What does quality look like? 
Part 1: Communication

I must start by saying that my experience of Nuclear Medicine departments is that we generally look after our patients beautifully while they are in our departments. And if you don’t think that’s true for your department, then you should make your feelings known, whatever your role.

However, I have recently been thinking a lot about how good our patients’ overall experience is. What do they consider to be a quality service? Is there anything that we can do better?

I think it can be easy to forget, when we talk about our patients, that sometimes WE are the patients.  Like many of you, I’ve had this experience. Not in Nuclear Medicine, but in other areas. And in most aspects, our wonderful NHS has been brilliant. But there were some opportunities to improve – for example in communication and the interface between different services and organisations. I’d like to share some of these experiences, as some of it may give some food for thought:

1. I like to think I’m a fairly intelligent woman, and I really don’t like being called sweetheart by someone I don’t know. In fact, I’m not that keen when it’s someone I do know. My brother-in-law, who I like very much, occasionally gets away with it. I’d rather someone used my name – and gave me theirs. This irritates me a lot, and I know I’m not the only one. 

2. I don’t like things being done ‘to me’. One example of this was when my 3 year old son was in traction for 4 weeks and had to stay in hospital. He was well looked after, and the nursing and medical care was good, but looking after a young child and keeping him occupied in hospital for that length of time was a challenge. We ended up with quite a lot of ‘stuff’ in the bed bay. I kept it very organised and for that time, it essentially became home. However, one day the nurses, without anyone saying anything to me, started moving everything. Suddenly having someone start to handle all our things without knowing why was alarming and upsetting. We were being moved to another bay, which was fine, but a simple conversation beforehand would have alleviated the upset. Letting patients know what is happening to them and why is important.

3. Another thing I really don’t like is when things have to repeated for what seems no good reason – what a waste of resource. My mum has recently been unwell and saw her respiratory consultant at her local hospital. He ran some blood tests and contacted us to say she needed to go to A & E that day. He wanted her put on a drip for severe dehydration and dangerously low potassium levels. We took her in to the emergency department (at the same Trust) and had to wait for hours to be seen, after which time, all the blood tests had to be repeated before anything could be done. My poor little mammy – 86 and confused, waiting all that time, and not going to the toilet even once because she’s so dehydrated (she’s normally a very habitual user of the facilities). She went to A & E at teatime, and it was past midnight before she was put on a drip. Why did it take so long, considering a consultant at the same organisation had said for her to go in, and why did we have to repeat blood tests? I know this isn’t directly relatable to Nuclear Medicine, but the communication between departments within our hospitals and the interface between different organisation is definitely something that can be improved in my experience. And it may be that the poor communication comes from other departments, but as far as the patient is concerned, they don’t see where it arises. It’s worth a review to see if we can affect any improvements. How educated are the ward and medical staff about Nuclear Medicine tests? Could we improve this, and by doing so, improve the experience of our patients? 

I consider the visit to our Nuclear Medicine departments as the meat in the referral sandwich. There is a slice of bread before they arrive, and this is the part where we communicate the details of the test or treatment they are being invited to have. How good is that communication? How many of us are communicating the appointment information in the patient’s own first language, for example? In the area where my Trust is located, for a large proportion of the population we serve, this isn’t English. Wouldn’t it be more reassuring and welcoming if some of our direct communication with them also provided some information in their own language? You may think this is too difficult, or maybe even disagree, but have you asked your patients about it? 

The final slice of the sandwich is what happens after the patient has been for their appointment. If I have a test for something at the hospital and don’t get the result for 5 months, do I really view this as a quality service, even if the people were lovely? If the result is likely to take a long time, are we giving the patient realistic time frames? And if a result slips through the net and for some reason, is late being reported, are we being open about it and apologising?
So going back to the question about whether you have asked your patients – many of us do gather feedback, but it can be quite passive. We sometimes get lovely thank you letters (and occasionally even sweet treats). We may have a box for suggestions, and we respond to any complaints received. But do we actively ask them for feedback? I know it takes time to process when it is returned, so it may not be something we’re able to do continuously, but could you consider how to do this in some way, if you’re not already?

If you’re wondering where to start with this, the BNMS can help. We have a patient advocate named Adrian Hardy on the BNMS Council, and who better to help us gather feedback from patients. He has put together some questions he feels would give us a better overview of how patients feel about their experiences. He has made this available on our website for you to give to your patients. Patients need only answer the questions that they see as relevant to their experience. Adrian would like to co-ordinate the feedback on a national level, so please ask your patients to send their answers to Adrian at apaulhardy@aol.com or if they’d like to speak with Adrian send him a text on 07707 901953 and he will get back to them.  

You can find the information at: 
https://cdn.ymaws.com/www.bnms.org.uk/resource/resmgr/patient_information_leaflets/v2_patient_experience_feedba.pdf

I hope you’ve found this interesting! Find me on X (formerly known as Twitter) @PresBnms

Ms Jilly Croasdale
BNMS President

The BNMS could be good for your health!

Countless psychology studies have investigated the underlying factors which support happiness and wellbeing. One such factor is gratitude. Gratitude is defined in the Cambridge dictionary as ‘a strong feeling of appreciation to someone or something for what the person has done to help you’, and that sums up how I feel about the part the BNMS and the people I have through it have played in my life and career. 

I first attended a BNMS conference in the early 90s, when I worked as a trainee Radiopharmacist at what was then Dudley Road Hospital in Birmingham. The conference was held at Imperial College, London – and was in fact, the last of a number of meetings held there. I remember sitting in the various sessions in awe of everyone – not just the presenters, but also the audience. The interactions, questions and debate coming from the audience totally impressed, and slightly terrified me. I so wanted to put my hand up and comment but was too shy in those early days. However, BNMS is full of people like Dr. Keith Harding, past BNMS President and my first Consultant back at Dudley Road - innovative, questioning, clever but also down-to earth and encouraging. I continued to be involved in BNMS through the rest of my time in Birmingham, whilst at Leicester Royal Infirmary and at the Royal Free Hospital, and then when back in Birmingham once more. I was so lucky to work with some wonderful people in each of these places. I grew in confidence and with the help of the BNMS, enjoyed not only learning about the wider world of Nuclear Medicine, but also making useful contacts both with other Nuclear Medicine professionals and with Industry colleagues. 

The BNMS is about a lot more that the conferences it puts on – although these are great, as anyone who managed to join us in Harrogate will hopefully attest to. It is about a unique community of professionals, all working together to achieve the same goals and all respecting the part they all play in the care of patients. It’s about all those Technologists and Radiographers who put the patient at ease, ensure the scans are of suitable diagnostic quality and much much more. It’s about the Radiopharmacy staff who work to ensure safe, effective and high quality Radiopharmacy services are provided. The Physicists who ensure our cameras are working to their optimum capability and that we are working safely within the boundaries of good radiation protection, for example. It’s the nurses and support workers who care for our patients whilst they are in our departments, and our doctors who ensure the test the patient receives is suitable as well as providing that important final report. Of course, all the people I mentioned do many other things, but the point I’m trying to make is that everyone plays an equally important part in the care, diagnosis and ultimately treatment of the patient. And I think that’s pretty unique, and to be frank, pretty fantastic. 

BNMS does many things behind the scenes to help and support our community. Elected council members, co-opted experts and our wonderful BNMS staff help provide guidance and leadership - you may have read some of our guidance documents and I hope you have found them useful. One which springs to mind is the guidance developed during the first COVID lockdown. BNMS worked with colleagues from all our different disciplines to pull together practical advice for how to manage our services during that challenging time. We represent the interests of our Nuclear Medicine community to government – for example, in trying to mitigate the potential impact of Brexit on our services.  More recently we have been working to put together a manifesto for PET CT commissioning, and going forward, I hope that we will play a key role in further developing Molecular Radiotherapy (MRT) services in the UK. We really are living in exciting times, and I feel we are on the cusp of something potentially game changing for many of our patients. There has never been a better time to work in Nuclear Medicine. 

So, I’d like to end my first newsletter article as BNMS President by bring this back to gratitude and the impact it has on health. I would like to say thank you to the BNMS for the opportunities it has afforded me. I’d like to say thank you to all the Radiopharmacists, Physicists, Nurses, Support Workers, Technologists, Radiographers and Doctors I have met, not only in the various departments I’ve worked but also through the BNMS, for their help, encouragement and friendship. 

Thank you. Two small words, but a very big meaning. 

As I said when I had the President’s baton handed over to me in Harrogate, I feel very grateful and very healthy! I sincerely hope that reading this prompts you to reflect on your BNMS experiences, and that you go home tonight feeling the same. Please consider joining us at the Autumn meeting at the Royal Society of Medicine (Wimpole Street, London) on Tuesday 31st October  for another dose of health and happiness!