So, the formal programme is at an end. The national AKI programme has completed its project plan and it is always good to reflect on what went well and what could have been better. What are my highlights?
Back in 2013, World Kidney Day focused on acute kidney injury. I think it is fair to say that at that time few people recognised the importance of Acute Kidney Injury. For me, as National Clinical Director at NHS England, AKI was to BE the focus of a large part of my role. AKI remains a significant and serious safety issue in modern healthcare and the joint work between the UK Renal Registry and NHS England Patient Safety was an important early building block to put in place. It laid the foundation for everything that was to come and enabled a broad range of stakeholders, including the public, patients and professionals to engage with and work with the system in a way rarely seen. So, my first personal highlight was acting as the glue in the structure.
When the programme started, I had a fair idea of what it should look like in terms of the project. When I spoke at that March World Kidney Day, I laid out a series of challenges to tackle the problem of AKI. It needed to educate people, guide people and develop the system that sits around the care. For me, the workstreams have been spectacular in their success – the depth and clarity of the work has been fantastic. But at the start, the programme had a long name but no identity OR clearly articulated vision – essential to capture the attention and enthusiasm of people. So, highlight number two for me was the work and team that lead to the brand Think Kidneys. Such a simple statement of intent, of purpose and of demand, it has crystallised the work around it.
Joan Russell and Ron Cullen will already have spoken about my third highlight, but probably from different angles. If Think Kidneys as a brand was the heart of the project, the brains came from the Patient Safety Alerts and the National CQUIN. That first safety alert gave in one fell swoop the permission, the data and the purpose to take out to the NHS across England. The data that flows from that alert will continue to drive the improvement that is so needed and in the space of a year everyone was talking AKI. The national CQUIN ran for just one year but demonstrated exponential improvement in communication of AKI into primary care, and huge strides in the understanding of AKI in community care. Highlight number three – using the system levers with the precision of a surgeon’s blade.
Despite a clear strategic structure – at least in my head – there was still a need and a challenge to make it work. That took people, that took meetings and that took time. I will be honest – I need to be organised by someone – be that at home, clinical work or in this project. Karen Thomas as project manager was the person who led that operational team and who made it happen. They organised me, endless meetings, the workstreams, conferences, workshops, slides, carried on organising me, and just made it work. And then you have the workstream chairs, the teams that supported them, and like a pyramid the work spread to involve hundreds of people, who gave of their own time to solve problems, bring new ideas, providing leadership across the country. People and their enthusiasm make up highlight number four.
I will finish my highlights with an unexpected one. Developing a brand with a clear vision and a central purpose provided that central beacon but I had always wanted the programme to be organic – allowing people and teams the freedom to explore the issues from their perspective and to bring new ideas and solutions to notice. There are so many example of that on the website – the Paediatric and Mental Health teams spring to mind as does the enthusiastic work of the Care Home group who just ran away with ideas and made it their own. The Public Health campaign was never a priority but it was brilliant success – I see echoes of it in work in other countries and organisations. That this happened is due to the ambition to embrace uncertainty and allow people to be creative. My final highlight is therefore this – the unexpected.
Five highlights and I could have added many more. There is little I would have done differently. The programme achieved its formal objectives but much more came out of it and the key bit is that it is going to stick. Sustainability remains the Achilles heel of improvement projects – I have no fears for this work. AKI as a concept is in the consciousness of all, data to support improvement is flowing and Think Kidneys remains to steer the course. Think Kidneys will be maintained by the UK Renal Registry but they are merely the curators. It does not belong to one organisation, professional or otherwise. Instead it is to bring people together and to be a source of information and guidance for all. It is there to support improvement in care for the public and people with kidney disease and has already broadened out to include work in chronic kidney disease and improvement methodology. It has been a successful and productive three years but it is just the start.
“It is not in the stars to hold our destiny but in ourselves.”
William Shakespeare, Julius Caesar
Richard Fluck
Richard is currently the Chair of Think Kidneys AKI Board and was NHS England’s National Clinical Director (Renal) until March 2016. He continues as Clinical Co-Chair for Specialised Internal Medicine and Consultant Nephrologist at Derby Hospitals NHS Foundation Trust.
Richard trained at Trinity Hall, Cambridge and the London Hospital Medical College, qualifying in 1985. His early training was in the East London area before he moved into research at St Bartholomew’s Hospital. Richard was appointed a British Heart Foundation Fellow to explore the link between cardiovascular disease, calcium signalling and abnormalities of calcium metabolism in chronic kidney disease. He returned to the Royal London Hospital as lecturer and honorary senior registrar in nephrology, before being appointed as a single handed nephrologist at Derby in 1996. In 2013 Richard was appointed National Clinical Director for Renal and has also chaired the Kidney Alliance as well as being President of the British Renal Society. Richard’s special interests are in chronic kidney disease, acute kidney injury, home dialysis therapies, reducing infection in dialysis patients and vascular access.
When he is not at work he looks at his running shoes or twiddles on his guitar.