Today was the second day in a series of safety culture feedback sessions. We were able to start unpacking some of the issues highlighted in the latest staff survey, and use them to think about how we can improve performance, safety and job satisfaction in our busy department. The themes were Learning Environment, Leadership, Burnout, Teamwork and Work-life Balance.
Three safety issues crop up again and again: crowding, staffing and space. These issues web their way through each of the broad themes discussed. It is tough when you end up “playing Tetris to get to the patient”, and you worry about losing your registration on a daily basis because of the current pressures in our department. So what have we discussed?
When the department is busy – which is all of the time – there doesn’t seem to be time to pause and reflect. With no formal mentorship programme, or protected time to reflect, this is most keenly felt by the nursing team. Could we all cash in on opportunities for genuine feedback during handover? There has been a recent drive during the doctors’ handover to create a culture of positivism and appreciation, regardless of what the screen looks like. Doctors acknowledge that “the nurses are being thrashed” by the workload and expectations, and appreciate the effort they put in.
There seems to be significant dissatisfaction with the amount and quality of feedback given. It was suggested that we could use the minors safety brief as an opportunity to give feedback to the team. It would be great to move away from the culture of ‘no feedback is good feedback’. In addition to Greatix (let’s use them more often!), we really enjoy reading the compliments emails.
A recent confidential meeting with the middle grades was a forum for the doctors to vent, reflect and suggest improvements in a safe, closed-doors environment. It has been suggested that this one-off meeting could be rescheduled biannually as a regular ‘health-check’. Could this model be used with the nursing staff?
The dynamics between doctors and nurses was discussed. It would be great to have more open and spontaneous feedback between the professions after difficult cases. It can sometimes be difficult to ensure effective two-way comms with new junior doctors rotating into the department. It takes time to get to know the team, what their level of experience is, how they work, and this can impact on how comfortable we are at providing feedback. So let’s try to get to know the newest members of our team whilst acknowledging and tapping into the wealth of experience our dedicated nursing team bring to caring for sick patients.
Despite such poor scores for feedback, there was a global recognition of the extreme stressors that the leadership face. Empathy!
There is a lot of it. We are experiencing burnout as a group and on an individual level. Probably because of chronic frustration – “no time to do what you want to do to do a good job”, because of crowding, staffing, space… Because we don’t necessarily feel valued.
Interestingly, the middle grades reported burnout the least. Protective factors were dedicated time for teaching, being able to reduce the load of multi-tasking (thanks to the role of the Fat Controller!), and having an extra MG on at night. A Fat Controller on minors could be the next step…
It is fantastic that many of our team feel able to ask questions if they don’t understand – let’s keep this up! It is easier to cope with the pressures of a busy department if we are working with a good team.
However, we still struggle to deal with difficult colleagues who are probably maxed out themselves, and who are at times rude or dismissive. This then causes breakdown in effective communication. So how do we approach this? Suggestions included being empathic, gently calling them out, trying not to take it personally, having a safe space to talk about it… and don’t forget our high burn out scores probably affect our ability to communicate well. We are all dealing with what we absolutely HAVE to deal with here and now, and have little time for working on our communications across the board. A thought: these better, kinder, more empathic communication skills could and should become part of our hard drive, so even when stressed and busy in the extreme, we can count on the fact that we, in ED, speak directly, yet compassionately to each other.
Aaargh! The frustration of life with and without technology! Multiple logins, printer issues, scanning barcodes for every test. Would it be worth having an IT troubleshooter making an appearance on the shop floor?
How can we make people feel valued? Remember to invite reception staff to the minors safety brief. Nursing staff, do you know you can access (and contribute to) the Derriforded.weebly.com site? Junior doctors, if you need space to complete audit or admin work, feel free to ask the middle grades and consultants.
Finally, if crowding, staffing and space weren’t an issue, it would be great to have more in situ training!
Dr Stephanie Rennie
Is it possible to take the best bits of this model for other staff groups? How do we change our culture to appreciate, value and celebrate the great things we do more effectively?
On that theme all staff groups highlighted a lack of positive feedback within the team; “the only positive feedback is the lack of negative feedback”. Who doesn’t like to be told they’ve done a good job or made a great decision or that their kindness has been noticed and appreciated? As humans we thrive on encouragement and positive words no matter what our exterior might say! There are loads of opportunities to spread some feedback love in the ED right now! Try a Greatix (like a datix but happier…see what we did there?!?), a thank you card or even toning down the cynicism to actually acknowledge “what went well” at the morning nursing briefing or contributing to the new “overnight success story” at medical handover. Look out for more feedback training for all staff roles and grades.
Applying a little empathy to our colleagues and giving a little grace for those times when we make mistakes/snap our answer/forget to smile whilst calmly and politely objecting to and ‘calling’ unacceptable behaviour might make all of our lives a little happier. Sometimes empathy actually makes life a little tougher – like when we recognise we are not supporting our colleagues as we would like or providing the level of care we would expect because we are busy or have too many other demands. This has been expressed in the departmental burnout scores with all staff groups recognising that the team are working unbelievably hard without always the resources or support that they may need. The departmental scores are higher than those reported by individuals however and the ‘coffee room’ chat may play a part in this…. As Oprah says (!), “what we dwell on is what we become”.
There was recognition that some of the band 6 nurses have had little or no management training and that there is a lack of protected time for management responsibility or development. Previous day with Dr Gurney had good feedback but more like this would be welcome.
It was great to have representation from the receptionist team and they brought a variety of ideas and suggestions. From this meeting Suzy is looking to set up a ‘book drop’ in the waiting room and the TV for waiting room project is to be revitalised! There was talk around consistency of approach from medical and nursing staff towards the booking in of trauma patients and when reception staff request assistance for patients prior to triage. We are hoping to find a consultant to link with the reception team and work on some of these areas. They are geographically cut off from the rest of the department and we need to make sure all other staff groups support them. We all set the tone for behaviour within the department and must not tolerate or reward rude, aggressive behaviour from patients. We’d also love a member of the reception team to join the morning minors safety brief!
So, take homes!
Sally Pearson / Annette Rickard
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