The ‘stranded patient metric’ is defined as the number of beds occupied by patients who have been in hospital 7 days or more. A proportion of these will have a truly catastrophic illness and need to be in hospital that long. However, a significant proportion will have spent 7 or more days in hospital because of unnecessary waits in the system. Many are internal, including waiting for a decision, diagnostic test, intervention, referral etc. It is important to be certain that whatever the patient is waiting for necessarily needs to be done as an in-patient. The effective use of Expected Date of Discharge (EDD) and Clinical Criteria for Discharge (CCD) from point of admission as part of the case management plan assists in the daily focus on what our patients are waiting for. EDD should be set assuming ideal recovery and no delays, thus helping to ‘flush out’ any constraints within a patient’s journey.

The daily Board Round and ‘one-stop ward round’ are the means by which waits are identified and effectively managed by the team. If the wait cannot be managed by the team, this should be escalated within the hospital for resolution. Peer review of stranded patients by one clinical team to another can ask key questions:

Why does this patient need to remain in hospital? • What is being done and by whom to get this patient home?

What could have been done in the first few days to prevent this patient becoming ‘stranded’.

The metric can be split between those aged under 75 and those 75 plus. For patients under 75, this metric could be considered ‘low hanging fruit’ as this group of patients usually, but not always, remain fairly simple discharges. For patients aged 75 plus, particularly those with frailty, any unnecessary waits are not ‘passive’ and can generate harm through de-conditioning which translates what could have been a relatively simple discharge in to a more complex one.

Hospital based de-conditioning results in a functional decline that is now dependent on external agencies to support discharge. The aim is to eliminate waits to shorten hospital admissions and reduce the consequences of prolonged admission. Patients at Risk of Increased Stay (PARIS) are mostly older people with frailty, but not exclusively, and need to be identified at the point of admission. They need zero tolerance of all unnecessary delays to prevent de-conditioning along with very pro-active case management, early mobilisation and prevention of unnecessary ‘bed rest’.

Hospitalisation, independent of the acute condition, frequently results in marked reduction in habitual activity which itself causes deconditioning. If de-conditioning is prevented, the patient’s discharge can remain simple. The ‘stranded patient metric’ frequently is at its lowest on Christmas Eve, rises after the Christmas/New Year period and is a major contributor to the ‘over-crowded’ status of hospitals in January. It is assumed that this increase in ‘stranded patients’ is due to the significant reduction in ‘care support’ in the community during and after the festive season and/or an increase in illness severity. However, there is a need to recognise that internal delays, diagnostics, decisions etc, are also significantly increased in this time period. Attention to internal delays during ‘predictable event planning’ can go some way to mitigating the rise of the ‘stranded patient metric’, whilst the wider system focuses on the external delays.

http://www.fabnhsstuff.net/2016/02/09/stranded-patient-metric-dr-ian-sturgess-associate-medical-director-monitor/

 

Saying sorry when things go wrong is vital not only for the patient and their family but also for us – so we can learn and improve safety.

Saying sorry isn’t an admission of liability.

The NHS Litigation Authority have produced a great leaflet to support us saying sorry when things go wrong.

Their key messages are:

The initial discussion with the patient should occur as soon as possible after the realization that something has gone wrong.

Patients and their families should be provided with a step by step explanation of what’s happened and they should receive clear and consistent information.

Patients and their families should have a single point of contact for further information or questions.

Throughout their care patients should continue to receive all usual treatment and continue to be treated with dignity, respect and compassion.

In the NHS, as in our personal lives, saying sorry is the first step in making things right.

Dealing with complaints isn’t that difficult. Listen, sympathise, don’t justify, make notes, agree a course of action and follow through – Six simple steps By equipping and empowering the patient-facing front-line of care to handle complaints and say ‘sorry’ is a simple way to make sure they don’t become grievances.

http://www.fabnhsstuff.net/2016/02/07/saying-sorry/

 

Why are we always exhausted at the end of a workday? Why do we come home wiped out, with barely enough energy to make dinner before collapsing for the night?

Normally, when we think about being tired, we think of physical reasons: lack of sleep, intense exercise, or long days of physical labor. And yet, as Elliot Berkman, professor of psychology at the University of Oregon, pointed out to me in an interview, in our day and age, when few of us have physically demanding jobs, we are wiping ourselves out through psychological factors.

After all, the physical effort we exert in our day jobs does not warrant the fatigue we experience when we get home. If you are a construction worker, a farmer toiling in a field, or a medical resident working both day and night shifts, then yes, physical exhaustion might be the reason for your fatigue. But otherwise, Berkman points out, your fatigue is mostly psychological. “Does your body get tired until you really can’t do anything at all?” asks Berkman. “Actually, it would take a long time to get to that point of complete physical exhaustion.”

One of the main reasons for our mental exhaustion is high-intensity emotions.

One way psychologists distinguish emotions is along two dimensions: positive/negative and high intensity/low intensity. In other words, is the emotion positive (like elated or serene) or negative (like angry or sad)? And is it high intensity (like elated or angry) or low intensity (like serene or sad)?

It’s easy to see how high-intensity negative emotions might wear us out during the course of the day – and not just frustration and anger. Many of us have come to rely on our stress response to get things done. We fuel ourselves up with adrenaline and caffeine, over-scheduling ourselves and waiting until the very last minute to complete projects, waiting for that “fight or flight” mode to kick in and believing we need a certain amount of stress to be productive.

But high-intensity positive emotions can also be taxing. And research shows that we — especially Westerners, and Americans in particular — thrive on high-intensity positive emotions. Research by Jeanne Tsai of Stanford University, with whom I conducted several studies, shows that when you ask Americans how they would ideally like to feel, they are more likely to cite high-intensity positive emotions like elated and euphoric than low-intensity positive emotions like relaxed or content. In other words, Americans equate happiness with high intensity. East Asian cultures, on the other hand, value low-intensity positive emotions like serenity and peacefulness.

When Jeanne and I ran a study to figure out why Americans value high-intensity positive emotions, we found that Americans believe they need high-intensity emotions to succeed — especially to lead or influence. In a study we ran, for example, people wanted to feel high-intensity positive emotions like excitement when they were in a role that involved leading or trying to influence another person. This intensity is reflected in the language we use to discuss achievement goals: we get fired up, pumped, or amped up so that we can bowl people over, crush projects, or crank out presentations — these expressions all imply that we need to be in some kind of intense attack mode. Go get it, knock it out of the park, and muscle through.

The problem, however, is that high-intensity emotions are physiologically taxing. Excitement, even when it is fun, involves what psychologists call “physiological arousal” — activation of our sympathetic (fight-or-flight) system. High-intensity positive emotions involve the same physiological arousal as high-intensity negative emotions like anxiety or anger. Our heart rate increases, our sweat glands activate, and we startle easily. Because it activates the body’s stress response, excitement can deplete our system when sustained over longer periods – chronic stress compromises our immunity, memory, and attention span. In other words, high intensity — whether it’s from negative states like anxiety or positive states like excitement — taxes the body.

High-intensity emotions are also mentally taxing. It’s hard to focus when we’re physiologically aroused and overstimulated. We know from brain-imaging research that when we’re feeling intense emotions, the amygdala is activated – that’s the same region that lights up when we’re feeling a fight-or-flight response. We need to use effort and emotion-regulation strategies from a different part of our brain, located in the prefrontal cortex, to calm ourselves enough to get our work done. This emotion regulation itself requires additional effort.

The result? You tire easily. Whether you’re getting amped up with anxiety or with excitement, you are draining yourself of your most important resource: energy.

Excitement, of course, can be a positive emotion and it certainly feels a lot better than stress. But just as a sugar high may feel great for a while, it sends your body into a physiological high that can end with a crash. You are bound to feel tired sooner than if you had remained in a calm state.

This isn’t to say you should never feel stressed or excited — nor should you lose your enthusiasm for your work. However, I’m suggesting you make more time for calm activities in your life and learn to tap into that other side of your nervous system — the parasympathetic “rest and digest” side, that helps restore your health and your well-being, making you more resilient over the long run. Doing so will help you save your energy for when you need it most.

This article is based on the book The Happiness Track (HarperOne, 2016) from which it is adapted with the publisher’s permission.

https://hbr.org/2016/02/your-high-intensity-feelings-may-be-tiring-you-out

What’s not leadership? For one thing, performing. Leadership is not making the right faces, memorizing the right lines, pumping your fist in precisely the right way at exactly the right moment. It’s being. Let me explain the difference. What happens, for example, when the situation goes off script, or when the audience heckles, or when the walls of the theater begin to collapse? The actor, if he cannot improvise, is left paralyzed. Yet that is what we see today: leader after leader left paralyzed by the unexpected turmoil of an uneasy age in an uncertain world, whether those leaders are political, social, cultural, or corporate. So we study the scripts, memorize the lines, carefully examine the angle of our fist pumps.

I’ll give you a simple example. No one would have predicted just a decade ago that Nokia would be something like a distant memory of a household name. Yet while its decline was happening, Nokia’s leaders, though they were acting like leaders — reassuring, confident, calm, giving fine speeches — were not being leaders. They weren’t doing the things they had to do to set their company up for the future, things that, precisely because the future is uncertain, sometimes make you look hesitant, or fumbling, or foolish.

Nor is leadership performing in that other sense, the sense of being “a high performer.” And yet too often we look for leaders among the profit maximizers and goal attainers. But a leader’s fundamental role isn’t merely to perform the same tasks as yesterday, just more efficiently; it is to redefine the idea of performance entirely. Consider: Pierre Omidyar, founder of Ebay, probably wouldn’t have made a great Sotheby’s auctioneer. Jimmy Wales, co-founder of Wikipedia, probably would have sucked as CEO of Encyclopedia Britannica. Craig Newmark, founder of Craigslist, probably wouldn’t have been a great classifieds editor.

If our goal is discovering and cultivating leaders like that, then we aren’t likely to find them among our best performers, but among those who are challenging our ideas of what performance can be. And if we only promote the “high achievers” to leadership, should we be all that surprised when we just get more of the same?

Nor are leaders merely politicians, human calculators of advantage whose main goal is to attain, and then maintain, power. But the job of leaders is not taking power, but the opposite: empowering. The job of a leader is create a reality in which performance itself stops being merely a performance — to focus people on the meaning and mission of their work, not on the politics of flattering and threatening, cajoling and conquering.

When leaders empower people through a higher purpose, they don’t have to “create buy-in” or use other marketing tactics to win over their followers. Leaders who do find themselves acting something like a pusher — resorting to perks, tit-for-tats, and bonuses — might want to ask themselves if they’re missing some larger point. A leader isn’t a salesman. When Steve Jobs asked John Sculley his famous question, “Do you really want to spend your life selling sugared water, or do you want a chance to change the world?” he was making just such a distinction. Selling sugared water might make you a few bucks — but only at the cost of doing something that matters. The purpose of a leader is to create a purpose.

And yet although that sounds very inspiring, a leader’s job still is not to give inspiring speeches. A leader isn’t an orator who claps everyone on the back once in a while when they’ve sunk into a torpor. The job of a leader is indeed to inspire people — but in the truer sense of the word: from the Latin inspirare, inspire, to breathe or blow into. Leaders breathe life into the organizations they lead, into the people they’re responsible for. They breathe life into possibilities. They make it more possible for the rest of us to dare, imagine, create, and build. They do not merely encourage us to do so; theirs is the hard work of crafting all the incentives, processes, systems, and roles that actually empower us to do so.

Leadership is in an uncertain place. We long desperately for better leaders. But perhaps it is precisely our longing that’s the problem. We’re waiting for a rescue at the cost of our own redemption. Because it’s easier to complain about the leaders we have than to try to do better. After all, it’s a pretty hard job.

https://hbr.org/2016/02/are-you-a-leader-or-just-pretending-to-be-one

Most bosses assume that, when they directly ask for feedback, people will offer their thoughts candidly and directly. It’s great when that happens. But it often doesn’t, especially in public settings and high-stakes situations. If you get unanimous, but mostly unvoiced, support for a decision that you thought might be contentious, it should be a warning sign.

Why do people hold back from weighing in? In some cases, junior people may hesitate to disagree with bosses or senior colleagues. In others, the most powerful team members may be disinclined, for political or other reasons, to express candid opinions in front of the group because they know they can always get access to decision-makers or launch a covert campaign to sway support their way after the fact.

How can you prevent this from happening? Set one key ground rule: “Silence denotes agreement” or “qui tacet consentire videtur,” as it’s been known for centuries.

These three words do a great job of forcing people to open up, no matter how reluctant (or passive-aggressive) they may be feeling. Explain to people that if they don’t say anything when given a proposal or plan, they’re voting “yes” to it. Silence doesn’t mean “I’m not voting” or “I reserve the right to weigh in later.” It means “I’m completely on board with what’s being discussed.”

You must then commit to enforcing the rule. If someone — even a powerful team member or friend — buttonholes you after a meeting to express reservations about what was said, the response should be: “You should have spoken up at the meeting. Now everyone is on board and the ship has sailed. Next time, say something.”

Sometimes the establishment and reinforcement of “silence denotes agreement” as a ground rule is enough to get the opinions flowing. But if you sense that some participants are still finding it difficult to express themselves freely, consider the following tactics, which allow perspectives to be aired in a way that focuses on the ideas rather than the individuals voicing them.

Take anonymous polls. Ask people to write down questions or concerns on index cards, put them into a bowl and read them aloud without using names. Better yet use a polling app or device to query meeting participants and see their answers in real time.

Heat map the topic. Put poster-size charts of the components of an idea or plan on the wall. Ask participants to place yellow dots on the charts where they have a question, and red dots where they have a significant concern. Use the dots to guide the conversation.

Break up a big group. People are more likely to participate in small group discussions. So divide people into teams with specific instructions to discuss any challenges to the proposal at hand. Appoint a representative from each group to summarize their and their colleagues’ thoughts.

Ask them to empathize. People are often more willing to speak on others’ behalf than their own. So when you solicit opinions with a question like “What objections or concerns might your direct reports have?” it can open the floodgates of reaction. That’s because it allows those in the room to externalize criticism. It’s not what they don’t like. It’s what they think their people won’t like.

When you enforce the discipline of “silence denotes agreement” and use the tactics above, everyone is incentivized to say what they really think immediately, and discuss it openly, rather than flagging problems after the fact.

https://hbr.org/2016/02/before-a-meeting-tell-your-team-that-silence-means-agreement

Imagine it’s time for your team members’ annual performance reviews. You’re keen to use these productively and effectively, and you look forward to building stronger relationships with your people through them.

In your mind’s eye, a member of your team is sitting across from you. He or she is clear on what his strengths are, and what skills he needs to develop to perform even better next year. The conversation is open and honest, and discussion flows naturally…

Now let’s get back to reality. How far is this scenario from your regular appraisal meetings? If your meetings tend to be more “awkward monologue” than free-flowing conversation, don’t despair. A growing discontent with the traditional appraisals system is prompting organizations, including some big-name companies, to experiment with alternative approaches.

In this article, we identify the shortcomings of traditional performance reviews, and we’ll explore how you can use an approach called the “Five Conversations Framework” to promote dialogue, increase positivity, and build better relationships with your people.

https://www.mindtools.com/pages/article/the-five-conversations-framework.htm

In this article, we’ll look at some common mistakes that people make when they set goals . Learn how to recognize these mistakes, so that you can avoid making them yourself!

Mistake 1: Setting Unrealistic Goals

When you’re exploring possible goals, you need to unleash your imagination and ambition, put your reservations aside, and dream big dreams. However, once you’ve decided on a goal, make sure that it is realistic, and that you can actually achieve it in the time frame that you have set for yourself.

For instance, if your goal is to run a marathon, it’s wildly unrealistic to sign up for one next month, unless you’ve already done several months of training. Or, if your goal is to become CEO of a company, but you have no experience, this goal might not be practical – at least not yet!

To set realistic goals, use SMART Goal Setting strategies: make sure that your goals are Specific, Measurable, Attainable, Relevant, and Time-bound.

Mistake 2: Focusing on Too Few Areas

Imagine that you’ve just written your list of goals for the next year. You’ve committed to increasing your sales by 15 percent, applying for a promotion, and reading one leadership book each month.

Although this is an ambitious but achievable list of goals, there’s a potential problem: these goals focus only on your career. You’ve completely omitted goals from other parts of your life.

Many people focus solely on their work when they set goals. However, you can’t neglect activities that bring you joy. Goals like writing a book, competing in an adventure race, or starting a home garden might also be incredibly important for your happiness and well-being.

So, when you set your goals, make sure that you strike the right balance between different areas of your life. And remember that “balance” is different for everyone – use the Wheel of Life tool to understand which areas of your life you need to focus on most.

Mistake 3: Underestimating Completion Time

How often has a task or project taken longer than you thought? Probably more times than you can count! You may also say the same for goals that you’ve set in the past.

If you don’t estimate goal completion time accurately, it can be discouraging when things take longer to achieve than you think they should. This can cause you to give up.

So, use Action Programs and effective scheduling strategies when planning your goals. And always pad your timelines to account for delays and setbacks. If you add extra time into your estimate, you’ll feel less pressure to rush and finish by a certain date.

Mistake 4: Not Appreciating Failure

No matter how hard you work, you will fail to achieve goals from time to time. We’ve all been there, and it isn’t fun!

However, your failures are what ultimately determine your character. They also contain lessons that can change your life for the best, if you have the courage to learn from them.

So don’t be too upset if you fail to achieve your goals – just take note of where you went wrong and use that knowledge to reach your goals next time around.

Mistake 5: Setting “Other People’s Goals”

Some people – family, friends, or even your boss – may want to influence the goals you set. Perhaps they feel that they know what’s best for you, or maybe they want you to take a certain path or do certain things.

Clearly, it’s important that you have good relationships with these people, and you need to do what your boss asks, within reason.

However, your goals need to be your own – not anybody else’s. So be politely assertive , and do what you want to do!

Mistake 6: Not Reviewing Progress

It takes time to accomplish goals. And sometimes it can feel that you aren’t making much progress.

This is why it’s important to take stock of everything that you’ve accomplished on a regular basis. Set small sub-goals, celebrate your successes, and analyze what you need to do to keep moving forward. No matter how slow things seem, you probably are making progress!

You can also take this opportunity to update your goals, based on what you’ve learnt. Have your priorities changed? Or do you need to set aside some extra time for a particular goal activity?

Goals are never set in stone, so don’t be afraid to amend them if you need to.

Mistake 7: Setting “Negative” Goals

How you think about your goal can influence how you feel about it, and whether you achieve it.

For instance, many people have a goal to “lose weight.” However, this goal has a negative connotation; it’s focused on what you don’t want – your weight. A positive way to reframe this goal is to say you want to “get healthy.”

Another example of a negative goal is to “stop staying late at work.” A positive way to rephrase this is to “spend more time with family.”

Negative goals are emotionally unattractive, which makes it hard to focus on them. Reframe any negative goals so that they sound positive: you may be surprised by the difference this makes!

Mistake 8: Setting Too Many Goals

When you start setting goals, you may see many things that you want to accomplish. So you start setting goals in all areas.

The problem with this is that you have a fixed amount time and energy. If you try to focus on many different goals at once, you can’t give individual goals the attention they deserve.

Instead, use the “quality, not quantity” rule when setting goals. Work out the relative importance of everything that you want to accomplish over the next six to twelve months. Then pick no more than, say, three goals to focus on.

Remember, the success of your work towards a goal rests on focusing on just a few things at a time. If you limit the number of goals you’re working on, you’ll have the time and energy you need to do things really well!

https://www.mindtools.com/pages/article/goal-setting-mistakes.htm

Many people believe that successful organizations need inspirational leaders to thrive, but they also need highly effective team members like Martina. So, what qualities make a team member exceptional, and how can you develop them yourself?

In this article, we’ll look at 10 top tips for becoming a star team player.

What Is a Star Team Player?

Highly effective team members aren’t necessarily the most outgoing or extroverted people in the group. However, they are committed and engaged , and they work well with their colleagues, toward team goals that meet organizational objectives. They encourage and support their fellow team members, listen to other people’s points of view, respect differences, and take responsibility for their own actions and mistakes.

These individuals develop mutual trust with their co-workers, respect and value others, and put their own issues aside for the sake of the group. They understand the importance of building good relationships , including with their boss, and they make developing these a priority. This leads to better decisions , increased creativity , and greater productivity.

10 Ways to Be a Star Team Player

There are many ways to become a star member of your team. In their articles, Jon Gordon and John Reed of Robert Half Technology provide their top suggestions for how to be a star player. These are:

Set an example. Instead of worrying about others’ performance, productivity or commitment, it’s a good idea to start by leading by example and focusing on your own hard work, passion and commitment. When you do your best every day, you’ll raise the standards and performance of everyone around you.

Use your strengths to help the team. The most powerful way you can contribute to your team is to use your gifts and talents to help it achieve its vision and goals. Your team needs your effort, focus and talent to succeed. You can do this by developing your strengths, so that you can help build a stronger team.

Share positive, contagious energy. Research shows that emotions are contagious, and that your mood affects the people around you, whether it’s good or bad. When you share positive energy and avoid negativity, you enhance the team’s mood, morale and performance. For example, if you had a tough commute into work, try to leave your irritation outside and remember that your colleagues aren’t to blame – put a smile on your face as you walk through the door. Read our article on emotional labor for more on managing your emotions at work.

Put the team first. Highly effective team members always put the team first. They work hard, develop themselves, and serve the group. Instead of taking all the credit for success, remember to give it to the people who earned it, and to the whole team. As part of this, make sure that your ego doesn’t get in the way of the group’s mission and purpose – this can be challenging because we all have our own goals and desires, but it’s an important step to improving your team’s effectiveness.

Build relationships. Relationships are the foundation that winning teams are built on. Highly effective team members take the time to connect, communicate and care, so they build strong bonds and relationships . You can be the smartest person in the room but, if you don’t connect with others, you will find it difficult to work effectively. Take the time to get to know your colleagues, and try to build meaningful connections with them. Even simple things like asking about a co-worker’s family or going out for lunch together can improve communication and break down barriers.

Trust and be trusted. Strong relationships can’t exist without trust . Highly effective team members trust their colleagues and boss, and they’re trusted in return. You can earn this trust by demonstrating integrity , and by being consistent, honest, transparent, open, and dependable.

Hold people accountable. Sometimes, people make mistakes and don’t meet the team’s expectations. So, don’t be afraid to hold your fellow team members accountable . However, make sure that you build trust and relationships with them first, otherwise they may not allow you to challenge them.

Be humble. Highly effective team members are humble, which means that they’re willing to learn and improve. Make sure that you’re open to feedback and suggestions, so that you can grow, build strong relationships, develop your skills, and put the team first. Be aware of the tremendous power in humility that makes you and your team more effective.

Be a good listener. The most effective team members don’t feel the need to make themselves heard all of the time. Instead, they feel comfortable participating through listening . As a result, they’re usually highly aware, informed and knowledgeable. Of course, there are times when you should speak up, but it’s a good rule to listen more than you talk. In a team environment, some people will always compete to be heard, but those who listen well are rarer – and are potentially much more valuable.

Accept criticism. Highly effective team members understand that criticism provides an opportunity to improve the end product or service. This applies whether you are giving or receiving constructive criticism . Accept input with an open mind, and be open to exploring alternative solutions. Likewise, when you have to offer criticism or feedback to others, be direct and respectful, as this will likely inspire people to want to improve their work.

Apply This to Your Life:

Think about how you can lead by example. What behavior do you exhibit that could influence other people? Are you positively or negatively affecting them? How could you inspire them to improve their performance?

Take the opportunity to give someone credit. Has a colleague performed well or exceeded expectations? Let him or her know that you value his work, and praise the performance of the team as a whole.

https://www.mindtools.com/pages/article/highly-effective-team-member.htm