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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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#NewResearch published on route to supporting #NHS staff in distress

This month I have had 2 pieces of  published with 2 of my favorite co-authors…@WendyClyne1 (Senior Research Fellow; Research Development Lead; Coventry University, Coventry · Centre for Technology Enabled Health Research) &  (Medical Doctor; King’s College London, London · Department of Primary Care and Public Health Sciences).

New Research word cloud

Wendy and I asked an expert panel what should be prioritised in the development of an online intervention designed to support midwives in work-related psychological distress. We did this via the Delphi methodology, and you can see the published protocol for this research here. Overall, participants agreed that in order to effectively support midwives in work-related psychological distress, online interventions should make confidentiality and anonymity a high priority, along with 24-hour mobile access, effective moderation, an online discussion forum, and additional legal, educational, and therapeutic components. It was also agreed that midwives should be offered a simple user assessment to identify those people deemed to be at risk of either causing harm to others or experiencing harm themselves, and direct them to appropriate support. You can read this full results paper here.

As this group of experts agreed that midwives would need both confidentiality and anonymity online in order to seek and engage with effective support, Wendy, Clare and I decided to explore the ethical issues associated with these provisions. We did this by conducting a Realist Synthesis Review. You can read our full review here.

We largely argue that..

In supporting midwives online, the principles of anonymity, confidentiality and amnesty may evoke some resistance on ethical grounds. However, without offering identity protection, it may not be possible to create effective online support services for midwives. The authors of this article argue that the principles of confidentiality, anonymity and amnesty should be upheld in the pursuit of the greatest benefit for the greatest number of people.

We now call upon the wider health and social care communities to join us in a further dialogue in relation to this in pursuit of robust ethical stability…Care to join us in this?

– Comment below or make contact via this contact form:

The findings of this research will inform the development of an online intervention designed to support midwives in work-related psychological distress, and we sincerely wish to express our gratitude to all of the participants who have contributed to this project so far.

Ongoing plans include the scaling up of this project to support other health care populations to enhance the well being of staff, patients and the NHS as a whole.

The best is yet to come. Until then, take care of yourselves and each other.

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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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#IDM2016 – Celebrating #Kindness to other #WeMidwives & Ourselves with @WeMidwives @world_midwives & @MidwivesRCM

I am blogging today in order to celebrate the International Day of the Midwife hosted by @world_midwives. This event is going from strength to strength, am I especially excited about some of the themes being highlighted this year!

The @WeMidwives community is celebrating the fact that “Kindness to others & yourself -does improve workplace health” – They ask that we share how we care for ourselves and one another as midwives.

The International Confederation of Midwives (ICM – @world_midwives) are also on board with this, announcing that we all must: Nourish the support system among midwives » Have a celebratory event where midwives can meet each other and learn about each other’s challenges and achievements and share coping mechanisms to support each other.

Also, @world_midwives have promoted another great activity: ‘I Am A Midwife, This Is What I Do’

They are inviting midwives to share the work they do using the “I am a midwife, this is what I do” activity on social media as a celebration of midwifery around the world. In their example they show a “Technical midwife adviser” – It is wonderful to see a wide range of midwifery roles being celebrated. This reminds us that you don’t have to be on the front line to contribute greatly to the profession. Research midwives, technical midwives, midwife educators and policy advisers all shape and contribute to the midwifery profession in their own unique way. The important thing to do is to embrace our diversity within the profession and unite in camaraderie and support for one another.

Last week, just ahead of #IDM2016, the Royal College of Midwives (@MidwivesRCM) launched their new guidance on ‘Work-Related Stress’ for heads of midwifery and individual midwives themselves.

RCM - ‘Work-Related Stress’.

I was thrilled to have our latest paper cited and referenced within this guidance as follows:

All this [Work-related stress] damages productivity and can affect outcomes for women. The research paper ‘Midwives Overboard!’ states: “Midwifery care aims to support optimal outcomes in childbearing. If, when caring for women, the potential consequences for midwives are ignored, we risk their capability to provide midwifery care to the high levels they aspire to. This threatens the very eminence of midwifery as a profession.” It also says: “Ethically, midwives are entitled to a psychologically safe professional journey… when maternity services invest in the mental health and wellbeing of midwives they may reap the rewards of improved patient care, improved staff experience and safer maternity services.”

Click here to see the full paper

So it really does seem that this topic I feel so passionate about is really gaining some much needed attention, and I am thrilled to influence guidance from my professional body is this way.

For made their theme “Workplace Stress: a collective challenge” free to read! Everyone is getting involved 🙂

Our own research project which explores what  for health care staff continues to thrive via @NHSStaffExp Please use the  hashtag to contribute your thoughts.

See full details here →  ..Please spread the word 🙂

Also, please check out The Virtual International Day of the Midwife     A great 24 hour conference for  – Catch up with the seminars online when you can!

Lastly, my favorite charity – is hosting many Muffins for Midwives events and is asking people to tag themselves and their muffins in photos for  – YUM!

Until next time….Take care of yourselves, and each other.

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#InternationalNursesDay celebrated during #MentalHealthAwarenessWeek… coincidence? #MHAW15

So… this will be a short blog for me today as I am working to get two new papers published so that I can do equally exciting, but different things next week 😀

I just wanted to sketch some quick thoughts down here about #InternationalNursesDay and  , as these events both fall within the same week and indeed #MentalHealthAwarenessMonth.

 celebrates self care and mindfulness this year, both extremely valuable tools (IMHO) to maintain ones own well being. The awareness week also brings our attention to the eternal war on stigma, which again IMHO is the biggest killer of all. This year was indeed an amazing #MentalHealthAwarenessMonth and I very much enjoyed reading and seeing the buzzing communities becoming involved on twitter.

Equally, #InternationalNursesDay  was celebrated with vigor, yet I saw this event in a different light.  saw those with mental ill health explain to the world how it feels to manage their mental health every day. They implore the world to take notice of their needs and  recognise mental ill health as being equal to physical health. They draw upon the importance of mental health awareness and the need for action. They are fighting for their rights and more. It was inspiring to see 😀

However, those celebrating #InternationalNursesDay seemed to share a different message. The main campaign which took my attention was the hashtag #whyInurse. This involved nurses from all over celebrating their work, acknowledging their privileged position and providing examples of the pride they share in nursing. It was really quite jovial. They were celebrating what they wanted to give, rather than anything they wanted to take for themselves.

This is seemingly a consistent pattern for health care professionals….they give all that they have….

Do they ever have time to look after themselves? Allow self care? practice mindfulness?

Many nurses celebrating their profession also celebrated #MentalHealthAwarenessWeek…Do they practice what they preach?

Although there is much to celebrate, I worry that health care professionals are placing themselves upon high ground. Through my research and the statistics I am seeing, I know that there are many health professionals who may be suffering in psychological distress. When these celebrations shout to the world that nurses are ‘having a ball’, it may make it that much harder for those in pain to speak out.

It may even make people think that health care professionals are much too happy in their jobs to be in psychological distress.

As it is #MentalHealthAwarenessWeek… I want to raise awareness about the healthcare professionals in psychological distress. They are dealing with horizontal violence, emotional and moral traumas, traumatic incidents, stigma, compassion fatigue and much more.

Remember that 1 in 4 people in the UK will experience a mental health problem each year. This figure also applies to health care professionals working within the NHS and all over the world.

I would like to bring #InternationalNursesDay and #MentalHealthAwarenessWeek together, so that healthcare professionals can become aware about their own mental health needs and the needs of their colleagues.

These are only my personal views. There is never any offence intended. Please see the support page of this blog if you have been affected by any of the content within this blog.

Thank you  for reading 🙂 

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Partnering with the Colombo Institute of Research and Psychology – Sri Lanka…

colombo institute of research and psychology

colombo institute of research and psychology

I apologize for the lack of posts over the last 2 weeks. I have been to visit the wonderful people in the Colombo Institute of Research and Psychology and the National Institute of Mental Health, Angoda.Then of course I had to deal with copious amounts of work/emails upon my return, which I am sure will fill exciting posts to come.

When I embarked upon this research journey, I also signed up for the Global Leaders Programme at Coventry University. I did this to become a part of the global healthcare community and reach key opinion leaders with the same directive goals as myself…Starting the conversation has always been the most productive way to make change happen. Indeed, it has already put me in touch with some inspiring people, and this trip proved to be no different.

I have always had a keen interest in getting to know how the various healthcare systems across our globe work. We are all human… so what works best? I have already visited the Royal Victoria Teaching Hospital in Banjul, The Gambia and the Gimbie Adventist Hospital, Ethiopia. With the help of Maternity Worldwide and clinical work placements, I was privileged to have the opportunity to see how our health care systems contrast and compare to other healthcare systems around the globe. I was excited to take part in this visit, which promised to enlighten us all to the mental healthcare provisions and psychology research in Sri Lanka.

National Institute of Mental Health, Angoda Colombo, Sri Lanka

National Institute of Mental Health, Angoda Colombo, Sri Lanka

Speaking with the researchers in the Colombo Institute of Research and Psychology, it was clear that their research shared the same concerns as western research. Healthy debates generated interesting insights into the work they were forming in breaking stigma and securing new funding for the people of Sri Lanka. However, their population base faces some new and very real challenges:

-Less than 1% of Sri Lankas healthcare budget is spent on the mental health care of the nation.

-Sri Lankan communities often use astrology and homeopathic remedies to treat mental ill health rather than access medical facilities.

– There are only 2 psychiatric consultants for the whole of Colombo and surrounding areas.

-Limited facilities for mother and baby units, which need more space for mentally unwell mothers and their families. (In Sri Lanka, reported maternal death due to suicide is notably high) – See Puerperal Psychosis.

– The stigma around mental health issues remains great in Sri Lanka, therefore many of those who may be ready to re-enter their communities following treatment have no where to return to. They become rejected by their families.

– This stigma creates a culture where those in need are reluctant to seek help.

– Families are keen not to disclose the mental ill health of loved ones and may isolate problems.

-Mental health facilities are used as holding places for those on remand following the identification of the antisocial behavioral symptoms of ill mental health.

Speaking to one of the consultant psychiatrists about these issues was so valuable to my research. Comparing the etiologies of psychological distress with the cultures and social norms of both populations highlighted how our UK populations may face triggers for distress which are entirely unique to the UK. Although some of these factors will also translate to other populations, it may be that specific factors correlate only with our own health care professionals, within western society.

From the point of view of research, this leaves much to be explored. How do we breakdown the populations into completely homogeneous samples? Is it ever possible to?

After speaking with Dr Shavindra Dias from the University of Peradeniya, (which by the way is the most beautiful university campus I have ever seen!) it is clear that the connections I have made throughout this research trip will last throughout my career as I continue to network with and learn from some of the most outstanding and inspirational leaders who take pride in making changes to ensure a brighter future for all. The struggle to improve the overall well being of society by authenticating and placing value upon the needs of those in psychological distress is hard. Yet I still believe that is the most noble and kind thing we can do for humanity. The connections I have made throughout this trip will forever remain a part of my professional journey going forward, and I would like to thank @PsychColombo again for hosting such an amazing trip of discovery in partnership with @covcampus.

In addition to this wonderful experience we also visited:

-Galle Face Green

-Galle Fort

-The National Museum of Colombo

-International Maritime Museum in Colombo

– The National Elephant Orphanage

-The Temple of the Tooth

-Anuradhapura

-Botanical Gardens

-Tea Factories

View from the World Trade Centre in Colombo

View from the World Trade Centre in Colombo

Sri Lankan Elephant Orphanage

Sri Lankan Elephant Orphanage

I hope to reunite with the amazing people I met here soon…. Perhaps for my up and coming Delphi Study?

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Naming Mental Health as the Cause for Disaster means a Reversal of Gains to Reduce Stigma

I am almost at a loss for words when I see the headlines in relation to Andreas Lubitz and the tragedy of Germanwings 4U9525. The horror is unbearable, but the press coverage surrounding the story has been abhorrent. I am scared to write this post as I do not want my words to detract from the pain that the families involved must be feeling…and I am sure I will not cover this issue as well as @MentalHealthCop or @BlurtAlerts… but I must share my thoughts.

Relating this story back to my own PhD research in supporting health professionals in psychological distress, this story should remind us all that high profile jobs in high pressure environments placed in the public eye can produce adverse health problems. Many people have been questioning what ‘Burnout’ actually is. For clarity I will define this as follows:

Burnout is a syndrome of emotional exhaustion. Burnout has been defined by Maslach as a syndrome consisting of emotional exhaustion, depersonalization, negative thinking towards others and a reduced sense of personal accomplishment (Maslach, 1986, Maslach, 1996).

Moving on to depression:

“Depression is a common, disabling disorder characterized by a period of at least two weeks in which a person loses pleasure in nearly all activities and/or exhibits a depressed mood“(Stewart et al, 2004;19).

Symptoms of major depression include feelings of sadness and hopelessness, diminished pleasure, changes in weight, changes in sleep patterns, lack of interest in life, chronic fatigue, a sense of worthlessness or guilt, muddled thinking and poor decision making (APA, 2013).

Sadly depression can affect all areas of a persons life, and yes some of those with depression will die by suicide. However, the headlines seemingly suggest that depression is the cause of this ‘Murder’. It will not be the only cause of this tragedy, and nothing is confirmed as yet. It frightens me to think that these assumptions are coming up so thick and fast before the facts are known. This highlights to me the stigma still apparent and surfacing in the wake of fear.

We do not know all of the facts, perhaps Andreas dissociated from everything around him and any decisions he may have been making, perhaps this is something completely unrelated. Whatever happened, the headlines of this story are damaging and risk the reversal of any progress we have made in reducing stigma.

Some news companies are scaremongering and stating that nobody with depression should be allowed to fly a plane. This at least makes a change from them saying that all those with depression are ‘fit to work and lazy’ – but I digress.

This idea is ridiculous as those with mental health issues can achieve great things… remember 1 in 4??? Do we get rid of 1/4 of our pilots?

What if our pilots have a headache? what if they have a brain tumor? what if they have a seizure whilst in flight? – the ridiculous parodies may continue…

I was hoping this would get people talking about what can be done to support those in *potential* psychological distress in order to improve overall services, instead it has led to an immediate reaction of fear. I am hoping the long term story will be a different one.

American Psychological Association (APA) (2013) Diagnostic and Statistical Manual of Mental Disorders (V) American Psychiatric Association, Washington, DC (2013)

Maslach C, Jackson SE. Maslach Burnout Inventory Manual, 2nd edn. Palo Alto (CA): Consulting Psychologists Press Inc; 1986.

Maslach, C Jackson, S Leiter, M, Schaufeli, W, Schwab, R (1996) MBI: The Maslach Burnout Inventory: Manual. Consulting Psychologists Press, Palo Alto (1996)

Stewart Donna ; Gucciardi Enza ; Grace Sherry (2004) Depression BMC Women’s Health, 2004, Vol.4(Suppl+1), p.S19