Safety Culture Feedback Session 2

Today was the second day in a series of safety culture feedback sessions.  We were able to start unpacking some of the issues highlighted in the latest staff survey, and use them to think about how we can improve performance, safety and job satisfaction in our busy department. The themes were Learning Environment, Leadership, Burnout, Teamwork and Work-life Balance.
Three safety issues crop up again and again: crowding, staffing and space.  These issues web their way through each of the broad themes discussed.  It is tough when you end up “playing Tetris to get to the patient”, and you worry about losing your registration on a daily basis because of the current pressures in our department.  So what have we discussed?

Learning environment

When the department is busy – which is all of the time – there doesn’t seem to be time to pause and reflect.  With no formal mentorship programme, or protected time to reflect, this is most keenly felt by the nursing team.  Could we all cash in on opportunities for genuine feedback during handover?  There has been a recent drive during the doctors’ handover to create a culture of positivism and appreciation, regardless of what the screen looks like.  Doctors acknowledge that “the nurses are being thrashed” by the workload and expectations, and appreciate the effort they put in.

Leadership

There seems to be significant dissatisfaction with the amount and quality of feedback given.  It was suggested that we could use the minors safety brief as an opportunity to give feedback to the team. It would be great to move away from the culture of ‘no feedback is good feedback’.  In addition to Greatix (let’s use them more often!), we really enjoy reading the compliments emails. 
A recent confidential meeting with the middle grades was a forum for the doctors to vent, reflect and suggest improvements in a safe, closed-doors environment.  It has been suggested that this one-off meeting could be rescheduled biannually as a regular ‘health-check’.  Could this model be used with the nursing staff?
The dynamics between doctors and nurses was discussed.  It would be great to have more open and spontaneous feedback between the professions after difficult cases.  It can sometimes be difficult to ensure effective two-way comms with new junior doctors rotating into the department.  It takes time to get to know the team, what their level of experience is, how they work, and this can impact on how comfortable we are at providing feedback.  So let’s try to get to know the newest members of our team  whilst acknowledging and tapping into the wealth of experience our dedicated nursing team bring to caring for sick patients.
Despite such poor scores for feedback, there was a global recognition of the extreme stressors that the leadership face.  Empathy!

Burnout

There is a lot of it. We are experiencing burnout as a group and on an individual level.  Probably because of chronic frustration – “no time to do what you want to do to do a good job”, because of crowding, staffing, space… Because we don’t necessarily feel valued.
Interestingly, the middle grades reported burnout the least.  Protective factors were dedicated time for teaching, being able to reduce the load of multi-tasking (thanks to the role of the Fat Controller!), and having an extra MG on at night. A Fat Controller on minors could be the next step…

Teamwork

It is fantastic that many of our team feel able to ask questions if they don’t understand – let’s keep this up!  It is easier to cope with the pressures of a busy department if we are working with a good team.
However, we still struggle to deal with difficult colleagues who are probably maxed out themselves, and who are at times rude or dismissive. This then causes breakdown in effective communication. So how do we approach this?  Suggestions included being empathic, gently calling them out, trying not to take it personally, having a safe space to talk about it… and don’t forget our high burn out scores probably affect our ability to communicate well. We are all dealing with what we absolutely HAVE to deal with here and now, and have little time for working on our communications across the board. A thought: these better, kinder, more empathic communication skills could and should become part of our hard drive, so even when stressed and busy in the extreme, we can count on the fact that we, in ED, speak directly, yet compassionately to each other.

Work-life balance

Aaargh! The frustration of life with and without technology!  Multiple logins, printer issues, scanning barcodes for every test.  Would it be worth having an IT troubleshooter making an appearance on the shop floor?
How can we make people feel valued?  Remember to invite reception staff to the minors safety brief.  Nursing staff, do you know you can access (and contribute to) the Derriforded.weebly.com site?  Junior doctors, if you need space to complete audit or admin work, feel free to ask the middle grades and consultants.
Finally, if crowding, staffing and space weren’t an issue, it would be great to have more in situ training! ​

SUMMARY

• No feedback is not good feedback!  Genuine, positive feedback needs to be embedded in our culture so that we can learn and support each other
• Make time to pause and reflect 
• Be aware of burnout and how this affects our communication skills
• Consider ways to make our team members feel valued

Dr Stephanie Rennie