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Following #Expo16NHS..I could be replaced… ‘technically’

And so another NHS Expo conference comes to an end. It was a lively 2 days with lots of amazing people coming together to share new ideas about the future of health and social care.

The conference was largely dominated by the digital and technical innovations that may help to create the NHS of the future (and make it better presumably)… I have always been interested in how technology may make a variety of health care improvements…I have written about one of my ideas here.

Sir @DrBruceKeogh providing a broad outline on recent ground breaking digital innovations

The digital news as reported by @keithgrimes was as follows:

  • Patients will be able to book appointments, order medications, and download records, US ‘Blue Button’ style, on a revamped http://www.nhs.uk to be launched at Expo 2017.
  • Anyone will be able to access detailed stats on performance in key areas such as dementia, diabetes, and learning disabilities
  • There will be online access to 111, which can lead to direct appointment, signposting, or callbacks.
  • By March 2017 there will be a directory of approved apps from March 2017, with subsequent support for wearables
  • 12 hospitals to become “Digital Exemplars” – each receiving £10m funding, matched by trust, and partnering with world leader organisations.
  • The creation of a second round of ‘national’ excellence centres, with more detail to follow.
  • The creation of an NHS Digital Academy to teach Informatics skills to NHS staff and create the next generation of Clinical Chief Information Officers and Digital Health Leaders.

And for more digital ideas….

MY DIGITAL FOOD FOR THOUGHT…

Often, whilst working clinically as a midwife, I also find myself behaving like a robot… (Don’t worry… I obviously use my gut and intuition too)!…but really, as midwives we are calculating risk at all times….like a computer. Also…we follow certain pathways as midwives…if a blood pressure becomes out of range…we take the next prescribed step in making a referral or delivering a new treatment to fix it. A computer could do this.

Imagine a woman coming into a clinic to see a robot (of sorts). She is scanned, measured and given the full M.O.T that she would normally receive from a midwife, but it is the robot who calculates the risks and the next steps to take. At the end of the exam.. the robot gives the woman a print out report, which outlines what should be done next in light of any new findings. The robot can answer questions too…

…(hopefully better than google can)

…or it can tap into a Skype call with a registered health professional. Imagine a future like this..better or worse? In a pressured maternity service, this could indeed be the new way of things. Could I be replaced as a midwife?…’technically’?

I think not. But a digital future like this could certainly support midwives in practice. Would it be safer? are human errors more common than digital ones?… Certainly worth exploring I think.

What do women want from their midwife? A human face? compassion? Human touch?…None of these could be delivered by a robot (probably)… and so perhaps a digital future like this would afford midwives more time to be compassionate and ‘human’..

MOVING ON…

Also at Expo.. there was @roylilley….with @JaneMCummings

Singing ‘Always look on the bright side of life…’

🌅🌻⭐️👀🙊👍

Obviously they were doing this to celebrate and introduce 

..not far away now (19th October 2016)

And we also heard more singing as we enjoyed a very moving rendition of “I will try to fix you”…

💉💐💊🏥🚑

By the @NHSChoir for the  at

from with bonus live sessions from

My colleagues and I also presented our #ShowsWorkplaceCompassion research for the first time and some of the other work we have been doing in partnership with @NHSEngland to commission for a positive staff experience. Thank you to everyone who came along and shared thoughts and ideas to help us shape this project.

I was also invited to join sessions on the

Maternity Transformation programme: Delivering the 2020 Vision at #Expo16NHS #MatImp #MatExp #BetterBirths #BUMP

and the …

@empathymuseum at #Expo16NHS #WalkAMileInMyShoes via @HealthFdn.

Click the links to read more….

Next year, I hope to be sharing more research and ideas. No doubt I will still be on my quest to improve the staff experience within health and social care..after all… patient experience and staff experience are both sides of the same coin..

2-sides-of-the-same-coin

See the Twitter activity from#Expo16NHS here

Until next time…be kind to yourselves, and eachother 💛💙💜💚❤

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Reflections from a session in the @empathymuseum at #Expo16NHS #WalkAMileInMyShoes via @HealthFdn

One of the best things I experienced at this years NHS Expo 2016 was the @empathymuseum …where I was invited to #WalkAMileInMyShoes via the @HealthFdn. It was rather strange to be invited into a giant shoe box, but nevertheless… Just like Alice in Wonderland I found myself uttering….’curiouser and curiouser’..

As I wondered in to the cozy shoe box to sit on the sofa, I was asked to put on a pair of shoes.. Theatre shoes…(See below)…

I walked around and listened via headphones to the man who had kindly donated his shoes and his story to this project. He was a specialist nurse working in A & E. He spoke about how he had to face the reality of death at work every day. Not only did he have to do this, he then also had to engage loved ones and relatives in incredibly difficult conversations and help them to make the best decisions in the darkest hours.

This nurse was able to celebrate the incredible gifts people were able to give as organ doners, and see joy in how a family was able to see a part of their departed loved ones go on… All of this was very uplifting…and there was no doubt in my mind that this nurse was indeed a superb example of the profession. However…as I walked on…I found my self wondering whether anyone asked the nurse how he was? How long could he maintain this uplifting approach whilst dealing with death and emotional pain on a daily basis? Would cracks start to appear?

I often see examples of how we celebrate this service and self sacrifice…and to nearly quote Paul Simon… every generation throws healthcare hero up the award charts!.. and so we celebrate this eternal culture of giving. I certainly empathize with this nurse, and greatly admired his approach to his work… He is a hero..but he is also very vulnerable, both psychologically and physically as he continues to give all of himself to provide the best service possible.

My worry is that the more we place service and sacrifice upon a pedestal…the further our heroes have to fall…

 

As you can see from the film above…this really is an amazing and thought provoking project, as those who visit are asked to write messages to those they now share a new found empathy with.

I would have liked to have walked a mile in all of these shoes…and perhaps some day I will have time to…as you can soon also experience this project online here. So as a lasting thought on this amazing project…I would like to repeat my mantra…which is…always be kind to yourselves… and each other….

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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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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The ‘Magic’ #Resilience Pill

There are no consistent definitions for what resilience actually is, yet I am beginning to actively dislike the word. It is beginning to sound as though it might be the magic pill everyone within the #NHS might need to take in order to survive. I am not so sure.

We don’t know much about resilience, yet it has been suggested that healthcare professionals need to be supported, not trained in resilience. I am inclined to agree.

Resilience building has a hidden cost in that “By introducing this focus on developing ourselves into “happy”, “positive” leaders one could argue that we are merely buoying ourselves away from, and in effect delaying, what is inevitable – the call to deal with the reality of our current state of play.”

Having ‘resilience’ puts the ownership of survival upon the beholder….. Does this mean that “You have had your resilience training (or ‘pill’) therefore you should be resilient now”? …. Will there be no room to show anything other than a new found ability to ‘cope’?

The NHS is a challenging place to work, and healthcare professionals are doing their best to survive and deliver the compassionate care that they wish to give. So should we be making the NHS a less challenging place to work? or be toughening up those who work there to become ‘resilient’ to adversities?

This is going to be a relatively short post, but I wanted to write down a few analogies that may help us all in thinking about what ‘resilience’ may really mean for us.

If you were being punched repeatedly in the face, would you:

A) Try to become resilient to the pain?

or

B) Try to reduce/stop the punching?

Perhaps a bit of both, but you see my point. The girl in the street who gets attacked does not need to wear a longer skirt, fight back harder or scream louder. Her attacker needs to stop attacking her.

The danger comes when staff feel that they should become more resilient rather than seek support for any pain they may be suffering. NHS staff health is vital to safe and effective patient care, and we would all like to see staff engaging happily with their work.

Yet perhaps the ‘Magic’ #Resilience Pill may actually be the placebo that masks our incredibly valued sensitivity as healthcare professionals.

It has been suggested that:

“The notion of resilience in midwifery as the panacea to resolve current concerns may need rethinking. Resilience may be interpreted as expecting midwives ‘to toughen up’ in a workplace setting that is socially, economically and culturally challenging. Sustainability calls for examination of the reciprocity between environments of working and the individual midwife.”

Whatever the case, it is time to be kind to each other. Always.

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Designing a platform to support midwives…The Research Protocol is out!…are you in?

As I was preparing for my yearly performance review this week, I had a new maternity unit want to learn more about my research. More and more people are wanting to join the swell of participants, willingly giving their time to help shape the design of a platform designed to support midwives in psychological distress. This is becoming a powerful collective movement just in time for the launch of the first round of Delphi questioning. By the end of this month I will be sending out the questions whose answers will shape the design of an online intervention. These are indeed exciting times.

Midwives online support

I wanted to thank those who have shown a last minute interest in taking part in this study. Your opinions will be valued ones and I cannot wait to see the ideas and opinions that will shape this project. There is still time to get involved if you, or someone else you know would like to enhance the evidence base for this project. You can read more about becoming involved with the project here.

For those already invested, I wanted to share the full protocol with you in the interests of transparency. This has now been published within the Journal of Medical Internet Research protocols, and you can read it in full here or below.

Pezaro, S, Clyne, W (2015) Achieving Consensus in the Development of an Online Intervention Designed to Effectively Support Midwives in Work-Related Psychological Distress: Protocol for a Delphi Study. JMIR Res Protoc 2015 (Sep 04); 4(3):e107

This paper details how this study will generate a consensus around the development of an online intervention designed to support midwives in psychological distress. With your involvement and support, the ideas you contribute will inform the design and build of a new platform, which I hope will go on to make a difference.

Thank you to all of you for showing your support and giving your time to this research. I am so looking forward to launching this study with you in a couple of weeks! – Until then my friends…be excellent to each other.

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Preparing for #Expo15NHS: Improving #StaffExperience to improve #NHS performance @NHSExpo

NHS_expo_speakers_email-signatures_500x124

So… I have been developing my seminar presentation for this years NHS Expo 2015. I am so excited to be a part of this day and to present a seminar on an area I feel so passionate about. Please let me know if you will be there, I would love to network with others interested in healthier staff for healthier patients!

@NHSExpo

If you are booking your sessions for the day remember to book in for the pop up university session:

Workshop 20

Improving staff experience to improve performance

This session will be run in conjunction with colleagues from Coventry University and Sheffield Teaching Hospitals NHS Foundation Trust, and will focus on the impact staff engagement and experience has on organisational performance, specifically patient experience. The session is aimed at commissioners and policy makers, and will outline why staff experience is so important, as well as offer examples from an organisation has has improved staff experience to great effect.

Sally Pezaro (Centre for Technology Enabled Health Research (CTEHR), University of Coventry) and Rhian Bishop (Staff Engagement Lead at Sheffield Teaching Hospitals Foundation Trust).

Hope to see you there!

Quick note: I have also begun to recruit for my up and coming Delphi Study. Thank you so much to those who have already expressed their interest in joining the expert panel, and to those who have shared this recruitment information via social media (please keep sharing and remember to email me and express your own interest in joining!)

So in preparing for  I have begun to look at more and more research in relation to staff experience, staff engagement and how this relates to improved outcomes and quality care. I am looking into all areas of the NHS, however I personally have a particular interest in maternity services. This blog post focuses upon one element of the midwifery staff experience, it is not a sneak peak of my NHS Expo seminar….there are no spoilers 😛

When I came across the following piece of research, I found myself reflecting deeply upon our NHS culture and the #StaffExperience in maternity services:

Prowse, J., & Prowse, P. (2015). Flexible working and work–life balance: midwives’ experiences and views. Work, Employment & Society, 0950017015570724.

This study uses a multi-method approach to explore midwives’ views and experiences of work within a large NHS maternity unit. The benefits of introducing flexible working and initiatives to encourage a healthy work life balance are clear. Should these interventions be successful, we may see the maternity workforce thrive and grow, rather than retire and burnout. It is also clear however, that supporting these interventions may require additional workloads to be placed upon supporting staff as they ‘pick up the slack’

What concerned me most about these findings in the experiences of midwives, was that where initiatives were introduced to promote flexible working and healthy work life balance, midwives became resentful of each other.

This cannot be psychologically healthy, and yet maternity services must find the right solution to support the staff experience. I think that the real tensions may actually stem from the expectation that to be a professional, midwives have to be committed to the profession and put the needs of the woman and maternity service first, before their own……

“Having a healthy work life balance may still be seen as being incompatible with being a professional midwife……”

This conclusion evokes a great sadness for me.

This study concluded that “Unless these tensions are addressed, divisions between midwives and within the profession will intensify.”

This cannot be conducive to patient safety, care quality or healthy staff experiences for a psychologically safe professional journey.

-Midwives need to be able to value their own well being in order to provide high quality patient care.

-NHS organisations need to reinforce the value of having healthy staff in order to be able to deliver high quality care.

-The midwifery profession may need a new narrative that accepts that midwives deserve to put themselves first some times, and that this does not make them any less of a professional midwife in doing so.

As the quality of patient care is intrinsically linked to staff well being, it would be unethical not to value the midwives’ right to a healthy work life balance. This right should be free of negative judgement and resentment, so that a healthy and caring culture of maternity services can thrive as we face the challenging times ahead.

Lets be kind to ourselves and each other…

Or rather – 1.1 treat people with kindness, respect and compassion

I would be keen to hear your views on this subject, what are your experiences in practice?