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As the team’s roles come to an end in March 2019, here we share some of what we have learned over the years… 

5th December 2018
Dear <<First Name>>

We are delving more deeply into why safer care is only possible if we care for those who care for patients. Last week we looked at how the complexity of healthcare makes it a difficult environment to work in day to day; this coupled with current pressures, unhelpful cultures, high rates of stress, incivility and bullying, makes it really hard for healthcare staff to work safely – you can catch up on that if you missed it here.

#4 Our message to you this week;

The safety of patients is dependent on the members of staff who interact with them being physically, psychological and emotionally well, and able to cope with the complexity of their day to day work.


To be physically, psychological and emotionally well, people need to be fed, watered, emotionally supported, thanked, rewarded, recognised, cared for, even loved, and helped to feel proud about what they do and to feel joy in their work.

Staff wellbeing is increasingly being understood as almost the most important aspect of preventing error and harm, and the time has come to apply these insights to the way we approach patient safety in the NHS.

Health and wellbeing includes being treated with respect and kindness (mental health and wellbeing as well as physical). Helping people enjoy their work is one way to show that respect and is proven to improve quality of care, staff engagement and wellbeing.
 
The key is to recognise that people are not the problem but are our greatest assets. We all have something to contribute but this needs to be discovered.  We often need help to find the roles most suited to our skills so ask questions of yourself and those around you. What are people naturally good at? What skills have they acquired? What are they passionate about? What could they learn? Always start with people’s strengths.
 
Another way to foster wellbeing is to bring people together and give them the opportunity to talk to each other. Listening to what others know, what needs to change and what needs to stay the same gives you a better grasp of work as it happens versus work-as-imagined.

Remember, how we talk to each other matters just as much as what we say.  Seek to really understand the problems you are trying to solve and how your staff can help by talking to them, asking them what matters to them, and what they know. 
 
Nearly everyone’s jobs affect patient safety, either directly or indirectly; to work safely, we all need to consider how we (our behaviours and actions) contribute or stand in the way of a safety culture.

What we think and feel about this

Suzette has written quite a bit about the role of joy in work. Her blog Joy and Happiness looks to understand what ‘joy’ is and how to help colleagues experience it. Another blog delves into the role that leaders play in creating joy for those they work with. 

Like we said, genuinely talking with the intent to listen is a great way to show kindness and respect for those around you. But, how do we approach difficult conversations with each other? Cat has written a brilliant blog about ways that we have found work, including; laying the groundwork, showing gratitude and coming from a place of humility rather than power

With growing evidence about how our behaviours and actions affect those around us and their ability to perform, our Associate Director, Dane Wiig, has just written about how nearly everyone's job affects the safety of patients.
 
What others think and feel about this

Appreciating People, who offer appreciative inquiry training, have an article on the power of appreciative journaling, reminding us that, although our wellbeing is dependent on many factors, one of those factors is ourselves. Training yourself to actively locate the good things around you, no matter how small, can help you deal with adverse situations more effectively. Moving away from the negative mindset that is pervasive in healthcare to a more positive one should also ring a bell if you’ve done any reading on Safety II.

 
That positive reframing is what underpins Learning from Excellence, who have been working with appreciative enquiry for the last two years. Appreciative enquiry courses were offered to people starting their Learning from Excellence journey and here’s a look at what they involved.

 
Kaleidoscope Health and Care explored staff wellbeing earlier this year with a series entitled NHS Joy where they look at the effects joy can have on our work and where we can find it. The latest blog in the series is from the founder of Buurtzog, a nurse-led healthcare organisation. It talks about the role the system can play in creating joy by injecting some “creativity and excitement” into the work we do.
 
 
The evidence for the benefits of setting aside time to talk is clear. This study shows that healthcare staff who regularly attend Schwartz Rounds to share the emotional, social, or ethical challenges they face in the workplace, experience less psychological distress, improved teamwork and increased empathy and compassion for patients and colleagues.

 
Someone else who sees the value of talking is Wanda Kaye Hambrick, Vice President of Quality and Patient Safety for Baptist Healthcare (Pensacola, Florida). In an interview with IHI, she shared her experience and advice on what makes a good leader. The article deserves to be read in full but if you’re short on time Wanda’s take-home message is to talk with others and prioritise people.
 
 
The Royal College of Surgeons in Edinburgh have recognised the detrimental effect that bullying, no matter how subtle, can have on staff wellbeing and quality of care - and the figures are with them. The consequences of bullying and harassment in the NHS cost the service in England at least £2.28bn (€2.58bn; $2.96bn) a year, an analysis suggests, and healthcare professionals have attributed disruptive behaviour in the perioperative area alone to 67% of adverse events, 71% of medical errors, and 27% of perioperative deaths.

Their cleverly titled anti-bullying campaign, #LetsRemoveIt, hosts a huge amount of resources on topics including; the research and literature, the law, how to recognise if you (yes you) are a bully and what you can do if you’re being bullied.

 
This report on employee engagement and NHS performance commissioned by The King’s Fund summarises the evidence and theories underlying the very clear connection between the two. There are many factors that influence engagement and a significant one, that the report recognises, is the perceived levels of support that people have from the organisation and from supervisors. As you might expect, the correlation is a positive one but the real lessons are the ways in which engagement can be fostered.

 
The logical step to make if staff experience impacts on performance would be to look at how that, in turn, affects patient satisfaction. This analysis of surveys from 2014 and 2015 does just that. It’s quite in-depth, so worth setting aside a little bit of time, but definitely worth the read to understand how having the right conditions to deliver patient care is about more than the absence of negative experiences: it is about being able to work effectively together in effective teams, with well-designed jobs.

 
This blog, from ED consultant Simon McCormick, on post-breakdown thoughts on emergency medicine, is an incredibly useful and insightful window into what can happen when staff wellbeing isn’t a priority. His post ’10 things to know about burnout’ was originally written for the 10 Things To Know website which Suzette wrote an article for, about caring for people who care. 


And, if you're more of a visual person, Ted Talks have compiled a playlist of 12 brilliant minds talking about why joy is so important, how to notice it and how to build it into your life.
Through Sign up to Safety, with your help, we’ve moved forward the understanding of what patient safety is, what it really means in practice, and how we can help people to work safely.  Everything we have heard across the five years has amounted to a clear understanding that safer care is only possible if we care for those who care for patients.

This issue is one of a series of newsletters which run all the way up to the end of March 2019 and that together explore this in detail. This collection makes up our last gift to you so that you can take this learning and continue this work in practice at a local level.

Stay with us each fortnight to receive evidence, practical resources and opinion that will help you gain a deeper understanding and give you what you need to help people in your organisation work safely.

With best wishes,

Suzette Woodward, Dane Wiig, Cat Harrison, Adam Mohamed
The Sign up to Safety team

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