Leading change

The Senior Nursing Lecturer in the Health Services Management Centre at the University of Birmingham led on the development and implementation of ‘Improvement Labs’. These were designed to support staff to embed high quality care. This programme has led to improved experiences and use of resources within the engaged organisations.

Where to look

An examination of the challenges to the nursing workforce following the Francis report generated interest from colleagues across several organisations. The report makes 290 recommendations, including those focused on openness, transparency and candour throughout the health care system, as well as the need for improved support for compassionate caring, committed care and stronger health care leadership (Department of Health 2013).

A wide range of evidence indicates that there is often insufficient staff support necessary to enable staff to deliver compassionate care (Strawbridge and Hewison 2011). The nursing leads identified that previous staff support interventions had not been approached in a systematic way, which led to unwarranted variation in sustaining these support systems for staff well-being.

What to change

The senior nursing lecturer conducted an analysis of the literature, which demonstrated that staff, particularly nurses, were required to undertake complex, emotional work, often without the necessary levels of support to enable them to continue to do this.

It is recognised that supporting and engaging staff who work in health services, results in tangible benefits for patient care (Ham 2014). These benefits include reductions in patient mortality and morbidity (West and Dawson 2012).  Staff well-being is essential if high quality compassionate care is to be provided (Maben et al 2012). However, if staff are to manage the emotional demands of their work, avoid burnout, and continue to provide care for patients, systems of support are needed in the workplace (Maben et al 2012) and caregivers have opportunities to recover during the course of a working day (Lilius 2012).

The literature indicated that there are many approaches that can be taken to providing staff support to enable high quality care. However these need to be sensitive to the context and applied appropriately (Hewison and Sawbridge 2015).

How to change

Although many staff support systems exist, it was identified by the nursing leads that organisations may need some additional support to apply these effectively. The team developed a support programme which consisted of a series of Improvement Labs. The aim of these Labs was to empower staff from a range of health and social care organisations by working with them to review and critique approaches to staff support. Health and social care teams were then supported to adopt, adapt, or develop a practical approach best suited to their organisational context.

The programme requirement is that teams of three attend from each ward/unit as this helps to ensure that peer support is available to implement any identified changes. A senior, middle, and operational level leader attend the Improvement Lab workshop and devise the system to be introduced in their setting. Prior to this, an organisational readiness tool is completed to ensure the organisations are at the right stage to derive maximum benefit from the Lab. In this way, multi-level leadership involving nursing staff is undertaken to introduce and implement the system. So far, workshops have been held within:

• Palliative care environments;
• Emergency departments;
• Maternity settings.

The Improvement Lab is a new and developing approach to service improvement which has emerged from the work of the Q initiative (The Health Foundation), launched in 2016 to connect people with improvement expertise across the UK. The rationale for Improvement Labs is to create space to work together on complex problems and to support the work with insight and analysis from topic experts which can support staff to spread and sustain improvements in health and care. The approaches to staff support examined in Improvement Labs include:

• The Samaritans Staff Support system;
• Restorative Supervision;
• Group Supervision;
• Mindfulness;
• Creating Learning Environments for Compassionate Care;
• Schwartz Rounds;
• Relation Centred Leadership;
• Compassion circles.

The introduction of the Improvement Labs are assisting the standardisation of local approaches to staff support, as well as providing support to sustain the changes and minimise any associated challenges.

Adding value

Better outcomes – To date, 190 health and care staff have attended the Improvement Labs, from a wide-range of organisations across England including NHS Acute Trusts, NHS Community Trusts, Hospices, Ambulance Trusts, and Academic Health Sciences Networks. As a result, engaged organisations have been facilitated to develop and improve their staff support which has in turn led to staff feeling increasingly positive about the impact of the system.

Better experience – The improvement labs have been well received by both individuals and organisations. Evaluative feedback from those who have attended the Labs includes:

“Really helpful and insightful. Great to hear that staff members are thought of. Thanks!”

“Thank you so much for being a catalyst. I am so grateful.”

“Provided useful ideas to implement within the ward setting to improve staff support”

“Really good supportive environment to come together and make some meaningful change to care for staff wellbeing”

“Really beneficial and empowering to raise awareness and give tools to begin to support staff with emotional labour”

“Excellent – good ideas to bring back to the ward. Tools! Thank you for a brilliant day.”

Better use of resources – Although an evaluation of the impact of the Labs on resources hasn’t yet been completed, the engaged organisations are currently reviewing the success locally. Anecdotally, it is reported to have had a positive impact on both recruitment and retention rates across the organisations, as well as the intended improvements in staff well-being.

Challenges and lessons learnt for implementation

Developing a programme such as this requires a partnership approach to working with colleagues in health and social care organisations.

Improvement Lab methodology has huge potential to contribute to service improvement and has been key to our successes.

Encouraging participants to make a short film on their mobile devices of the change they are planning can be a powerful means of communicating the planned change.

The interactive/discovery element of the Lab makes it engaging and enjoyable for those attending.

Regular contact and peer support is important for sustainability of the change.

There is a desire on the part of organisations and colleagues for this approach.

Due to the success of the programme a further two Improvement Labs are in development for delivery in 2019 and will continue to focus on developing staff support systems in order to enable staff to deliver compassionate care.

For more information contact

Dr Alistair Hewison – Senior Lecturer, End-of-Life-Care Research Programme Lead and Postgraduate Research Lead for Nursing

a.hewison@bham.ac.uk