Community Health Innovators

Transforming health through frontline innovators


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I saw a goat.

This is a guest post from Stuart Hayward was on the first cohort of Nurse First.

The other day, driving to work, there were two sets of roadworks which to a cynical mind would have appeared to have been contrived to inflict maximum mayhem and misery. One set was on a main hub into Bristol, the other was at a mini-roundabout serving commuters seeking to avoid the first set. The lack of alternative routes lead to my being stuck in traffic for an hour on a leg of my journey that can take only six minutes.

I sat there letting Radio 4 ramble in one ear and out the other, watching the growing frustration in those around me. Cars were being slewed around in aggressive three-point turns, arms were being thrown up in frustration and bonnets were dipping violently as drivers braked sharply at the last second, after having crawled forward another twenty feet.

Two things then happened to me.

Firstly, I thought to myself ‘I have a glove box full of CDs I either haven’t listed to at all recently, or are my wife’s choice.’ The one I grabbed was Adele. It was something new, out of the ordinary (for me) and took me one step away from the scene around me and the pressures of the world being described on the radio.

Secondly, as I stop-started along a bridge across the motorway I saw the allotments to my left. I often notice the allotments, holding one myself. What was different on this occasion, however, was the paddock between the allotments and the motorway.

‘Ponies!’ I thought to myself.

I then saw a solitary goat. I don’t know what type/breed/make/model or whatever, I’ve never been a goat aficionado. It had big curly horns and was white-ish and shaggy. And chewing grass.

A bit like this:

It didn’t seem to pay me as much attention as I did it. Maybe their eyesight isn’t great.

What did strike me was the fact that in all this frustration, chaos and anger, I noticed it. And I noticed that I’d noticed it. And it was good.

Natural history programmes show great herds of wildebeest migrating across the plains. There’s always an individual stood still for several seconds while the others blur past it.

Hollywood has the thoughtful protagonist standing still while all the others flow past him.

In this near-stationary traffic jam, that was me.

Crisis and woe all around, but I didn’t care. I took time out for me. I noticed the world. I was safe, warm and not going anywhere. Why worry?

The impact of this event was huge. I now have that picture as my desktop background, and now have a method to mentally put the brakes on when events threaten to careen away from me.

More importantly perhaps, my colleagues now understand why, when the work is threatening to pop, I can refocus us all with four words.

“I saw a goat.”

-Stuart Hayward, recently awarded QN, is linking nursing and military experience in his job as a Specialist Veterans Practitioner. He’s married with two energetic young sons, two quirky chickens and a neglected allotment! He occasionally tweets to @stunursefirst and is trying to improve life in his village through www.facebook.com/lockingtothefuture

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What difference could YOU make in healthcare?

Innovation in healthcare can seem really tough right now with all the ‘negativity soup’ we are swimming around in. So what type of projects are being considered and being moved forward?

  1. A project to improve the nutrition in the elderly in care homes, using ‘real foods’ instead of sip feeds…saving money, using local sources of food and creating a ‘real food’ culture ( this Nurse First project already has funding and is underway)
  2. Avoiding hospital admissions in respiratory care – again saving money but also improving the lives of the patients by treating them at home
  3. Reducing the stigma in children’s mental health – thus making sure the people who need care and treatment receive great care when they need it
  4. Preventing falls in the elderly – a huge cost to the NHS in orthopaedic surgery and long-term care
  5. Working with individuals with learning difficulties improving their sexual health, support, reducing social isolation, and improving the quality of life – with special clinics, a ‘befriending bus’ and more
  6. Creating nurse-led phone or skype follow-up for patients – reducing costs for the service and the patients – why do we have so many clinics?
  7. Creating an online system in sexual health so people can access their results much quicker, as well as getting advice, a forum and online access to healthcare professionals
  8. Reducing STI’s in young people with a ‘pub quiz’ style game to engage them and entertain them at the same time as teaching
  9. Creating videos instead of worksheets for teaching speech and language therapy to kids
  10. Working with young people in the criminal justice system who have learning difficulties

How can you implement new ideas?

What ideas do YOU have for changing the service you provide?

Can you fund any of these projects?

Join our programmes for training, input, support, ideas and more?

-Claire


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So what do you do when your manager is an idiot?

“So what do you do when your manager is an idiot?”

If I had a pint for every nurse I met who felt their boss was an incompetent idiot, I would spend nearly all my waking hours staggering around in a drunken haze. I would go even further and say that most of the nurse entrepreneurs I meet would not be looking to leave their current organisation if they had a creative, supportive and empowering manager.

So what do you do when your manager is an idiot?

Well a couple of suggestions and approaches might help make your job and your life more bearable. If you find yourself thinking about your manager a lot when you are away from work and talking about them a lot with friends and family, then this is a sign that they are having a very unhealthy impact on your life and you need to do something about this. Either that or you have a crush on them and that is an entirely different blog ☺

Firstly a word of caution. Acting like you know they are an idiot (no matter how tempting) will only make things worse. If you antagonise, embarrass or annoy your manager they can easily transform from being an idiot to a bully and the bane of your life.

So where do you start?

The easiest route is if you can turn them from being an idiot into an ally. Do you understand why they act the way they do? What are their priorities? What are their problems? What would make THEIR life easier? If you don’t know the answers to these questions, then find out. Nurses are highly skilled in verbal and non-verbal communication and in making complex assessments – use these skills on your boss. Find out what drives them, what their priorities are, what their hopes and aspirations are and what they really care about. Very few people ever spend much time analysing situations from the world-view of others and it can be a very rewarding and transforming experience.

So let’s assume that you’ve worked this out. How do you use this information to improve your life (which is the purpose of the exercise)? What you need to do is to reframe what you want in terms of what they want. Do they want shorter waiting times, reduced sickness and absence, cost savings, more recognition from their manager or peers, better clinical outcomes, service redesign, etc? Once you know what THEY want, then you can present your ideas and your changes in terms that meet THEIR needs. So (for example) if you want an additional nursing post, you have to come up with a way of selling that as a way of meeting what they want and solving their problems (e.g. will this new post improve documentation, reduce complaints, help implement a new care pathway, reduce spend on agency staff, etc). It is like a move in the martial art of judo, where you use their energy and their momentum to move them where you want them to go.

So what if that doesn’t work?

There are a few things that you can do which will definitely make the situation worse. The worst culprit of all is complaining about your manager to anyone who will listen. Not only does this make you look very unprofessional but your manager will have friends and allies all around you, particularly people who see their future career success as something your manager can help them with. Very quickly your manager will find out what you are saying and then the relationship is likely to deteriorate very badly very quickly.

What if your manager just enjoys dominating others?

There are people out there who just enjoying dominating others, whether this is about their own insecurities, their personal ambition or this is the approach they learned from their early role models. If you have a dominating manager there are no easy solutions. One solution is to give in on some things and consider them as insignificant as it will become personally draining to fight them on every front. If they insist on small issues are done in a certain way then sometimes it is easier to just go along with it and do what they want.

If they want all the pillowcases facing away from the door (these Ward Sisters really do exist!) sometimes it is just easier to turn the pillowcases. However, whilst it is good to give in on small things, there are certain issues where we cannot allow ourselves to be pushed around. If your manager is encouraging you to be unpleasant to others, to treat other people badly, to ignore the needs of others and even to lie for them, then you should not feel compelled to follow. If you feel inwardly awkward about something then avoid doing it. If you simply follow all the whims and dictats of your manager, they will exploit this and the situation will only get worse, but choose the issues to argue over and if you can trade “your way” on a few important issues for “their way” on minor issues, then this may be enough for you.

What if your manager is constantly criticising?

Some people seem to have real knack for spotting every mistake and error around them, no matter how small. Some of them even seem to get a perverse pleasure in pointing out other people’s errors and mistakes and this is annoying enough in a colleague but awful if they are your manager. They even seem to get a certain sense of satisfaction from pointing it out. There are ways of coping with this though. The most important approach is not to take this as a personal criticism. If you have made a mistake at work, it doesn’t mean you are a bad nurse or a bad person, simply that you did something wrong. This could be a great learning opportunity to improve your skills and performance but only as long as you don’t react to this as a criticism of you as a person. Remember that one of the roles of your manager is to manage your performance and pointing out mistakes is a legitimate part of that activity. Some nurses react to any performance management as if it is bullying without recognising that it is a legitimate and important management function.

If your manager is pointing out all your mistakes all of the time, remember all the things you do well even if this is not mentioned or recognised by your manager. The worst thing you can do is criticise them back as you will be locked in a cycle of criticism in which you will inevitably suffer. If your manager does infrequent performance reviews (or does them in a very mechanistic way), use the opportunity to present some of the excellent work that you have done and your achievements. Even the act of thinking about your success and achievements and writing the down will make you feel more positive, irrespective of your manager’s reaction or level of interest. Whatever their motivation for constant criticism, if you can put this in the context of all the good things you are doing, depersonalise it (even if only in your own head) and learn from it, then this will reduce the impact of this criticism on your self-belief and your happiness.

So when do you openly challenge them?

Many people think that openly challenging and confronting your manager is the way forward. Sometimes, particularly when the welfare of patients or other staff are concerned, openly challenging your manager’s behaviour and decisions is the way to go. However, even if you win, this is not a slight that they will easily forgive and neither will their allies. It is rare to find a nurse who has openly challenged their manager, has won and has still stayed very long afterwards in that area. Some complain of ongoing bullying from the manager, some complain of bullying from their manager’s manager, some complain of being ostracised by many of their colleagues and some feel that they have won a battle only to lose a war. If you are going to openly challenge then you need to make sure you get plenty of good professional support (e.g. trade unions, professional bodies, legal advice, etc) and plenty of personal support (e.g. friends and family). It is also worth assuming that after you have won, you need to move to another area or organisation afterwards and you should plan your exit strategy as early as you can. It is much easier to go through this difficult process knowing that you are leaving to a better environment and you will also find job-hunting difficult in the middle of a complaint, grievance or even legal process.

Finally, it is very unlikely that you will be able to change your manager’s behaviour or their personality. If you can turn them into an ally then that will make your life easier and will help you push through the changes you want. If you can’t then you will either have to live with it (which can be a pretty miserable existence) or leave. If other people’s welfare is at stake then you may choose to openly confront and challenge your manager but you need to plan your support and our exit strategy in advance.

Whatever happens, remember that a good job is a job doing what you love, surrounded by colleagues you like and respect with a manager you respect and who supports you – having only one or two of those in place means that it isn’t a good job and there are better jobs out there for you. As Confucious one said “Choose a job you love and you will never have to work a day in your life”.

– Dave


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Angels, or uncaring brutes? The image of modern nursing.

It has not been a good year so far for press coverage on nursing.

The Francis report published in February highlighted scandalous stories of poor nursing care. A few celebrities have put in their two penneth and MPs like Ann Clwyd have started movements to bring back compassion to nursing.

Nursing is under pressure as never before. The changes to the health service –restructuring, cost cutting and changes in nursing itself — have often been forced upon the profession, rather than worked through and agreed with nurses themselves.

A public who admire and support you is something many of us nurses have taken for granted, but there has been a shift in some of that opinion. The number of criticisms levelled at the nursing profession has grown.

So what has been the response of the profession?

Dr Peter Carter of the RCN has said that poor care cannot be tolerated and everything should be done to ensure it doesn’t happen again. He has said that the RCN needs to learn lessons about how it supported members in Mid Staffs and has called for the regulation of Health Care Workers.

The Chief Nurse said in her bulletin in February

The report made extremely uncomfortable reading and I remain appalled that members of our profession could betray the trust placed in them by patients and their families. Compassion is a word that keeps coming up in the Francis report and it is clear we must now restore this value to its rightful place in our day-to-day work.

Jane Cummings has launched the 6 C’s

  • Care
  • Compassion
  • Competence
  • Communication
  • Courage
  • Commitment

in order to support compassion in practice. Jane Cummings does go on to say that lack of compassion and empathy is rare but for those nurses who do not have it there is no place in the NHS.

Interestingly, Unison has used the Francis report to talk about staffing levels, skill mix and sisters being on wards not in offices dealing with administration. It has also focussed on a change in culture towards openness, transparency and supporting whistleblowers.

Nursing is a profession with proud past and it is apparent that whilst there have been mavericks such as Beverley Allitt, the public remains supportive of most nurses.

To keep that trust means being open about our faults and not closing ranks, but at the same time ensuring that we do not become scapegoats when the system needs changing. Nurses tend to hate being called “angels,” get cross when nurses are always portrayed in uniform, and dislike stereotypes. But some of these have protected us from a reality which of late has become all too focussed on poor care rather than good. We need to get our image right and concentrate on what we do well rather than letting the bad outweigh so much that is good about nursing.

What do you think about the image of nursing? Is it realistic of the profession or the job that you do?

-Ali


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What can healthcare learn from Undercover Boss?

In the programme Undercover Boss, the CEO of a large corporation goes ‘undercover’ with the everyday workers to find out what is really going on at the ‘shop floor’ level. The ‘boss’ wears a disguise and is introduced as someone looking for work.

I have watched many episodes of this programme and there are a few key points that I think directly integrate with my experience in healthcare.

  1. The ‘boss’ has a title like COO or CEO or Director. Does anyone not in the boardroom know what this means? Titles can be misunderstood or a barrier.
  2. Many of those at this level have come from other organisations or backgrounds, and have never done the job they are the ‘boss’ of.
  3. Most of the bosses are amazed at how hard – physically and emotionally – their employees work. They are generally unable to keep up with the pace or reach targets that they have often set themselves!
  4. The ‘boss’ is usually going in looking at productivity, targets and how to make the company more effective or successful. They come out of it with a real respect for their workers, and the loyalty of many of them.
  5. The ‘boss’ often sees that those doing the job have a real understanding of improvements that can be made, but have never approached the Board out of a lack of confidence that they will be listened to. Some of these ideas end up being adopted in the whole company – including community and charitable projects.
  6. The workers get taken to head office where they learn ‘the truth’ about the undercover project. This is always emotional for me! The workers get rewarded with promotions, holidays, charity donations, funding for education…..they feel valued, sometimes for the first time in 30 years with the company.
  7. Lots of the companies have families working for them – partners, parents and kids and so on. The workplace becomes another ‘family’ and the relationships workers have both with colleagues and clients/customers is one of the most important factors in their satisfaction with work.
  8. Many don’t have time to do their job as well as they would like due to the ‘targets’ set by individuals in the head office.
  9. The younger employees don’t understand the organisation, or their place in it. They see it as an ‘old boys’ club’ where you get promoted depending on who you know, not what you can do.
  10. The values of the board are different to those of the employees, and the larger the organisation is, the more detached the employees feel from those in charge.

What can we learn from this?

  1. Think about the titles your organisation has – do the staff and patients understand them and the roles?
  2. How would you feel if your Chief Exec turned up wanting to work with you?
  3. Do you speak to your Chief Exec – do you think they understand your role?
  4. Make sure that you give feedback to your colleagues – it makes them feel valued – a basic human need.
  5. If you are the ‘boss’ be approachable, help your team to innovate, and give them a format to suggest ideas. Then make sure they have support and time to implement their ideas – Nurse First can help with this.
  6. Make sure you really understand the roles of others before setting targets – you may be setting them up to fail or burn out.


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Nurses ‘too busy’ to feed patients??

Not long ago there was a headline screaming out at me on the front of a tabloid newspaper about nurses being ‘too busy’ to feed patients.

Why the use of the apostrophes? It seemed to me as if the journalist was doubting that nurses really are ‘too busy’ and are sitting round drinking tea and chatting while patients starved……!

The reality is, as anyone keeping up with the Francis Report will be realising, is that nurses’ jobs have been cut, posts left vacant and care assistants de-skilled in some areas, in order to save money.

Let’s do some simple maths – it can take 30 minutes or more to feed a patient who cannot do this for themselves.

You have a caseload of 6 patients. 3 meals x 30 mins x 6 patients = 9 hours of an 11 hour shift just on feeding!

This does not include toileting, turns to prevent pressure sores, washing the patients, changing the beds, speaking to the relatives and the patient themselves, paperwork, the doctors’ round, medicines round, answering the phone, organising and assisting with investigations, observation rounds, keeping the ward clean and of course being compassionate and cheerful at all times.

Sheesh!

So, what is the answer? We need to get back to speaking up when we cannot do our jobs properly, or do not have enough staff to provide safe and effective care. This means that managers have to listen and do something, not brush the topic under the carpet.

We need to create a new leadership paradigm so that nursing jobs – even the ‘menial’ ones like feeding patients, changing sheets and spending time listening to patients, are seen as at least as important as the newest technology, if not more so. The real costs of death, grief and legal challenges by the families is far more than providing good care. This can only be done with robust training, great leadership and enough resources.

What can we learn from this?

  1. Start speaking up if care is compromised in your area – follow the Nursing Times campaign.
  2. Speak as a group, and follow any systems in your workplace.
  3. Get support from your union.
  4. Focus on the good bits about being a nurse
  5. Contact Nurse First for details of our innovation programme so you can lead from the front.
    1. -Claire


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You too can write a press release!

Feel like your voice isn’t getting heard? Have a story you’re dying to tell about your work?  You can write a press release about it.  Local papers are always desperate for news, and publications about nursing and healthcare are often open to contributions from their audience.

A press release allows you to “give an interview” without needing to wait to be asked for one. You can proactively give a journalist your story.

And story is the key word – you want something that will grab the journalist’s attention, something that they think will interest their readers.

The easier you make their job, the more likely they are to publicise your story.  Find out when the deadlines are – ring the publication you want to pitch your story to; they’ll tell you. Make sure they get the press release well in advance.

Keep it short and snappy, not waffly or boring. Your contact details are part of the press release so they can always get more information if they want it.

Write as clearly as possible. Avoid jargon, but also, don’t feel the need to spell out that, for example, NHS means National Health Service. If possible, look at other stories in the publication you’re writing for to get a feel for how they’re written.

I learned from the NO2ID coordinator handbook a really good list of things to think about putting in your press release.

  • News
  • Information
  • Controversy
  • Heroes and villains
  • A new chapter in a saga
  • Involving a famous person
  • Immediate relevance (a “local” angle or something that makes it particularly relevant to your audience if you’re eg writing for a publication about your profession)

You’re never going to use all these at once; don’t feel the need to shoehorn them in! But they can help with the all-important framing of your story.

Here are the elements of a press release.

Date: Put today’s date at the top. You might not want it to be published today, but don’t worry, that’s in the next bit.

Embargo: If you are, say, giving a speech, going to an event, or something else that you want to have your press release distributed before but not printed until after, you can put an embargo on it. It makes life easier for you and the journalists to get the story written ahead of time, but makes it clear that it can’t be used until a certain date and time. If you don’t need an embargo, write For Immediate Release. You need one or the other of these in this slot.

Contact name and number: Most likely your own. It helps to put an out-of-hours or mobile number too; journalists don’t work regular business hours.

Headline: Keep it short, and tell the reader exactly what they’re going to be reading about.

Opening paragraph: Get the Five W’s – who, what, when, why and where – in the first paragraph.

Details and quotes: This is where you get to imagine what you’d say if you were giving the perfect interview, as if you got to review your words carefully to say just what you wanted. This will appear in the article as if the journalist has interviewed you (or whoever you’re quoting; make sure you get their permission if it’s not a quote from yourself!).

Ends. Writing “Ends” makes it clear the recipient has all of the press release and there are no more pages or anything.

Notes to editors: This is where you add background information that the publication might want to throw in, like biographical details of the person quoted, or further information on stuff you refer to.

-Holly