The Big Conversation about the Quality of Nursing ... - CLAHRC-NDL

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The Table Top Discussions Delegates were allocated tables so that people were distributed and each table was facilitated by a member of the Board or from East Midlands Leadership Academy. The tables were asked to engage with: 1. What is good practice, what are we getting right? 2. When and how are we letting our patients down? 3. What is needed and how will we know we are delivering good quality care consistently? Delegates were firstly asked, “What are we getting right?”. Although the conversations started with thoughts about good practice, tables soon slipped into conversations about poor practice. One group noted, “We are not good at blowing our own trumpet and it‟s hard because there is no point of reference”. The conversations recognised that intentions are usually good which should be appreciated, however practitioners are reticent about celebrating what they do well. Good practice should be celebrated and talent should be spotted at whatever level. Nurses are good at listening and big thoughts need to be retained and shared. When considering „how we are letting our patients down‟ and „what is needed and how will we know we are delivering good care‟, a number of issues were discussed. These included organisational culture, the impact of time, problems of communication between different services and a lack of staff. Delegates wanted a „no blame‟ culture, however, they also highlighted the stigma of mentioning a shortage of nurses; it was seen to be regarded as „an old chestnut‟. An honest discussion was often not had for fear of reprisal amidst a highly political context. The lack of ownership over patient care was highlighted and it was considered important to find evidence that there were problems, there is a need to sharpen up thinking but there are concerns that this may „kill‟ the Darzi principles. It was noted that nurses can and do expose poor practice, however, communication needs to be improved to make this more effective. Delegates also talked about the need for good leadership and clinical supervision to support exposing poor practice. Groups used stories to help understand each other‟s perspectives and recognise how poor practice is manifest. It was noted that the understanding of culture often comes from intuition - a gut feeling. This is not problematic if used against indicators, but intuition still needs acting on. Nurses need patients to help them to evaluate care, however, patients are not always able to recall details retrospectively. Members of Derbyshire LINk informed other delegates about their model of partnership and successful visits to care homes and how this information was used by NHS Derby County. Delegates representing from LINk had brought patient feedback 8
which were complimented by groups swapping real life stories with each other and considering what it must feel like to be a patient. It was suggested that we are dominated by targets and numbers and forget people. A return to patient/nurse thinking was called for rather than just thinking about the process. It was suggested that stories should be used in meetings with business managers to help them to understand the anomalies in the service and processes. The problem of understanding different „languages‟ between roles was recognized, however, so much so, that things often need spelling out. This was recognised to be part of the” game we play”. It was also suggested that issues could be themed or to think about the internal and external factors that influence nursing care. Following the plenary, several key points emerged. These included a welcome of the patient focus (putting their patients first), to get the basics right and encourage a just, fair and „no blame culture‟ where nurses care for each other and celebrate success. Communication was considered to be central to providing excellent care and managing expectations and education and training should be at all levels, including the Board. There was also a strong recognition that there needs to be more collaborative working and sharing of good practice and systems, and we should all ask what we would want for our own VIPs. Story telling dominated the conversations at the tables. 9
Page 1 and 2: The Big Conversation Tit about the
Page 3 and 4: About the author Bridget Roe is a d
Page 5 and 6: Acknowledgements The author is grat
Page 7: Executive Summary Background This m
Page 11 and 12: someone noted, develop an “NHS Sp
Page 13 and 14: Feedback Around 50% of delegates fi
Page 15 and 16: Report of the Day’s proceedings T
Page 17 and 18: 11. Variable quality of monitoring/
Page 19 and 20: 2. Delegate: Are things worse? DEF:
Page 21 and 22: often do not take responsibility an
Page 23 and 24: Delegates from learning disability
Page 25: About CLAHRC-NDL The Collaboration

The Big Conversation about the Quality of Nursing ... - CLAHRC-NDL

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