Prioritising our people and going with the flow

Everybody has a story to tell.

Human stories are the most powerful form of communication and the way to touch the heart. They capture the essence of the human spirit and can inform, help, amaze and inspire us.

That's why we start every board meeting with a patient story.
 
Over recent months we've heard some very powerful ones. From a teenager on our Horizon unit in Bury who said that whilst it was difficult to be away from family, the ward staff “made me feel safe", to another young woman on a Tameside ward, who through the continuity and stability of her relationship with staff, was able to gradually improve her mental health. Both were uplifting stories of recovery and both individuals now want to become mental health nurses, which is brilliant for them and our services.

We've also heard from the mother of an autistic child who praised the quality of our care, but spoke passionately about the toll of a long wait for the initial assessment. And a man with a harrowing back story, who reduced many of the board to tears last month, as he explained how feeling trusted on Tatton ward in Tameside made him feel liberated and valued for the first time.

At this week’s board meeting, a young man who has used our learning disability services talked about getting a job as a steward at Man United. He's now living independently and has completed qualifications along the way.

These stories are unique in their own way, but they are all so powerful in their impact. We are moved and inspired in equal measure, and are now looking at different ways to share the board patient stories with you.

As well as weaving the patient voice across all our work, for example, through the Triangle of Care where carers, patients and professionals work together; and engagement programmes such as our mixed sex accommodation, we need to ensure the staff voice is also heard.

Listening to our patients and staff is the most important thing we need to get right. I remind myself every morning that nothing I say this day will teach me anything. If I am going to learn, I must do it by listening.

Our work is all about people, and the stories we heard from staff at our recent Just Culture conference helped bring to life the importance of this new initiative.

I know Clare Parker's recent blog talked about the Just Culture approach, so I won't cover the same ground, except to say that it's great to see the Health Service Journal recognise the importance of what we are trying to do in an article this week. You can read the story here.

None of us like making mistakes. We all do our jobs to make things better, so it can be hugely stressful and upsetting when we get things wrong, especially if an investigation has to take place. Which is why creating a Just Culture, where people feel safe to speak up, but most importantly, feel listened to when they do, is so important.

It’s actually stress awareness month in April, where health care professionals and health promotion experts across the country join forces to increase public awareness about both the causes and cures for our modern stress epidemic. It’s the top reason for staff sickness here, so it’s a big issue.

I know everyone has their own way to try and manage stress. For me, spending time with family and climbing helps. I’ve just come back from a week’s holiday climbing, which I appreciate would be super stressful for some! But it’s the only thing I’ve found that keeps me ‘in the moment’ when I’m doing it. I just breath, focus and concentrate solely on putting my hands and feet in safe, solid places!

Whatever your de-stress activity is, remember that there’s on-going support out there. We’ve got a stress clinic on 3 April where you can speak to a psychological wellbeing practitioner, and all the information will be in the Connected weekly update on Monday.

Stress is often related to how out-of-control we feel, and so I’ve learnt over the years to try and accept more easily that I have to let some things go. That’s not to say that I don’t care, but I know I need to keep things in perspective. If you change the way you look at things, sometimes the things you look at change.

I often think of the Aesop fable about the tree and the reed. The tree boasts to the reed about being firmly planted in the ground, and then ends up as a log after a vicious storm whilst the reed survives, having bent to the force of the wind until it passes over. The moral of the story is that it is sometimes better to be flexible, and go with the flow, than stay rigid and try and face the full force front on.

Finally, to those of you who have ever faced the full forcefulness of a child’s temper tantrum - Happy Mothering Sunday this weekend!

Best wishes,
Claire

Guest blog on our new Just Culture approach

Clare Parker
Executive director of
nursing, healthcare professionals
and quality governance

Your best teacher is your last mistake.

That was my opening message for our Just Culture conference last week. I also talked about Tom Hanks and an error I made which has stayed with me. But more of that later.

Almost 200 staff packed the room to hear about our new Just Culture initiative, which is ultimately all about improving patient care. We also had the honour of welcoming Dr Bill Kirkup CBE as our guest speaker.

Bill was Chairman of the Morecambe Bay Investigation and has previously led investigations into the Oxford paediatric cardiac surgery unit and Jimmy Savile’s involvement with Broadmoor Hospital, as well as being a member of the Hillsborough Independent Panel. He spoke about his experiences and eradicating a blame culture in a honest, moving and inspiring speech.

Although a Just Culture approach is already being used in the airline and nuclear industries for example, it’s new to the NHS and I’m proud that we’re one of the first Trusts in the country to adopt it.

It’s basically based on an approach where staff aren’t blamed for honest errors. Instead we feel supported and encouraged to come forward and share our experiences to allow lessons to be learned. It aims to get to the heart of what, not who, was responsible for the error. 

Healthcare is risky; it always has been and always will be. When humans interact with humans its always complex, and in addition to that, we have limited resources and often have to make speedy decisions in a fast paced environment.

So mistakes are a fact of life, but they are an opportunity to learn.

No-one likes owning up to mistakes, and it’s even harder when people are harmed.   How we respond and learn from when things don’t go as we would have liked is fundamental to good patient care.

When an incident or near miss happens, it’s incredibly rare that it was intentional, malicious or someone not learning from mistakes. So supporting people positively is the only way we can make progress.

Often when we investigate, we miss the human factor. If you’ve seen Tom Hanks in the brilliant film Sully, which is about the pilot Chesley Sullenberger who dramatically landed his plane on the Hudson River in New York, saving all 155 passengers, you’ll know what I’m talking about.

If you’ve not seen this film, I highly recommend it. Not only is it a thrilling film, but within it is a powerful message about human factors.

Everything is unprecedented until it happens for the first time.

I pride myself in engaging and involving people, but I will always remember in a previous job when I met with a family to talk about our response to their complaint about one of our nurses.  Three days later I received an email from the nurse who was upset that I had never met with her or told her what I was going to say to the family. She felt her reputation, built over many years through consistently good care, had been ruined because of this complaint.

Her email floored me. She was absolutely right and I arranged to meet her and apologised. I used it as piece of reflective practice for my revalidation, and told the nurse I was doing this. 

I certainly learned from this and it has influenced my practice ever since.

There’s no easy or quick fix to eradicate a blame culture, but a positive and open workplace culture, with trust and respect among colleagues can help. This will form part of the wider piece of work around our culture and values.

We’ve got over 5500 staff and we care for thousands of patients every month, so we also need to always remember to put any incidents in context. Amazing work is taking place every day which is changing people’s lives.

We mustn’t carry our mistakes around with us, or jump to a blame game, but use them as stepping stones for us all instead.

Best wishes
Clare
Clare Parker
Executive director of nursing, healthcare professionals and quality governance

Let's celebrate our fantastic women

Women all over the world are celebrating International Women's Day today.

I was surprised to hear that the day has been going for over 100 years. It originally started in Soviet Russia after women gained suffrage in 1917 and March 8th became a national holiday there. It has since spread to the rest of the world, and certainly seems to have ramped up its profile over the last few years. #ThePowerOfSocialMedia.

This year's campaign theme is ‘Balance for Better’ which promotes gender balance and asks how can we help forge a more gender-balanced world; one in which we celebrate women's achievements, raise awareness against bias and take action for equality.

My husband is very ‘right on’ so I was a bit taken aback when he asked whether we actually need a women’s day. It made me ponder, but only momentarily before I gave him short shrift and a curt reply which included the words ‘Yes!’ and ‘still a long way to go’.

But his point was not about whether we should be promoting gender equality, as a trade union representative he has been passionate about equality for all his working life. It was rather about the value of a dedicated day when this is such an important agenda it should be part of our mainstream business and we should be supporting all areas of equality.

Of course he is right, equality, diversity and inclusion should be one of the bedrock principles that underpin how we develop and deliver our services and as such, be in our hearts and minds always.

However, campaigns such as international women's day and others, such as LGBT month which has just finished, are massively important ways of raising the profile of these issues and celebrating what has been achieved and the progress being made, but also highlighting what more is needed.

Whilst today is a great way to focus on gender balance, we should be focused on equality and balance in its broadest sense.

If you think about our organisation, women make up over 70% of our workforce and 10 out of our 15 board members are women, so we’re doing OK in terms of girl power. We still have a bit of a gender pay gap so there’s work still to do, but we need to take a wider approach to equality and our Board is keen to support balance in all areas.

We know that the experience of some of our minority groups is not as good as it should be, and our latest staff survey results for example show that we still need to make improvements around discrimination and fairness of career progression.

We want our organisation to be a place where difference and diversity is welcomed and valued for the richness of experience, strengths and views this brings. We want our workforce to reflect the diversity of the local communities we serve so that we can bring a real understanding and appreciation of their lives to our work. And we want to create an environment which is fair, inclusive and non-discriminatory so that everyone's contribution counts.

We’re doing a big piece of work about diversity as this needs a much bigger profile within the organisation. Earlier this year, we held a board session specifically about equality, diversity and inclusion where we talked about the issues, what we currently have in place and what more we need to do.

Yvonne Coghill, national director for the NHS Workforce Race Equality Standard, is coming to do a follow-up session with our board which is brilliant. Yvonne’s a former mental health nurse and has also helped the Institute for Healthcare Improvement in the United States develop their inclusion strategy, so she brings a wealth of expertise.

We’re also re-launching our equality and diversity group, and the plan is to launch our new equality, diversity and inclusion strategy later this year, and then work on embedding good practice across all our teams.

You’ll know already that I’m very interested in how we create a positive culture in the organisation, where we live and breathe our values, and this is a fundamental element of it.

There is a tendency to see cultural change as 'soft and fluffy' because of the large people element.

But an essential part of cultural change is ensuring that the systems and processes we use are aligned to our values and our expected behaviour. For example, it's no good saying we are an organisation that is fair, when some of our processes such as recruitment are seen as biased and unfair. So we do need to focus on improving our key systems and processes.

This links in with the Just Culture national initiative which we are also launching today, which is focussed on one of our most important processes - dealing with, and learning from, patient safety incidents.

I’m at our first Just Culture event today, and we’ll share more about this next week as we’re one of the first NHS trusts in the country taking this forward. But in a nutshell, the Just Culture approach recognises that any error or problem is seldom the fault of an individual, but the fault of the system.

The single greatest impediment to error prevention and learning is that we punish people for making mistakes. The Just Culture framework supports a consistent, constructive and fair evaluation of actions when people are involved in patient safety incidents.

So, here’s to International Women’s Day. Let’s celebrate the achievements of women everywhere; but here’s also to our wider equality, diversity, and inclusion approach which we will strengthen over the coming months.

Best wishes
Claire Molloy