Oct 1, 2021

Meet an Improver: Dal Hothi

Author: Daljit Hothi, MBBS, MRCPCH, MD

Consultant Pediatric Nephrologist and Associate Medical Director for Wellbeing, Leadership & Improvement, Great Ormond Street Hospital for Children, London.

My clinical education and experience...

I am a Pediatric Nephrologist and trained predominantly in the UK, but also spent 2 years as a fellow in Toronto, Canada. I then completed an MD, with a research project focusing on the impact of hemodialysis sessions on our cardiovascular system prior to securing my consultant job. During my medical training and subsequently as a consultant I sought opportunities to advance my understanding of Clinical Governance, Quality Improvement, Safety, and Healthcare Leadership and Management.

My experience in health system improvement...

I have over 10 years of experience in Health System Improvement. I have designed, developed and delivered a number of Quality Improvement training programs, both face to face and virtually. I was the Quality Improvement theme lead for the Harvard Global Pediatric Leadership program for 3 years which gave me considerable insight on the opportunities and challenges in delivering a training program to an international audience. Over the past 3 years I have become a member of the ISQua conference faculty delivering learning labs and learning journeys with learning opportunities for everyone at beginner, intermediate and advanced level around a specific theme. I have led a number of local and national QI program and am now the QI Lead for the British Association for Pediatric Nephrologists initiating Pediatric KQUIP, a national Quality Improvement collaborative for children with kidney diseases.

Why I work in health system improvement...

The enthusiasm and drive in my medical career stems from a desire to reach perfection and a belief that there is always room for improvement. What I have subsequently realized is that change does not intimidate or frighten me, I actually thrive on it. This took to my natural place of becoming an improvement agent.

Tips for current and future health system improvers...

Over the years I have learnt that in order to translate a new idea to a sustained change in practice we have to be able to build relationships, lead and create alliances and socialize the idea for wider engagement. It is only when this is executed successfully that we are rewarded with shared narratives and new belief systems and norms of practice.

I would also like to acknowledge and normalize the fact that health system improvement is not easy. One has to develop tenacity, strategies for self-care, help build team resilience and not be frightened of failure but redirect that energy to the pursuit of continuous learning.

A personal challenge that I experienced with health care system...

A relative with dementia and malnutrition was admitted to hospital. As part of her treatment plan a decision was made to give her an albumin infusion. Unfortunately the 20% albumin was given as a bolus as opposed to a slow infusion resulting in acute pulmonary edema. The hospital failed to acknowledge that a mistake had been made and did not speak to the family about what had happened. In fact the family were given the impression that nothing unusual had happened, “there was no complication, the breathing difficulty is expected in patients receiving albumin”.

What health system improvers can do to prevent something like this from happening again...

I think healthcare improvers really need to support organizations to cultivate a culture of open, transparent dialogue with patients and their families; to design, develop and implement structures and processes for exemplary patient safety and duty of candor practices. I would like to engage, educate and empower patient to become partners in patient safety, co-designing and driving improvements alongside healthcare professionals.

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