Beyond Patients First

13 February 2018

Jilly Ireland, Professional Midwifery Advocate

I received a pack of nicely produced A4 ‘Improvement Insights’ from FoNS in the post the other day (‘Bump, Baby and Beyond’ – creative ways of designing antenatal preparation sessions in collaboration with women). It summarises the Patients First Programme project I was involved in for eighteen months from 2014 to 2016. During that period, I benefitted from collaborative learning with other teams in the workshops and from ‘living out’ the service improvement as it evolved with mentoring support from FoNS’ practice development facilitator, Jo Odell.

The experience validated a lot of the feelings and experiences I had from a long working life in the NHS. I have seen changes imposed without consultation with those the changes affected most and I have seen better service improvement which had an eye for sustainability and ongoing evaluation from all stakeholders, including users. The input and support we had from FoNS gave validation not only to the ‘feeling’ that this is the right and correct approach but also the evidence. A powerful double effect.

This has meant that the effect of being a participant on the Patients First Programme has carried on in my career and in my life away from work. I have been using creativity more. I have written a poem and lullaby based on the knowledge base around mothers’ wellbeing and foetal development (Ireland, Evans and Buisson-Lex, 2016) and how wellbeing in pregnancy can be addressed at least in part by introducing crafts (Ireland and Croucher, 2017). Having the bursary and workshops facilitated expansion in my knowledge in this area and my abilities to share and use it in a variety of impactful ways.

My current post as a Professional Midwifery Advocate involves supporting staff through restorative supervision. Our Head of Midwifery in Poole, Sandra Chitty, has allowed the role to evolve and hopefully become what our staff group needs. I have spent several months gathering information from the whole workforce and from service-users. Some examples of engagement activities are:

• ‘Whose Shoes?’ workshops, whereby staff from a variety of areas and disciplines and across different Trusts; service-users and user group representatives; providers (CCG) and others affected by maternity care issues have worked together to elicit the main issues requiring attention
• Sharing colleagues’ insights and working towards personal and group solutions at workshops during mandatory update days
• Breakfast workshops using ‘forum theatre’ to facilitate midwives’ learning around the new birth ‘de-brief’ appointment to be offered to each woman 21-28 days after their babies’ birth (RCM Better Births)
• Attending external training (e.g. motivational interviewing) and procuring bespoke maternity training for community midwives (to start May 2018)
• Developing a ‘birth afterthoughts’ service for women so that those who need it can come and discuss their experiences with an experienced midwife who may be able to ‘fill in gaps’ in their memories; make sense of what happened and the most frequent comment made in the evaluation form – have their feelings validated
• ‘Work afterthoughts’ service for staff – guided relaxation following update days (to start at the end of January 2018)
• Professional Midwifery Advocates across the South Coast have organised a multi-Trust working group so we can provide each other with support and share knowledge and particular expertise across the whole area

Currently I am preparing to calculate a whole staff measure of ‘self-efficacy’ which will form a baseline measure against which we can compare repeat results in 6 and 12 months’ time. The questionnaires will be filled out anonymously and a copy kept by each individual staff member and used to aid reflections for NMC re-validation and, in the case of non-midwife staff, for their development/appraisal discussions if they wish. The data will be used as evidence of staff support for CQC evaluations in future.

My current role requires and uses facilitation and engagement more than any other I have held. Being part of a FoNS programme has been fundamental in validating my beliefs and helping me to hone the skills required to turn beliefs into actions. Thank you FoNS!

References

Ireland, J., Evans, R., Buisson-Lex, R. (2016) ‘Bump, Baby and Beyond’: Participant-led Antenatal Sessions using Creative Collaboration. Journal of Health Visiting. Vol.4. No. 5. pp. 248–253 and reprinted in British Journal of Midwifery (2016) (Published Online: September 01, 2016).

Ireland, J. and Croucher, H. (2017) ‘Knitting Quitters’. The Practising Midwife. Vol. 20. No. 4. ePub. April 2017. Royal College of Midwives. Retrieved from: http://betterbirths.rcm.org.uk/ Accessed 19/01/18.

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Dear team …

Siobhan Weaver, Lead Nurse, Children’s Continuing Care Team and 2017 Richard Tompkins Scholar

“Dear Team,

 This week at Herstmonceaux Castle I have been learning about practice development. What I have experienced has been a personal journey of discovery. What I have learnt is that it is people who hold the answers; that using creativity alongside questioning and enquiry will enable great, meaningful and positive learning to happen. I would like to share this with you all.

You can support me by being open minded to what I show you and join in if you feel this is right for you. If you are worried, talk to me and tell me how we can work together to change and learn,

Love Siobhan x”

So this was my starting point as I left that beautiful week that was the FoNS hosted practice development school 2017. I have a job to do, I am ready and energised to make a change in myself. It’s a different kind of energy than I am used to though. It’s not the fizz popping, ‘tigger’ style enthusiasm that I have (occasionally) been known for – you know the one…. the overwhelming, over-riding, million miles an hour and already 10 points ahead energy. If I sit quietly, I can feel it deep within me. It’s a step back and watch energy and I am practicing funnelling it in a completely different way.

So, my starting point … ‘talk to me – I will listen’. Active listening has never been one of my strong points. I know this now because so much of my calm energy is needed at the moment to make sure that I do it well. I am having to physically and mentally concentrate (hard) on doing it. My mind still likes to wander. I find a thought stream can take over and, if left unchecked, will consume my active listening, polishing it off in one swift gulp. I find I sometimes jump in with more directive (closed) questions, which are really just dressed up solutions (solutions, solutions) instead of allowing the silence (sometimes long, sometimes uncomfortable), facilitating the space for the person to find their own answer. I still find that I am more guiding that I really would like, but I am working on it.

‘How are you keeping this up?’ I was asked a few days ago by a colleague. I am writing reflections, nearly every day, for the first time in my nursing career (oh, how I wish I’d listened more thoughtfully to my wonderful personal tutor 20 years ago!). The reflections are personal and cathartic, enabling an exploration of the emotions that I experience on a daily basis …’a step back, to take a step forward’ and hey … better late than never! They are aiding my learning, helping me discover (and rediscover) things that would have remained invisible to me. They create an energy of their own that sustains me and enables me to continue to improve my active listening skills. They are my memory to look back on lest I forget.

Recently I listened to a podcast from the Accidental Creative. Todd Henry shared his thoughts on 3 daily practices that he thinks can improve your life.

1) STUDY everyday (just 20-30 minutes of learning about something important to you),

2) REFLECT on the learning

3) take a WALK to help unlock the creativity in your learning.

I’ve been doing all three of these and I can tell you it’s working for me. My learning is taking me on a wonderful journey – and my ultimate destination? To help co-create the right conditions in the workplace environment to facilitate person-centredness, learning cultures, wellbeing and healthfullness. It feels a big goal to achieve, but every journey starts with just one step and I know it is in the right direction.

Click here to visit the 2018 Practice Development school pages

Facilitative leadership in creating a caring culture

28 November 2017

Jo Odell, FoNS Practice Development Facilitator

Last week I had the pleasure of leading a workshop at the Nurse-led Clinics 2017 run by Healthcare Conferences UK. The aims of the workshop were to:

• Enable participants to identify their own leadership qualities and behaviours against a framework
• Explore the ‘Creating Caring Cultures’ model as a framework for developing nurse-led clinics.

The participants were from a wide range of clinical practice and were currently running nurse led clinics or wanting to develop them in their own sphere of practice.

I started the workshop by describing the resources that FoNS has available to health and social care staff on our website. We then used Evoke cards to introduce ourselves and to share our expectations of the workshop. Participants were then invited to look at the Facilitative Leadership Model

and to select 10 characteristics that they felt they used regularly in their roles. They then looked at these identified characteristics in relation to the three styles: Visionary, Manager, Facilitator. This was an opportunity to identify their strengths but also to think about and discuss the merits of each style. During the discussion we identified different situations in which each style maybe more appropriate within their role and work.

I then introduced the participants to the Creating Caring Cultures animation and resources. We watched the 5-minute animation and discussed each of the ribbons (as in the picture) of the model in turn and the different approaches and methods that could be used under each one. So, for example if you were looking to establish a nurse led clinic it was important to develop a shared purpose for the new clinic, but not to do this in isolation, but in collaboration with patients, staff and other key stakeholders. If you wanted to evaluate an existing nurse led clinic, you could look at the gaps between your shared purpose and what was really happening in practice. You could do this in several ways:

• Asking staff “what’s it like to work round here?”
• Ask patients about their experiences in a meaningful way for example using an emotional touchpoint approach

Lastly, we talked about the importance of celebrating success on a regular basis and recognising small achievements as well as formal final evaluation outcomes. We all identified that a facilitative leadership style would be the most helpful when working with these resources. We closed the workshop by sharing individual learning points from the workshop. Participants fed back that they liked the simplicity of the resources and felt they could really apply them to their roles and in relation to working in nurse-led clinics.

If you are a clinical leader and would like to explore the Creating Caring Cultures resources, to get some support to apply these to your own practice and to look at methods and approaches for implementation, come and join us at the masterclass on the 22nd January 2018.

More information and discounts are available via the FoNS website.