We are all just simple gardeners working in the great NHS garden.

It was just a seed of an idea.....

1. Is the idea healthy

NHS employees have always been innovative as we work in a constant environment of change.

Like a garden the NHS is impacted upon by external forces . As a result ,we the gardeners find ourselves constantly looking to improve systems and promote quality outcomes for our patients.

I am one of those gardeners and had an idea to promote such an outcome. I wasnt any Alan Titchmarsh within the NHS world.  Just a worker  with a willing pair of hands and warm heart. Like many nurses I knew what I wanted to see in my part of the garden but perhaps didnt have all the skills to make the idea grow.

Within my area of the garden that is the NHS ,the protected climate within Critical Care makes for a perfect environment for ideas to germinate .However not all ideas grow to maturity and that is often due to inhospitable conditions. You need time to tend , support and promote the right conditions. Thats not an easy task in a busy hospital enviroment ! When you are ensuring quality outcomes within your day to day activity , taking on a new 'hothouse' project can be fraught with frustrations. The outcomes to patients and the clinical area can be glorious and bountiful though .

So how do you get your small idea to take root , grow and impact within your clinical area. Many have been asking me , how I have managed the change ? Creating that difference that we as health professionals strive for.






Best Intentions are not enough , to make ideas grow.

2. Care makes it grow


The best ideas which go on to fruition are the ones that come from a strong source I've found. Planted with great care and nurtured.

Compassion drives many ideas in the NHS and in my case it was the predominate factor.

I saw a patient issue and wanted to bring change to improve their outcomes. My heart went out to the individual. There had to be a better way to improve their lot.

In their case finding alternative communication means not readily available in the time frames needed.

Like many ideas I  researched and established a solution for them. Noted in isolation the patients needs were met and outcomes acceptable.

So that one patient would have an improved outcome but it was an imperfect outcome. As what about the wider good? As a nurse I couldnt move on from the fact that others could also benefit from the innovation . Providing that critical communication bridge.  Available at point of access more importantly plus being adaptable for all across the Trust. An innovation which would breach the walls of my clinical area and make a huge difference.I felt accountable to make it happen , driven to ensure equality and equity in a new service provision .

Thats what pushes you to go beyond the individual need , looking beyond the short term solutions . I defy that any health professional worth their salt would do differently.And I know others who have managed amazing changes just by doing similarly.There are many fabulous NHS gardeners , just look at Twitter or Facebook for examples.

 In my case I could see the amazing difference immediate and accessible provision would offer. Regardless of finance this was something I knew had to be achieved for a wider range of patients.

It is very easy to plow into any project fuelled with that initial passion. The thing is that right at the beginning this is when you need to take a breath and consider carefully just what it is you want to achieve. Harness your passion to bring about  the change . Be honest , open and geniune with others about what you want to bring about. If you do this and are respectful of all those who need to be involved , the idea will grow naturally.Planning and appropriately engaging with patients, the wider team members and support network ensures your idea gets the commitment it deserves. I know that I have relied on the knowledge and skills of many of those with relevant expertise across many disciplines during our teams project developments.

And still do ! You should never aim to go it alone , there is great strength with your teams support and involvement.



#Intensivevoices   Strong, spirited and commited to support till the last note !

Get your hands dirty and use an umbrella when it rains!

3.Find support

I have never been one to shirk from hard work . Like many nurses I have over the years become used to long hours .However do not underestimate the additional time it takes to plan, organise and carry out all those additional tasks required in project work.

This is when that 'original passion' will help you through. I'm pretty sure thats why many projects fall flat.You need to dig deep and tap into the fuel of your original spark.

You also need to get your hands dirty. The NHS works hard and the many gardeners in each area who have tended their areas carefully  may be protective of their precious resources . If you are to get your project to grow you need to show them how your idea will impact on their area and on the wider scale. What are the benefits ? Paint them a picture of the new garden .

Give them as much detail as possible, with as much colour as you can.

As part of this you will need to weed out every issue that has potential to stunt the projects growth .

I found I spent hours mindmapping things out exploring these . Questioning others to ensure the validity of my own research. I cannot tell you how often I asked myself if I should even be the one undertaking this work at all. Others reinforced that I should. And they invited me under their umbrellas when it rained negativity.


All as I waited for the seed of my idea to grow .



The ICU team in its entirety rallied to provide valuable support in all its forms:-

Trialling devices , contributing to the debate on process and outcomes.

Formulating ways forward with active discussion.

Joining forces in forming a choir and engaging with our extended families, including ex patients.

Fundraising on a grand scale , with individuals reaching out to our wider community to promote and spread the word.

Assisting in publicity events for press /media and so much more.


Speech and Language although a small team they found the time to listen tirelessly to my calls for addditional information. Providing a sensitive ear and expert knowledge base which was so valuable in this case.

However even they relied on others, so we extended our reach to the tertiary referral centre to assist further.People travelled , met out of work hours and worked with me. Always with a shared goal in mind .


Specialist support came from Smartbox and also Special Effects a charity who tirelessly loaned devices, switches . More importantly they gave their time as we explored how eyegaze technology and software plus a variety of screens and switches combined to meet ICU patient needs.

It took months of liasing and meticulous problem solving to ensure we had the right set up.

Without their umbrella I would have drowned in the questioning and problem solving!







You dont have to stay under an umbrella (ie with a support source) you can try a few out for assistance . However variety gives you a much better idea of what is most effective overall .






Add finance and saturate project thoroughly..

4. Sort finances first

Just because its a great idea and your team can see the benefits ,doesnt mean that your Trust will.

The bottom line is that every project has a cost implication. And the NHS like every other company needs to ensure best value and quality. When presenting projects to your Trust board ensure you know its full cost. That means looking ahead and not being shortsighted.

This includes looking for those hidden elements which at first glance are not evident . If you are purchasing devices for instance.Will they incur servicing , updates , is there a cover plan to cover breakages in future years ? This includes equipment and services which you might have believed covered by fundraising efforts within the  initial purchase. 

In our case we managed to factor in protective cover over several years . Which would give us the opportunity with our new fundraising group to continue to provide cover for future years too. Its all about thinking forward , so talk to your finance department. You need to know their processes, paperwork and make the effort to meet the team. Dont do everything by phone or email ! Get to know the people you are dealing with .I have to say if you make the extra effort to engage you will get further , faster and it will be much less stressful.

The NHS garden is beautiful when we work together and grow ideas to their potential.

In a nutshell Id like to say in summary

NHS projects need teams with effective leaders , good planning  and support from effective partners plus firm finance.

In addition within the NHS they need people to care . Not just about the end concept but the process and people involved in every stage of the project development. Change is dynamic and that takes a huge amount of positive and progressive thought from all .

However I can say from my own experiences  that the seed you plant within your part of the NHS garden will transform a life .So do it , its truly worth it . I know I've seen the results on patients faces .

Make those ideas reality and change lives today

Caroline x