think the movement really matters, and it's how people stay connected. And, you know, for the team to know that, you know, we took a week of big moves, now we have to do the small ones that are meaningful that keep us moving forward, and the importance of sharing that communication that, the moves right now aren't as big as the moment we had in the 3P, but they are moving forward. I think that continues to bring people's trust in the process back. Would you agree?

Amanda Rowley I absolutely agree, and I think the important thing is not forgetting around the importance of maintaining presence on the Gemba connecting with staff in your areas.

It was a few weeks following the 3P event, and I was thinking, having had previous sort of events where you turn things around and you see change quite quickly, you know, or, is it all sort of how are we gonna maintain that momentum? And I did a positive leadership round, and I met some staff who actually hadn't been on the event, but they worked in, it was in our early pregnancy unit.

And between them, they had such brilliant ideas that absolutely fitted with things within the 3P that we've been able to draw on and, and build into the work streams. So the work doesn't stop there. It's about how you maintain that connection, how you keep hearing those ideas and draw those into that sort of long-term vision so that people can see that step change along the way.

So that's been really important for us.

Chris Backous Mona, how about you?

Mona Modi I totally agree with what Amanda says, that the Gembas are very important, and it should be ongoing as a leader. Also managing expectations, because some team may otherwise feel a bit dejected if their ideas then did not materialize.

But not all ideas will materialize. That is also the truth. And keeping the team in loop, being clear in your communication, will help them understand. And the aim is to get majority of these ideas across, but some ideas may have to fall behind that is the nature of how things are, or may evolve into something different by the time.

For example, they created the space based on the estates and finance and planning. However, the reality is that at the subsequent meetings, it was slightly tweaked again, and it may still further tweak again. But keeping them informed of the changes and why that has happened will help them move forward as well.

Amanda Rowley Yeah, and I think there was an important point during the week, wasn't there, Mona?

It was at the open house event on the Wednesday, and there was a lot of, "We're gonna move everything that's downstairs upstairs, everything upstairs downstairs. Things are going over there, we're building an extension." And it was all really great stuff, but there was some feedback at the open house that said, "Actually, this won't work for these reasons."

And for Mona and I, it was about making sure that the staff didn't think, "Oh, somebody's come in and said, 'Oh no, you can't do it.'" So we maintain those ideas, but how we could support them to adapt based on that feedback so they maintain the idea. It might have just looked a bit different by Friday, but that they didn't feel that we were saying, "Oh no, you've come up with this idea," and we're just saying, "No, you can't do it."

So that was also an important part of our role during that week because it was absolutely brilliant, but it wasn't without some of its challenges, both during the week and also also following the week in terms of the meetings that we've had going forwards and, you know, us being realistic about our expectations and how we're gonna navigate some of the sort of barriers and difficulties we find along the way. So that's been an important part of the process, too.

Chris Backous Yeah. And that's the important part of leaders and maintaining the right engagement, is embracing the paradox between urgency and patience. And I think what the 3P allowed you to do is the patience, is we have a plan, a very big, bold vision, that we can continue working towards.

And the urgency is we need to start something now. And even that example you just shared where the team got a little bit of feedback of, you know, we can't build an addition- By the next day, they let go of the idea of a building, but they maintained the concept of connection and continuity. And I think the other thing that led them to realize is there are some services that really shouldn't be together given the experience, because not every maternity experience is a delivery.

And recognizing that there is loss for some people, and the pain of experiencing that loss in the milieu of delivery, or for the, woman who's undergone surgery where delivery is not gonna be possible for them. They will have to pursue other opportunities of, you know, adoption and surrogacy and other options because of their surgical situation, they've now lost that.

And I think that by the end of the week the focus on the patient was just so deep. It was very much there from the first day, but it was, you know, we are working for the patients, the patients aren't going through our processes, and that shift was quite big.

As we kind of come to the end of our conversation, I would love each of you to just share something that came out of the 3P, a moment in the 3P that really delighted you.

So I'll let whoever wants to go first, but just something that surprised you, delighted you made the effort all worthwhile. What, was that maybe one or two things?

Mona Modi It didn't surprise me, but the collaboration was just amazing, the work they did together. And I felt like people say it's necessary collaboration.

I think collaboration is the only way to sort of sometimes design services. Otherwise it's not possible to have that holistic approach to when you design a service. So I found that quite pleasantly. I knew there would be, but I was very happy to see that in action when I went to observe.

The other thing, that obviously people's skills, lots of people had their hidden talents, which surprised me. For example, Amanda mentioned the pretty artwork that one of our colleagues did to represent the ideas. It was a big surprise, but equally, there were people who I felt may really exceeded my expectations when they came up with ideas, and like it's always a very pleasant surprise to think, "Oh, actually, I got it completely wrong. They are right. This is how it should be done." So I felt that that was really good.

Amanda Rowley And for me, the thing that sticks out in my mind is the report out on the final day. I remember just the immense sense of pride that I felt. So the staff that were involved had been busy preparing what they were gonna say and how they were gonna present, and I hadn't heard that until I came in the room to hear that.

And Mona and I obviously did a little bit of feedback at the end. But just hearing the pride that they spoke with and people that, you know, public speaking might not be something that they thought they might have been doing on Monday, and just to hear them speak with such confidence was really fantastic.

And the other thing is the people who came to the report out to listen, they weren't just from maternity and gynecology services. We had people throughout the organization and a really strong attendance from executive colleagues. So for these frontline staff to be able to present to the executives of the organization and really feel heard and listened to, and the feedback that they got was really incredible.

So I remember that very clearly.

Chris Backous I shared a comment with the group on Thursday afternoon because, there's so much energy, but mentally they're exhausted because they've been out of the box thinking and realizing they're using a part of their brain that they normally don't do and use.

And so I shared a quote, and it happened to be a quote from a very famous person from Great Britain, Florence Nightingale. And she said years and years ago, "I think one's feelings waste themselves in words. They ought to all be distilled into actions which bring results." And I think at the end of the day, that's what happened during the week of the 3P.

And I think it began with the courage of you as leaders to say, "Maybe we don't have all the answers, but the answers exist within our people." And so I want to applaud you for that. Is there anything that you would like to share now that you've lived with the vision and the results for a couple months, anything you'd like to share with the team who partnered with you in creating this vision?

Amanda Rowley I want to say thank you. Thank you for the opportunity and for your support and for giving us the opportunity to use these techniques to learn and grow. And we haven't always got everything right, but we've learnt from it, and we've come such a long way as a service in terms of what we are achieving through use of these techniques.

So yeah, for me it's a big thank you. And I'm already thinking about what comes next, both following the 3P and the different work streams, but where else in the service that we can use that. In fact, we did have a two-day event last week, another fast-paced one, and we've implemented a service change.

And you know, this encourages us to keep thinking about other areas that we can improve our service, which staff we can involve. I keep using the word opportunity, but the opportunities just keep coming in terms of how we can use this to benefit the women and families that use our service and the dedicated, amazingstaff that work here.

Mona Modi And I would want to echo the same feeling. I really... Chris, you were the good force. I can't believe that with all the jet lag and everything, you still every day looked like you were fresh and ready for the challenge. And you worked with our team. And I think, you know, it's one thing to just have a tool, but to have that support that you guys provided us to sort of use this tool, it is very important because, yes, I did the five-day year-round course but it wouldn't have been possible had you not given us that support.

So yes thank you so much.

Chris Backous So as we wrap up, what advice do you have for people like you, working in Trusts across the country and also working in hospitals in the US and other countries - 'cause we support 24 different countries with the institute - What advice do you have for people who have a similar experience where the press and the story publicly is not a very positive one, and yet the people who show up for work every day are amazing?

Any advice that you would like to give to those folks who are probably listening to this story?

Amanda Rowley I would say: Embrace that passion that comes from your staff. The staff that come to work every day, they're passionate about what they do. That's what brings people into work. And harness that.

Think about, you know, even if it's not as a first step thinking about that sort of large scale, what's my vision for the future? Think about what's important to staff, what's important to service users, and just start somewhere. Test the processes, test the methodology, trust in the process and the support that you're getting, and then just see where you can get to in such a short amount of time.

And let that be your starting point, and rather than looking at the sort of negative impact of some of these big national reports, look at the positives and how you can use that to drive improvements and change in both culture, experience, and the quality of the services that we're providing.

All of the ideas and the knowledge are in the room. They're here when we come in every day. But let's create the environment for people to be able to thrive and have the opportunity to just think a bit differently for a few days and see where you can get to. It really cannot be underestimated what events such as this can achieve and how they can change staff's outlook and how they can benefit the people that use our service every day that are at the center of you know, that's why we're, that's why we're here.

Mona Modi I would just say: what a great ending. I don't think I can add anything to this. But yes, people, staff, as Amanda said, they have passion. We just as leaders need to enlighten that passion again, and also everybody comes to work to do good. It is usually the processes and the systems that sometimes fail them.

It is not a personal failure I feel and all the reports, the national reports, they can be looked at in a positive light as in the nation is engaged. The trust board is engaged. These reports just tell you that we've been in the lowest step, now there is always a way up rather than a way down.

We can't go further down. So yeah, no, but trusting your people and making sure we harness their knowledge and skills to improve is the key.

Chris Backous I'll leave you with a final quote that I think really ties this all together, and it's from Robert Redford when he was trying to put together the Sundance Film Festival and hit all kinds of barriers.

He said, "Problems become opportunities when the right people come together." And I think that's proof. This experience has definitely proved. All we heard about were the problems, but they became opportunities and compelling for the vision because you brought the right people together, and then we brought the method forward.

So that's about all the time we have for today. I want to thank you, Amanda Rowley and Mona Modi. Thank you for joining us on the podcast today. And I do hope that the people listening take the inspiration from your courage as leaders to really frame the opportunity and give that problem-solving responsibility and opportunity to your teams.

And it's just amazing. Over and over again, we see the power of an idea put to action turned into innovation in healthcare. This is the path to transformation. Getting the right people together, framing problems correctly, and then seeing where they go with reliable methods like 3P and other kinds of strategies.

So thank you so much for your time today.

Amanda Rowley Thank you. No, thank you as well, Chris. Thanks for all your support.

Chris Backous Thank you for listening to Better Never Stops. You can stay up to date with our latest episodes by subscribing on Apple Podcasts, Spotify or wherever you get your podcasts. You can also find us on social media or send us an email at info@virginiamasoninstitute.org. Thanks again for listening, and remember, transforming healthcare is not just a pursuit of perfection, but a mindset that we can always do better, because better never stops.