Reflections on the long-term collaboration of UHB and Vanguard

Natalie and Chris met when, after nearly six years, the Vanguard mobile theatres were soon to leave Solihull Hospital. Over that time, the theatres and the three clinical teams staffing them had played a key part in addressing and preventing backlogs in elective surgery, before, during and after the worst of Covid-19. The three laminar-flow operating theatres provided a safe clinical environment, facilitating high efficiency but, as always when Vanguard's clinical team is present, it's the people that made the greatest impression.

For greater insight, there is a case study, here.

For another view on this collaboration, an interview with Paul Super, Consultant Surgeon, is here.

Chris:

Natalie, it's really good to see you today, and, genuinely, thank you for your time. I wonder if we just start by introducing yourself and letting us know your role here at the hospital.

Natalie:

Definitely involved in the project, yes, for Vanguard One, for the gallbladder project.

Chris:

So, do you want to just talk us through what the process was at the time, and why you felt having an additional theatre on this site was going to be helpful?

"The speciality decided that they needed to get some of the gallbladders out of the system, and stop them becoming hot gallbladders and blocking up the emergency pathway. So, by having a dedicated theatre, we could actually get them all through and done in a timely manner.."

Natalie Arnold, Operations Manager, Pre-Op, SEAU, Theatres, EPOC and Surgical wards

Natalie:

The speciality decided that they needed to get some of the gallbladders out of the system, and stop them becoming hot gallbladders and blocking up the emergency pathway. So, by having a dedicated theatre, we could actually get them all through and done in a timely manner.

The process of getting it in was really easy. We did a lot of work with Estates. I was based at Heartlands at the time, looking after Solihull from there. So, Estates did a lot of the work to get the Vanguard in, and then it was just working with the team to get them integrated within the other team, which all happened quite quickly and easily with just one theatre.

Chris:

So, Natalie, had you had experience of Vanguard before we came on site here in 2019?

Natalie:

Before I came to UHB, I worked at the Children's Hospital, where they put a theatre and a ward in. And I worked with Simon Squirrel on getting that in. Unfortunately, I left to come to UHB before that got fully up and running, but, yeah, I had worked with some of the team already.

Chris:

And how did you find it?

Natalie:

Very good. Very. Very involved. Easily contactable. There was no step that you didn't know what was happening next. Yeah. So, really good.

Chris:

That’s good to hear, actually. We talked about 2019 and the lap choles and, the whole gallbladder approach that you've taken. Then, obviously, we can't not talk about Covid, I guess, from 2020 onwards, March 2020, it's all burned in our memory. So, how did the theatre, support the hospital at that time, during Covid?

Natalie:

So, obviously all elective activity stopped at Solihull. It became a ghost town. Because all the staff went to Heartlands ITU to support there, and actually some of the Vanguard staff volunteered and went over to Heartlands to help with ITU, and you could never have enough staff over there helping.

I mean, you know, we're all human. We're all going through it as well once we’ve left work. So, yeah, that just shows the integrity of the staff that you've got working for you.

Chris:

That’s good to hear. And I think you became a green site. Is that right, during Covid?

Natalie:

Yes. I moved over to Solihull then permanently when Covid hit, to try and get it open as a green site, an elective hub. And obviously I think for Vanguard, well, for all of our theatres, every three months, the priority of what needed to go through theatres changed because nowhere else was really doing elective, still.

And Vanguard were brilliant: the theatre staff, when you spoke to them about change every three months.  Obviously, upstairs was changing, in our main theatres, but also Vanguard changed. So, what you'd signed up to do was gallbladders, when actually, there was a bit of gynae that came in, there was a bit of urology that came in…

Nothing was ever too much. As long as I had the right skill mix and we had the right amount of kit that they could have, nothing was ever too much for them.

Chris:

And then obviously there is that post-Covid period, elective backlog, growing for all the obvious reasons, actually. You went from one theatre to three theatres. So, be really good just to understand the thinking behind the additional expansion from one to three, and then also how you've used the theatres since that point.

Natalie:

Okay. So, Solihull was an elective hub, post Covid, obviously pushing as much through theatres as we could. Because we hadn't got the front door, we had more ward capacity than we were using. So, it was how could we utilize full ward capacity and influence the waiting list and how people get operated on and, you know, back home fit and healthy?

It was thought that we could cope with two theatres, extra work, fill the beds and still not have cancellations due to beds. So, we obviously approached Vanguard and asked for two extra theatres.

Post-Covid, every three months the waiting list changed and the pressures changed on what was needed more. And as we were the only site to do any elective work at the time, every three months it's slightly changed. So, Vanguard, bless them, were doing…could be doing anything. They were set up for obviously gallbladders but they did gynae, they did some urology. So it kind of changed what they could do every three months until we stabilized. I think on the back of that, obviously with the Vanguard going from 1 to 3, post-Covid, they had the same issues as us with retention and recruitment of staff. We know we've seen a lot of people leave because Covid made them re-evaluate, life for themselves and some of them decided it was time to leave. So, we had a lot of changes within the Vanguard setting, which meant the leadership as well. But then after that, we got the lovely Della and Simon who are still with us today. Obviously, they cover each other. They know how we work, they know what we want.

It stabilized, and we've never looked back from a theatre point of view. For me, working with them, I've never looked back.

"I've tried to poach some of your staff for the new build... I'll be sad when they go. Some of the team, I've worked with for 5 or 6 years. They have become part of the family."

Natalie Arnold, Operations Manager, Pre-Op, SEAU, Theatres, EPOC and Surgical wards

Image: Natalie corners Vanguard's Clinical Leads, Simon Barker and Della Smith

Chris:

Yeah. And it's interesting because we talked to Paul, one of the consultant surgeons, on actually having that regular Vanguard team. It just inspires so much confidence within the consultant base to then come and work in the theatres.

Natalie:

It helps productivity as well, and what people are willing to put on the list to make sure that they're fully utilized. And you get higher productivity and utilization, which is only a win-win for everyone. So yeah, it definitely turned around to be a positive.

Chris:

And then as you started to change and flex with the activity that's happening as well. Again, having that stable team that you have the confidence in. Yeah, it just makes everything so much easier.

Natalie:

Yeah, it did. It had its challenges in the beginning, but actually once they were ironed out and they were unforeseen. We're not going to hopefully have another Covid, you know, there were things that we had never done before. So, everyone was trying to work through the best way they could. And again, we're all human. We were all dealing with Covid outside and what it means for everybody outside of work.

So yeah, it was a very trying time, but we came through it and like I said, once we've got this stable team never looked back.

Chris:

And I think your role, in part, has been that sort of key liaison and management of the Vanguard, and working with the Vanguard team as well, actually. So, it sounded like, in the answer you’ve just given, a responsive team, but it would be good just to hear how you’ve found working with Vanguard over the last sort of 3 or 4 years.

Natalie:

Well, I've tried to poach some of your staff for the new build. You'll be glad to know that all of them have said no, because it's too far from home. Which I'm sad about, but they would if they were closer, which again, is a positive on how they've worked with Solihull. I'll be sad when they go.

I mean, like I said, some of the team I've worked with 5 or 6 years, they become part of the family. It's like if anyone leaves from main theatres, you know, there is that sadness. They're people. It doesn't matter if they work for Vanguard. They've worked with us. Yeah. So, I'll be sad when it goes.

Chris:

It's really nice to hear, being Chief Executive of Vanguard, just the impact the teams from Vanguard have had on the rest of the team here, but also on patients as well, over that period of time, to the point where, like you say, they feel part of the family. That's really nice to hear. So, how long until the new theatres open?

Natalie:

Next month. I had to think what day we were on!

Chris:

I guess it's always a good time to reflect, then, on the last 4 to 5 years. So any overarching thoughts in terms of how the last 3 to 4 years have gone working with Vanguard?

Natalie:

Just push as much through as we can for the next six weeks! No, I think I've talked already, really, about how we've learned as we've gone along. So, to be quite honest, right now, you know, I’ll just be sad to see them go, as people. I can't say I'm going to miss the activity because I'm doubling it with six new theatres.

So, that has its own challenges coming in six weeks. So, it will be the people I miss.

Chris:

Yeah. And I think we have absolutely loved as an organization supporting Solihull. And it's been a long time. It's been one of our longest contracts actually. It will be just coming up to six years. So, we genuinely thank you for your support and that of your broader team.

And we've loved being able to support you and your patients. So, good luck with the new theatres.

Natalie:

Thank you. I'm going to need it!