How do you initiate change within a pressure cooker?

Summary

Frontline staff are being told to work harder, discharge more patients, be quicker, be more efficient, but are also expected to innovate and give safer care. Where can we find the time to innovate? The time to discuss and implement new ideas? One nurse gives her thoughts in this insightful blog.

Content

Working in healthcare has never been so demanding. The demand outweighs capacity in most services. There is a constant need for patients to be ‘flowing’ through the system. So much so, that there is little capacity for deviation from pathways that we have set up for certain groups of patients to enable their care to be ‘safer’.  

Our staffing templates and bed occupancy has no wiggle room for the ebbs and flows within the system at different times. Winter pressures now span from mid-summer to late spring – it just feels like the status quo. 

Having a busy day used to be every now and again, it seems that busy days are just the norm now. It is relentless. The huge machine that is ‘the acute Trust’ keeps turning. If you slow up due to covering staff sickness, a swell in emergency department admissions, a swell in ‘failed discharges’ you will tumble around this machine and be spat out at the end of the day with a little less resilience to when you started.

There are times when we get sent an email from Comms. "We are experiencing high volumes of admissions and a low number of discharges – this is an internal critical incident". I often read this email a week later. Staff who are doing the clinical work often have no access to a computer at work as the computer is used for looking at clinical results or used by the ward clerk. Plus, when will there be time?

An email telling us to work harder and be more efficient by people in their Comms room is as helpful as an ashtray on a moped.

At times, us frontline staff feel as if we are being told to ‘work harder, discharge more patients, be quicker, be more efficient and while you are fighting the fire... innovate and give safer care.

Innovation is rife within the healthcare system. I see it on a daily basis. Small pockets of great people doing amazing things. How are these people implementing their innovative ideas in an environment where there is little room for a full lunch break?

Good will. Often, these people have been driven to innovate in their area due to an unforeseen circumstance. They may have been involved in a safety incident, a never event, bullying or just wanting to make their job easier. Ideas often start small, then grow. What was a seemingly 'simple fix’ has now turned into a beast.

A band 5 nurse may introduce a new way of working. They do this alongside their full-time clinical role, often in their own time. They stay late, they come in early, they send emails on their day off, they read up on the theory behind their initiative.  

Great ideas and solutions are made everyday in our healthcare system by dedicated, passionate people. It is in our nature to ‘fix’ something that is broken: bones, wounds, people… healthcare?

Is this pressure cooker of a place producing the ‘right type’ of solution? Or are we just papering over the big issues such as bullying, poor leadership, pay and conditions, management of long-term conditions, staffing… the list goes on.

It feels as if we are putting sticking plasters over gaping cracks; it may work for a while, for that ward, that department, that Trust – but it needs to be more robust than that. We can not rely on the goodwill of our front-line clinicians to come up with the solutions.

About the Author

A burnt-out emergency nurse turned programme manager.