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MatNeo Case study
Author: Hayley Butler Organisation / Site: UHB (HGS)
Job title: PMA PSC / Region: West Midlands
Telephone: 0121 424 2195 Date: 5/11/18 Email: [email protected] Project title: Learning from Excellence Background description: University Hospitals Birmingham (UHB) is a multi-site large acute hospital Trust serving a diverse population across Birmingham East and North, Solihull, Sutton Coldfield and South Staffordshire. UHB provide maternity services across 3 sites and has a birth rate of approx. 10000 births per year. In 2018 UHB merged (by acquisition) with Heart of England NHS foundation trust (HEFT). Following the Care Quality Commission’s (CQC) inspection of Heart of England in 2014, the Head of Midwifery commissioned an Internal Quality Review. This review took place at Good Hope Hospital in 2015 and Birmingham Heartlands Hospital in 2016. Reviewers identified that there was an issue with low staff morale and motivation, it was also noted that retention of staff and high sickness levels were adding to the low staff morale. Staff clearly voiced that they felt at times there could be a culture of blame and ‘finger pointing’ following clinical incidents. The reviews also identified that although the staff worked well within their teams, there were issues around how different wards within the maternity unit worked together. Following the reported success of Learning from Excellence (LfE) at Birmingham Children’s hospital and University Hospital Birmingham, a team of senior midwives decided to implement LfE within Maternity. The same staff also attended Appreciative Inquiry (AI) training which compliments the LfE approach as Appreciative inquiry is a model that seeks to engage stakeholders in self-determined change. Aims, objectives and scope: To embed Learning from Excellence within the maternity unit at UHB NHS Foundation Trust and utilise the learning to improve team and organisational resilience by December 2018. Method and approach: Created a working Standard Operating Procedure for the project Adopted quick start up guide from Birmingham Children’s hospital for LfE Involved key stakeholders
service leads governance team matrons ward managers
Created driver diagram
Held multiple planning meetings Large communications campaign on social media and email, posters in areas Launched project Used PDSA cycles to test small changes- made changes to report forms after analysis of data quality submitted by staff reporting excellence Ensured prompt feedback to staff who are nominated Newsletters Measurement plan: Quantitative data - Gathered using numbers of LfE reports completed, nominees and nominators divided by staff groups nominated. Qualitative data - Collected via staff survey distributed to all staff who have been nominated for Excellence in the first year of the project. Results and evaluation: What worked well: The nomination process- the nomination process was simple and easy to follow Communications- staff WhatsApp and Facebook pages were utilised as well as ward focus boards and staff email to disseminate the project. Natural spread: the project spread very quickly across the entire maternity unit very quickly. Challenges: Size of project – started small scale but grew very quickly to other wards and then across site Quality of reporting- initially some reports were of poor quality, the exact description of that was excellent was often vague and needed exploration. Keeping up momentum- after the initial peek reporting dropped and staff needed regular reminders that the system was there Paper reporting system- this was time consuming as all certificates and email responses had to be manually typed and created. Lack of quantitative evidence- the trust wanted quantitative evidence that LfE was making a difference to staff retention and absence rates…however any change to these figures could not be attributed to LfE alone. Negative attitudes- some senior staff saw LfE as rewarding staff for things they should be doing in their normal day to day role; there was a lack of understanding regarding LfE that needed to be addressed. These negative attitudes usually subsided when the person was nominated themselves. Possible solutions: Increased communications such as monthly updates to staff Online reporting system to make reporting more accessible to all LfE champions in each area
Fig 1 shows the number of LfE nominations received since launch in April 2017, reporting was high in the first 3 months following launch, this was likely due to the communication strategy and the fact that staff felt they needed a process to voice their appreciation of their colleagues. Reporting peaked again 12 months after launch, at this time there was increased communication to celebrate the first year of LfE and some staff members attended a local LfE study event held by the Patient safety collaborative (PSC). The average number of nominations is 19 per month.
Who is nominating staff?
Fig 2 shows the staff groups that nominate their colleagues for excellence, the greatest group or reporters are midwives. The midwifery workforce are the largest staff group within the obstetric workforce (n=520) and this is likely to explain the large volume of reporting within this staff group.
Who is being nominated for Excellence?
0
10
20
30
40
50
60
LfE staff nominations
number
Fig 3 shows the staff groups most likely to be nominated for excellence, midwives received the highest number of nomination, followed by Maternity support workers and obstetricians. Themes of Excellence reports: Text from the nomination forms was analysed, staff behaviours and actions were then sorted into common themes. Words like communication skills, language, listening were grouped into a larger communication theme. Words like development, mentoring and teaching were grouped into a larger Education theme.
Fig 4 shows the themes for Excellence reporting
Supportive: instances where colleagues offered then help and support at a time they needed it.
Patient focus/centred: patients were at the forefront of care given i.e. planning birth against
SUPPORTIVE17%
PATIENT FOCUSED15%
TEAMWORK14%
COMMUNICATION11%
LEADERSHIP8%
EFFICIENCY7%
ABOVE AND BEYOND6%
DEDICATION6%
EDUCATION6%
PRESSURE6%
INNOVATION/INITIATIVE2%
MORALE2%
Themes for LfE reports
guidance Teamwork: related to how the team worked during obstetric emergencies, ensuring positive
outcomes Communication: various examples of where improved communication had a positive effect Leadership: often managers nominated for their leadership style and moving the service
forward Efficiency: new ways of worked trialled to make the service run more smoothly Above and beyond: staff went over what is usually expected of them Dedication: staff who showed they are dedicated to their role or the service as a whole Education: staff training that improved safety Pressure: worked well under pressure Innovative: new ideas implemented to improve safety and outcomes Morale: people who worked to increase the morale of others
Staff survey: All members of staff who had been nominated for Excellence in the first 12 months of the project were invited to complete a short survey via survey monkey, invitations were sent out via work email. There were 42 responses. Staff survey results:
1. I believe that there is an opportunity for learning from best practice:
2. I believe that the best way to learn is from other people’s mistakes:
strongly agree
agree
neither agreenor disagree
disagree
stronglydisagree
strongly agree
agree
neither agreenor disagree
disagree
stronglydisagree
3. I believe that I learn best from reflecting on my own mistakes:
4. I believe that LfE reporting can help to improve patient care
5. I believe that LfE reporting can improve staff motivation
6. I Believe that LfE reporting can improve staff morale
strongly agree
agree
neither agreenor disagree
disagree
stronglydisagree
strongly agree
agree
neither agreenor disagree
disagree
stronglydisagree
strongly agree
agree
neither agreenor disagree
disagree
stronglydisagree
7. LfE has made me feel more valued by my organisation
8. I believe that there should be a stronger focus on achievement rather than failure
The majority of respondents felt that there is an opportunity to learn from best practice and that LfE can improve patient care, staff motivation and staff morale. Personal journey: The journey has been complex with the requirement to engage in different stakeholders across
strongly agree
agree
neither agreenor disagree
disagree
stronglydisagree
strongly agree
agree
neither agreenor disagree
disagree
stronglydisagree
strongly agree
agree
neither agreenor disagree
disagree
stronglydisagree
different staff groups, implement across multiple teams and multiple sites. The plan had initially been to implement in a small area first, however due to a successful communication campaign the staff in other areas heard about the project and began nominating staff in their areas. The natural spread was much faster than first planned. The project has been time consuming due to the fact that the reporting system continues to be paper based; however discussions are underway to move to an online reporting system in the next 12 months. The project has been very rewarding; feedback from staff has been positive and appears to have genuinely made a difference to staff morale and motivation. I feel it has enabled me to make a difference to how my colleagues feel within the workplace. Quotes from staff who have been nominated:
‘I have just opened this e-mail...and I can feel a tear in my eye!! The fact that somebody would go to the trouble to do this for me is very touching indeed. I am humbled. I am so privileged to work with a truly, fabulous team in Heartlands maternity, all of
whom make my job seem such a pleasure’
‘Thank you so much for this beautiful email’
‘Awww made my day!’
‘Always nice to get a pat on the back, sending you one back to for driving the LfE approach’
‘Thank you so much that is a lovely email and nomination to receive’
‘What a nice surprise, thank you very much for letting me know. This definitely made my day!’
Learning points: Essential elements…
Start off small Have a team behind you that is multi-professional Have key stakeholders on board who can make organisational changes Push the project forward giving it a bigger profile Online reporting Regular consistent communication with staff
Plans for spreading learning and encouraging adoption: This project is easily transferable as the Birmingham children’s hospital LfE team have produced start up guides and resources that are all publicly available online on their website. Key contacts and further information: Hayley Butler – [email protected] www.learningfromexcellence.com
