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20 Ways to Create a Thriving #NHS workforce: #Leadership Lessons from @BSC_CCG

One head of Midwifery and one clinical matron have come to me this week asking for hints and tips about how they can support their staff (Great!) – They reported high sickness rates, clinical errors, high staff turnovers and stressed out staff. I am, as always, sorry to hear this. So I thought I would put together 20 hints and tips which have been proven to reduce mistakes, reduce complaints, reduce sickness and absence rates, improve retention rates, increase innovation and enthusiasm and create positive working cultures where staff are happy to be at work.

I have been on my travels again this week, one leader I met with in particular inspired me to learn more about how every NHS organisation can drive improvement through leading with compassion and actively supporting their staff in the workplace.

Cherry Dale is currently working within Birmingham South Central CCG (@BSC_CCG)….and her journey towards promoting healthy working cultures and staff well being is truly inspirational . I believe that her example now shines as an exemplar model for us all to follow. She doesn’t just talk the talk either…Her sickness rates are currently down to 0.2% in comparison with 4.44% average within the NHS, her staff engagement is high, recruitment and retention rates are high and the way her organisation can now innovate is amazing.

Hierarchy of needs - employee engagement

As I listened to Cherry’s words of wisdom, trying to take it all in…She pointed me to her latest published paper and her transformation journey -> How to get apples, not cactuses: an organisation fit for purposeMeeting the well being needs of staff and community. By Cherry Dale.

Cherry had a dream to create a “Very different sort of service”…Knowing that performance and well-being were “inextricably” linked, she looked to prioritise mental well being, and was keen to make sure that the needs and resources of staff as well as those using the healthcare services were “at the heart” of the way her organisation worked.

How can we all ensure that this comes to fruition? 20 Hints & Tips:

  1. Ensure that decision making is shared between all operational staff so that everyone is empowered to “Lead and act upon good ideas”
  2. Adopt the management style, promoted by the concept of the “Sunao Mind” (Untrapped, calm and highly adaptable)!
  3. Ensure that there are “No Dark Corners” – Share all knowledge and cascade it throughout, right from the top….This actively promotes ‘no blame cultures’.
  4. Embrace “Stand up meetings” Where staff are encouraged to share what went well, be down to earth and collaboratively share everything openly (30 mins in length).
  5. Imagine your organisation as a “Jigsaw” in which everyone holds a vital piece of the puzzle – encourage them to nurture this and take responsibility for it.
  6. Ensure there are no “Departments”, instead refer to “Natural working areas” so that boundaries are no longer in force and silo working becomes thing of the past.
  7. Ask “Who has the capacity?” to perform a task and “Who needs help?” – staff may be reluctant at first to share when they are at capacity, but in time the culture can metamorphosise into a supportive and emotionally intelligent culture, where staff are given extra support by colleagues whilst they are stretched to capacity.
  8. Ensure that staff realise that this is how you want and expect them to behave…You set the tone in communicating “This is how we do things here!”
  9. Erase the concept of ‘Grades’ or ‘bandings’ – If someone has the talent, motivation and capabilities to do the task…They can and should be empowered to do it! (Follow this with active talent management)
  10. See leaders as coaches and invest in training… for effective communication, ask coaching questions and avoid simply ‘directing’ people.
  11. Ban internal emails! – (A scary thought!) – This promotes conversations, movement and positive staff relationships.
  12. Promote open office spaces where senior staff are situated in the centre to promote open collaborations and discussion.
  13. Listen with interest and encourage staff to speak openly about concerns.
  14. Develop a ‘Human resources working group’ with members from each of your natural working areas to develop guidelines, policies and strategies with those at the top.
  15. Recognise and celebrate achievements, new ideas and acts of kindness.
  16. When staff are not quite themselves..Snappy…Tearful etc… encourage yourself and others to notice and check it out..”Is there anything you would like to talk about?…Feel free to come over and offload”
  17. Consider training all staff in the ‘Human Givens approach’…from this develop a staff wellbeing strategy, wellbeing days and events.
  18. Movable office furniture and bright colours inspire innovation.
  19. Link with the community and #GetInvolved with local fundraisers, initiatives and activities.
  20. Take this leap, make these changes and believe in them. Ripples will occur, people will notice…and your #NHS organisation can reap the same rewards.

As some of you will know… I have strong feelings about the term ‘Resilience’…But I do like this model below:

Resilience

 

Things to ask your team on a regular basis…

Have you laughed today at work?

Do you have someone you feel you can confide in at work?

Do you feel able to contribute to decision making?

Do you know what is really happening in your organisation?

Do you feel able to influence the direction of travel?

(Discuss your findings and create an action plan in response to results…Monitor progress!)

Spheres of control

“Don’t expect apples when you have sown the seeds of a cactus!”

 

Activity: Making the best of me…

1: Ask yourself how others can get the best out of you

2: Offer what you can realistically do

3: Communicate what inhibits your productivity with others

4: Actively describe what you need from others in order to thrive

 

Getting the best of me

A Sunao Mind: Having a sunao (untrapped or open) mind means being tolerant without selfishness, being open to the teachings of others, and being able to find joy in any circumstances. It also means being quiet yet dynamic, dynamic yet quiet. It is a state of mind that leads to the truth.

I hope we can all learn and embrace these lessons within our everyday lives. We know that the mental well being of #NHS staff directly correlates with the quality and safety of patient care…So let’s all create cultures in which we can thrive!

We are all leaders…so let’s all lead the way and leave our foot prints in the sand for those who wish to follow….

Until next time ❤

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Midwife Burnout: A Brief Summary

This week I have seen midwife burnout rear its head more than a few times. This is an issue close to my heart and one I dedicate my research to on a daily basis. Being a registered midwife and having practised through turbulent times myself, I know how it feels to give all that you have and yet forget to put yourself first at any time. You become a burnt out midwife, unable to give the highest quality or safest maternity care.

Here’s how it may happen…

 

The recent National  Maternity Review highlighted that midwives were more likely than any other professional group to report feeling pressured at work. Also, levels of staff stress in the NHS are the highest of any sector and staff consistently report a lack of compassion shown to them from leaders and managers within their organisations.

I find this incredibly sad…. We want to care so much for women and their babies…yet we fail to care for ourselves and each other.

The latest  work-related stress guidance cites one of my paper’s, which claims that “Midwives are entitled to a psychologically safe professional journey”… This is wonderful to see…but will we ever see midwives being cared for in equal partnership with the women and families they care for?

A colleague of mine recently noted that ‘as soon as we say that patients come first…we immediately devalue the staff’….

This got me thinking….and writing this blog post.

In the midwifery news this week:

I have come across the following articles in one way or another…

The experience of professional burnout can be one of extreme personal pain which some midwives feel they may never recover from. Despite global recognition of the destructive phenomenon of burnout, midwives may not understand what was happening to them. They can feel judged as managing their practices poorly, experience isolated feelings of shame, and feel unable to disclose their escalating need for help.

Young, C. M., Smythe, L., & Couper, J. M. (2015). Burnout: Lessons from the lived experience of case loading midwives. International Journal of Childbirth, 5(3), 154-165.

My 3 latest papers have addressed the issue of midwife burnout and psychological distress in great detail…I shall be publishing more shortly… for further reading see:

Pezaro, S. The midwifery workforce:  A global picture of psychological distress – ARTICLEinMIDWIVES: OFFICIAL JOURNAL OF THE ROYAL COLLEGE OF MIDWIVES 19:33 · MARCH 2016

Pezaro S (2016) Addressing psychological distress in midwives. Nursing Times; 112: 8, 22-23.

Pezaro, S., Clyne, W., Turner, A., Fulton, E. A., & Gerada, C. (2015). ‘Midwives overboard! ‘Inside their hearts are breaking, their makeup may be flaking but their smile still stays on. Women and Birth. In press.

Midwife burnout is rarely understood…Yet one thing is clear, we really do need to find new ways to support each other and look after ourselves for the benefit of all midwives working within midwifery profession, and the families we care for.

This week I will continue to write my systematic literature review which aims to identify the nature and existence of interventions designed to support midwives in work-related psychological distress, and their effectiveness at improving the psychological well-being of midwives.

Once this is complete, we will be one step closer towards effectively supporting midwives in work-related psychological distress.

Until then, look after yourselves…and each other.

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Reflections from the 4th International Well being at work conference 2016

wellbeingatwork

So…This week I have been visiting the wonderful city of Amsterdam to attend and speak at the 4th International Wellbeing at Work conference hosted by VU UNIVERSITY MEDICAL CENTER AND TNO.

This conference was great for networking, meeting people of like mind and learning about new research in the field of wellbeing at work. As I continue to carry out my own research into the psychological wellbeing of the midwifery workforce, I was happy to see other research work that will no doubt steer my own future work.

I was humbled to meet Christina Maslach who has done so much work in the field of burnout in healthcare and other staff around the world. The development of the Maslach burnout inventory (MBI) has been instrumental to the understanding of burnout in all types of professions. As such, I was very excited to share a quiet glass of chilled white wine and discuss further research in this field. There is so much to learn from you Christina!

The MBI Surveys address three general scales:

  • Emotional Exhaustion measures feelings of being emotionally overextended and exhausted by one’s work
  • Depersonalization measures an unfeeling and impersonal response toward recipients of one’s service, care treatment, or instruction
  • Personal Accomplishment measures feelings of competence and successful achievement in one’s work.

Christina Maslach is also now the editor of the newly found journal of burnout research. I hope to submit a paper to this journal in the not too distant future!

Having always had a keen interest in leadership, I was delighted to hear researchers from the university of Lausanne outline the key role that leadership has to play in the development of healthy workplaces. When we focus on the development of managers and leaders in the workplace, we essentially set the tone of the wider organisational cultures and behaviours. They lead the way and essentially show ‘How we do things here’!

wellbeing at work in leadrship

Equally, we must understand that health and well being at work and job satisfaction is more than a fruit basket! As we heard from ,  it became clear that interventions such as free exercise and health checks are insufficient in the development of a healthy workplace. They do no harm, yet we must look at new ways to promote healthy work cultures which set the tone of good workplace well being. I found this presentation very useful, and I will be reflecting upon the ways in which the findings of this particular work can be extrapolated to the #NHS workplace.

Also Lars L. Andersen is a really great guy 🙂

@LarsLAndersen

Although I found many of the presentations enthralling (and I cannot possibly list them all!) – I was particularly interested to hear researchers from  speak about mitigating employee silence. Through my own research I am quickly finding that health care workers can be reluctant to speak up about poor care, ill health and episodes of ‘impairment’. Occupational health and safety leading indicators are key to enable organisations to thrive.

The Top 3 Leading Indicators Organizations Should Adopt

Tracking and recording leading indicators is most useful to management when it tells the whole story of processes from start (or sometimes preparations to start) to finish. This makes it easier to gauge employees’ commitment to workplace safety and where to start from a training and communication perspective. Below is a short list of priority indicators to track.

  1. The more observations that employees and managers report, the more robust the data. One to two observations per employee on a weekly basis is excellent. This should not be considered a “tattle-tale” exercise, but a way to offer suggestions for improvement, recognition of underlying issues and maintenance needs as well as near misses.
  2. Employee engagement is critical for number 1 to work correctly. If all levels of the organization are paying attention to these things and talking about safety, a true safety culture will permeate throughout the organization. Best in class companies aim for 80 percent participation. This can ensure that many different aspects of your company’s processes are being evaluated and reported on.
  3. How long does it take the organization to act on observed deficiencies? Most corrections will be achievable very quickly. However, having more than 20 percent of these issues taking more than 48 hours to correct can mean that your company and management staff is not very effective at managing risk, which is a leading indicator in itself.

(Todd Hohn, Workplace magazine)

Mitigating employee silence

The mediation model of burnout provides a way of linking the quality of a nurse’s worklife to various outcomes, such as turnover. This will definitely be an interesting model to explore in my own future research where I look to find new ways to support midwives in work-related psychological distress.

Although there were a number of presentations which focused upon supporting the well being of health care professionals at work, none addressed the needs of midwives as a specific population to focus upon. This reinforces my own belief that in researching the support needs of midwives and the development of interventions to support them is still widely under researched. I hope I can conquer this niche area of very important research work to be done.

This particular presentation reflecting upon a meta-analysis of resources that contribute to the resilience of nurses was indeed fascinating. As I am currently working on a systematic literature review to explore the efficacy and existence of interventions to support midwives in work-related psychological distress, I hope my own work can complement new and emerging discoveries in this area.

resilience in nurses

My own presentation was very warmly received by an audience passionate about psychological well being of staff. I thank you all for your insights and questions in relation to my current work, I hope you enjoyed the healthy discussions and debates had by all.
wellbeing at work conference
The conference itself was buzzing with passion and enthusiasm from it’s delegates, and the hosts certainly took care of us with hydration, fresh and healthy food…massages during the breaks! (A first for me)… Strange characters invited delegates to the screening of a new health motivated movie (Some kind of space girl and a huge Postman Pat type character no less!
massages
…Also.. a health cafe was available for delegates to check  their blood sugar levels, cholesterol levels, blood pressure and BMI to make personalised and informed life changes to improve overall health. If only all conferences were so innovative!
Lastly, I wanted to reflect on how beautiful Amsterdam is at this time of year! The sunshine, flowers and beauty of this buzzing city really shone this week. The people of Amsterdam are also very welcoming and warm…Thank you for a wonderful and enlightening experience!
Amsterdam
I hope to see you all at the 5th Well being at work conference in 2018, France.
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Hospital Staff Absences for Mental Health Reasons Double – but do the Figures Add Up?

Today I was up early to watch Danny Mortimer NHSE_Danny (Chief Executive Employers) Speak on BBC Breakfast in light of new figures obtained via a Freedom of Information Act Request, that Hospital staff absences for mental health reasons has doubled across England in the last 4 years!

This information is obviously very relevant to my PhD study, and I will be reviewing it in time. However, the initial response that Danny Mortimer gave was that  staff feel comfortable talking about their . Hmm…

Has all of my research to date been wrong? Are #NHS staff comfortable talking freely about their mental ill health? (would love to hear your thoughts, but ironically you may feel unable to speak out – I tell myself this is the reason for a lack of comments on, and interactions with my blog all of the time :P)

Anyway, as you can imagine, I became worried that I was ‘missing something’ and asked Danny if he had any evidence for this? – See our conversation here

As you can see, he did not provide me with evidence for this statement, but agreed that we all need to do more to support our colleagues, and I know that we all share the same constructive goals. Unfortunately people don’t always have an answer, they just know that something needs to be done. I still believe that my PhD research could be the key to effective support, but this project is in its infancy and I will keep the readers of this blog as updated upon its progress as I am able.

So… the evidence provided by NHS Employers upon the mental health & well being of NHS staff is this:

MentalHealth Infographic WEB FINAL

A great infographic! However, one thing concerns me…. Apparently 76% of NHS trusts report that they monitor the well being of their staff (RCP, London). Yet 3 out of 4 people suffering from mental illness get NO TREATMENT AT ALL. (www.mentalhealth.org). So, are NHS trusts doing anything about the staff they find to be unwell? or are NHS staff fine? I think not. I worry that there is a lot of good rhetoric out there around NHS staff health and wellbeing, but not many interventions to support staff. The figures don’t add up, and seemingly only smarties have the answer.

I hope I have the answer coming… I hope its not too late.

http://www.mentalhealth.org.uk/content/assets/PDF/publications/fundamental_facts_2007.pdf?view=Standard

http://www.rcplondon.ac.uk/resources/nice-public-health-guidance-workplace-organisational-audit’

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Health Professionals who Die by Suicide – 5 Tips for Change


If the content of this post has affected you in any way, please visit the support page of this blog….

Yesterday was #NHSChangeDay, and I pledged to #StartTheConversation and raise awareness about health professionals who are in psychological distress. As it happens, @WeDocs conveniently hosted a  #WeDocs Tweetchat on preventing suicide in health care professional populations. It was great to see an issue I feel so passionate about being discussed, shared and given some much needed attention. This kind of innovative Twitter usage is one of the things I love about our NHS radicals!

Throughout the conversation, there were seemingly many people concerned and wanting to prevent clinician suicide, but not many solutions to prevention were put forward. -> See the chat summary here

A recent situational analysis into Suicide by clinicians involved in serious incidents in the NHS has identified the current support services available clinical staff, yet there is no consensus on how to effectively support clinical staff, and nobody has yet taken responsibility for the well being of NHS staff (Strobl et al, 2014). This has been further complicated by the fact that Clinicians often have difficulty in recognising symptoms and risk factors associated with their own suicidal behaviour (Goldney et al, 2002). Clinicians are at a higher risk of suicide than the general population, can be misunderstood and left unsupported whilst under immense pressure (Chan et al, 2014). The GMC have recently published a report in regards to a high rate of professionals dying by suicide whilst under investigation. A tragedy for all.

Psychological safety for NHS staff is critical for patient safety and every shiny new white paper will tell you this. But it is also critical for the NHS’s ‘ethical well being’ to care for it’s staff. If the NHS as an organization lets its staff suffer, how will it ever live with itself? The trauma will inevitably become endemic.

So what changes can we make to prevent suicide?

1. We could treat NHS staff as ‘innocent until proven guilty’ & eradicate ‘Name Blame and Shame’ Cultures.

2. Consider that poor behaviour may actually be ‘ill’ behaviour in need of medical treatment before disciplinary action takes place (Brooks et al, 2014).

3. Consider alternatives to discipline & create psychologically safe work cultures.

4.Expose investigation staff to front line clinical practice to understand organizational cultures and pressures.

5. Develop a tailor made national support programme for NHS staff which is confidential, anonymous and provides professional amnesty (The aim of my entire PhD research project)

Also… please keep the conversation going 🙂

Brooks, S, Del Busso, L, Chalder, T, Harvey, S ,Hatch, S, Hotopf, M, MadanHenderson, M (2014) ‘You feel you’ve been bad, not ill’: Sick doctors’ experiences of interactions with the General Medical Council BMJ Open 2014;Vol.4 (7) :e005537 doi:10.1136/bmjopen-2014-005537.

Chan, W., Batterham, P., Christensen, H., Galletly, C (2014) Suicide literacy, suicide stigma and help-seeking intentions in Australian medical students. Australas Psychiatry April 2014 vol. 22 no. 2 132-139

Goldney RD, Fisher LJ, Wilson DH (2002). Mental health literacy of those with major depression and suicidal ideation: an impediment to help seeking. Suicide Life Threat Behav 2002; 32: 394–403.

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Should NHS Staff really ‘have’ to be resilient?

Firstly, I was very happy to see the issue of NHS staff stress and burnout recognized within the Lancet this week

Trawling through the literature this week and talking to colleagues, I find the word ‘resilience’ being thrown around as an offerable solution to stress. Resilience training has seemingly been offered as a tick box exercise to ‘equip’ staff with the right weapons to defend themselves, but should they have to be at war with the system?

‘Resilience is essential now for a nursing leader; you just won’t survive without it,’

Are we to be on guard at all times?

The word ‘resilience’ conjures up images of holding up the fort, guarding the gates and resisting some kind of attack. We are giving our warriors weapons for a fight.

So…after we have received our resilience training, are we expected to then cope?

Following any other form of NHS training, this would be the case. Training day = See one, do one, teach one…..right?

So, having been to resilience class, we no longer have any excuses NOT to cope…do we?

Suggesting that resilience is the remedy to cope with stressful situations, is to suggest that some people can cope, and others just cannot. ‘You either have it or you don’t’

Can it really be taught?

What if you have been to resilience training and you are still struggling?

With the stigma associated with ‘not coping’, the majority of clinicians will not feel able to seek help (Munro, 2011).

I am concerned that the focus of remedy seems to be based upon the resilience of clinicians and their abilities to cope rather than the fact that some of the things they have to deal with on a daily basis, should not be occurring in the first place. (Bullying, stigma, name, blame and shame cultures, punitive action and burnout etc..)!

There are obviously daily events which put a strain on our NHS workforce that are outside of any control. Can we ever prepare ourselves for coping with such things?

Sometimes, no amount of armor will protect us from the pain of experiencing a traumatic incident. Therefore, suggesting that there is a magic weapon to protect us from such things may be a dangerous thing.

One cannot fix the pressures of NHS work with training alone.

We all suffer from the condition of being ‘human’ – Should we ‘have’ to be resilient to a toxic work environment?

Or should the NHS be remedied to care for us when no amount of resilience training can catch us when we fall?

Resilience is a dangerous word with many connotations. There should be no bar set for what it takes to ‘cope’…the price of expectation is too high.

I would be interested to hear your thoughts on this – please see the support page if you have been affected by anything discussed within this article.

Munro, R (2011) Sick day scrutiny: as the NHS seeks to slash its 3 billion [pounds sterling] annual staff absence bill, nurses are facing tougher checks on leave taken; Nursing standard [0029-6570] Munro, Robert yr: 2011 vol:25 iss:18 pg:24

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7 Tips for Implementing culture change within the NHS: Contributions from Occupational Psychology

A shorter post from me today as I focus on a new report I have come across in my research. The British Psychological society has an amazing group of Occupational psychology experts which I felt would bring to light a new perspective on NHS staff well being.

The new report: Implementing culture change within the NHS: Contributions from Occupational Psychology presents a series of chapters by occupational psychologists, each drawing on evidence and expertise from the field to address the question of how this culture change can be implemented within the NHS. These tips are taken as a general overall structure of recommendations from the report.

  1. Implement a values-based recruitment for patient-centred care
  2. Effectively manage staff experience to improve organisational culture
  3. Ensure you have a work design for compassionate care and patient safety
  4. Effectively lead and manage high performing teams 
  5. Foster a continuous learning culture within the NHS
  6. Trust boards and governance: Improve Composition and behavioural styles
  7. Build cultures of transparency and openness  

Ultimately, the report embraces the concept that the psychological safety of NHS staff is critical for patient safety. The report clarifies the development of negative cultures within the system that erodes trust, openness and a just culture.

It suggests that the current NHS system drives organizational behaviour, and the tone of this behaviour is set at a senior level. Negative tones may lead to undue pressures and stresses within the NHS, which may in turn lead to NHS staff behaving counter-productively.

“Leadership predicts staff satisfaction, which in turn predicts patient satisfaction.”

The more staff we can empower to lead change and positive cultures, the better the outcomes will be. These staff want to set a positive cultural tone and promote positive organizational behaviours, but this must happen from the ‘edge’. key areas are still in need of improvement if we are to increase the levels of staff psychological well being.

Picking apart these organizational cultures seems to be filling up my thesis as I see it becoming a large part of why staff are broken and battered. New reports are being released almost on a weekly basis, illuminating new failings and seeing organizational cultures as the cause of poor behaviour.

These cultures are becoming viruses within our NHS, and whilst we are swamped by a fear of blame and failure, the NHS will not recover.