My mission statement

The times we are working in now need a great deal of accelerated change and there must be no negotiating that down. So my mission statement for this part of my consultancy career is to be clear that there needs to be and will be a lot of change from the work that I do with individuals and organisations and if organisations don’t want that, then it is probably best to go somewhere else.

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Developing the Power of Nurses – US style

Filed Under (Health Improvement, Health Policy, Public Health, US opinion, USA) by Paul on 24-03-2010

One of the interesting meetings that I had whilst in Portland – the largest city in Oregon – was with nurses in one of their biggest hospitals – Providence.

I have been in the US with the excellent Helen Bevan – Director of Transformation at the NHS National Institute. One of the things we have been discussing in all our meetings is whether US hospitals would be interested in using one of the improvement tools developed in the NHS – the “productive ward”. The “productive ward” is a nurse-led project aimed at working with nursing staff on the ward to release staff to devote more time to care. It’s aimed at cutting out waste and is, in many ways, a classic time and motion study. The difference is that this study is carried out and implemented not by “men in suits” but by the nurses themselves. Some of the improved output figures are very good.

So along with trying to ‘sell’ the NHS as a set of political organisational relationships we are also selling the “productive ward”.

Last Friday saw us, at 7 o’clock in the morning, in the social room of Providence Hospital with 150 nurses. At a simple level there is one obvious similarity with nurses in the UK. They are 95% female. Under those circumstances a wise man goes and sits quietly at the back and supports what Helen is doing at the front.

The meeting was part of a development day. We started at 07:00 so that it could catch the night shift coming off duty as well as the day shift starting their day. The session started with a DVD called “See Me”. A great story about a very old lady in a hospital ward who was all too invisible to the staff on their rounds. It’s a true story of how she wrote out her life in a few pages as a memo to the nurses – “I wasn’t always this old and crabby” – and this crumpled note was found and distributed to the staff. The staff then realised how they failed to see her.

150 people – including me – in the room all in tears at 07:15 on a Friday morning. Most of the tears caused by the realisation that we all, in our business, walk past people who need to be seen and heard a lot more than we do. What was impressive wasn’t the emotion, but the fact that the nurse leadership in the hospital knew that they had a duty to remind the staff of why they were there.

The banner under which the day’s development was talking place was “Connected Care – Leadership at the Bedside”. Every nurse was being reminded to step beyond their division of labour – to work with each other to connect up the care. And they were also being told how important their leadership was to ensure the patient got better quickly and safely.

The introduction was reminding nurses of some of the development themes in the hospital. Purposeful rounding – making sure that nurses looked and did things purposefully when they walked round to see their staff. Individual nurses were congratulated on specific tasks they had taken on. One had been asked to look at all the documentation about patients and make sure that it made sense to nurses and, where they could, to develop it in that direction – they had struggled what to call her but they came up with the “Documentation Goddess”.

Every paragraph spoken emphasised the way in which their empowerment could empower the patient and lead to improvement. They were encouraged to empower themselves but on every occasion they were encouraged to think about what they might do with that power for the patient.

All of this was slightly more “full on” than its English equivalent, but it did demonstrate that celebration and emotions were an important part of improvement.

Helen’s development of the productive ward in front of them energised them further and the nurse sitting in front of me left saying “I want to do this in my critical care ward now”.

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