Table 5 Illustrative quotations for Theme 3 – changing the culture

Elucidation

 I think we need to raise awareness. And I think the only way to raise awareness is making sure that it doesn’t… it doesn’t feel like the neurology of a baby is unimportant

6, C, Neo, M

 You will have resistance, of course, people have fixed practices on how they do things. I think a lot of it is whether you are able convince, because you’re talking to a group of people who look after children on a day in day out basis, isn’t it? And if you’re able to convince them that this is going to make sense for the child, then you will be able to push it forward

23, C, PNeurol, F

Development

 Appropriate examination

I think the only way you can do this is you try and make it more structured

6, C, Neo, M

It needs to focus on the things that you can do in a real world not in a perfect world, because it’s never going to be a perfect world because they are sick

4, Tr, Neo, M

If it’s slightly shorter, I would really welcome it. Then you would do it, maybe, over time to see progression or improvement or, you know, if there is any deterioration

17, C, Paed, F

The nursing staff could actually give you a lot more information

15, Tr, PNeurol, F

I think just encouraging people to think whilst they are watching. Just to observe and look

7, C, Neo, M

 Proforma to improve documentation

I think something as a proforma in a neurological examination would be useful

15, Tr, PNeurol, F

Put an actual checklist in the notes, rather than relying on freehand documentation. Because if you have something ready to print out, and then you just have to tick which part you have examined, or say, “this needs examining later.” Um, if it’s sort of standardised between units as well, that would be really useful

13, Tr, Paed, F

 Aid to interpretation

The tool is not much use unless it then leads to a “this constellation equals this”

3, C, Neo, M

I think there’s too much mystery and… you know, there’s some new methods coming up and new scores coming up and, er… so, I think it… I think it needs to be made more accessible to trainees and clinicians as a whole

10, C, Neo, M

An algorithm, you know, that points you more towards peripheral muscle rather than central nervous-type aetiologies

7, C, Neo, M

 Communication of results

It would be handy to be able… over the phone for the registrar, to be able to say, “I’ve done a…” you know, whatever score it turns out to be called, “and they score this.” And then I can say, “Ok. Well, where did they lose points?”

11, C, Paed, M

 Scoring

In the ideal world, everything should have a score attached to it and we add up the scores and that tells us which category the baby goes into

9, C, Neo, F

So, change over time is nice if you’ve got a score or a scale, isn’t it, to follow changes over time?

12, C, PNeurol, M

I don’t know if they maybe hamper people’s ability to think through things and understand things. I wonder if people who have less of an interest or, if you’ve got a very junior person doing something, they still might at the end have absolutely no idea of what that means. Whereas, if you’re going through something less structured and less with a score, it might help you think a bit more

8, Tr, Neo, F

 No need

I would say is I have never felt that there was a deficiency, erm so I think in using anything new, one has to feel that there is the need for that. So, one has to be very clear about where is the area of need. And erm this is just my general impression of what this study is about, erm, because I haven’t personally felt a particular need in that area. But all the best, I think, you know, there’s always scope for improvement and one probably doesn’t realise it till it actually happens

22, C, PNeurol, F

Training

 Teaching courses and videos

I think a course is something that would help people

6, C, Neo, M

I think there’s an opportunity for the clinical examination to have videos of abnormal signs demonstrated and to have people having to interpret them

11, C, Paed, M

 Induction

Making it sort of part of the induction, and you know, making it part of routine practice, then automatically will include it in the normal things that we know that we need to be aware of

22, C, PNeurol, F

 Curriculum

It needs to be a part of training right from early on. I think the ideal way is the way anybody learns to examine any patient in medical school – it’s got to be down at that level

23, C, PNeurol, F

More focus on it in the curriculum, particularly in the Tier 1 curriculum, because that’s where it starts

9, C, Neo, F

 Assessment

Workplace assessments are a good way of assessing

9, C, Neo, F

I think there should be more of neurological assessments for babies and children in the… in the RCPCH assessments

10, C, Neo, M

Embed

 Culture change

It has to be a culture change. It has to be, like, “everybody, from now on we’re doing this.”

17, C, Paed, F

 Guidelines and protocols

I personally think, the neurological assessment, there is potential for improvement and it could be better if we have a dedicated protocol or guideline

16, C, Paed, M

I think it would be helpful if there was a guideline, um, of which babies we need to look out for

13, Tr, Paed, F

 Using research studies to implement clinical change

So as part of the study you had to have this neurological examination documented in a specific sheet. So, my way of bringing that examination into the department was to say, “well, we actually are including babies for this study and therefore we have to do this.”

6, C, Neo, M

 Modelling

You, kind of, need to improve the confidence of the Consultants to then filter down to the juniors

1, SG, PNeurol, F

I think that kind of comes from the top… from the trainee’s point of view it comes from the culture of the Consultant

12, C, PNeurol, M