Table 1

Fix, Improve, Change: defining, triaging and addressing problems in the learning system

FixResolve problems in reliably doing what we said we would do. These were usually issues that could be resolved with rapid operational changes.Installing mirrors into the donning area to improve the safety and reliability of donning of personal protective equipment (PPE), particularly for non-clinical staff.
Ensuring contact telephone numbers were correct and prominently displayed on the ward.
Ensuring adequate stock levels and visible storage of drugs and key supplies.
ImproveFind better ways of delivering standard care; improve what is currently being done.Introducing a day zero simulation training day ahead of individuals’ first shifts to improve readiness of staff for the floor and clinical environment (staff came from different hospitals, clinics or organisations that had different ways of working and different equipment).
Streamlining the donning process at shift handover: reduce the time for staff to put on PPE and ensure it is correctly worn before entering the clinical area.
ChangeSignificant changes in clinical or operational practice.The design, development and implementation of a new venous thromboembolism protocol.
Developing the extubation protocol.
  • When a challenge arose, the Quality and Learning Team would define the problem by synthesis across the Bedside Learning Coordinator observations and insights and any additional relevant data sources, categorise and triage the problem. Next, the appropriate Specialist Decision Forum would review and either decide on a change to be implemented or pass along to the daily Clinical Forum (a multidisciplinary meeting) for a decision on a change or, if appropriate, to designate for simulation, testing and research. Source: Bohmer et al.1