Changing paediatric practice from the bottom up and with no central funding might sound like an ambitious task. But that’s what the Paediatric Innovation and Education Research Network aims to do, as clinical lead Dr Gary Connett, from Southampton Children’s Hospital, explains.
The great American comedian and actor W.C. Fields famously said ‘Never work with animals or children’. But then he was talking about the arts, not medicine.
And for Dr Gary Connett, consultant paediatrician with a special interest in respiratory medicine, there is no greater attraction in professional terms than working with youngsters. ‘I think the thing about children is they don’t take any nonsense’ he says with brutal honesty. ‘Young people call a spade a spade and are honest about what they see in front of them.That’s quite humbling and brings us all down to earth.’
‘I guess the most rewarding thing is being able to positively impact someone’s life from such an early stage.’
That guiding principle of improving children’s lives is what underpins the Paediatric Innovation and Education Research Network (PIER), set up two years ago by clinicians and other health professionals in the Wessex region to standardise and gradually improve quality of care for all sick youngsters, wherever they are in the region.
It’s raison d’être is to ‘support integrated, child centred, multi-professional care at all levels through group learning, shared best practice, the development of regional guidelines and original research’.
It aims to flag up good practice in paediatrics and disseminate it to all corners of the Wessex region, driving up quality, sharing skills and, crucially, reducing variation in the standards of care patients receive.
If that all sounds a bit worthy, it’s important to remember this is an initiative being driven by the desire of those at the coal face of paediatric medicine to make things better, not by a conventional top-down government approach.
‘PIER is a bottom-up initiative,’ says Dr Connett. ‘It’s about paediatricians and other healthcare professionals trying to improve care around the child on a regional basis. The difference between PIER and what people did in the past is we are multi professional in the education and training work we do. We transcend the boundaries of the individual district hospitals and the regional centre. It’s about being joined up in a meaningful way that is centred around better care for patients. That’s it in a nutshell.’
But that’s just the objective. Putting it into practice, says Dr Connett, has been a challenge, not least because of the need to break down the barriers between professions in order to create meaningful multi-disciplinary care. ‘We have to develop the profile of the professional roles of nurses, dieticians, physiotherapists and other healthcare workers. We need them to feel valued and able to contribute as part of a team, rather than working in silos. We have a relatively small organisation and there are many silos and many communication challenges.’
But perhaps the biggest challenge so far has been running PIER on a shoestring. There is no central funding, says Dr Connett, so the emphasis is on people ‘working within their own professional capacity’ to enhance what they are doing.
Money aside, there are cultural challenges that need to be faced as well. One, Dr Connett says, is the use of simulation-type training to assess and improve working practices. It’s not something everybody initially welcomes but there is widespread acceptance that it is one of the best ways to drive up standards across the board.
‘We think it is a very powerful way of learning as it emulates real life scenarios. But getting people to embrace that culture of being put into a simulation environment and then having their performance critiqued and given feedback on how to do better is a cultural change for many.’
Another example of how PIER is changing things is paediatric nurse training, taking it out of hospital ‘silos’ and delivering it on a regional basis – so that standards are uniform across the area.
Dr Connett says: ‘This is a model of care that is transferrable. We are challenging the way we train healthcare professionals in silos and asking organisations to think about how we can have more meaningful joined up training. We want consistent good practice, providing specialist care from all health care professionals wherever children are. So it’s not a postcode lottery or based upon who you are seeing where. Instead, you’re being looked after, wherever you are in a region, according to best practice because the people who are providing the service are joined up and working together across that locality.’
It’s still early days for PIER. But it has just held its first annual conference, frequented by everyone from doctors and nurses to dieticians and play therapists. And if Dr Connett is right, things can only get bigger and better.
‘I think we need to extend paediatric training further into primary care. The learning and the best practice needs to be much more integrated into primary care and we need to do that in a way that enhances and empowers what GPs and health visitors are already doing. We also need to be thinking a lot more about prevention and education around best practice towards keeping children healthy. There is an unmet need in terms of prevention. But we are hopeful and optimistic because there is a lot of energy around this project and in particular from amongst our trainees. We are extremely fortunate in that we have some fantastic junior trainees who have great vision and fresh ideas. We aim to empower them to move forward with their own initiatives because, after all, they are our future leaders.’
by Pat Hagan
For further information about PIER: http://www.piernetwork.org/