Systematically Capturing And Acting On Insights From Front-Line Staff: The 'Bedside Learning Coordinator'

Insights from front-line staff are generally agreed to be vital for informing quality improvement. However, health services often struggle to gather internal experience-based insights from staff systematically. When such data are collected, standard, systematic mechanisms are often lacking to act on the insights the data convey. To better exploit this potentially rich source of insights we propose that health services invest in a systematic mechanism to gather data from front-line experience. We trialled one such mechanism, the ‘Bedside Learning Coordinator’ (BLC) at the National Health Service (NHS) Nightingale Hospital London (Nightingale), a field hospital established in an exhibition centre to provide additional ventilated bed capacity for London’s patients with COVID-19.1\n\nFront-line healthcare staff whose roles and experience give them rich insights and ideas across a range of dimensions (including how to improve patient care, workplace efficiency and staff well-being) often lack time or power to enact change or make systemic change. One study found that nurses solved most of the problems they encountered locally, escalating only 7% of problems up the organisation for definitive solutions to be designed and implemented.2 While local problem solving can be helpful, a default to firefighting and finding local ‘workarounds’ rather than systematic improvements mean that valuable systemic learning is lost and standard ways of working are not improved as part of routine operations. The net result may be worse organisational performance—combined with wasted resource and frustration for staff.3\n\nIn contrast, senior hospital decision-makers can effect change, but may not have timely access to ‘ground-level’, rich staff and patient insights to inform changes. Qualitative insights from patients and front-line staff are seldom part of routine data capture, and when captured are frequently underexploited. Furthermore, failure to enact local operational change contributes to healthcare’s slow pace of innovation adoption4 and can also …