Lt Col Chris Gibson, MBE, Specialist Leadership Adviser, Former Lieutenant Colonel, Defence Medical Directorate, gives the keynote address at our event in June 2018, Innovation in health and care: overcoming the barriers to adoption and spread.
I think this is the context about where we stood within defence medical service; in '95 we were way behind with regard to our performance and our patient care but somehow we managed to create a strategic drift and I think those components are there on the left where our new concepts and capabilities, where we adopted new technology and equipment... and I think the training is a really important component of that.
We're going to talk a bit about the imperative for change, we actually have a model that we apply against the problem and then work out what the solutions are. So the steeple component where we look at the social, the technical bit, the economic, the environmental, the political, the legal, it's all well-known stuff but we apply it all the time because actually the imperative upon us for innovation hits us very hard and I carried that coffin at the front, which was Simon Hamilton-Jewell's coffin, onto the plane in Iraq. He was a really good friend of mine and that was the imperative for me to make sure that innovation... and we got on top of how to stop the trauma killing so many of our people.
One of our bigger drivers was the use of technology in war, it was always trauma and the use of novel haemostatics and tourniquets where the tourniquets were on and tourniquets were off and now we see them not camouflaged or black within our health services but bright orange because doctors may miss a tourniquet. Then how we looked at [inaudible] and making sure that we put the right amount of fluids into a patient without blowing the clot. All of this we are able to do in the middle of the desert. And certainly understanding the environment, every war of choice that we've been in has a different set of signature injuries and therefore a different pathway for our patients, whether that be Northern Ireland with its coffee bombs to Iraq with its hidden munitions, to the plastics that are being used in Afghanistan to this day. In Afghanistan we managed to achieve a 98.6% survival rate of anybody that went in the front door of that hospital. That's the highest survival rate in the history of medicine worldwide; in seven hours of flight away delivering UK standard care, audited by the CQC, like any facility back here. In 2007 we managed to identify the requirement for whole blood and FFP to be carried on a rotary platform so we were taking the consultants out to the patients, which was a real change in philosophy of care and one to watch out for. Having identified it we had the bloods in place within 24 hours on the helicopters being utilised and you can see that now ink blotting within our organisation because I believe most of the air ambulances in the UK are now carrying whole blood products.
ADOPTER: this is the acronym that we've created about being agile, decisive, outcome focused, politically aware, absolutely tolerant of risk, empowered and rewarded. As I tried to take on things in my career I've looked at it and been swamped by the challenge and therefore I've tried to break it down into bite size chunks where you can make an incremental gain; and it was Sir Dave Brailsford that talks about incremental gains in Team Sky where they look at just making these marginal approaches to getting it right, but this guy Colin Powell, talks about this principle, the 40/70 principle, which I have adopted myself. He used this to lead the first Gulf war in getting the Iraqi forces out of Kuwait where he basically said, "If I wait for above 70% of the information to come in to me I will have lost the window of opportunity and therefore the precise window is between 40% and 70% of the information, to make a rational decision to move your organisation forward."
I think you have to be politically aware, you have to understand what's acceptable to government. When I was given the task of Ebola I was given the task of doing all the training, setting up the capability training and then assuring everyone that went out from the UK and when we asked the question of, what does success look like, to Downing Street, and it was Downing Street that we were asking the questions to, they said we were allowed a less than 1% casualty rate. It was really interesting and we had to apply the rigor to the training to ensure that occurred.
We understand what the firm base looks like because it looks the same for you in your organisation I think, where it's slightly risk averse, it has a centralised authority which governs us and doesn’t give us much freedom of movement in that it doesn't allow mission command to be fully exploited and it has a regulation culture. Where I like to work is in the deployed space, you're given the space to do it, we have great success with it and somewhere in the middle there should be a common ground where work can really go ahead in a much more effective manner.
We get people to do amazing things in the military for a piece of tin. We don't pay them for delivering excellence, we don't reward them other than doing it in public with something that really matters and therefore when you're creating your innovation programmes, how do you reward your people for delivering excellence? It doesn't need money but it needs a public acknowledgement of the fact and it's really massively important to ensure that occurs.
There's the model, I'm really happy to share it with you, thank you.