strategy of delivering excellent clinical services.
Taking a charity a major step forward
The Air Ambulance Service comprises three services: two local Helicopter Emergency Medical Services (HEMS) in the East and West Midlands as well as The Children's Air Ambulance (TCAA) - a new service we launched last year. TCAA is the only service solely dedicated to the transfer of critically ill children and babies between paediatric care centres in the UK.
Finding and nurturing people with the right mix of skills was vital to the successful launch of The Children's Air Ambulance. And maintaining this variety of management skills within the team has remained a key reason for our success as we approach the anniversary of our first transfer.
Before we launched TCAA the first task for management was to do our research – and leave no stone unturned. We had looked at taking on TCAA back in 2011 when the previous charity was under threat of closure. Undoubtedly it was a huge challenge, so we made sure we understood the paediatric care landscape and clinical facts behind the argument for this service.
We did vast amounts of research with the clinicians involved in paediatric retrieval services. What became apparent was how far behind we were in this country (and to a certain extent still are) than other European and Western countries with air based paediatric transfer services.
Too fragile
Our research, as well as independent research carried out by clinical teams, showed that for the 5,800 critically ill children and babies who need transferring between hospitals every year a proportion of these are too ill or too fragile to travel by road. What’s more, a dedicated service concentrating solely on the transfer of critically ill children could also significantly decrease out-of-hospital time for clinical teams and help to make the most of stretched NHS resources. In short, anything which helps save time can help save lives.
Once this need had been identified, we felt we had enough knowledge to begin to build a sound case for launching TCAA. At the centre was a detailed and actionable plan and, more importantly, a team of driven and tenacious people to deliver it. Like any charity, there is no one person that could meet all the requirements of a service like ours. I am fortunate to have an excellent team around me who all complement each other.
I am, and maybe always will be, the creative thinker and innovative income generator, while my deputy is process and detail driven. It means that we are not only pioneering in our approach and ideas, but we deliver on them too.
Clinical governance
There are high levels of clinical governance and practice to comply with in this sector. This includes CQC and NHS Audit requirements on the medical side and CAA, EASA and Health and Safety standards to meet for aviation, financial audit and public scrutiny regulations. Again, we knew that getting our ship in order would require finding or training the right people capable of doing these jobs.
We have an expert aviation partner in Sloane Helicopters, as well as our own in-house expert pilot who acts as our head of aviation. On the clinical side there are several excellent consultants in A & E, anaesthetics and paediatric retrieval who each keep us informed of requirements in their specialisms. They are under the guidance of a medical director who ensures our practices are continually meeting their needs.
As well as the doctors, we have two senior critical care paramedics who run each airbase and manage the crews. I continue to lead the income generation, along with my retail director who runs the trading company to good effect. Finally, and perhaps most importantly of all, I have a brilliant PA. A large and disparate organisation like this can at times be difficult to align but we are guided by our core values, and work to a simple strategy of delivering excellent clinical services.
Energy diverted
There was a big concern that by taking on this charity, too much energy would be diverted from the regional Helicopter Emergency Medical services we had spent years building. The most significant management challenge involved in overcoming this was ensuring each and every person, from trustee to volunteer level, felt involved and engaged in our vision for The Children's Air Ambulance.
We needed to have the whole charity united behind us if we were going to make it work. We invested a lot of time and resource in the short-term to make this happen, understanding that in the longer term this buy-in would help us succeed.
The team were excellent at delivering our action plan. We set up a test service with a Yorkshire based paediatric care team to ensure the service worked as best it could for the NHS, the beneficiaries and their families. Once we knew our service was the best it could be, our next significant management challenge was making people aware of the distinction between TCAA and the other regional HEMS.
Little understanding
It's fair to say that this challenge will remain with us until we have achieved widespread national recognition. It is hard for people to understand how TCAA is different from the emergency operations that are so synonymous with helicopter medical services in the UK.
As you would expect, there isn’t much understanding of how paediatric care is organised in the UK, so there was hostility from other air ambulance charities. This was quite possibly one of the hardest periods of my career to date.
I tried to ensure that the team and I kept focused on the factual arguments and continued to make the case for
clinical viability.
It is true that 95% of care for critically ill children is carried out in specialist units, which are not available in every hospital in England. Without a dedicated helicopter, seriously ill children are forced to travel on long and sometimes life-threatening journeys by road. We are the only helicopter in the UK to be equipped with the specialist equipment required to make these transfers as safe as possible.
Thankfully, other air ambulance charities now better understand what we have done. There is ample room for a specialist children’s air ambulance as well as local HEMS operations.
Public perception
The biggest challenge we continue to face is the issue of public perception and how we communicate a complex paediatric care landscape message and our purpose in lay terms. We’ve just undertaken a brand strategy project to really hone our message and understand (both internally and externally) what we are about and what we are striving for. This is work in process, but we have some really interesting options and finding one clear message that will work for the public as well as satisfy the clinicians we work with is the hardest part.
Looking ahead to the rest of the year and into 2015, our major management challenge is to raise the funds for a second helicopter and to keep the service going whilst we build support across the country. Our marketing strategy has changed this year and once we’ve decided on our unified message, we will be using social media platforms and PR to reach potential donors. This is an emotive subject and these channels lend themselves well to telling our story.
What major management lessons have I personally learnt taking on this challenge? You need to be robust in your preparation, focused and confident that what you are doing is right, because you will come up against obstacles that you might not have predicted. I often equate it to managing a football team. The manager knows his players, knows what he wants them to do and knows they will succeed if they do it – but there will always be 30,000 on the terraces exclaiming otherwise. Until the team wins of course – and then it’s a case of waiting until the next time!
Biggest lesson
I think my biggest lesson, and what I’d want people to take away after reading this article, is that assembling a team who complement each other skills-wise whilst concurrently showing tenacity and drive in everything they do is fundamental to your success. Your people are your greatest asset, allies and brand ambassadors.
