Professor Meghana Pandit, CEO, Oxford University Hospitals NHS Foundation Trust
In the first instalment of Innovation Perspectives, a Q&A series with OAHP Board Members and local thought leaders, we chat with Professor Meghana Pandit, OUH’s representative on the OAHP Board. Read on to learn more about Meghana’s perspectives on innovation and quality improvement, addressing health inequalities and how the pandemic has ushered in a new future for healthcare.
“We ask our own clinicians to come up with innovative ideas, based on clinical need, that we can help them to mature and get into practice.”
Of the many ways the NHS adapted in the response to the Covid-19 pandemic, what would you like to see become the new normal for the future of healthcare?
The pandemic was in many ways unusual because we didn’t have a manual for how to respond, I certainly didn’t. We found that lots of people had to suddenly adopt different roles and different working practices.
Digital technology is an enabler of health services, and the fact that we ramped this up during the pandemic and went from zero virtual consultations to several hundred thousand consultations by phone or video link is definitely something we want to keep in the future, not just in Oxford, but across the wider NHS.
Linked to this is hybrid working for staff, which I think allows for a better work-life balance. There are some disadvantages like reduced social interaction, but nevertheless, this way of working allows those staff who live outside of Oxford to still work in Oxford without the need to commute long distances each day.
In addition, the agility of the way in which things were changed during the pandemic is something we need to adopt as business as usual, rather than something that is forced upon us.
During the pandemic, we saw many staff change roles or work to the maximum upper limit of their roles so we could adapt our services to offer the necessary care. This showed us how important it is to retain a bank of talented individuals who we know can work differently, who can be kept ready and prepared to respond and train others to respond to future crises.
From your own experiences, what are the critical factors in making healthcare innovations and new ways of working stick and spread into practice?
Over the years, I’ve been involved in several change and quality improvement programmes and I’ve seen that improvements that last are those that are made by staff who recognise that change is needed.
Making change stick is one of the most difficult steps in any quality improvement programme. I firmly believe that one of the critical factors to make this happen is for the Trust to actively facilitate the changes that are recommended by our own staff who understand most about what their services are and how their services can improve.
It’s the same with innovation, where through The Hill, our digital innovation hub, innovations from outside the Trust are identified to test clinically, but more importantly we ask our own clinicians to come up with innovative ideas, based on clinical need, that we can help them to mature and get into practice.
One important aspect that helps innovation and improvement stick is the culture of the organisation, particularly since change and culture are so closely related. The tone is set from the top, from the Board. We put our patients and our staff at the heart of everything we do, we appreciate positivity and excellence, we value compassion, we strive to communicate clearly, and we work collaboratively and in partnership across the organisation.
I think that with these collaborative approaches to improvement and culture, change will stick.
How can health and care staff be best supported and empowered to get involved in quality improvement initiatives, particularly those who have little or no experience of research?
I am a QI enthusiast and I when I came to Oxford in January 2019 as the Chief Medical Officer, two consultants came up to me saying that they would like to start QI education in the Trust and I said, “let’s do it, I’ll support you”.
Despite the pandemic, our QI education programme has now matured into a fantastic award-winning QI hub, where several staff have gone through the training programme, we’ve developed an improvement team and we are currently running eight improvement programmes. Each of those programmes have measurable smart aims and include stakeholders who are genuinely involved in creating that change.
We have also created a “QI Standup” forum, where people share and discuss their projects and outputs.
Our approach to QI is to show others what can be achieved, encouraging people to start small, inch wide but mile deep, and to recognise that failure will come, but where you fail, fail forward fast to find success.
How do you see Oxford’s research assets supporting the developing research and innovation agenda across the BOB Integrated Care System to tackle the region’s complex healthcare challenges?
We are very fortunate to be in partnership with Oxford University and to host the NIHR Oxford Biomedical Research Centre. For this year’s grant application we were really keen to include multimorbidity as a research theme, given we see this at the front door of our hospital every day. We’re planning to look at innovative ways to address this, either by employing digital technology or by looking at data and creating models so we can predict when someone is most likely to come in with a health problem. This means we can plan our services accordingly.
It goes without saying that we also delivered the Oxford / AstraZeneca Covid-19 vaccine, which was developed here in Oxford and is saving the world. This was possible through partnerships with AstraZeneca and the Serum Institute in India, an amazing vaccine production facility that I visited recently.
These are the sort of collaborative arrangements and partnerships, combined with the extent and reach of Oxford’s unique position being at the forefront of research, that we have to leverage for patients in the region.
Going forwards, as a healthcare organisation, we should look to partner more increasingly with industry and consider what it is that we can do together to improve our cancer treatments, advance our technology and equipment, and respond better to pressure on services.
We could also look to widen the footprint of our local OAHP partnerships to welcome other universities into the fold, so the benefits of developments like the secure data environment can be felt in healthcare organisations beyond Oxford and the BOB ICS.
How can partnership working address health inequalities in our region in the wake of the Covid-19 pandemic?
Health inequalities have always existed, they just were brought to the forefront by the Covid-19 pandemic as we started to understand the impact of the virus. Through our health inequalities steering group, we are planning to look at our waiting list to see whether the burden is higher for people from certain demographics – are they waiting longer or are they presenting later? We will also work on the NHS Core20PLUS5 Framework and on the cross-cutting theme of reducing smoking.
One of the most common morbidities in secondary care is cardiovascular disease, and there’s some very good collaborative work going on in Oxfordshire measuring blood pressure in the community, for example.
Programmes like this, delivered outside our hospitals with our community partners, can help to empower communities by providing them with tools and support so they are better informed about their own cardiovascular health.