Safety Culture feedback

The first of our safety culture feedback sessions happened today(2017-03-20) following the recent survey looking at issues from burnout to feedback, safety to leadership. It’s an opportunity for a ‘pulse-check’ on the workforce within the ED team and how well we feel we’re looking after our patients, ourselves and each other. The aim of the feedback meetings is to unpack some of the issues that continue to affect us as a team and strive to hear and respond to themes, problems and opportunities raised by you! They are also a moment to celebrate the excellent work we do in the ED often in a super tricky environment.
We spent a while hearing people’s feelings on the access to leadership in the department (in all of its forms). It was suggested that doctors would benefit from another consultant on the shop floor in the mornings for more informal advice and supervision without ‘bothering’ the already swamped Fat Controller. Nursing staff shared similar feelings of protected time for teaching and professional development not being anywhere near protected enough! Recently the medical team have started a specific work-placed-based-assessment clinic once a week to intentionally tackle some previously raised concerns. ​

Is it possible to take the best bits of this model for other staff groups? How do we change our culture to appreciate, value and celebrate the great things we do more effectively? 
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​On that theme all staff groups highlighted a lack of positive feedback within the team; “the only positive feedback is the lack of negative feedback”. Who doesn’t like to be told they’ve done a good job or made a great decision or that their kindness has been noticed and appreciated? As humans we thrive on encouragement and positive words no matter what our exterior might say! There are loads of opportunities to spread some feedback love in the ED right now! Try a Greatix (like a datix but happier…see what we did there?!?), a thank you card or even toning down the cynicism to actually acknowledge “what went well” at the morning nursing briefing or contributing to the new “overnight success story” at medical handover. Look out for more feedback training for all staff roles and grades.
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​As a department we reported that we deal with difficult colleagues frequently both within and without the department. Many of us recognised that even those people we cannot see (the SAU coordinator or neurosurgical reg for example) are probably also working hard and feeling somewhat ‘maxed out’. 

Applying a little empathy to our colleagues and giving a little grace for those times when we make mistakes/snap our answer/forget to smile whilst calmly and politely objecting to and ‘calling’ unacceptable behaviour might make all of our lives a little happier. Sometimes empathy actually makes life a little tougher – like when we recognise we are not supporting our colleagues as we would like or providing the level of care we would expect because we are busy or have too many other demands. This has been expressed in the departmental burnout scores with all staff groups recognising that the team are working unbelievably hard without always the resources or support that they may need. The departmental scores are higher than those reported by individuals however and the ‘coffee room’ chat may play a part in this…. As Oprah says (!), “what we dwell on is what we become”.
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There was recognition that some of the band 6 nurses have had little or no management training and that there is a lack of protected time for management responsibility or development. Previous day with Dr Gurney had good feedback but more like this would be welcome.
It was great to have representation from the receptionist team and they brought a variety of ideas and suggestions. From this meeting Suzy is looking to set up a ‘book drop’ in the waiting room and the TV for waiting room project is to be revitalised! There was talk around consistency of approach from medical and nursing staff towards the booking in of trauma patients and when reception staff request assistance for patients prior to triage. We are hoping to find a consultant to link with the reception team and work on some of these areas.  They are geographically cut off from the rest of the department and we need to make sure all other staff groups support them. We all set the tone for behaviour within the department and must not tolerate or reward rude, aggressive behaviour from patients. We’d also love a member of the reception team to join the morning minors safety brief!

So, take homes! ​

• Positivity in our words helps set an atmosphere (just because it’s touchy-feely doesn’t mean its not true!).
  
• Everyone is stressed, lets assume the best of everyone. 
• No one objects to being told they’ve done a good job – lets do that more. 
• People need education, support and supervision, we need to protect that even more and build more of it into our everyday leadership roles and functions. 
• Reception are a key staff group and need our support even when we can’t see them. 
• ​Life in ED is tough – you are not alone in feeling that! Let’s talk about it so we can do something about it!

Sally Pearson / Annette Rickard