Changing how I work as a ward leader

Joanne Mohammed, FoNS Inspire Improvement Fellow

My journey began earlier this year when I was fortunate to have been selected as one of the Inspire Improvement Fellows 2019 In March, I attended my first residential workshop which completely put me out of my comfort zone. I returned to clinical practice, unsure at that point how what I had learnt would translate into something I could use to develop my team. Sceptical, but hopeful, I stored the ideas and thoughts that I had gathered and allowed them to rumble in my subconscious, taking root.

A few days after my return, my ward was involved in an internal inspection. The results were not great! We had a lot of work to do in order to achieve the standards that were expected of us by the organisation. Eight weeks earlier we had also failed to achieve these required standards, so this second inspection came as a major blow. I felt we were a team in crisis; morale was at an all-time low. We as a team felt that we that we were providing safe care and patient feedback was excellent but the inspection results highlighted gaps in documentation and a lack of consistency in our work. It was obvious that what we had been doing to try and improve standards for the last 8 weeks was not working and I was hit by the realisation that I needed to try something radically different.

Inspired by the new ways of thinking I had been exposed to as a Inspire Improvement Fellow, I changed my mindset from: How am I going to fix this? to: How are my team feeling right now and what do they think the solutions and way forward could be? As a frontline manager you are often faced with conflicting priorities. There is the need to reassure senior nurse leaders, managers and ultimately the trust board that your workplace is providing safe, personal and effective care. But equally, the situation I was faced with was trying to motivate staff who were already working so hard and who were dispirited and demoralised after they had failed to measure up to the organisational standards. When I asked them how they felt at that point they came up with: tired, exhausted, disheartened and dispirited.

At this point I decided that I needed to do something completely new and innovative. I determined that in order to progress the team, we should spend an away day together, the aim being to co-create solutions. I asked Jo from FoNS if she would help me facilitate this. I had anticipated around 12 members of staff would attend but there were 18. I was so pleased as this showed me how much my team cared and wanted to make a difference.

The day began with my team being encouraged to step out of their comfort zone and experience something different. Using the Evoke cards ( and exploring what was important to us, in teams we used our creativity and came up with 3 distinct but complementary visions of the care we wanted or aspired to deliver as a team. The key ideas were that we all put the patient at the heart of everything that we did. We were aware of the pressures that we were under in terms of time, staffing, workload etc. but also that team work was key and that we actually had a good team. And also we recognised that we needed a more in depth understanding of what was expected of us in terms of the internal inspections.

For the final part of the day we used a claims, concerns and issues exercise to help us identify the key issues that we needed to address to allow us to move forward as a team. From this we developed an action plan that everyone contributed to, which was robust, had clear outlines and which we took back into the workplace.

For me as a manager, the experience has been an eyeopener. It is the first time I have asked my team members to articulate their feelings and in doing so I have had some honest and frank conversations with different members of staff. There was a clear and tangible benefit to taking the time out to spend with each other and to spend it ‘listening … but really listening to each other’. The team have discussed what we needed to do to improve and we have co-created the solutions as a team. Everyone had a voice and an opportunity to contribute. It was fabulous to see all the staff employing their creative skills. Everyone took to it like ducks to water, the visual representations were amazing and were developed further at ward level. There was no organisational hierarchy on the day, everyone’s ideas were of equal, value which is something that is important for me. I had to take a back seat and try to facilitate the day rather than direct it, thus allowing the team to come up with their own solutions. It also allowed the team to identify what they were struggling with and what they needed me to do to allow them to flourish. Feedback from the team members after the day was positive and they all said that they had enjoyed it and they have made me promise that we will have future days like this.

We had another inspection a few weeks after the day and the inspection team were able to see clear improvements. They also commented on how it was evident that the team were proud of their work and that they had gelled as team, it was like a different place! For me the day was a turning point in that we:

‘Switched the focus from trying to pass the inspection and instead concentrated on what we were going to do on a daily basis to ensure that we provided the best care that we could for our patients whilst respecting each other as valued members of the team.’

Once we did this, our performance improved and the changes we made are becoming embedded in our daily work. I am so proud of our team and cannot wait to continue on our Creating Caring Cultures journey with the Inspire Improvement Fellowship.

Joanne is an Inspire Improvement Fellow 2019.

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