In a series of blogs, Gina Winter-Bates, Associate Nurse Director Quality and Safety at Solent NHS Trust, shares her experience of implementing Safety Chats. In Part 3, Gina shares with us how the Safety Chats were conducted and the key themes that came out of them, and what empowers and blocks staff in improving safety.
Previous blogs in this series explored the personal and evidence basis for having honest conversations about safety at the frontline of healthcare. There is often a perception that we are affording staff the opportunities to be open but this can be derailed when there is an unheard consequence in having an open conversation.
This could be a for a number of reasons, many of which were identified in the C-LINK Consulting article 'Don't let the 'iceberg of ignorance' sink your company':
- Staff may be uncomfortable sharing bad news with either their bosses or team (Mum effect).
- Time – there is so much to communicate and time is limited to share it.
- We think we know what is going on but only from our own perspective.
© C_LINK Consulting
This last point is vital in raising questions about the understanding of those who do the work and know the environment and those who plan the work and visit the environment. This is well illustrated in the above graphic. This perfectly describes why I believe that a process of unstructured regular Safety Chats could allow teams an opportunity to discuss things safety. They can be open about the good and the bad, and it will enable them to make changes that could prevent safety incidents occurring in the future. This will not replace Freedom to Speak up processes but will offer an earlier opportunity for change and awareness.
How were the Safety Chats conducted?
Between July and August 2021 four safety chats were held with two inpatient teams. The original six chats planned for the pilot had to be reduced due to significant system pressures: an important factor in the findings about how staff perceived safety, as it turned out later.
Staff were from all grades and a wide range of disciplines, both registrants and non-registrants, clinical and non-clinical. Several did not work for the Trust but were identified as members of the team so were invited to join by colleagues. No further identifying factors were gathered and names were only shared when staff offered them.
As previously described, four broad questions were posed and answers either written by the staff or placed on a whiteboard. Staff who were on alternative shifts also requested to join in and in a number of cases left their responses for me to collect. These questions were:
- What makes you feel safe/the ward feel safe?
- What makes you feel unsafe/the ward feel unsafe?
- Can you make changes to improve safety here?
- What empowers you or stops you?
Most staff confirmed that they/their ward felt safe to them.
Key themes for staff to feel ‘safe’
None of the themes around feeling safe are a surprise. They exemplify what good looks like for our frontline staff – most of them are about interpersonal or understandable issues.
- Communication: being able to ask and get information.
- Teamwork: absolute trust in colleagues, induction and welcome.
- Time to assess patient and support colleagues.
- Having time.
- Being trained and able to give training.
- Equipment, training, availability and maintenance.
They focus on how systems can either support human factors or, as the case of feeling ‘unsafe’, hamper staff in remaining safe.
Key themes that made staff feel 'unsafe'
- Changes to the care model and rapid changes to type of patients on the ward.
- Communication: not being able to ask (absent leader, lack of authority, being too busy), not being kept informed, mixed messages.
- Security: environment, job.
- Staffing: busyness, workload, stress, no time to train or induct staff.
- Equipment: training, availability and maintenance.
- Pandemic: rules changing, patients, central decisions, fear and guilt.
These findings are characteristic of many areas within the NHS. Changing care models mean that community wards are now having to take sicker patients who are much earlier in their recovery or rehabilitation journey. Covid has made staff wary of visitors due to the perceived harm via infection they can bring to the staff and the patients. Some of these issues are complex and systemic and will take time and work to resolve for staff. The most commonly focused area in feeling unsafe, unsurprisingly, was poor communication, not feeling involved or not being told what is going on. This is entirely within the gift of each of us to improve and this was fed back to the leads in these areas.
What empowers and blocks staff in improving safety?
- 70% of staff said they felt they/their ward was safe and they could make changes.
- Despite these figures, staff gave many more answers about what prevents them from making changes than what empowers them.
- Empowering factors, including their core values (patient comes first), communication, being considered or involved in decisions and very visible leadership, were key drivers to empower.
- Blockers included feeling that they could not communicate with leads, not being considered or involved, central changes over which they had no power or say.
- Not being listened to when staff reported or raised concerns was an enduring blocker to change.
- Emerging at the second Safety Chats was the feeling of how system pressures were impacting on staff. They described feeling that they could not speak up and make changes; non-visible management was a key concern as their ward managers were dealing with operational pressures and not clinically on the ward.
- When speaking about positive elements, staff described support from their ‘leadership’ but when describing negative elements of safety they talked of ‘managers/management’. It is unclear how this distinction was made but it was replicated in all four sessions.
- The way in which staff talked, in an open and transparent way about safety, meant that they were able to consider, challenge, question and reflect on safety in their environments with each other.
- Many staff approached us after the session and thanked us for the chance to have time to just talk about safety and the opportunity this presented.
If you would like to discuss Safety Chats further, please email me at: Gina.Winter-Bates@solent.nhs.uk
In my next blog...
In the next blog, I will detail how Safety Chats are being rolled out across the Trust. It will describe how Safety Chats will be the springboard in a range of staff support measures that we are introducing to improve psychological safety, to support Just Culture and to find out the real truth about what safety means to staff delivering care.
Other blogs in the Safety Chat series
- Safety Chats blog series: Part 1
- Part 2 -Safety as measured
- Part 4 - Talking about safety and creating safer environments
About the Author
I have been a nurse for 25 years with experience in acute and community care. I specialised as a cardiac nurse practitioner in ED and as a diabetes specialist nurse in the community and acute settings.
Throughout my career, patient safety, governance and service improvement has been key elements of my interest. I believe that engaging with our people and respecting their knowledge is key to quality improvement. I work closely with colleagues in education, equality and diversity, Just Culture and psychological safety to ensure that we are continuously improving. I am a very proud Florence Nightingale Foundation Scholar (2021/22).
I want to be part of an NHS that will look after people safely when they need it which is what drives my passion at work. I am married with adult sons and a granddaughter.
Linkedin: Gina Winter-Bates
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