This is going to hurt us: Women hit back at ‘belittling’ BBC portrayal of NHS labour ward

Here I am with @drclairekaye & @millihill for @mailplus on #ThisIsGoingToHurt

An important & complex conversation was had here on staff trauma, trust & safety.

View the media piece here

#ThisIsGoingToHurt

I would love to hear your ‘respectful’ thoughts and views here. I have to admit I watched in through my fingertips and found it quite triggering. This issue I have is that I would love to see the real lives of healthcare professionals portrayed through drama. Nevertheless, it is not a comedy out there.

I heard one interesting view from a woman who had experienced a traumatic birth. She found it cathartic and helpful to think of staff as being human in this way. What are your thoughts?

Until next time…Look after yourselves and each other 

Follow me via @SallyPezaro; The Academic Midwife; This blog

Exploring the narratives and experiences of Healthcare staff working through the COVID-19 Pandemic – Could you contribute?

“Don’t clap for me” “The health service is not staffed by heroes” and “’We are fragile, tearful, afraid, and we are human” are recent accounts voiced by healthcare workers, working through the COVID-19 pandemic (Anonymous 2020; Watson 2020).

In contrast to the common portrayal as invincible “heroes” or “saints”, it is increasingly recognised that healthcare workers (HCWs) working through the COVID-19 pandemic may be experiencing negative emotions and moral distress related to certain situations (Williamson et al. 2020). These situations may include: Being redeployed, witnessing the suffering of patients or colleagues, ethical decisions related to care, delivering bad news or making the decision to distance oneself from family or children. The wellbeing of HCWs, as well as having an impact on individuals and families, is intrinsically linked to the quality and safety of healthcare services so there is a pressing need to understand more, including how we can help (Pezaro et al. 2015; The Royal College of Physicians, 2015).

We know that even the smallest demonstrations of compassion can make a difference to individual HCWs: Small acts of kindness, caring language or the opportunity to be listened to for example (Clyne et al. 2018).  Williamson et al. (2020) state the importance of informal support and opportunities for discussion of events that may have caused moral distress to allow HCWs to process and make sense of events.

We are commencing a research study to explore the real narratives and experiences of HCWs working through the COVID-19 Pandemic, as well as where HCWs have experienced self and workplace compassion, using an arts-based research approach which includes creative writing, storytelling & theatre. Participants will contribute to the script for a piece of audio art-work that will creatively depict the emotions and experiences of healthcare professionals contrasted against the social celebration of them as ‘heroes’ during this Covid-19 pandemic. The recording aims to both give a truthful account of the HCW narrative during this crisis, whilst also being relatable, hopeful and human. It is hoped that it will be a point of stimuli for discussion for the general public and inform the development of additional resources to help HCWs debrief and recover.

Aspects of the arts-based research process itself, such as the opportunity to make sense of experiences through creativity, reflection and commonality with other participants, have been noted as “transformative” (Beltran and Begun 2014). Lennette et al. (2019) describe this type of research as an ongoing reflective process, in which the researcher and participants collaborate to expand the meaning of each individuals’ story and find links and common themes with those of other participants.

We are recruiting a small group of 4-6 healthcare workers to explore their experiences and narratives of COVID-19, within a 1-hour online workshop, taking place at the end of June. The group of HCWs will discuss their experiences and work with a writer, Nick Walker and theatre professionals from China Plate Theatre Company to create a piece of creative writing and a script for the audio artwork, which will be exhibited at a digital exhibition for Coventry City of Culture 2021. If you wish to take part, your information will be kept anonymous & confidential. You are under no obligation to take part.

China Plate are independent contemporary theatre producers of adventurous and imaginative new work with popular appeal and a social purpose. Their mission is to challenge the way performance is made, who it’s made by and who gets to experience it. Lead artist, Nick Walker is a Coventry-based writer, producer, and director. He was co-founder of theatre company, Talking Birds whose work has been presented across the UK, Europe, and the USA. He has worked with some of the country’s leading new work theatre companies including Stan’s Cafe, Insomniac, Action Hero and Theatre Absolute. His plays and short stories are regularly featured on BBC Radio 4, including 3 series of The First King of Mars (starring Peter Capaldi), and 6 series of Annika Stranded with Nicola Walker. He has a great deal of experience in writing plays and stories that are based on conversations/workshops with people around their real-life experiences, for example, exploring stories of male suicide with Coventry Men’s Shed. His writing has successfully fictionalised these experiences and made them relevant to a wider audience without losing their essence and truthfulness.

Date/time for workshop confirmed as: Wednesday 17th June 19:30

To request a Participant Information Sheet please email Kerry Wykes: ad3078@coventry.ac.uk.

References

Anonymous (2020) I’m an NHS Doctor and I’ve had enough of people clapping for me. The Guardian. [Online] https://www.theguardian.com/society/2020/may/21/nhs-doctor-enough-people-clapping

Beltran, R., & Begun, S. (2014). “It is medicine”: Narratives of healing from the Aotearoa Digital Storytelling as Indigenous Media Project (ADSIMP). Psychology and Developing Societies, 26, 155-179.

Clyne, W., Pezaro, S., Deeny, K., & Kneafsey, R. (2018). Using social media to generate and collect primary data: The #ShowsWorkplaceCompassion twitter research campaign. JMIR Public Health and Surveillance, 4(2), e41.

Pezaro, S., Clyne, W., Turner, A., Fulton, E. A., & Gerada, C. (2015). ‘Midwives overboard!’ inside their hearts are breaking, their makeup may be flaking but their smile still stays on. Women and Birth: Journal of the Australian College of Midwives, 29(3), 59-66

The Royal College of Physicians. (2015). Work and wellbeing in the NHS: Why staff health matters to patient care.

Lenette C, Brough M, Schweitzer R et al. (2019) ‘Better than a pill’: digital storytelling as a narrative process for refugee women, Media Practice and Education, 20:1, 67-86, DOI: 10.1080/25741136.2018.1464740

Williamson, V., Murphy, D., Greenberg, N (2020) COVID-19 and experiences of moral injury in front-line key workers, Occupational Medicine,  kqaa052, https://doi.org/10.1093/occmed/kqaa052

Further reading…

Watson, C (2020) Nurses are no heroes – they’re just finally beginning to be recognised as they should. The Telegraph.

https://www.telegraph.co.uk/health-fitness/body/nurses-no-heroes-just-finally-beginning-recognised-should/

http://talkingbirds.co.uk/pages/sitespecific.asp

http://saveourstories.co.uk/

 

19 Things That Show Workplace Compassion for Healthcare Staff

We are all well aware of how the wellbeing of healthcare staff can affect the quality and safety of care. I have also talked at length about the wellbeing of health care staff and the theories surrounding work-related psychological distress. But do we really have any concrete idea of what shows workplace compassion for healthcare staff?

My research published in collaboration with Dr. Wendy Clyne, Dr. Karen Deeny and Dr. Rosie Kneafsey asked Twitter users to contribute their views about what activities, actions, policies, philosophies or approaches demonstrate workplace compassion in healthcare using the hashtag #ShowsWorkplaceCompassion. It can be cited as follows:

Clyne W, Pezaro S, Deeny K, Kneafsey R. Using Social Media to Generate and Collect Primary Data: The #ShowsWorkplaceCompassion Twitter Research Campaign. JMIR Public Health Surveill 2018;4(2):e41. DOI: 10.2196/publichealth.7686. PMID: 29685866

The results of this study outlined 19 things or ‘Themes’ in relation to what shows workplace compassion for healthcare staff as follows…

	Leadership and Management
1	Embedded organizational culture of caring for one another
2	Speaking openly to learn from mistakes
3	No blame/no bullying management
4	Inspiring leaders and collective leadership
5	Financial investment in staff
6	Recognize humanity and diversity
	Values and Culture
7	Common purpose in a team
8	Feeling valued
9	Being heard
10	Enjoying work
11	Being Engaged at work
12	Use of caring language
	Personalized Policies and Procedures
13	Recognition of the emotional and physical impact of healthcare work
14	Recognition of non-work personal context
15	Work/life balance is respected
16	Respecting the right to breaks
17	Being treated well when unwell
	Activities and Actions
18	Small gestures of kindness
19	Provision of emotional support

How will you implement these things within your healthcare workplace? I would love to hear your thoughts on this…

If you would like to follow the progress of my work going forward..

Follow me via @SallyPezaro; The Academic Midwife; This blog

Until next time…Look after yourselves and each other 💚💙💜❤

Making Birth better: How research shapes practice #bbresearch17

Indulging in my passion for research, I am today reflecting on my time at #bbresearch17 …an intimate conference made into a delightful day thanks to @researchMWs & @HinchMidwives…More specifically …  @taraApauley  &  @GallyHJ …

I personally enjoyed this as a more intimate conference, where deeper conversations could get the brain working on what was really needed in maternity services and health research…Another reflection of the day can be seen on Steller here…

As you can see, we had a great line up for the day, and a fish and chip lunch no less!

Highlights for me include:

Stop sexualising breastfeeding!!!! The great presentation by @Dr_AmyBrown #BBResearch17 #breastfeeding #stigma #pressure #midwife…

Learning about #research associated with @NPEU_UKMidSS at #BBresearch17 with @RachelRowe3 #whywedoresearch #MatExp #obesity @HinchMidwives

Learning so much about #research at #BBresearch17 with Prof. Soo Downe #whywedoresearch #NIHR #hypnosis #MatExp #childbirth #analgesia

Getting a wave from miles away from @JennytheM across the miles #bbresearch17 sending #SkinToSkin & midwifery love to us all …..

Powerful words from @helen_shallow at #BBresearch17…. how do we cope as midwives, & ensure excellence in maternity care?

And of course.. ##bbresearch17 learning all about making sure that blood goes to baby with @bloodtobaby with @optimalclamping…

Learning about the barriers to identifying poor #perinatalmentalhealth shared by prof @JulieJomeen at #BBresearch17 #mentalhealth #MatExp with @HinchMidwives

Yet there were a couple of overarching themes that came from the day…including….

 

Thank you to everyone who came to see these wonderful presentations (including those who came to see my own presentation of course – you gave me lots to think about!)!…and thank you all for such an intimate and heartwarming day discussing my favorite topic…Research in Midwifery 😍…

 

And a last word from the Head of Midwifery at Hinchingbrooke  Hospital….(Heather Gallagher)…..

If you would like to follow the progress of my work going forward..

Follow me via @SallyPezaro; The Academic Midwife; This blog

Until next time…Look after yourselves and each other 

 

‘Making & Breaking the Maternity Experience’#Uclhmw2016 – A midwifery conference

Attending and presenting work on midwife wellbeing at #uclhmw2016, I was thrilled to see so much of one conference dedicated to supporting the midwife, as well as the mother. I was also keen to hear  Jacqui Dunkley-Bent update us all on the new plans for maternity services in 2017! – Bring it on!

-Improvement in Perinatal mental health in maternity services was highest on the agenda as we can see here – midwives were really responsive to making these a commitments a reality.

Yet we can see that NHS England is also looking to transform the workforce as part of this plan. There are so many ideas buzzing around my head at the moment that I am feeling dizzy… “so much to do and so little time” – As Willy Wonka would say.

We also saw how mothers are experiencing poor support in decision making…

Both @QuashieMichelle and @CArmstrongLDN really must be heard by all midwives, everywhere, more often! Read more about these experiences here. …and here.

Women are roaring for change!

There are so many great resources available from dignity in childbirth @birthrightsorg… We really need to challenge the way that women experience respect in maternity care.

And the #CaringForYou campaign?

Sadly, bullying still a real issue in midwifery, as @JacqueGRCM confirmed … punity, public shaming & undermining must stop.. We must be kinder to one another…remember why we became midwives in the first place and love each other for the critical safety of mothers and their babies.

…..more  is needed!

We must ‘Create a positive culture’ –  @JacqueGRCM says at #Uclhmw2016

What can we do?

There is indeed much to be done. I wanted to personally thank @Yanarichens, and @MaureenMcCabe15 (and their teams) for looking after me so well as a speaker at this conference myself. I have never been so well looked after at a conference 😘😍

And thank you to all of those who appreciated my presentation and engaged in this very important work. I love this particular image that people have been sending me (see below)…I believe it was created at the#BirthTrauma2016 conference & shares a powerful message 💜💙❤💚

There really is so much to do and so little time!

As a last thought introduced to us by Sheena Byrom ‘Midwives are humming birds never too small to make a difference’

Until next time – Take care of yourselves & each other ❤💚💙💛

Reflecting on the #MaternalDeath report from @mbrrace as a midwife…💜

During the December of 2016, everyone involved in the provision of care for childbearing women (and the women themselves) began to reflect upon the findings of the latest Confidential Enquiry into Maternal Death. As a midwife, I am dedicated to supporting, protecting and caring for other midwives, childbearing women, babies their families. There is no doubt in my mind that these deaths have affected all of these groups profoundly, and society as a whole. But before we begin to reflect, let’s remember that the mortality surrounding childbirth (in the UK) is thankfully rare #savingmotherslives

#mbrrace #savinglives #MentalHealthMatters #MatExp #maternalmortality

 

When we lose mothers…we also tragically effect babies…The Stillbirth and Neonatal Deaths charity (Sands) responds to new MBRRACE maternity report here

There is no doubt that we must learn from all of these #MaternalDeaths as the president of the RoyalCollegeObsGyn ‏explains here. Clearly there is much learning to do and many improvements to make. These key messages should remind us all to ask the question…start the conversation…notice the subtle clinical cues which alert us all to danger, react to risk and remain emotionally intelligent to the needs of childbearing women.

However, what struck me most was the sheer number of women who die from mental health related causes. The MBRRACE report found that “one in seven of the women who died during the period of review died by suicide. Although severe maternal mental illness is uncommon, it can develop very quickly in women after birth; the woman, her family and mainstream mental health services may not recognise this or move fast enough to take action”.

You can read the ‘expert’ reaction to MBRRACE-UK report citing mental health as main cause of perinatal death here. Maternal mental health matters – toolkit now available from @MMHAlliance for those developing a community perinatal mental health service.

Learning to save maternal lives and making change happen will not only improve the lives of mothers, babies and families. It will also improve the lives of midwives, as they will be better equipped to give the care they would like to give as their job satisfaction improves. When the psychological wellbeing of midwives is left uncared for, maternity services may see less safe maternity care. When we care for midwives, the safety and quality of maternity care may also improve. This will in turn contribute to a reduction in maternal mortality rates. So when we are looking to improve maternity care for women, their families and their babies, lets make sure that we also look to support those who are caring for them. It really is two sides of the same coin.

What can we promote?

= That it’s “OK to ask”

How can we support women & midwives? = With trust, compassion & respect

How can we improve safety?

= Evidence based care & excellent communication

 

Looking globally?

Key messages taken from the evidence base

Preventable maternal morbidity and mortality is associated with the absence of timely access to quality care, defined as too little, too late (TLTL)—ie, inadequate access to services, resources, or evidence-based care—and too much, too soon (TMTS)—ie, over-medicalisation of normal antenatal, intrapartum, and postnatal care.

Although many structural factors affect quality care, adherence to evidence-based guidelines could help health-care providers to avoid TLTL and TMTS.

TLTL—historically associated with low-income countries—occurs everywhere there are disparities in socio-demographic variables, including, wealth, age, and migrant status. Often disparities in outcomes are due to inequitable application of timely evidence-based care.

TMTS—historically associated with high-income countries—is rapidly increasing everywhere, particularly as more women use facilities for childbirth. Increasing rates of potentially harmful practices, especially in the private sector, reflect weak regulatory capacity as well as little adherence to evidence-based guidelines.

Caesarean section is a globally recognised maternal health-care indicator, and an example of both TLTL and TMTS—with disparate rates between and within countries, and higher rates in private practice and higher wealth quintiles. Caesarean section rates are highest in middle-income countries and rising in most low-income countries. Although researchers partly attribute the increase and variable rates to a shortage of clear, clinical guidelines and little adherence to existing guidelines, multiple factors—economic, logistical, and cultural—affect caesarean section rates.

Quality clinical practice guidelines need to be developed that reflect consensus among guideline developers, using similar language, similar strengths of recommendation, and agreement on direction of recommendations.

Strategies for enhanced implementation and adherence to guidelines need multisectorial input and rigorous implementation science.

A global approach that supports effective and sustained implementation of respectful, evidence-based care for routine antenatal, intrapartum, and postnatal care is urgently needed.

There is much work to be done. Until next time, take care of yourselves and each other 💜💙💛

Mentorship in healthcare and research: Role modelling for excellence

Mentoring, coaching, role modelling, training…. leading….Whatever you want to call it, I would be nothing without it. That phrase was once hurled at me as an insult…

YOU WOULD BE NOTHING WITHOUT ‘X’ – Well yes..That is true.

Workplace cultures in healthcare and research are created and shaped by what we do rather than what we say. Simply put, the way we behave is how we end up living. Although we can all be influenced by what we see, hear and experience …YOU can choose how you will and won’t behave. You can equally decide what behaviour you will and will not accept from others. But who will show us the way we want to go?

As I remember training to be a midwife, many people said …”‘take the good bits and leave the bad bits’ out of your own practice, as you develop and grow alongside your mentor”. I did this, and yet it took me a long time to define who I wanted to be as a professional. Some mentors were good, and some mentors less so – personal preference perhaps?… Many tried to direct the way in which they wanted me to go, and it took great courage for me to challenge this directive behaviour. However, as my career progressed, I was able to study Leadership in health and social care at Masters degree level. This really helped me to understand the theories behind good and bad mentorship…

A good mentor:

• Has confidence in you
• Trusts you
• Empowers you
• Gives constructive feedback
• Wants you to succeed
• Supports your new ventures
• Listens to your new ideas
• Identifies your strengths and helps you develop them into constructive outputs
• Identifies your weaknesses and helps you manage them effectively
• Shares their wisdom
• Gives you wings to fly
• Behaves with integrity, professionalism and dignity
• Inspires you
• Is kind to you (and others)!
• Feeds your passions and thirst for new opportunities
• Invites you into their network of expertise
• Grows with you as you as a professional

A bad mentor:

• Is concerned only with their own success
• Talks about doing things that never happen ‘All talk’
• Is always negative about everything and everyone
• Is never around
• Cannot commit to your development
• Bullies you
• Dictates how you must behave
• Doesn’t pay attention to the way you would like to develop professionally
• Never admits when they are wrong
• Refuses to believe that you may know more than them in certain areas
• Compares you with others (negatively)
• Never lets you progress
• Kills your confidence
• Makes you feel bad about yourself

Once you find your way, it is important to find the courage to decide which behaviours you are willing to accept, and to role model yourself for the benefit of others. These are important choices to make, as they will contribute to the cultures in which you and your colleagues will be working. Ask yourself the following:

• What do you need in order to be productive?
• What do you need from others in order to thrive professionally?
• How do you want to behave?
• What are you willing to accept?

The answers to these questions must be acted upon. Have the courage to communicate these needs…Others will want you to succeed, they will appreciate this information…

…If not…..are you willing to accept that?

My final tip for ultimate success is to find your flock. Gravitate towards those who inspire you… hang around with those who allow you to fly…. learn from those who lift others up and share your thoughts with those who seek out change.

I would be nothing without my ‘Flock’…my wonderful mentors and my inspiring colleagues.

Each and every one of us ‘mentor’ a growing professional every day (whether we realise it or not)! Therefore each and every one of us needs to decide how we want to behave every day..We all create the workplace cultures, leaders and workforce of the future. Lets create something wonderful…

Thank you to all of you wonderful mentors out there….

Until next time, look after yourselves, and each other 💙💜💚

Birth Rights & Attitudes Towards Autonomy in Maternity Care

This blog post shares some of my learnings from and reflections of a seminar I attended recently, hosted by the Birthrights group at University Hospitals Coventry and Warwickshire. I have always found medical law very challenging to understand, even having studied it at Masters level…I am still largely perplexed by the complexity of it all. Yet this session seemed to simplify things for me, offering case studies and easy to understand facts…for which I am very grateful! For further learning, please see more factsheets here.

Many of the topics under discussion were drawing from the work of the White Ribbon alliance, which I am highly drawn to in their quest to promote the wellbeing of midwives for the benefit of services around the world. Below I will discuss a few of the topics highlighted which have aroused my interest in relation to my own practice.

“Women have the right to choose how and where to give birth, but they do not have the right to put their baby at risk”. – (Lancet 2010).

This publication evoked moral discomfort within me immediately. Having previously practiced as a home birth midwife, I am used to challenging the notion that home birth is a less safe option where mothers put their babies at risk. As with many studies which examine the safety of various birth places, I often see biases where the skill of the birth attendant and other relevant factors are seemingly ignored to promote the argument that ‘It wouldn’t have happened if you had only been in hospital’…But the thought that women are putting their babies at risk (and choosing to do this) fundamentally goes against my own clinical knowledge and beliefs.

This paper has led to some women having forced cesarean sections…surely this is a path which nobody wishes to go down.

The discussion and debate around fetal rights has also led to mothers being prosecuted for drinking alcohol during pregnancy. This is a moral pathway which sees the woman become a vessel for a means to an end, rather than being an end in her own right. Again, do we really want to take this path? Having explored ethical arguments myself, I think there is a better way..

In this same vein, the issue of when a fetus has rights or not has also been debated and contextualized. Now that the 24 week limit upon abortions has been lifted (decriminalized), it is clear that the mother has more choice in her reproductive decision making abilities. For me, this can only be a good thing.

Human rights-based approaches guided by the World Health Organisation

• Non-discrimination: The principle of non-discrimination seeks ‘…to guarantee that human rights are exercised without discrimination of any kind based on race, colour, sex, language, religion, political or other opinion, national or social origin, property, birth or other status such as disability, age, marital and family status, sexual orientation and gender identity, health status, place of residence, economic and social situation’.
• Availability: A sufficient quantity of functioning public health and health care facilities, goods and services, as well as programmes.
• Accessibility: Health facilities, goods and services accessible to everyone. Accessibility has 4 overlapping dimensions:
  • non-discrimination;
  • physical accessibility;
  • economical accessibility (affordability);
  • information accessibility.

Healthcare practices that violate human rights: Drawn from the Charter for Respectful Maternity Care

Physical Abuse: Episiotomy , non consensual force, restraint, unnecessary procedures, failure to provide pain relief

Disrespect: Verbal abuse, bullying, blaming, shaming and reprimanding

Non-confidential Care: Unauthorized revelations and psychical exposure

Non-consented Care: Anything performed without adequate information or dialogue to enable autonomous decision making, or with undue pressure

Misinformed Care: biased, non transparent information given, which inhibits a woman’s ability to make an informed choice

Depersonalized Care: Inflexible application of policies or guidance, which fail to take into account of a woman’s individual circumstances.

Discriminatory Care: Unequal treatment based upon personal attributes (age, race, religion).

Abandonment of Care: Refusal to provide care due to inability to pay or birth choices (or any reason)!

Check out the Birthrights info on human rights in childbirth here

Attitudes to Autonomy

Lastly, the following statement from a paper published in 2013 had me thinking about the impact of blame cultures within our maternity services.

“Both maternity care professionals demonstrated a poor understanding of their own legal accountability, and the rights of the woman and her fetus. Midwives and doctors believed the final decision should rest with the woman; however, each also believed that the needs of the woman may be overridden for the safety of the fetus. Doctors believed themselves to be ultimately legally accountable for outcomes experienced in pregnancy and birth, despite the legal position that all health care professionals are responsible only for adverse outcomes caused by their own negligent actions.”

The statement outlines how both midwives and doctors are happy to accept that the mother has the right to make any final decisions, yet they were under the impression that it was them a the practitioner who would be legally accountable for any adverse outcomes which occurred. This may be in part due to the nature of our regulatory and litigation systems, which can invoke a fear in practitioners that they will be ‘blamed’ in some way for any adverse outcomes.

Yet adverse outcomes occur all of the time, in any case, and sometimes cannot be controlled. This is of course very sad…yet it is also an inevitable reality of some women’s childbearing experience. Nobody’s fault.

When women have true autonomy and the power to make their own decisions around childbirth, they also have inherent accountabilities in relation to the choices they make.

That is why it is more important than ever to make sure that we are recording the conversational dialogue that we are exchanging with women. Consent forms really have no use unless the information can be recalled and maintained. The law dictates that we must be open, honest and avoid influence in open discussion with women.

I personally believe that these conversations would be best recorded in digital format. See my paper on this here.

As always, it is the relationships we build with women that will always be the key to building trust, opening dialogues and beginning advocatory conversations which support women’s ability to make truly informed decisions. We must work in partnership with women and the wider multidisciplinary team in order to ensure that women can make the right decisions for them, and in turn take accountability for the decisions they make. We can only do our best in managing any situation to the best of our abilities as midwives (and as any other clinician). That is what we are personally accountable for.

(Image via http://hakam.org.my/wp/)

Until next time – Look after yourselves and each other  💛💙💜💚

Why the health, wellbeing & engagement of #NHS staff matters..financially, practically & morally speaking…

I spend a lot of my time talking to clinicians, managers, commissioners, those outside of healthcare and leaders about the importance of promoting and supporting staff wellbeing within the #NHS workplace. Some are already on board with the reality that excellence in healthcare simply cannot happen in the absence of a workforce that is cared for and nurtured to thrive. Others feel discomfort at the thought of caring for staff when the ‘patient comes first’ and some simply don’t know what to do for the best. In any case, nobody seems to want to destroy the NHS workforce (correct me if I am wrong)!… and everyone seems to want to learn more.

A good staff experience where staff feel ‘engaged’ is critical to  achieving excellence in healthcare…What do we mean by ‘Staff Engagement’?

‘Institute for Employment Studies (IES), defined staff engagement as a positive attitude held by the employee towards the organisation and its values. An engaged employee is aware of business context and works with colleagues to improve performance within the job for the benefit of the organisation. The organisation must work to develop and nurture engagement which requires a two-way relationship between employer and employee (Robinson et al 2004, p 4).’

Recently, I was asked to provide some evidence as to why the wellbeing of NHS staff matters by someone else who was keen to make a difference in this area. They needed to make the case to others in order to make change happen. I imagine that lots of other change makers will be needing to provide evidence too, and so I have set out some arguments for the case below. I hope many of you will find it useful to have some of the arguments in one place.

Please feel free to share this evidence widely with others…. If you have other evidence to add to this, please feel free to comment below…

(There can never be too much to share)!

Financial reasons to care for NHS staff:

Over 2014/2015, the NHS Litigation authority (NHSLA) paid over £1.1 billion to patients who suffered harm and their legal representatives, this coming year it will be c £1.4 billion and with accumulated provisions in our balance sheet of over £28 billion further significant increases are already in the pipeline. When staff are unwell, in psychological distress, communication is hampered by poor working cultures and there is a lack of staff engagement, NHS staff are more likely to make medical errors (Hall et al, 2016).

Good staff health, wellbeing & engagement = reduced medical errors = reduced litigation costs

Estimates suggest that recruiting a nurse from overseas costs between £2,000 and £12,000 and return-to-practice costs some £2,000 per nurse, while training a new nurse costs around £79,000. Additionally, recruitment costs to replace staff who leave owing to work-related stress and/or poor job satisfaction is estimated to be £4500 (More for senior posts). As such, in order to get best value for money, the NHS will need to work hard to retain and recruit a high quality workforce.

Good staff health, wellbeing & engagement

= Increased recruitment and retention = Best value for money

Staff sickness absence rates cost an estimated £3.3million annually per NHS organisation. When staff are absent, there is the added cost of agency staff to fill in gaps (The NHS Improvement team now expect the NHS to spend a total of £3.7 billion on agency staff by the end of the 2015/16 financial year).The Francis inquiry into Mid Staffordshire also exposed the consequences for patients and staff of not addressing this issue of staff morale and sickness. Typically, if an NHS organisation reduced staff sickness rates by a third,it would provide an additional 3.4 million working days a year for NHS staff, equivalent to 14,900 full-time staff, saving an estimated £555 million.

Good staff health, wellbeing & engagement = Decrease in sickness absence = reduced agency/sickness spend & therefore, improved patient care

(Image source :http://www.slicedbread.co.uk/solutions/employee-engagement/)

Practical reasons to care for NHS staff:

Ultimately and practically, the NHS exists to provide high quality and safe care to patients. Evidence so far shows that better staff health and wellbeing is associated with improved patient outcomes.

Some of the many benefits to improved NHS wellbeing is that better staff health results in lower infection rates and lower standardised mortality figures. The Keogh review of 14 hospital trusts with high patient mortality rates found all these trusts also had higher levels of staff sickness, compared to national average.

Good staff health, wellbeing & engagement = Safer and higher quality patient care

When an NHS organisation invests in staff health, wellbeing and engagement, they improve their ‘Brand’. Branding is one of the most important aspects of any business, large or small, and its impact shouldn’t be underestimated when it comes to engaging staff with health and wellbeing initiatives.

Good staff health, wellbeing & engagement = Your NHS organisation looks good & therefore attracts more staff

A report from the Kingsfund suggests that job satisfaction, organisational commitment, turnover intentions, and physical and mental wellbeing of employees are predictors of key organisational outcomes such as effectiveness, productivity and innovation. Everyone wants more of these things..right? They all have the potential to save money and improve the safety and quality of care.

Good staff health, wellbeing & engagement = Higher productivity, staff effectiveness and innovation = Cash savings and better services

Moral reasons to care for NHS staff:

Staff are entitled to a psychologically and physically safe professional journey. Caring for them is not an optional issue, it is an ethical one.

 

When staff are well cared for, they experience greater job satisfaction, improved morale and general wellbeing. Few aspire to be ill, and many feel great shame in letting others down or asking for help.

Where the emotionality of distressing work  remains unrecognised and void of support, distorted thinking, emotional distress, reduced productivity, increased sickness rates, poor decision making, and maladaptive patterns of behaviour may present. Physical symptoms can also result, where severe job stress evokes irregular menstrual bleeding patterns for female healthcare workers, poor sleep quality and bodily exhaustion.

The NHS workforce is one of the largest work forces in the world. They are patients, they are the public, as are their friends and families. As such, by caring for this group, we are also caring for a large part of society. Moreover, there is also a strong statistical link between the wellbeing of staff and patient satisfaction. This means that if we are failing to care for staff, we are also missing an opportunity to improve patient satisfaction.

Good staff health, wellbeing & engagement = A nice and decent thing to do for all.

There are many more reasons for NHS organisations to care about the the health, wellbeing & engagement of their staff..Financially, practically & morally speaking… Please feel free to add these below.

I hope that these few facts and figures can be shared and used to convince everyone throughout the NHS of these facts. Many will say that it is the patient that must come first. However, I argue that excellence in health and social care may only be achieved if both the staff and patients are cared for equally, as they work in partnership to achieve the best outcomes.

Looking for ways to turn this vision into practice? See my blog on 20 ways to create a thriving NHS workforce here

Until next time, look after yourselves and each other 💛💙💜💚.

Following #Expo16NHS..I could be replaced… ‘technically’

And so another NHS Expo conference comes to an end. It was a lively 2 days with lots of amazing people coming together to share new ideas about the future of health and social care.

The conference was largely dominated by the digital and technical innovations that may help to create the NHS of the future (and make it better presumably)… I have always been interested in how technology may make a variety of health care improvements…I have written about one of my ideas here.

Sir @DrBruceKeogh providing a broad outline on recent ground breaking #healthandcare digital innovations #Expo16NHS

The digital news as reported by @keithgrimes was as follows:

• Patients will be able to book appointments, order medications, and download records, US ‘Blue Button’ style, on a revamped http://www.nhs.uk to be launched at Expo 2017.
• Anyone will be able to access detailed stats on performance in key areas such as dementia, diabetes, and learning disabilities
• There will be online access to 111, which can lead to direct appointment, signposting, or callbacks.
• By March 2017 there will be a directory of approved apps from March 2017, with subsequent support for wearables
• 12 hospitals to become “Digital Exemplars” – each receiving £10m funding, matched by trust, and partnering with world leader organisations.
• The creation of a second round of ‘national’ excellence centres, with more detail to follow.
• The creation of an NHS Digital Academy to teach Informatics skills to NHS staff and create the next generation of Clinical Chief Information Officers and Digital Health Leaders.

And for more digital ideas….

MY DIGITAL FOOD FOR THOUGHT…

Often, whilst working clinically as a midwife, I also find myself behaving like a robot… (Don’t worry… I obviously use my gut and intuition too)!…but really, as midwives we are calculating risk at all times….like a computer. Also…we follow certain pathways as midwives…if a blood pressure becomes out of range…we take the next prescribed step in making a referral or delivering a new treatment to fix it. A computer could do this.

Imagine a woman coming into a clinic to see a robot (of sorts). She is scanned, measured and given the full M.O.T that she would normally receive from a midwife, but it is the robot who calculates the risks and the next steps to take. At the end of the exam.. the robot gives the woman a print out report, which outlines what should be done next in light of any new findings. The robot can answer questions too…

…(hopefully better than google can)

…or it can tap into a Skype call with a registered health professional. Imagine a future like this..better or worse? In a pressured maternity service, this could indeed be the new way of things. Could I be replaced as a midwife?…’technically’?

I think not. But a digital future like this could certainly support midwives in practice. Would it be safer? are human errors more common than digital ones?… Certainly worth exploring I think.

What do women want from their midwife? A human face? compassion? Human touch?…None of these could be delivered by a robot (probably)… and so perhaps a digital future like this would afford midwives more time to be compassionate and ‘human’..

MOVING ON…

Also at Expo.. there was @roylilley….with @JaneMCummings

Singing ‘Always look on the bright side of life…’

Obviously they were doing this to celebrate and introduce #FABCHANGEDAY

..not far away now (19th October 2016)

And we also heard more singing as we enjoyed a very moving rendition of “I will try to fix you”…

By the @NHSChoir for the #KGAwards16 at #Expo16NHS

#kategrangerawards from #expo16NHS with bonus live sessions from @Choir_NHS

My colleagues and I also presented our #ShowsWorkplaceCompassion research for the first time and some of the other work we have been doing in partnership with @NHSEngland to commission for a positive staff experience. Thank you to everyone who came along and shared thoughts and ideas to help us shape this project.

I was also invited to join sessions on the

Maternity Transformation programme: Delivering the 2020 Vision at #Expo16NHS #MatImp #MatExp #BetterBirths #BUMP

and the …

@empathymuseum at #Expo16NHS #WalkAMileInMyShoes via @HealthFdn.

Click the links to read more….

Next year, I hope to be sharing more research and ideas. No doubt I will still be on my quest to improve the staff experience within health and social care..after all… patient experience and staff experience are both sides of the same coin..

See the Twitter activity from#Expo16NHS here

Until next time…be kind to yourselves, and eachother