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The New Queen Elizabeth Children's Service. Maggie Rogers, BSc (Hons), RSCN, RN, DN (London). Breda Gahan, BSc (Hons), RSCN, RN. The planned change. On October 28, 1998, Her Majesty Queen Elizabeth II inaugurated the new Queen Elizabeth Children's Service at the Royal London Hospital. At this early stage we still have what is a comprehensive and complex secondary and tertiary children's service (see figure 1). This is a considerable achievement from what was an extremely ambitious plan to move a children's hospital, reconfigure a children's service and achieve as many services on one site as possible, all within one year. We are now undergoing a process of reflection and evaluation of the planning and change process which involves all disciplines and participants. This will provide lessons to be learned and give direction for the planning of the new Children's Hospital. This article describes the process of the move, the central role of nursing and highlights the importance of integrating children's services. The examples below give a flavour of the complexities of the move, but are by no means exhaustive. We knew that the change process would affect all three units at the Royal London (RLH), St. Bartholomew's (SBH) and Queen Elizabeth Children's Hospital (QEH). It was not a simple movement of a service from one site to another but probably the most complex move of services that the Trust had undertaken. Each of the three units had their own traditions, cultures and loyalties. Vehicles for change are principally to do with communicating and consolidating its acceptance. (1) The commitment for this change was generated by the shared belief that children and families would benefit from a centralised, comprehensive high quality service, essentially on one site. Feelings of conflict were understandably strong. For many specialist paediatric staff, support staff, children and families it meant the loss of 'their' children's hospital, but hopefully only temporarily. This feeling of loss should not be underestimated: the local community expressed passionate views about the closure of QEH. On the day of the move two parents telephoned to ask if their children had been buried on the hospital site many years ago, they were reassured that this was not the case. The memory of the hospital ran through many local generations. Identified factors to facilitate change The luxury of planning change in small steps was not one that we could afford.(2) The appointment of a project manager for such a large-scale change, within such a tight time frame, was crucial to its success. The enormity of the change had a significant impact on many staff who were fulfilling roles that under 'ordinary' circumstances are demanding and challenging. Strong leadership and direction from the project management team: project manager, clinical director, operations manager, business manager, lead nurse, and the senior nurses and sisters was critical. At an early stage the importance of involving staff and teams in the change process was recognised. It would have been easier and speedier to make decisions and given rationales later for not consulting, but we knew this would not work. Every attempt was made to avoid this and follow a rational empirical approach to change. (3) Providing information and support for the change with direction, negotiation and delegation was needed. Keeping the nursing teams together, and specialist clinical focus of the teams, wards, and departments was a priority. One of the strengths of the service are the opportunities offered to Children's Nurses to gain specialist experience and expertise alongside general medical and surgical experience. The importance of continuing the development of practice, identifying training needs, is essential during the change process. (4) This enables staff to continue to provide high quality care. This was a major challenge in a nursing service where recruitment had become increasingly difficult through a period of extreme uncertainty and involved a significant level of risk. At times, in response to the level of agency nursing usage, and the work demand, the lead nurse and senior nurse walked a tightrope between providing safe care and further reducing available beds with possible devastating consequences to the future service. The commitment of the nursing teams was a significant factor to the success of the change, and maintaining the service through what were difficult times. Communication was key in keeping all staff fully informed of the progress. Regular briefings gave all staff an opportunity to be informed and all regular meetings became absorbed into the change process. However, the most important communication was to children and their families and to the local community, to create a level of confidence that the new services being developed were going to be responsive and of a high quality. Not just the changes at The Royal Hospitals Trust, but across East London, with the East London and City Health Authority strategy to develop high quality equitable services across East London. The development of the operational policies proved to be one of the most important processes. The benefits of developing the policies made a significant contribution to the teams who were moving to the new site. They fostered an understanding of how things would work, networking and building relationships with key personnel, as well as identifying problems and differences. With the appropriate support and guidance the ward sisters lead the development of their own operational policies. This empowered them to establish new links, and ensure that the multidisciplinary aspects of the policies would work. This gave the sisters the opportunity to recognise their individual capacity for growth and self-determination. (5) We strongly suggest that the development of operational policies will be key to the success of the new hospital development in the future. The need for team work created team building opportunities and increased awareness of the needs of children within the Trust. Concurrently, through the move process the work of the The 'Needs and Rights of Children and Young People Steering Group', established by the Chief Nurse, continued, as did the work of the Paediatric Nursing Policy and Practice Group. The need to continue to identify best practice and offer equity for all children within the Trust is of paramount importance within a centralised service. The work of these two groups will continue with an aim that all children are cared for under the umbrella of a comprehensive children's service. Families and children, especially the regular attendees, required an enormous amount of support, information and preparation prior to the move. Some of these families 'loved' QEH, and had significant 'life event' memories of the hospital. Staff reassured and promoted the move, whilst experiencing personal uncertainties and anxieties. The knowledge that the same teams of staff would be caring for children was a major positive factor in bringing families from QEH. However, this was not the case for some of the regular families who had attended Grosvenor Ward at The Royal London Hospital, as the nature of this ward would change. The enormity of the change, for children and their families attending all three sites, was recognised. The move of patients on the day was poignant. If this was achieved safely and smoothly, it was felt that any other snags could be dealt with. This was co-ordinated by nurses whilst organising the packing and last minute removals, and admitting patients onto the new site. Some teams had the benefit of more time to prepare their clinical areas than others. The cancellation of planned and elective work enabled the move to take place, and the absence of potential 'early winter' admissions at the end of September prompted sighs of relief from all clinical staff. For hospital staff to provide high quality care a suitable environment is needed. The National Health Service has provided high quality care in debilitating, out of date, and sometimes inhibiting environments for many years. Staff therefore make the real difference. We now have a quality environment for quality care, we have adequate space as well as aesthetics and decorations demonstrated by the wonderful floor designs on the fourth floor. For children, families, and paediatric staff, the ethos of the environment is of critical importance. Team work and 'togetherness' is part of this. This is one of the major challenges facing the new children's services. The geographical split across one site and a small isolated unit on another, creates added challenges to create cohesion. Areas of further development include improving the care and philosophies for adolescents, and facilities for families. Every attempt was made to maintain the facilities for adolescents. This proved to be difficult because of the space constraints. The need for facilities for families and accommodation is being pursued. Data analysis of parents who are resident, and who wish to be resident, is being collated to build our case to obtain charity funding to develop these much needed facilities. Finally, security is of great concern to all children's units. The security systems that have been established are constantly being evaluated and strengthened. The most secure measure is for staff and families to be vigilant and challenge unknown persons. This must be accepted by all Trust staff, and seen as a positive action to ensure the safety of children in our care. Removal of uncertainty about the future of the service has enabled a more positive approach and response to recruitment. Having already achieved virtually 100 % registered children's nurses in post, strategies continue to reduce the vacancy factor further. Early responses from potential recruits suggest a positive view of the comprehensive opportunities offered, and new facilities, in what is the second largest children's service in London. The location also offers increased access from a wider geographical area than the QEH site. Further strengthening of our professional development and education programmes will also create an attractive unit to work in. Educational opportunities are expanding with the development of paediatric modules and courses with the Department of Children's Nursing at City University, and the development of rotational posts for nurses to gain a wide range of experience in a multi-speciality service. Children's hospitals were originally developed because children were not allowed into hospitals at all. Children's nurses emerged because children's hospitals existed. This did not mean that professional staff in 'adult' hospitals did not recognise the needs of children, and this was the case in East London, where the beginnings of Queen Elizabeth Children's Hospital began at the, then, London Hospital when Ellen Phillips volunteered her help and was placed in charge of the cholera wards, and subsequently with her sister opened their dispensary. (6) So now, in 1998, we have the Queen Elizabeth Children's Service at The Royal London Hospital (and St Bartholomew's Hospital), where the seeds of the service were planted long ago. The success of such a major change - clinical, organisational, and emotional - owes much to many. Our special thanks goes to those listed below. Those of us in Children's Services recognise that planning, collaboration and effective management have successfully accomplished a major task. Children in our care will continue to benefit from the richness of our legacy, now and in the future, matched with the 'best of the modern' we can offer for their treatment and care. Acknowledgements Barbara Thompson, Senior Nurse Policy Development. A comprehensive secondary and tertiary children's service including:
Paediatric Secondary and Tertiary Specialities
1. Johnson G, Scholes K. 'Cultural Fit' Exploring Corporate Strategy.1993. 2. Quinn JB. Strategies for Change - Logical Incrementalism. New York, Irwin, 1980. 3. Bennis WG, Benne K D, Chin R, Corey KE. The Planning of Change. London, Holt Rinehart and Winston, 1976. 4. Kochan and Baroccie (1995), Miles and Snow (1994) in Martin R, Pheiffer G. The Life Cycle Model, Human Resource Strategies for Flexibility and Change, 1997. 5. Gibson C. Concept analysis of empowerment. Journal of Advanced Nursing 1991: 16; 354-61. 6. Kosky J. Queen Elizabeth Hospital for Children, 125 years of achievement. The Hospital for Sick Children London. John Brown Ltd., 1992 Nursing Progress: Issue 5: January 1995. Copyright: Nursing Progress, Royal Hospitals NHS Trust Return to Nursing Progress contents list Last updated by DEB on 06/03/04 |
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