Improving care by taking time to review the day

A mini after-action review at the end of each day, which gives staff the opportunity to discuss what’s gone well and what could have been handled better, is boosting morale and improving care.

The Daily Flush - the name comes from the flush-out of chemotherapy in cancer care - has been running for two years at the Sussex cancer centre at RSCH and is now firmly embedded into the daily routine.

The idea is being taken up in haematology and Cancer Matron Sophie O’Brien says other areas of care could benefit, by adopting a similar version of their own. It’s distinct from the Patient First huddles and acts as a “download” for staff before they go home.

“We meet up for 15 minutes at the end of the day,” Sophie explains, “and we go through what has happened. How is everyone? How were the bookings? The idea is that we review the day, flush everything out - what’s good, what could be better and then we don’t take it home. It makes you think about how you give feedback. There are ways of saying things that are positive, that can be useful and constructive.”

Obviously the good things are easy to say but as the mini review has evolved, Sophie says staff are finding it easier to challenge what’s happened and learn from it to improve care for patients. “It’s not about showing up a member of staff. It’s about having the time to talk things through, finding the positive as well as what could be improved, and the team connecting with each other. I think it has definitely helped us improve. The daily flush makes us constantly review our service, iron out any issues and provide the best care possible.

“A good example is our bookings. Because we’re constantly reviewing our booking system during the daily flush, the flow of patients is much better. Also, if something happens during the day, we discuss it at the daily flush and we’re much better prepared to deal with it, if that situation comes up again.”

Team members are now more likely to praise a colleague at the time and not wait until the end of the day meeting, and Sophie says they really benefit from this peer-to-peer feedback.

Although the daily flush has a serious side, Sophie says there’s also lots of laughter which the patients enjoy. “We’re sort of in a goldfish bowl when we have the daily flush,” she says, “with windows all round. We’ve had so much feedback from patients saying they like to see that we can all laugh together. Cancer, like other areas of care, can be hard. People are here for a long time during the day having chemotherapy and we try to make the atmosphere as friendly, calm and non-clinical as we can. It is serious but we also laugh a lot and the patients love to see us chatting and laughing.

“Whatever happens, good or bad, it comes out in the flush and no one takes it home. It’s better to get it out of your system and not brood on it. The daily flush brings us together as a team and there’s a real connection. We always end on a positive note and that’s what we take home. It’s about learning, supporting and encouraging, and always trying to make our service the best we can. I think the fact that we do it every day, no matter what has happened or how busy we are, proves that it’s working.”