When she qualified from Norwich Medical School in 2011, Dr Maryanne Mariyaselvam expected to follow a clinical career path like her fellow medical students.
That she is now a recognised expert in patient safety innovation within the NHS is partly due to a tragic incident she saw during her core surgical training.
'At medical school I had a naïve view of the NHS,' Maryanne reflects. 'I learned the theory but after qualifying, I discovered that clinical work can be chaotic. During one posting, I saw a patient death which occurred after a series of system failures, over two hospital sites. I was really affected by the incident and it was clear looking at this patient's pathway, that there was a high likelihood of it re-occurring.
'I spoke to my consultants at the time, however there didn't seem to be a reliable system in the hospital, which could lead to a meaningful and sustainable change. I felt that I should do something about this.'
Fortunately, a previous foundation training post had brought Maryanne into contact with the clinical group on the critical care unit at Queen Elizabeth Hospital, King's Lynn. 'They were great mentors and working with them on their safety innovations really opened my eyes,' she explains. 'I saw a practical way to prevent these kinds of adverse events.'
The opportunity to do just that came after Maryanne had begun her core surgical training. She discovered there was a clinical research post available at the Queen Elizabeth Hospital, where she could pursue her interest in patient safety innovation. She successfully applied and quit her clinical job, to the amazement of her colleagues, friends and family.
'The core surgical training job was fantastic, with supportive colleagues and consultants – so the general reaction to quitting the job was basically, what are you doing, are you mad? Fortunately, the consultants at the critical care unit in King's Lynn were supportive.'
I saw a practical way to prevent adverse incidents.
Maryanne also had to convince her family that she was doing the right thing.
'I was the first doctor in my family and I was taking a career break to undertake safety and implementation research. They couldn't understand why I wasn't going to be a hands-on doctor. I had to explain that clinical practice is really important, but the work I wanted to do was also really valuable as it meant I had the chance to help patients and doctors around the world.'
And true to her word, Maryanne has been involved in the design and development of ingenious yet practical devices which address recognised patient safety risks in hospital settings.
For example, central venous catheters are used in operating theatres and critical care units for monitoring and administering strong medication. An error can occur when placing central lines when the clinician accidentally forgets to remove the guidewire used to place the line. If this occurs, the guidewire can travel to the patient's heart, causing disastrous complications.
'We developed a solution, the WireSafe, which ensures that the clinician cannot complete the procedure without first removing the guidewire,' Maryanne explains. Thus the patient is protected, and the doctor is supported to do their job safely.
Clinical practice is really important, but the work I wanted to do meant I had the chance to help patients and doctors around the world.
Another of the devices Maryanne has been involved in was designed to improve the safety of arterial lines, which are used to monitor blood pressure and take blood samples. There have been reported incidents where drugs have been mistakenly injected into the arterial line. This error has the potential to cause serious harm to the patient.
'We developed a solution, the non-injectable arterial connector (NIC) with a one-way valve, which allows the clinician to take blood samples but physically prevents drugs being accidentally injected.'
As well as winning the National Patient Safety and Care Award in 2012 and the Innovation Prize from the Association of Anaesthetists in 2015, the NIC was one of the innovations recently selected for fast-track funding under NHS England's Innovation and Technology Tariff. It means hospitals in England will be fully reimbursed for adopting and using the device, which protects patients and ultimately frontline staff.
Thanks to her work in this field, Maryanne's career has taken flight. In 2015, she was one of only two junior doctors selected as a fellow on the NHS Innovation Accelerator Programme (NIA), started by Sir Bruce Keogh to promote best practice innovations and spread learning across NHS England. She was a founding member of the Q Initiative, a programme led by the Health Foundation, which connects people involved in healthcare improvement within the NHS. And with a group of like-minded clinicians, she founded the Kings Lynn Institute of Patient Safety UK (KLIPSuk) to develop and promote patient safety innovations.
At the same time, she has been able to pursue her research interests and develop her business skills. She is about to complete a doctorate at Cambridge University, researching why errors occur in healthcare and how developing engineered solutions can prevent never and serious adverse events. She actively participates in mentoring, training and networking opportunities as a member of the Clinical Entrepreneur Programme, a national scheme established in 2016 to support young talent within the NHS.
I had a feeling that I wanted something different, but I had to take a risk and figure out how to make it work.
Maryanne's work has given her opportunities to do things she had not dreamt of at medical school, from being able to conduct research through her doctorate, to contributing to international high impact publications, to being an invited speaker on human factors, patient safety and innovation at national and international conferences. But she recognises that it's not always easy for young doctors to find out about alternatives to clinical medicine.
'The early years of medical training can feel a bit like a conveyor belt, and I had no idea about the different careers out there. I had a feeling that I wanted something different, but I had to take a risk and figure out how to make it work.'
It was only later that she discovered she wasn’t alone. 'After I had made my decision, I was surprised how many people opened up to me about how they too had changed course during their careers,' she recalls. 'It’s a shame I didn’t find out earlier.'
Maryanne believes anyone considering a career change should talk to as many people as possible about their experiences, but also have the courage of their convictions.
'Don’t feel you have to listen to everything people tell you, even if they are experts,' she advises. 'What's worked for them might not necessarily be the best path for you. Ultimately you need to be brave and say, I'm going to step off even if I am not sure where it's going to take me.'
I have had to work harder to progress and make my own luck, but I'm truly happy.