Facilitating change; not fixing

Deb Smith, Ward Manager, Royal Manchester Children’s Hospital

Hello, my name is Deb Smith and I’m a ward sister on a busy paediatric ward. My journey as a FoNS Inspire Improvement Fellow started in earnest following my annual leave at Easter. I had not long completed the first residential workshops (March 19) and was brimming with ideas for creative (glitter and glue) sessions with the staff! However, what primarily greeted me on my first day back on the ward were some difficult teamwork issues the staff were facing.

bees art displayAt the end of the day, while I was driving home, I reflected on the day and came to the conclusion that the team wanted me to fix the situation and to solve the problems. I have tried this in the past, but the underlying issues and behaviours did not change. I decided to take a different approach. The following day, before the shift I spread out the Evoke cards (I had experienced them myself at the Inspire Improvement workshop days). I decided to use the words rather than the pictures in this situation. Before handover I explained what had occurred the previous day. I went on to say that they were the ones who could change and that we were going to use the cards before each hand over to express how we wanted to behave towards others and how we expected them to behave towards us. There were quite a few ironic comments regarding the negative words however I began using the word ‘respected’. Using their chosen words the staff expressed their desire for improvement in the team. Happily, though extremely busy, the day went well. The following day I removed the negative words to comprehensively focus on the positive. Again, the day went well. Throughout the day staff laughingly referred to their chosen word to remind their colleagues what was expected of the team.

As part of the residential workshops we were asked to explore with our teams on the ward ‘what it is like to work round here’. I had been planning the best way to draw this out from staff for the previous couple of weeks so this was the perfect time. Before I started, I made a little video using Renderforest, an online tool, to create a presentation in the form of animation to share with the staff about the fellowship and what it meant for them and emailed them a copy. I started with two staff members and asked them into the interview room. There before them was an A4 sheet of paper with a bee on the top asking ‘what it’s like to work on the ward’ and asking them to consider what’s good, what could be developed and what are the challenges for our ward? They also needed to get creative!! I asked them to make a bee with the templates I had provided and use the wings to write about the qualities they brought to the team and what they thought a team looked like. They produced fabulous bees but asked to take the questionnaire away with them to allow for serious consideration. Based on this feedback I asked for the questionnaire to be handed out at each handover to allow everyone the chance to give the questions some thought rather than a quick reaction. It hasn’t been easy to release the staff to take part in this exercise, as we have been busy on the ward, however the staff who have managed to create their bees have done a wonderful job! I also continue to use the Evoke cards before a shift although I haven’t, as yet, used the pictures!! Perhaps I will soon.

This simple exercise has allowed each member of staff to reflect on their role within the team and ‘what quality do you bring to the team?’. This has helped them to connect to their values and where they fit within the collective team values. Use of the Evoke cards starts the day off on a positive note which I find influences the day ahead. Staff members who slip into negative comments are gently, and with good humour, reminded by their colleagues of their wish for positive

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