Doing a retrospective to support the hospital through industrial action

Many Digital or ICT teams would have found different ways to support hospitals through the recent industrial action. I thought I’d share how @BucksHealthcare did it, and share some of what we learnt from the process.

We hit the first period of industrial action in March a little too fast. The blue gilets from the Digital team agreed to person a roster to allow coverage across the 3 main sites of the Trust (Aylesbury, High Wycombe and Amersham), including up to 10pm at night.

Our initial feeling was we wanted to show support, to fix stuff that was broken (and would add to the stress and frustration staff might be feeling), and also to support people who may be working in different roles or logging in to systems they haven’t used for a while. We were also a roving fire fighting team going where the need was most urgent.

We covered the immediate pressure points — mainly the different front doors we have — the adult and children’s emergency departments, our specialist Cardiac and Stroke Receiving Unit and also maternity.

As it happens the work the Trust put in leading up to the strike meant we didn’t have a catastrophic few day, far from it, but this was only due to the exceptional effort of the various teams across BHT (and inevitably deferring some patient appointments).

But back to being Digital, being the Digital folks we are we held a retrospective of our experience. The retro board can still be seen here, and here’s an illegible picture to show you what it looked like!

From this retro we came up with some priority points to take forward for the ‘next time’ (which came around too soon)

1. Make sure GP (general profile) update pushed to all machines, and check!
2. Delete profiles not used for 90 days to speed up PCs
3. Identify any Windows 1909 users and proactively reach out to them/go to them
4. Have folks from the desktop team assigned to blue gilets
5. Work with POCT and Medical Engineering teams (Heightened awareness? Walking the hospital with us?)
6. Download a list of items in Service Now by location e.g. Ward 10 has 6 issues etc
7. And fix the basics beforehand e.g. non-working printers (target as per previous point), logins broken etc — proactive by Service Desk, Desktop team and Digital
8. Plan in advance e.g. draw together Digital, Service Desk, Desktop, Medical Engineering and POCT to brief — have a floorwalking plan (as before) — start the week before
9. Include wider Rad/Path/ICE managers in planning/floorwalking chat
10. Communicate to the Trust where we’ll be coming (if strike action on the 11th — fix 3rd, 4th, 5th, 6th) — use a list of named ward contacts
11. Have Alto on site through strike action to fix printer problems as they emerge
12. Extend Service Desk support into the evening
13. Promote refresher training e.g. DocGen
14. Equip floorwalkers with a stock of common kit e.g. USB C cables
15. Reinstate Service Now chat for strike events (or Major incidents)
16. Prioritise areas for Service Desk support e.g. ED, Paeds ED, ICU, Maternity, CSRU (still got a dodgy printer)
17. Stand up a Bronze procedure for ICT through the week
18. Build a knowledge base for common issues (or promote existing ones!)

And then the brilliant Julia Fish (one of our PMs) created an action plan to make the above real.

Keeping it simple! Using MS Word…

And then we hit what was a 10-day period of heightened support — the Easter weekend, the 4 day period of industrial action and the following weekend. I say ‘we’ I mean the team as I was on holiday 😉

In terms of the week we had a rota for where people would be (and shared this with the hospital), we ‘went where problems were flagged’ and extended Service Desk hours into the evening. We also built connections into the ‘ologies and had a hotline to Medical Engineering. We used a MS Teams chat as our hotline, in the end with 49 people on it, and looking at this on returning from leave it was a real time running commentary on what folks were finding, asking for help, and directing fixes to the appropriate people.

This was almost running a 4-day incident with an open hotline in MS Teams.

The folks did brilliantly (and there’s too many to name individually!).

And my takeaways from this?

• Everything is great when you’re part of a team (as the Lego movie taught us)! This work really brought together the parts of ICT — Digital teams, Desktop Support, Service Desk and tech folks in the hospital (the ‘ologies and Medical Engineering)
• It’s all about the people. This wasn’t about people ‘just doing their job’ — folks volunteered — folks stepped out of their day role, folks went out of their comfort zones and no-one complained. I also think folks got a lot out of it — feeling a part of the hospital and genuinely welcomed as we walked into clinical areas
• Plan, plan, plan. Do it in a simple fashion if you want, emails, MS Word docs like the above, Kanban, Monday.com but do it in a flexible responsive manner, I think I mean…. Be Agile! Our planning was made much better by doing a retro on the first period of industrial action, and hey, through the second period of action we were truly Agile in going where the need was greatest!
• Communicate, communicate, communicate. We used a Teams chat as our running commentary on what was happening where. We had 49 people on the chat which meant we had an instant pool of expert knowledge near to hand. If the blue gilet floorwalker didn’t have the answer, they had 49 plus people a Teams chat away who did! This meant we could be instantaneous in our response, which is not the norm for hospital ICT…. 😉
• If you’re outside an Acute Trust, have empathy. On a national call it was mentioned ‘it’s Easter next week so will be quiet…’, had to mention for those working in a Provider it would be very busy because of the strike. One NHS, always be empathetic.

Post authoring note

We carried out another retro after the second Dr’s strike and the results can be seen here https://retrotool.io/P-KBCniVxqGhdQ4xiI1-t. What’s interesting is the ‘what could be improved’ (or ‘Lacked’ on the retro board) was much smaller than previously! Which I wholly attribute to the fact we had a previous retro and a plan!