Working in new ways: on a path to transformation

Joanne Mohammed, FoNS Inspire Improvement Fellow

As the New Year begins and I head for pastures new for a few months, I have taken the time to reflect on what the team and I have achieved over the last 12 months. Looking at the effect of the changes that have been implemented following learning that I gained after attending a series of workshops facilitated by Jo Odell from the Foundation of Nursing Studies (FoNS) as part of the Inspire Improvement Fellowship Programme, and the effect of those changes.

We started the year 2019 in difficult circumstances, with a new ward environment that was challenging in terms of size and geographical layout. Staff morale was low, people were leaving and we were failing to achieve required standards. Fortunately, I began my journey as an Inspire Improvement Fellow at this point in time. So instead of reverting to tactics that I had used previously, I tried a different path, different ways of working. I used the ‘fresh eyes’ I had developed at the workshops and took an objective and critical look at my workplace.

 I asked the staff how they felt. I encouraged them to tell me where they felt that we were going wrong. This resulted in some difficult but constructive discussions and there were moments when I had to accept that my leadership style had at times been lacking, when it was not conducive to staff feeling that they had a voice or opportunity to suggest changes in the workplace. I learnt to listen to what the staff were telling me, how they articulated ‘What it feels like to work round here’ and what the culture of the ward felt like to them.

These discussions and the hitting of rock bottom as a team allowed us then to forge a way upwards. We had an away day which set us on the path to success. We learnt to talk to each other, to listen; to allow each one of us to have a voice and opportunity and encouragement to contribute to shared action plans. Our team motto, which we co-produced, became ‘Working Together, Caring Together, Learning Together’ and one morning I came into work to find it beautifully displayed on the ward wall. It had been created visually by the night team whilst I slept, like a Banksy mural it appeared unexpectedly out of nowhere. It is there as a constant reminder throughout our working days and nights of our shared values and aspiration as a team.

The changes have been small, but they have been constant. Eventually we started hitting targets, we started to demonstrate that we were able to deliver high quality personalised care for our patients. We now celebrate each other’s successes and our successes as a team. Our ‘Above and Beyond Award’ allows team members to nominate a fellow staff member who they feel has made an exceptional contribution the previous month. We use ‘Evoke Cards’ (www.evokecards.com) to check in as a team and discover how we are each feeling and this allows us to support each other. A recent video that we shared on twitter and a visit to the fairground have enabled us to embrace lighter moments and have joy at work.

It’s not perfect, but then no workplace ever is, however the difference is evident. Staff are happy here. The positivity is tangible. Staff greet each other as they come on shift. New starters have said that they are quickly made to feel welcome and that they enjoy working here. Staff have told me that they enjoy coming to work now. Staff are confident to advocate for the patients’ wishes and they cater for diversity of patients’ needs. They are learning to listen more intently to patients and over the last week I have seen fantastic examples of staff ensuring that patients’ voices are heard over those of medical and therapy teams. The staff are very patient focused and this is demonstrated in the little touches such as the marshmallows and hot chocolate on Christmas eve for the patients and the visit from Santa on Christmas day.

I had a conversation with one of the FoNS facilitators a couple of months ago about this change in the ward and she introduced me to Fay’s (1987) idea that reflection enables a process of enlightenment, empowerment and emancipation, or transformation (Middleton, 2017). In my mind this is the journey that I and the team have been on. The Creating Caring Cultures Framework introduced me to a new way of being and working which I then shared with the rest of team and thus encouraged them to think differently. They now have new confidence in each other as team members and feel empowered to do what is best for our patients. We are definitely heading towards transformation and although we still have work to do, I am ever hopeful and excited for the future. What this journey emphasises is that once you get the local workplace culture right then great things can happen.

Finally, the pride of my colleagues in what we have achieved was brought home to me today when one wished me luck in the new post that I am taking over for a few months.

‘We will keep it right you know, the ward’, she said, ‘We are proud of our workplace’.      

References

Fay, B. (1987) Critical Social Science: Liberation and its Limits. Cambridge: Polity Press.

Middleton, R. (2017) Critical reflection: the struggle of a practice developer. International Practice Development Journal. Vol. 7. No. 1. Article 4. pp 1-6. https://doi.org/10.19043/ipdj.71.004.

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