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The Face of AfPP Competition - August Winner

Released on - 01/08/2020

The Face of AfPP Competition - August Winner

The Face of AfPP Competition - August Winner

We are delighted to announce that the August winner of our Face of AfPP Competition is the Cleveland Clinic in London. Congratulations to the team and all involved in this initiative, below is their submission.


  • Theatre Nurse Manager: Minija Joseph
  • Cath / EP lab Manager: Kerry-Ann Gordon-Watson
  • Theatre Deputy Manager: Ian Coyne
  • Theatre Nurse Educator: Warrant Little
  • Director of Perioperative Services: Jilly Hale
  • Chief Nursing Officer: Deborah Small

Operating Theatre Design and Management Perioperative Team


Cleveland Clinic is in the process of building its first hospital in the United Kingdom (UK) and will be opening a new 185-bed hospital in London in spring 2021. The perioperative service will consist of 8 operating theatres, a post anaesthetic care unit (PACU), 3 invasive labs, staff lounge, and changing room facility.

At Cleveland Clinic London all employees are known as Caregivers regardless of their role; both clinical and non-clinical background. Our teams in the kitchens, housekeeping, marketing, finance, IT, concierges, Specialist Perioperative Escort Service, secretaries; all are Caregivers. This is not currently adopted within the United Kingdom's healthcare service. It is a different perspective, but one that makes sense as all caregivers are involved in providing high-quality patient care. Our Caregiver culture means we are always striving to exceed expectations and building patient trust.

Perioperative Service Development

The perioperative service is probably where the challenge of integrating new technology with UK and US best practices is most acute. To do this, it had to recruit an expert team of perioperative nurses and managers with the skills and knowledge necessary to lead and develop not only processes and procedures but also direct the design of the theatres and perioperative areas. The chief nursing officer, Deborah Small from US arrived in the UK in 2018, and immediately started building the perioperative team.

Cleveland Clinic Culture Training

The perioperative leadership team was trained in the core values of the Cleveland Clinic (Quality & Safety, Empathy, Inclusion, Teamwork, Integrity, and Innovation) that are the foundation of the “Patient Experience” induction training for new Caregivers (Employees). The leadership team is committed to the Cleveland Clinic guiding principle of “Patient First”, by ensuring exceptional outcomes and improving health by delivering best quality care with compassion, multidisciplinary teamwork, evidence-based practice, research and innovations.

Leadership Goals

The theatre leadership team's goal is to ensure all theatre staff are aware of their expected roles and responsibilities, have the right knowledge, skills, and experience to provide high quality patient care whilst ensuring practitioners feel safe within the workplace. The leadership team works collaboratively alongside practitioners, acting as a resource that is approachable and visible to all theatre caregivers. We believe visibility makes the team more effective, open and creates learning opportunities for practitioners. The leadership team encourages caregivers to raise concerns, foster a no-blame culture, reporting and learning from incidents and listening to Caregivers concerns/feedback to improve the service.

The team is also involved in recruitment and review of the overall hospital facilities, to ensure fitness for purpose within each department. A significant amount of time and expertise has been deployed to work on a strategy for standardisation of surgical instrument sets, and the creation of appropriate digital documentation which can assure a safe and quality experience for our patients and Caregivers. The development of an operational model and workflows, allows the clinical team to provide safe, effective and efficient service across all disciplines. The overall ethos within the team is that everyone is treated fairly and equally, from executive level throughout the entire workforce ranking. Each member of staff is acknowledged as an imperative part of delivering appropriate and effective quality care, and a crucial link in the team. No one is considering as less important than any other, and all are treated with equal respect and dignity.

Policies and Procedures

Currently, Policies, Procedures, and Guidelines are being developed and many finalised with our physician colleagues closely aligned. These will be presented to staff in several venues to include team simulation training, case studies, educational portals and local department induction.

Communication and Engagement

The leadership team has in place during our start-up phase a system based on open communication and Caregiver engagement process. This facilitates new ideas to promote patent safety and Caregiver retention. Theatre huddles are conduted with Caregivers prior to theatre team briefing and will be introducd from day one onwards. Huddle communication will go up to the chief nurse daily. We want the team to feel this is not just a job and we will make sure the messages accessible to all Team members. We have committed to listening and being empathetic to our Caregivers. This will allow us to learn from underlying issues that may need to be addressed and change for continuous improvement.

Technology in Perioperative Area

The operating theatres will utilise a fully digitalised patient health record system that will transform the way care is delivered, recorded and shared. Our patients will have the ability to digitally view their health records, including scheduled surgery, patient information leaflets and videos, electronic consent form, discharge information, medication summary, post-operative instruction, and health education. Integrated theatres will have teaching and remote consultant reviews available.

Perioperative Facilities, Caregiver Gratitude and Professional Development

Dedicated facilities for the theatre team include a staff lounge with a catered meal, changing room facilities, theatre shoe washer and scrub dispensing machine. There is also an appreciation for Caregivers at theatre daily huddles and gratitude stations.

There is a robust induction programme consisting of twelve weeks of onboarding, departmental training, and induction. Further training provided in team building, situational awareness, human factors and an e-learning platform for all theatre practitioners. As part of our commitment to professional development, we are building strong relationships with various universities and developing specialist courses for theatre practitioners such as theatre manual handling, patient positioning, anaesthetic, and perioperative courses. Theatre practitioners will be highly trained and supported through all aspects of their development with dedicated theatre simulation-based scenarios and reflective learning to improve standards and mitigate risks.


Safety is one of CCL’s core values which ensures our standards and practices do not compromise patient and caregivers' well-being. In the theatre environment this is demonstrated through adherence of the five steps to safer surgery (WHO checklist), policies and procedures, departmental risk assessments, checking equipment and sets are safe for use, training and competency assessment of all theatre practitioners, ensure safe staffing levels, maintained skill mix at all times and effective communication through sharing information and ensuring this is accessible to all theatre Caregivers. In addition CCL will be introducing a a digitalised and standardise visitors and vendor process to protect all patient and Caregivers safety.


The process of the early design of the perioperative services at CCL demonstrates the opportunities to build on the foundational safety processes that are known, embedded in our culture of safety with every hire and improve healthcare by working collaboratively across national boundaries. The CCL perioperative management team would be honored to be selected as one of the Faces of AfPP, demonstrating how teamwork can build an advanced perioperative environment blending the best aspects of the UK, US, and global influences to transform health and care for the world.

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