Friday, 15 March 2019

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 Parker
Executive director of nursing, healthcare professionals and quality governance

Friday, 8 March 2019

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

Friday, 15 February 2019

Moving forward with a purpose

We've progressed some big stuff over the last couple of weeks, including a board session at which we heard feedback from the engagement work we have been doing on our mixed sex accommodation.

We emailed about this on Wednesday, and I want to thank you again for your invaluable input. It's brilliant how engaged everyone has been and your views have helpfully raised issues beyond how we address mixed sex accommodation, for example, how staff are supported and the wider safety issues on our wards. We're looking further at this feedback alongside other information we have about safety, and will of course keep you updated as we move to making decisions.

We've also been doing some more work on our new strategy, which I know I said I'd talk more about in my last blog.

I believe we have a bright future and a real opportunity to build on our core mental health and learning disability services, especially in areas where we excel, to make a positive impact on people's lives.

Earlier this week, we held a workshop to talk about what sort of organisation we want to be going forward. The idea was to have some time and space to think creatively about our future. There was a mixed group of about 30 people, which included clinical and professional leaders from our mental health and learning disability services, operational and corporate managers, as well as board members.

We talked about the opportunities we think we have and what philosophy should underpin our service models. We also considered what sort of partnerships we want to build, and how we could make our organisation a really great place to work.

The group discussed how we could build on our existing services with an enhanced offer around the whole family, supporting people in primary and community settings with a greater focus on prevention, early intervention and recovery. 

There was general agreement that we need to have a braver approach to risk, described by one attendee as 'safe experimentation'. It's not about doing things that create unsafe situations, but having a culture that means we don’t automatically default to the least risky approach, but support people to make the decisions and improvements they believe are right, knowing the organisation will ‘have your back’. 

In terms of being a great place to work - where you trust the people you work for, have pride in what you do and enjoy the people you work with - we said that it would be brilliant to truly excel in how we look after staff.

The better we support your wellbeing, the better you can care for others. It's common sense AND it's our line of work. We really need to get this right as an organisation providing mental health services. If we don't, it’s like a security firm not making sure their staff are safe!! 

And I think we are well placed to do this as we already have a fantastic staff wellbeing service which I visited recently. This small but perfectly formed team are already doing a great job but the service has huge potential to expand. I was so impressed to hear about the range of psychological support they provide, which now includes mindfulness programmes and a new mental health first aid course.

Having a strong staff wellbeing service is critical. You do an amazing job, day in and day out, often in difficult circumstances. However, we always need to recognise and remember the pressures that come with that and show in actions, as well as words, how much you are valued. It can be tough, and it’s ok to not feel ok.

The first sentence of the book The Road Less Travelled is; 'Life is difficult'. The author goes on to explain that this can either be ignored or handled, but that it will remain difficult if its ignored and easier if it’s handled.

The point I'm making is that it's normal to feel stressed at different times in both our personal and working lives. I've certainly experienced that, and it’s not just incredibly helpful to acknowledge and be open about it, it's also essential to get support; in whatever way works best for each individual.

There's nothing wrong with us if we struggle at points. We're human. That's what makes each of us so unique and special.

Friday, 25 January 2019

Setting the course for a positive future

In the past, including my interview for this chief exec post, I have used the example of the Ernest Shackleton expedition to the South Pole on the ship, Endurance, as a way describing our collective challenge and how it must sometimes feel working in the NHS. You know, extremely challenging conditions and dubious recognition, but something driving people to be ambitious and to keep going with determination and resilience.

Now, there are still days when this must feel true for you, but recently in a chat with Chris Reynolds, our director of IM&T, he used the analogy of the Dunkirk rescue during the Second World War as a better way of describing our aspiration.

In other words, we don’t consist of a single ship, but a flotilla of boats and ships of all shapes and sizes, united in a joint purpose and a shared sense of direction. I like this analogy a lot as it acknowledges the differences across our organisation in terms of services, size and locations, and what we contribute we make, but recognises that, at heart, we all want the same thing for the people we serve and try to demonstrate a set of shared core values of kindness and compassion, fairness, ingenuity, courage and determination.

We all want to deliver the highest quality care to patients, and through the work we have been doing over the last year on our strategy, we are increasingly making our direction of travel and shared purpose much clearer. 

It feels as if we are on the right course and moving closer, even though we acknowledge we still have a way to go in terms of our journey. So, it's really encouraging the CQC report that will be published on Monday recognises this.

This report feels like it has a distinctly different tone to the last one. I always say that it is accurate to say the glass is both half full and half empty, but this definitely feels like a 'glass half full' assessment. Yes, it acknowledges things we still need to improve, but it very much recognises the progress being made and the hard work and commitment of our staff and services.

Without wanting to repeat the key messages in our email which went out a bit earlier, I'm so pleased the CQC recognises our improvements in both quality and culture. 

And let's not forget that this has been done in a challenging climate. We’re seeing more patients, with limited resources and a whole load of change going on, so it’s a real credit to you all that even through these most challenging times, you have still managed to make improvements.  

We have something you can't put a price on, and that's compassionate and committed staff. It's the most precious commodity we have, and reflected in the CQC report.

I saw that care and felt that commitment earlier this week when I visited Taylor and Saxon wards, Beckett Place and Tatton unit at Tameside Hospital.  I met some really motivated and enthusiastic managers who have a lot of ideas for improvement. What we need to do is find ways of making this easier for them.

It was also great to talk to some front line staff and patients. I sat in on a gambling awareness session being run by our Health and Wellbeing college and its clear this is making a big difference to people’s lives. 

What I appreciate most about these visits is the honesty. I don’t want a ‘royal’ visit where people try to present what they think I want to hear. I am really interested in hearing how things really are. As I have said before, unless we know what doesn’t work we can’t work on fixing it together.

I think the CQC report helps with this because as well as highlighting things that are working, it also helps us stay focused on the areas for improvement. It will also help support honest conversations with commissioners about priorities and resources, as we all want to develop good and outstanding services. 

I think the CQC rating is a fair one, and reflective of where we are on our journey, but our aspiration is to move to good and to use this as a platform to become outstanding and that's where our new strategy comes in, in helping to be clearer about how we do this.

Although the decision about our strategic direction has been tough, it comes from wanting to, and considering where we can, make the most difference. I strongly believe we can make a huge difference as a strong mental health and learning disabilities trust and there will be a lot of opportunities over the next few months for people to be engaged in what this means and to help shape our future. I'll talk more about this and our strategy development in my next blog.

But I leave you with the thought reflecting back to the Dunkirk analogy, that it’s the set of the sails, not the direction of the wind that determines the way we go. We are after all the masters of our own destiny. 

Best wishes
Claire Molloy

Friday, 11 January 2019

Winds are changing and stars are aligning: our Trust is set for a big year

So 2019 is the Chinese year of the pig!

Not exactly the most exotic or cuddly animal. But, forget Miss Piggy and think more Piglet because the Chinese new year pig represents honesty, sincerity, and bravery.

I believe you all have these powerful, positive characteristics in bucket loads, and they will be hugely beneficial throughout this year of transition and change.

I know that when the festive cheer of Christmas has faded, the prospect of a long January can leave even the most positive of us feeling flat. Cold, dreary weather, and too much Christmas food and drink can leave people feeling sluggish and overweight. Plus, I’m aware many people felt really tired at the end of 2018 and, on top of that, there are plenty of winter lurgies going around. I was struck down with norovirus over Christmas which was pretty horrible.

Its therefore more important than ever that we all look after ourselves and each other. Let’s call it a joint new year ‘wellbeing’ resolution, to sit alongside any others we all might have.

I know some of you are already doing RED January and Dry January for the month and hope you’re already feeling the benefits? Incorporating wholesome habits into our daily routine can also provide a pick-me-up, from taking proper breaks to connecting with people.

Like a lot of you, I will be trying my best to be healthier in 2019, and so I’ve agreed with Evelyn, our Chair, that I will be temporarily reducing my hours of work to four days a week in order to spend a bit more time with family. So, I won’t be in on Thursdays, when Henry our medical director will head up things as current deputy chief executive; supported by other  exec director colleagues. Work is hugely important to us all, but we all need to find ways of balancing that with life outside and things that bring us joy and energy and most importantly perspective.

According to Chinese astrology 2019 should also be a year full of joy, friendship and love, as well as a good year to make money and invest, as the pig attracts success in all spheres of life. Which sounds just the ticket! They do say that the only ‘dark side’ to the pig is its stubbornness. Personally, I think that a bit of stubbornness, when its firmly wrapped around ‘doing the right thing’ and sticking to your values, is not necessarily a bad trait.

I’m not really into astrology or horoscopes, but it’s spooky that Mary Poppins is back on the big screen after 25 years and interestingly both actresses Julie Andrews and Emily Blunt were born in the year of the pig. The film is predicted to be a huge box-office success because of its timely message of joy and hope. Its message is set against the backdrop of the film’s only certainty, that whatever happens, the wind will change.

So, here’s to joy and hope, a positive wind of change and your wellbeing in the year of the pig (and the occasional spoonful of sugar….).

Best wishes
Claire Molloy