The other, original, Ipswich

When you are from Massachusetts, Ipswich is a town that brings to mind steamed clams.  Here in the United Kingdom, the original town of Ipswich has a number of attributes -- as a major port, as the center of a farming district (the football team is known as "The Tractor Boys"), the location of British Telecomm research and development center, and -- my destination -- Ipswich Hospital NHS Trust.  I have been invited to give some presentations and hold workshops on quality and safety, front-line driven process improvement, and transparency.

The first meeting this morning was with the Trust Board of the Hospital.  (You see here interim chief executive Nigel Beverley and board chair Ann Tate.)  We discussed the similarity of issues facing hospitals in the UK and the US, notwithstanding differences in the institutional and funding structure in place in the two countries.  Questions of how to sustain process improvement and calling out of impediments, errors, and near misses was a key topic.

I was later joined at lunch by medical director Peter Donaldson (left) and chief nursing officer Catherine Morgan (above, center) for a discussion about pre-surgical protocols and check lists and other mechanisms for reducing variation in the delivery of clinical care.  Peter related a couple of stories to me from his own clinical career, many years ago, one in which he experienced a near miss before such protocols were in place.  This one involved almost removing the wrong kidney from a patient.  Each person in the clinical chain of treatment had repeated that it was the left kidney to be removed, notwithstanding the patient's saying to her GP that she was confused because it was the right kidney that was painful.  The GP said to her, "You can trust Mr. Donaldson to do the correct thing."  When Peter arrived in the OR to remove the left kidney, there were no X-ray images posted, and he asked to see them before proceeding.  Once they were displayed, he understood the error he had almost made.  He still shows evidence of the shock of that moment as he tells the story.  Peter tells this story to other doctors in training to reinforce the need for proper adherence to the pre-surgical protocol.  Unfortunately, as we all know, there are a persistent number of wrong site surgeries throughout the world (with a pertinent example shown here), and the potential for such harm exists everywhere.

I was impressed with the staff's commitment to quality and safety initiatives and their openness in learning from their own errors and near misses.  I look forward to sharing stories and ideas with them over the coming days.

Original Edwardian entrance, with maternity suite above

Ipswich Hospital original architectural detail