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Found 40 results
  1. Content Article
    So, you have a network in place, a few allies and that’s working well. Your curiosity means that you are asking great questions. Then you hit a brick wall Push a few boundaries and you may find yourself in the middle of a disagreement, whether that’s you as a leader sharing power with your team or as the one brave soul who says "you don’t have the full picture". Whilst it may seem that people ‘in authority’ must find this easy to handle, otherwise they wouldn’t be in charge, at the end of the day this can be scary stuff wherever you sit within your team and the wider system. You could turn back at this stage, but I hope that you don’t. Top tips for dealing with conflict Here’s a few more tips from me, all drawn from my experience of working with individuals and teams wanting to make the right difference for their patients: Pause and take a long hard listen to what’s being said. Stephen Covey says that most people do not listen with the intent to understand, they listen with the intent to reply (1). Take a moment to reflect on how you listen. Empathic listening is not listening until you understand, it’s listening until the other person feels understood. Combine this with patience. Rome wasn’t built in a day and a big shift in the way things happen may take time. Use this opportunity to grow your network of people who share your passion for making a real difference. Last time I talked about power; from our formal positions, expert power derived from our knowledge and experience, and personal power. There’s also a wonderful power expressed through appreciation (2). Nancy Kline recommends a 5 to 1 ratio of praise to criticism. Researchers studied how appreciation effects blood flow to the brain. Less flows when we are thinking critical thoughts. Appreciation is necessary for optimal brain function. It moves to the heart to stimulate the brain to work better. Infectious, it goes a long way especially when someone may be quietly wondering whether something was the right thing (3). And, unusually, emails and texts can be the unsung heroes of appreciation. Being appreciated for what you did that day, that week makes a real difference. So far so good but what if you really cannot agree with the direction of travel? Well you can disagree respectfully and politely. There is a time and place for agreement and disagreement (4). And finally seek some feedback. One of the real benefits of building a network of support is that it can help you hone your practice and build your confidence. It can be difficult to fully engage, give your best and then know how you landed. Was I clear in that meeting? Could people understand what I was trying to say? Was I too forceful? But you can identify a trusted colleague and ask if they will give you some feedback. I often suggest people set this up ahead of time, you receive richer feedback as a result. The Healthcare Leadership Model is also a brilliant tool (5). It’s not just for people with leader in their title. It’s made up of nine leadership dimensions that you can explore at your own pace and then, if the time is right for you, seek feedback from others using the online tool. In return you receive a comprehensive 360 report along with a session with a trained facilitator to help you get the best out of your report. Thanks for reading this – let me know your experiences. Next time I am going to be talking about our responses to change and why it really is a bit Marmite – some of us are wired for change, others less so. But it’s a little more predictable than you might think… References 1 Stephen R. Covey. The seven habits of highly effective people. Franklin Covey, 1990. 2 Video: French and Raven's Bases of Power. YouTube. 2017. 3 Nancy Kline. Time to Think: Listening to Ignite the Human Mind. Ward Lock, 1999. 4 Peter Khoury. How to Disagree Respectfully, magneticspeaking.com 5 Healthcare Leadership Model. NHS Leadership Academy.
  2. Content Article
    This web page is specific for manager and provides useful resources, advice and support.
  3. Content Article
    The authors of this paper, published by BMJ Quality & Safety, believe that although there are deep anxieties and many sources of resistance to change in health care, there are also individuals and organisations which are exhibiting creativity and leadership. To support these efforts, they offer concepts and practical examples drawn from several industries including healthcare. Three ideas underlie their argument: Healthcare organisations can improve quality and other outcomes by enhancing their capabilities for organisational learning. Organisational learning requires leadership from executives, line (middle) managers, and informal network leaders throughout organisations. Leaders are more effective when they take a broad view of the interdependencies among individuals, teams, task flows, systems, and cultural meanings.
  4. Content Article
    Often, there are many perspectives that we need to consider before we have a complete picture. 'The Blind Men and the Elephant', and earlier versions of this parable, show us the limits of perception and the importance of complete context. This also applies when we are facing a difficult or complex issue in relation to patient safety. As part of the Patient First programme at Brighton and Sussex University Hospitals NHS Trust, we used A3 problem solving. Many others do too. It’s a structured problem-solving tool, first employed at Toyota and typically used by 'lean' manufacturing practitioners. Flexible and succinct, it captures everything you need on a single piece of paper – A3 in size, hence the name. It also brings together some widely used improvement tools – cause and effect diagrams (fishbone diagrams) the 5 whys and small change cycles (Plan, Do ,Study, Act). Most recently, I've had the pleasure of using it with teams wanting to improve elements of their services such as time to triage, discharge or wanting to minimise avoidable harm (e.g. patient falls). I have also used it with families and clinical teams wanting to take forward a key service change. Its’ real power is that, rather than jumping in with solutions in hand (which are, more often than not, shopping lists of resources required), you don’t move forward until you have absolute clarity on what the ‘problem’ is you are trying to solve. Plus, this is a team activity. It is rare we know everything about our issue and the power of an A3 derives not from the report itself, but from the development of the culture and mindset required for its successful implementation. There are several formats around – just google A3 problem solving. I have summarised the first 4 steps below: Step 1: Problem Statement Set out why this is important? A couple of sentences about the size of the issue, how long it has been going on, impact on patients, their families and staff. For example Over the last 4 months we've seen a reduction in patients triaged from X% to Y%. There was a near miss event last week that would have been averted had triage been in place on that shift and staff are concerned that there is no single process for them to follow. OR Our surveys over the last 6 months indicate that only X% of our clients are fully engaged in the development of their care plans. We need to address this urgently in order to ensure best outcomes for our clients and support family members and carers who are willing and able to participate. This is your call to action – if it isn’t making your staff and clients sit up and want to engage then it needs more work. Step 2: Current Situation What you know about the issues, what staff are saying, what patients and their families are saying (small surveys are great), what the data is telling you, any protocols or algorithms, and anything else that you need to know. Step 3: Vision & Goals Vision: A softer statement of quality AND Goal(s) : Measurable goal(s) and when you are aiming to deliver, for example: From June 2020: ‘X% of patients to be triaged within Y minutes of arrival‘ AND ‘Y % of patients triaged to the correct clinical pathway’ Step 4: Analysis: Top Contributors & Root Causes Use a cause and effect (fishbone) diagram to ensure you are capturing the many causes For example, the methods in place that may not be working quite so well, things to do with the environment, equipment and the people, both patients and staff. Once these are all out on the table then you can use root cause analysis to get underneath them. It’s only at steps five and six that you start to think about the actions that you will take forward and how you might fix some of these big issues. The full A3 is pasted below: And finally, it goes without saying that step nine, ‘insights’, is key. In my experience, people get best benefit if they complete this as they go along. There is always learning, for example people you might have engaged sooner, early identification of others who are already on top of the issue and able to share their work with you so you can adapt for your own use – we used to call it ‘assisted wheel re-invention’ when I worked for the NHS Modernisation Agency. Please leave a comment below or message me through the hub @Sally Howard if you want to know more. I'm very happy to talk further about this approach.
  5. Content Article
    Over the past ten years, I have helped dozens of organisations in the NHS, higher education and in corporate contexts start using AAR to improve the quality of learning after events. Yet despite the proven value of AAR to patient safety and team performance,1 AAR has still not made the impact it can and should. This short article explains some of the barriers to implementation that I have encountered during this time so that you can mitigate for them in your own context. In 2009, I joined a team at University College London Hospitals (UCLH) that had adapted the AAR concept from the military for use in the NHS. AAR provides a deceptively simple vehicle to structure healthy blame-free team interactions and the aim was to improve patient safety, clinical practice and team behaviours.2 The AAR approach has since become business as usual at UCLH where it is now widely understood and frequently used. What my colleagues at UCLH recognised so well is that AAR is so much more than the four questions you get when you type After Action Review into a search engine3 and, thus, designed the introduction of the approach with this in mind. A paper in the Harvard Business Review4 describes why AAR has so often failed in the corporate environment and this gives useful insights, but I have witnessed three particular challenges in the healthcare setting. 1. Fear The organisational and psychological barriers to being able to talk honestly about errors in multi-professional teams are accentuated by the hierarchical nature of the clinical context. Put simply, this means, despite everyone’s best intention to learn from a near-miss or an unexpected event, there will be fear about being fully open in front of those more senior or junior and those from other disciplines. If we are being really honest with ourselves, we know this to be true. Fear of what others think about what we have done, and whether it will affect our standing in some way, is a universal human trait which is increased when the boss is in the room. This fear is in direct tension with the AAR concept of openness and cross-disciplinary learning and will act as a barrier to calling AARs unless leaders act as role models in AARs and set the scene by being honest and open themselves. 2. Blame The emotive nature of clinical care heightens the response when things go wrong meaning the tendency to find something or someone to blame is increased. Not only do we have institutional demands pressing hard for straightforward answers, meaning we look for something obvious to blame, we also have our own human reaction to distance our self from responsibility. This traditional reaction again lies in direct tension with the very idea of AAR, where the process is not to blame but to learn. The research is clear, that in this most complex of operating environments there is rarely a single point of failure or a single individual who is to blame, instead there are multiple causes and effects, which ,when better understood, provide a firm place from which to make effective changes. 3. Responsibility The concept of clinical professionalism is centred around the individual’s’ responsibility to deliver safe effective care and it is rooted in the very foundations of how the NHS was created. Clinicians are raised in the belief that they should know the answers to problems and the whole structure of career progression is based around acquiring more knowledge, research papers and letters after your name. AAR is a process of learning as a group and taking responsibility together to find out how to improve, so it is not surprising that it sits in tension with the historical emphasis on the individual healthcare professional and the value of their existing knowledge. AARs allow for the creation of new knowledge through a collaborative process. The joint guidance from the General Medical Council (GMC) and Nursing & Midwifery Council (NMC) on the professional duty of candour states: “Clinical leaders should actively foster a culture of learning and improvement.”5 AAR is one of the best mechanisms to both foster and drive a culture of learning and improvement, but the simplicity of the AAR process itself should not blind you to the need to be very considered in how you mitigate and manage the barriers in a clinical setting. If you would like to discuss AARs further, I'd love to hear from you. Contact me at: judy.walker@its-leadership.co.uk References 1. Tannenbaum SI, Cerasoli CP.  Do team and individual debriefs enhance performance? A meta-analysis. Hum Factors 2013;55(1):231-45. .2. Walker J, Andrews S, Grewcock D, Halligan A. Life in the slow lane: making hospitals safer, slowly but surely. J R Soc Med 2012;105(7):283-7. doi: 10.1258/jrsm.2012.120093. 3. NHS Improvement. Online library of Quality, Service Improvement and Redesign tools: After Action Review. 4. Darling M, Parry C, Moore J. Learning in the Thick of It. Harvard Business Review: July-August 2005 issue. 5. Nursing and Midwifery Council. Openness and honesty when things go wrong: the professional duty of candour. June 2015. Read Judy's previous blog: How can After Action Reviews improve patient safety?
  6. Content Article
    In this article, Miles suggests that we need to recognise that the culture of any one organisation does not arise in isolation. It is part of, and to some extent derives from, an overarching NHS culture. And the national culture does not always seem to treat patient feedback as a valued resource for learning. Evidence of this includes the following: We tolerate the use of dismissive language. Patient feedback is routinely referred to as 'anecdotal evidence'. That diminishes patient experience, and robs it of its value for learning. We are comfortable with a double standard in use of evidence. Medical evidence is cherished, preserved and used. Patient experience evidence is treated as disposable. Both sets of evidence should be accorded equal value. We are content to weaken the independent patient voice. Healthwatch, set up in the wake of the Francis Inquiry, was meant to be a strengthened successor to the Local Involvement Networks. But Healthwatch funding has fallen by over a third since 2013. So what can be done? Miles says we can make a start straight away by tackling the cultural issues referred to above. The term 'anecdotal evidence' must be challenged wherever it is used. Directors of Nursing could lead on this. Patient experience evidence should be embedded in professional training, clinical guidelines and practice protocols—just as medical evidence is.
  7. Content Article
    In this video, Senior Paediatric Intensivist, Adrian Plunkett from Birmingham Childrens Hospital UK, discusses positive reporting (as opposed to incident reporting) in improving morale and outcome in sepsis.
  8. News Article
    Leadership behaviour from the “very top of the NHS” has led to an increase in bullying, according to an official strategy document produced by an acute trust. East and North Hertfordshire Trust published its new people and organisation strategy in its January board papers. Within it, the report said: “Leadership behaviour from the very top of the NHS, during this time of pressure has led to an increase in accusations of bullying, harassment and discrimination.” In a separate section, the paper noted the difficulties of being a healthcare professional, saying “many staff leave before they need to and many more cite bullying, over work and stress, as reasons for absence and mistakes”. Read full story (paywalled) Source: HSJ, 13 January 2020
  9. Content Article
    Movies from 1939 are engrained in American culture. They share narrative, characters and quotes that people are aware of even if they, alas, haven’t seen the films. The list of films produced in what some consider the finest year in Hollywood history speaks for itself; it includes Stagecoach, Ninotchka, Destry Rides Again, Mr Smith Goes to Washington, The Wizard of Oz and both my and the Academy’s favourite, capping the impressive output with a December 1939 release, Gone with the Wind. While recognising that certain characterisations in these movies haven’t aged well, the films have made an indelible mark on Hollywood history. The films of 1939 laid the groundwork for great things to come. They launched the careers of artists that have made a cultural mark worldwide: need I say more than John Wayne or Judy Garland? Another capstone to a productive year is the end of the 20th year post the publication of To Err in Human. The widely influential 1999 US publication showed us how to fight for patient safety – our Tara. It outlined approaches to address the seemingly reoccurring tornadoes in healthcare built to instead point toward home – a safe health system. Scarlett’s tenacity, her force of personal will and sustained belief in Tara is what pulled her through the maelstroms of civil war Georgia. Clinicians, however, cannot rely on grit and willpower alone to address clinical and organisational threats to safety. The lack of control to minimise systemic pressures on their moral imperative to do a job well in non-supportive situations reduces a clinician’s ability to practice safely. Building on the To Err is Human legacy, The US National Academy of Medicine (NAM) is committed to understanding factors that contribute to unsafe care. A NAM recent report on burnout lays out a system-focus strategy for organisations to reduce conditions that degrade physician health and, thus, safe practice. Dorothy’s quest to return home energised her instead to engage a multidisciplinary team. The skills of Scarecrow, Tin Man, Cowardly Lion and, yes, even Toto got them through the forest to safety. Without their individual commitment to the mission, humanness and competence the team would have never gotten to Oz. The American Association of Medical Colleges (AMMC) recently released a set of competencies expected in physicians to support quality practice. By suggesting what educators embed in their training efforts, the AAMC helps ensure learning opportunities that build competencies are embedded in programmes on the yellow brick road to safe care provision. Transparency helps us to see situations as they really are. Peaking behind the curtain enables exploration that, if used appropriately, can drive improvement. Toto pulled back the curtain to expose a threat that, once clarified, launched a collaboration that got Dorothy back to Kansas. The US-based Leapfrog Group has also forged a partnership to look behind the curtain. The latest release of the Hospital Safety Score data has focused attention on what isn’t working to support safety while celebrating hospitals that demonstrate sustained safety and quality. The scores track weaknesses in hand hygiene, infection control, and patient falls as elements of whether a hospital is safe. There have been challenges: wicked witches, budget constraints, refusal to accept change and conflicts. It has not been an easy road to Tara since Err is Human was released. Experts in the field have shared their dismay in the lack of progress. Yet stories of resilience, partnership and teamwork continue to motivate the resolve of Dorothy and Scarlett to keep going. Goal-focused efforts can backfire and not live up to their expected purpose. The South didn’t win the Civil war though they believed it was their destiny to do so. Scarlett never won back Ashely no matter how hard she tried. A recent article published in Health Affairs highlights the lack of correlation between the US Medicare and Medicaid programme reimbursement initiative and direct impact on patient safety in the state of Michigan. Its impact is questionable—which for a large-scale solution embedded throughout the system—is humbling. Questionable actions can be a human reaction to stress that needs to be called out and managed to reduce their presence and impact. While centering her as a force for action, Scarlett’s spoiled and selfish behaviour also destroyed her most meaningful relationship. Such destructive behaviours degrade relationships needed for the safety of care. A large US study published in NEJM found that harassment and inappropriate behaviours effect one-third of general surgery residents surveyed, particularly women. The mistreatment and bias generated by both patients/families and medical team members were identified as a key factor in burnout and physician suicide. The stories from great films of 1939 illustrate the power of grit, resolve, focus and leadership as elements of achievement. They share with us memorable characters that live with us long after the movie theatre lights come up. Through the embodiment of the tenacity of Scarlett and the team-focus of Dorothy we can and will work through the known barriers to reduce patient harm due to medical care. We have not yet arrived at Tara, but we continue to work tomorrow toward getting over the rainbow.
  10. Content Article
    This document presents a basic description of ten topic areas relating to organizational and human factors influencing patient safety. It also identifies a selection of tools for the measurement or training of these factors which may be suitable for application in developing, as well as developed, countries. The ten topics are: organisational safety culture managers’ leadership communication team (structures and processes) team leadership (supervisors) situation awareness decision making stress Fatigue work environment.
  11. Community Post
    A question posed by a delegate at our Patient Safety Learning conference 2019: 'Does your employer praise staff and patients for reporting safety concerns?' Tell us about your experiences of how reported concerns are received. Does it differ depending on whether they are raised by staff or patients? Are there any examples of great practice you can share where people are really praised for raising patient safety concerns?
  12. Content Article
    Speaking on 2 October at the Healthcare Excellence Through Technology conference, Heather Caudle and Ijeoma Azodo, both members of the Shuri Network, stressed the importance of diversity when developing new technologies like artificial intelligence (AI).
  13. Content Article
    Ward leader, Sarah King, had only been in post for 1 month when all of these concerns came to light and she was set an improvement action plan to improve the feel of the ward by developing the leadership team and creating a strong and supportive environment for a junior workforce. Following the inspection, Sarah developed an action plan that included setting the leadership team clear goals and objectives, improving record keeping, improving medicines management, addressing low moral on the ward and changing a chaotic feeling ward into a busy but controlled feeling ward.
  14. Content Article
    The Gloucestershire Hospitals NHS Foundation Trust combined learning from Nottingham’s model and project meetings with education and operational colleagues to determine what would work best for newly qualified staff in Gloucestershire. This programme offered the trust’s most talented newly qualified recruits leadership development, including a diploma in leadership and management, quality improvement training, leadership coaching, facilitated action learning sets and mentoring opportunities with the Chief Nurse. It also resulted in improvements to retention, with all fellows reporting they now felt they had the courage, confidence and skills to pursue their next role within the trust.
  15. Content Article
    The report argues that better engaged staff have higher morale, make fewer errors and deliver better patient experience. It demonstrates that patients receive more appropriate care and better outcomes when they are actively engaged in their care and highlights how leaders must be increasingly effective at integrating healthcare activities across healthcare systems. It sets out recommendations and outlines the argument for engagement, looking at what engagement means and why it matters. It looks at engaging across the system as well as with specific groups: Staff Patients Doctors Nurses and allied health professionals Boards
  16. Content Article
    The guide includes: How to select, implement and evaluate the guide’s strategies. How patient and family engagement can benefit your hospital. How senior hospital leadership can promote patient and family engagement. Strategy 1: Working with patients and families as advisors shows how hospitals can work with patients and family members as advisors at the organisational level. Strategy 2: Communicating to improve quality helps improve communication among patients, family members, clinicians and hospital staff from the point of admission. Strategy 3: Nurse bedside shift report supports the safe handoff of care between nurses by involving the patient and family in the change of shift report for nurses. Strategy 4: IDEAL discharge planning helps reduce preventable readmissions by engaging patients and family members in the transition from hospital to home.
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