Professor Gary Smith: innovation against deterioration

Professor Gary Smith says that he attended December's NHS Leadership Awards at Barts Hospital in London "with trepidation". He explains that no one was more surprised than him when he scooped the prize for innovator of the year. "I never thought I was going to win - well you just don't do you? When they called out my name, I was shocked," he says. With more than 30 years of clinical experience, Smith says that the event was a real eye opener as it gave him a chance to see what his colleagues at other hospitals were doing. A short video about each nominee from every category was shown to the audience and he says that this segment of the event really stands out in his mind, because he was very impressed by what he saw. "Quite often you work in almost a silo environment, even within your own hospital, and it can be quite difficult to find out what colleagues are doing, so it was good to see," he says. He was also surprised, although happy, to find that a number of the nominees were "incredibly young". Education has been a notable part of the projects created by Smith, but his main initiatives have been about preventing deterioration, which has meant working with technology. He co-designed VitalPAC, a hand-held wireless computer-based system. It allows nurses to enter vital signs at the bedside and automatically calculates patients' Early Warning Scores (EWS) and transmits data to the hospital computer system, creating an electronic vital signs chart. He says that he has always felt comfortable with technology due to working with computers "even in the 1960s" and being constantly exposed to it during his time in the NHS. Anti-IT allergy But Smith knows that not everyone in the health service shares his enthusiasm for new technology and admits that winning staff over to his ideas has not always been easy. "One of the biggest challenges when trying to introduce new ideas is the cultural change – it is a very difficult area," he says. Initial reactions from employees to ideas he has implemented have ranged from ambivalence to a complete "anti-IT" mindset. "What you have to do is convince the doubters. You have to get someone within the department who can see the potential benefits and get them to champion the product. If they have a positive view it can encourage the non-enthusiasts. It is very important in getting things done," he explains. He also acknowledges that colleagues at other hospitals who want to introduce new technology or initiatives now have the added difficulty of departmental cuts, which will limit the amount of money they are able to spend. They will have to be creative in order to overcome these barriers, adds Smith. "You can implement concepts that don't cost very much. Evaluating how you look at things and implementing a concept doesn't cost anything." Some of his innovations are now used internationally, with perhaps the most well known being a training programme for general ward staff called Alert (Acute Life-threatening Events: Recognition and Treatment), which focuses on response to patient deterioration. The clinician was inspired to create the one-day course in 1999 due to what he saw as "undervalued clinical priorities". The main aim was to continue to educate people as staff often focus on diagnosis rather than symptoms, he says, adding that at the time he felt medics would only react when things got to a critical stage, which was "far too late". Although initially only intended for Portsmouth Hospitals, Alert snowballed "beyond the borders" after a nearby hospital asked if it could also use it, as it was suffering from similar problems. He selects the programme as the highlight of his career so far. "Alert had a very clear goal, so if I had to pick out anything, that would be it. But I could never have guessed how much it would take off." Despite his notable achievements, Smith says he still has one big aim for the future. He wants to team up with other trusts where possible and hopes for more shared services between hospitals in the region. "It's about simplification and trying to create a more united way of doing things," he concludes. To hear about more innovative work using wireless technology, register for the Guardian's Mobile and Wireless Healthcare event in Birmingham on 16 February. This article is published by Guardian Professional. Join the Guardian Healthcare Network to receive regular emails on NHS innovation.