Minutes from Meeting 17th May 2017
Innovation at Pace
Brigadier Tim Hodgetts CBE
The meeting was opened by the President of the LSA Dr Clare Howard who welcomed members and honoured guests notably the Gray family, Brigadier Hodgetts and Prof Webster, chair of the BJA board.
Dr Howard then introduced the 4th T.C. Gray BJA medal lecture. She explained the links that Prof. Gray held with the Medical Defence Services. She then introduced Brigadier Tim Hodgetts.
He started talking about the model for innovative change and said that every conflict in history had led to substantial changes in medicine from the Napoleonic war creating the first paramedics, to the use of the Thomas splint in World War 1 and the birth of the modern transfusion service in World War 2. He said modern conflicts have been no less transformational creating radical change in the character and practice of military medicine. He showed a paper demonstrating ‘Improved survival in UK combat casualties from Iraq and Afghanistan: 2003-2012’ from the Journal of Trauma and Acute Care Surgery. It showed incremental improvement in outcomes year on year and even a cohort of unexpected survivors that have returned to work.
Brigadier Hodgetts then focussed on sustaining innovation at pace. He talked about testing new diagnostics in the field and why we need to continue to innovate. He talked about external and internal factors. The former were represented by the mnemonic STEEPLE (Social, Technological, Economic, Environmental, Political, Legal, Ethical) and the latter by the mnemonic TEPID COIL (Training, Equipment, Personnel, Infrastructure, Clinical, Organisation, Information, Logistical). He gave examples of external factors, e.g. a social and political one is the low tolerance for solider deaths for which the public has a very low tolerance; a technological one being the development of haemorrhage control using Celox, Rotem and tailoring replacement of blood products to the patient. Another example of an environmental factor was that every conflict has a different injury pattern requiring adaptation and change in practice; Northern Ireland dealt with big bombs, Kosovo with landmines, Iraq with multiple projectiles and Afghanistan with improvised explosive devices that defeated metal detectors.
Brigadier Hodgetts then discussed internal factors and innovation adoption and how there used to exist the same process for bringing in a new tank as well as a new bandage taking up to two years. He explained how this process has changed so now it is a matter of days to introduce new medical kit such as intra-osseous devices. He talked about the acronym ADOPTER (Agile, Decisive, Outcome focussed, Politically aware, Tolerant of risk, Empowered, Rewarded) which describes taking external concepts, technology and practices and bringing them internally into military practice. He went through each of these, commenting that the Medical Defence Services (MDS) are tiny compared to the NHS so it is easier to change direction. The MDS is a military construct so they will make decisions with limited information (decisive). Management is about doing things right but leadership is doing the right thing (outcome focussed). The MDS is very politically aware and has a close relationship with government. It is an organisation of two cultures: on operation, they are very risk tolerant and have an empowerment culture but when at home base, they have a risk adverse and regulated culture with centralised authority.
Brigadier Hodgetts went onto to talk about innovation translation, developing ideas and trying to spread them widely especially the idea of transferring military know-how to civilian major trauma systems. He spoke about what is still needed and the existential threats that exist, especially our vulnerability to attack by shooting, stabbing and bombings. He said in the military, they have pushed training onto the soliders and in turn they are now pushing military know-how onto the public using the application, book and website he has developed called CitizenAID. He said the CitizenAID concept is an example of innovation translation. He used the mnemonic TRANSL8 to explain the qualities of the application: Transformational leadership, Relevant e.g. saving civilian lives by pushing care far forward, Adaptability, Network e.g. using a community of volunteers to spread information to the public, Simple- picture based & age agnostic, 8 steps- relating to the 8 steps from Cotter’s model for implementing complex change. He said that the CitizenAID application was needed because the reality is that in the event of a terrorist attack, the medical services will be held back from entering the scene until their safety can be guaranteed. Therefore one’s chance of being saved and treated is dependent on those around you being able to improvise and use equipment to hand to treat others. He said the CitizenAID concept has been charity funded and there has been global interest in it. They are working with schools, national counter-terrorism organisations, building a base of volunteers and ambassadors and they have received positive feedback on it.
Brigadier Hodgetts then spoke about innovation constipation and the fire blanket to innovation and creativity. He said the things that stop innovation include a bullying culture, apathy, exploitation, opposition & unappreciation. He spoke about dealing with toxic individuals and the different characters we encounter when trying to implement change. He showed his ‘Process Zoo’ which outlined these characters: the diligent and active monkey who tends to get promoted, the lazy but active porcupine who potentially can make life easier, the passive but diligent sheep who can be damaging and the lazy and passive sloth!
Finally he challenged the audience to think disruptively, to look for big change, and to swim in the opposite direction even though they may work in an organisation that expects conformity.
Brigadier Hodgetts then took some questions from the floor on calculated risks, examples of innovation at pace in the NHS and military commanders taking senior NHS roles. He was then presented with the T.Cecil Gray BJA Medal. Dr Clinton Jones gave the vote of thanks.
Minutes written by Dr Gemma Roberts