British Journal of Nursing, Vol. 23, Iss. 6, 27 Mar 2014, pp 338
This series explores what reflection is and how it can be applied to your clinical practice. It examines some of the techniques that you can use to aid reflection and looks at portfolios, reflective learning and helping others to reflect.
Reflection: from staff nurse to nurse consultant. Part 4: Reflective feedback – (BJN Article request full text from Trust Library Services or call 01942 822508)
Whistleblowing Helpline –
This guidance contains a number of recommendations, aiming to help make whistleblowing an important part of improving the quality of service user support and patient safety.
If you were asked to identify the most strategic and valued unit in your corporation, the procurement department would probably not come to mind. The term procurement itself has a very administrative connotation: It’s associated with buying ‘stuff’ for the lowest prices possible.
Today’s corporations are directing more and more of their budgets toward a complex web of global specialist providers and suppliers to help deliver on their businesses’ core strategies. A recently released global study of nearly 2,000 publicly traded companies found that 69.9% of corporate revenue is directed toward externalized, supplier-driven costs. In the last three years alone, companies have increased their external spend as a percentage of revenue by nearly 4%.
As a result, the role of procurement is magnified. Or, at least, it should be magnified. Suppliers must now be viewed as an extension of the company. Like the internal workforce, they must be incentivized, coached, sanctioned, and rewarded to help achieve corporate objectives.
However, procurement doesn’t register on the C-suite’s radar in a manner proportionate to its growing importance within the organization, and most procurement departments are neither ready nor empowered to take on their new responsibilities. This post gives some of the reasons for this.
With the exception of “dyed-in-the-wool” unforgiving types (you know, the people who seem to delight in ruining family holiday dinners), one of the things nearly all of us are defenseless against is a sincere, earnest, unsolicited apology.
Despite its power, there are not a small number of people in this world who have never received one — and an equally sizable number of people who have never felt they owed one to someone. And yet for the majority of people, it’s disarming and intriguing enough to lower their guard to hear what the apologizer has to say.
If you’re unsure of the value in delivering a sincere, earnest, unsolicited apology, you need go no further than the neurology of mirror neurons. Mirror neurons appear to help us with learning and empathy. But they can also have a negative impact, such as when criticism triggers defensiveness (i.e. a reciprocal criticism from the criticized) and bared teeth trigger reciprocally bared teeth. In the case of a sincere, earnest, unsolicited apology, receptiveness begets more openness. Still too soft? You need look no further than conflicts you have successfully resolved at home with your spouses, children or parents… unless of course you truly believe that your “my way or the highway” approach to life has served you well.
So, I can’t guarantee that it will work, but if there is someone you work with that is not cooperating and with whom you would like to improve cooperation, it might be worth your trying. The sincere, earnest, unsolicited apology consists of five steps:
More than 65 years ago in Massachusetts, doctors began a longitudinal study that would transform our understanding of heart disease. The Framingham Heart Study, which started with more than 5,000 people and continues to this day, has become a data source for not just heart disease, but also for insights about weight loss (adjusting your social network helps people lose weight), genetics (inheritance patterns), and even happiness (living within a mile of a happy friend has a 25% chance of making you happier).
Upon reading about the study, I wondered if the idea of such long-term research could be attempted in another field that touches all of us: work. After more than a decade in People Operations, I believe that the experience of work can be — should be — so much better. We all have our opinions and case studies, but there is precious little scientific certainty around how to build great work environments, cultivate high performing teams, maximize productivity, or enhance happiness.
Inspired by the Framingham research, our People Innovation Lab developed gDNA, Google’s first major long-term study aimed at understanding work. Under the leadership of PhD Googlers Brian Welle and Jennifer Kurkoski, we’re two years into what we hope will be a century-long study. We’re already getting glimpses of the smart decisions today that can have profound impact on our future selves, and the future of work overall.
Podcast by Harvard’s Robert Kegan on companies that do really personal development.
This briefing from the King’s Fund describes the different types of accountable care organisations (ACOs) – a group of providers that take responsibility for providing all the care for a given population for a specified period of time, emerging in the United States; presents some early evidence on their performance; assesses the future for ACOs; and discusses the implication of these developments for integrated care initiatives in England. They have emerged in the US to provide a more integrated approach to care.
Identifying feasible and effective implementation strategies that are contextually appropriate is a challenge for researchers and implementers, exacerbated by the lack of conceptual clarity surrounding terms and definitions for implementation strategies, as well as a literature that provides imperfect guidance regarding how one might select strategies for a given healthcare quality improvement effort.
Implementation Science 2014, 9:39 doi:10.1186/1748-5908-9-39
Department of Health –
The duty of candour will require all health and adult social care providers registered with the Care Quality Commission to be open with people when things go wrong. The regulations would impose a specific and detailed duty of candour on all providers where any harm to a service user from their care or treatment is above a certain harm-threshold. This consultation sets out what the Department of Health are proposing, includes a draft of the regulations that will introduce the duty of candour and asks about the impact of our proposals and the impact of the new regulations on providers. The consultation closes on 25th April 2014.
Carers UK –
With our ageing population and workforce, dementia is becoming an increasingly significant issue in the workplace, with more and more people combining work with caring for a loved one. In recognition of this, Carers UK and Employers for Carers carried out an employer and employee survey between October 2013 and January 2014 to find out the impact of working while also caring for someone with dementia. This report sets out the key findings and emerging issues from these surveys. It concludes by making 10 recommendations for employers, health and social care services and government to take to facilitate better support for employees who are caring for loved ones with dementia.
Acute services in the NHS in England are facing a year of particular financial pressure in 2015-16, when changes to funding arrangements will see £2bn transferred to community health and social care provision, a parliamentary report has warned.
MPs: Monitor ‘must not be an obstacle to change’ – (HSJ Article request full text from Trust Library Services or call 01942 822508)
NHS Trust Development Authority chief executive David Flory has warned “a significant proportion” of the trust sector has no “clear plan for sustainability”.
Flory: ‘Significant proportion of trusts have no clear plan for sustainability’ – (HSJ Article request full text from Trust Library Services or call 01942 822508)
Executives who combine work and family emphasize the importance of defining success for themselves. In our last blog post, we talked about objective versus subjective success — the difference between your quantifiable, Wikipediable list of accomplishments and your day-to-day emotional and intellectual pursuits. Like everyone else on the planet, you have only 168 hours per week to spend. So it’s important to strategically allocate your time to the objective goals that will bring you the most subjective satisfaction.
But what brings satisfaction? It’s different for different people — even at the same workplace, even in the same role. If you’re trying to answer that question about yourself or your employees, here’s a helpful framework from Managing the New Careerists, by former BYU management professor C. Brooklyn Derr. Though the careerists aren’t so new anymore (the book came out more than 25 years ago), Derr offers an interesting historical perspective on the rapidly changing world of work — and keen insights about human nature, which evolves much more slowly. He outlines five “career orientations,” which tend to shift over time, depending on life circumstances.
The second rounds of the NHS’ two technology funds are due to be “promoted and launched” over the next two months and will focus on integration.
The first round of funding has been approved and awarded for both the ‘Safer Hospitals Safer Wards: Technology Fund’ (known as the ‘tech fund ’) and the Nursing Technology Fund, and second rounds will soon follow.
An update of the NHS terms and conditions of Service Handbook and published a new record of amends, following the publication of Pay and Conditions Circular (AfC) 1/2014.
The new pay circular contains details of a non-consolidated increase of one per cent, payable in monthly instalments, with effect from 1 April 2014 and ending on 31 March 2015 for staff who, on 31 March 2014, are on the top pay point in their pay band.
These new arrangements for pay for Agenda for Change staff, are incorporated into Amendment number 30 to the NHS terms and conditions of Service Handbook.
A new ambition to reduce avoidable harm in the NHS by half over the next three years, cut costs and save up to 6,000 lives has been outlined by Jeremy Hunt. In a speech at Virginia Mason Hospital in Seattle, the Secretary of State has announced details of how NHS organisations can work together to improve patient safety and save money.
Each NHS organisation will be invited to ‘Sign up to Safety’ and set out publicly their ambitious plans for reducing avoidable harm, such as medication errors, blood clots and bed sores over the next three years. The NHS Litigation Authority, which indemnifies trusts against law suits, has agreed to review the plans and, when approved, reduce the premiums paid by all hospitals successfully implementing them. Every year the NHS spends as much as £1.3 billion on litigation claims.
Additional Item
Hunt to launch patient safety ‘movement’ to halve harm -(HSJ Article request full text from Trust Library Services or call 01942 822508)
A colleague has just sent you an email relating to a meeting you’re having in one hour’s time.
The email is supposed to contain key information that you need to present, as part of the business case for an important project.
But there’s a problem: the email is so badly written that you can’t find the data you need.
There are misspellings and incomplete sentences, and the paragraphs are so long and confusing that it takes you three times more than it should to find the information you want.
As a result, you’re under-prepared for the meeting, and it doesn’t go as well as you want it to.
Have you ever faced a situation similar to this? In today’s information overload world, it’s vital to communicate clearly, concisely and effectively. People don’t have time to read book-length emails, and they don’t have the patience to scour badly-constructed emails for “buried” points.
The better your writing skills are, the better the impression you’ll make on the people around you – including your boss, your colleagues, and your clients. You never know how far these good impressions will take you!
In this article, we’ll look at how you can improve your writing skills and avoid common mistakes.
Short quiz to help judge your listening skills. Provides basic overview on three different levels of listening and tips and links to additional resources on how to improve.
Providing compassionate care is not only a concern for nurses, it is relevant throught the health service. “Compassion” was undoubtedly one of the healthcare buzzwords of 2013. A year of negative headlines, chief among them those arising from the scandal in Mid Staffordshire, spoke of a system in which production-line attitudes and procedure-driven philosophies have condemned the fundamental notion of humanity to shell shocked afterthought. It’s perhaps revealing that the vast majority of discussions concerning compassion in the NHS continue to champion it as essential to the nursing profession while neglecting to contemplate its relevance anywhere else.
Compassion and cost-effectiveness can work together – (HSJ Article request full text from Trust Library Services or call 01942 822508)
Alongside midwifery units (AMUs) were identified as a novel hybrid organisational form in the Birthplace in England Research Programme, to which this is a follow-on study. The number of such units (also known as hospital birth centres) has increased greatly in the UK since 2007. They provide midwife-led care to low-risk women adjacent to maternity units run by obstetricians, aiming to provide a homely environment to support normal childbirth. Women are transferred to the obstetric unit (OU) if they want an epidural or if complications occur.
This study aimed to investigate the ways that AMUs in England are organised, staffed and managed. It also aimed to look at the experiences of women receiving maternity care in an AMU and the views and experiences of maternity staff, including both those who work in an AMU and those in the adjacent OU.
An organisational ethnography approach was used, incorporating case studies of four AMUs, selected for maximum variation on the basis of geographical context, length of establishment of an AMU, size of unit, management, leadership and physical design. Interviews were conducted between December 2011 and October 2012 with service managers and key stakeholders (n = 35), with professionals working within and in relation to AMUs (n = 54) and with postnatal women and birth partners (n = 47). Observations were conducted of key decision-making points in the service (n = 20) and relevant service documents and guidelines were collected and reviewed.
Women and their families valued AMU care highly for its relaxed and comfortable environment, in which they felt cared for and valued, and for its support for normal birth. However, key points of transition for women could pose threats to equity of access and quality of their care, such as information and preparation for AMU care, and gaining admission in labour and transfer out of the unit. Midwives working in AMUs highly valued the environment, approach and the opportunity to exercise greater professional autonomy, but relations between units could also be experienced as problematic and as threats to professional autonomy as well as to quality and safety of care. We identified key themes that pose potential challenges for the quality, safety and sustainability of AMU care: boundary work and management, professional issues, staffing models and relationships, skills and confidence, and information and access for women.
AMUs have a role to play in contributing to service quality and safety. They provide care that is satisfying for women, their partners and families and for health professionals, and they facilitate appropriate care pathways and professional roles and skills. There is a potential for AMUs to provide equitable access to midwife-led care when midwifery unit care is the default option (opt-out) for all healthy women. The Birthplace in England study indicated that AMUs provide safe and cost-effective care. However, the opportunity to plan to birth in an AMU is not yet available to all eligible women, and is often an opt-in service, which may limit access. The alignment of physical, philosophical and professional boundaries is inherent in the rationale for AMU provision, but poses challenges for managing the service to ensure key safety features of quality and safety are maintained. We discuss some key issues that may be relevant to managers in seeking to respond to such challenges, including professional education, inter- and intraprofessional communication, relationships and teamwork, integrated models of midwifery and women’s care pathways. Further work is recommended to examine approaches to scaling up of midwifery unit provision, including staffing and support models. Research is also recommended on how to support women effectively in early labour and on provision of evidence-based and supportive information for women.
The National Institute for Health Research Health Services and Delivery Research programme.
Donna Willis
Senior Consultant, Leadership Development
Shortly after joining The King’s Fund, I facilitated a commissioned leadership programme for newly appointed consultants. A general surgeon, challenged by the issues the programme raised for him, asked me: ‘Would you perform your own appendectomy, Donna?’
The possibility had never crossed my mind: ‘I wouldn’t know where to start,’ I replied, rather meekly. ‘Quite!’ he exclaimed. ‘That’s how I feel about all this leadership stuff!’
There are times when all of us feel anxiety around our competence. It’s common and a part of being human. Clinicians are experts in their specialties and we, as patients, rely upon their competence to aid recovery from illness. However, the skill-set clinicians need to lead effectively is quite different, and learning to confidently and competently deploy leadership skills, attitudes and behaviours is paramount. Diverse teams of health care professionals who have shared collective leadership are absolutely crucial to the leadership of today’s health service.
Emergent clinical leaders are the leaders of the future. It is they who will increasingly provide care across organisational and health and social care boundaries. It is they who will establish fit-for-purpose multidisciplinary care that leads to better patient outcomes, centred on the needs of patients and service users.
This set of multi-media resources share valuable learning and insight from HWBs across England on their development as system leaders and explore three key themes: facilitating shared ownership; working across boundaries; and the future of system leadership.
We all have good ideas. The hard part is making them happen.
HR departments love handing out worksheets on how to plan your time. Management gurus have written hundreds of pages of advice on how to better manage your week, your day, and your hour.
But what happens when you try and apply that advice to your team or organization? How do you deliver complex, multi-level, multi-year programs of work across teams and business units that may be, quite honestly, in chaos?
I sat down with three senior executives leading major projects at complex, fast-moving organizations and asked them what they do to be effective. They had all worked across multiple industries in their careers, run successful projects (and also some that had failed), and extracted lessons that made sense at every organizational level.
Here are the three tips they said had the biggest impact.
The potential benefits of workplace variability are numerous — increased morale, motivation, and the ability to attract and retain talent — yet many managers don’t know where to start. Others are afraid that performance could suffer or something important could fall through the cracks.
Even the most employee-oriented managers have concerns about having employees work outside of normal work hours or at places other than the office. However, by taking a job design approach to workplace flexibility, managers can get the benefits of offering more flexibility while minimizing the downside. Here’s what you need to know.
Are you working endlessly but not accomplishing all you want? Mystified that continuous attention to work is not resulting in satisfactory progress toward your goals? So focused on work that you’re not thinking about or doing much else? If so, you may not be giving your brain the benefit of adequate downtime. A recent article in Scientific American, Why Your Brain Needs More Downtime, summarizes the evidence that “mental breaks increase productivity, replenish attention, solidify memories, and encourage creativity.”
How can hard-working business leaders get the downtime they need? In my executive coaching practice, I help clients reach peak performance by actually doing less work at key times—and by engaging in downtime activities that cutting-edge research shows to be effective in boosting productivity.
Here are five tips for getting downtime so that you can perform better than ever.
How many times have you been in a brainstorming session this week? Chances are the answer is, “More than I can count.” But no study has proven that brainstorming works well, even though it has been the go-to method for idea generation since 1953.
But there is an alternative. After researching why brainstorming inhibits creativity and innovation, my colleagues and I came up with a new process we call Brainswarming. Watch the video on the website for more information on what it is and how you can implement it.
The National Information Board will release a new informatics strategy for consultation in May, to be used to inform commissioning decisions from September this year.
Plans for the 2-5 year strategy are outlined in a paper presented to a NIB working group meeting today.
Successful Nursing Technology Fund trusts will spend millions on mobile devices such as tablet computers before the end of this month.
According to analysis done by EHI Intelligence, 31 of the 85 projects that have been awarded funding from the £30m first round of the Nursing Technology Fund involve deployments of mobile devices or systems.
Dympna Cunnane, Organisation Development Consultant and Programme Director at London Business School, discusses her views on how healthcare leaders respond to the pressures of the job and their role in ensuring high quality, compassionate care for patients.
Slide deck detailing the following:
The key findings from discussions with HWB members about enabling and encouraging cross-HWB working:
Research briefing that explores local charities and voluntary organisations attitudes and experiences of local health organisations. This report explores the extent to which they feel able to influence Joint Strategic Needs Assessments (JSNA). Finds a mixed picture in terms of voluntary organisations feel their views and those of their beneficiaries influenced and impacted upon local priorities. Some local relationships are in their early stages of development, although others report feeling excluded from the development of JSNA or that involvement has been largely symbolic and so has little impact.
The Cloakroom and Saddleback Leather are selling quality. But the same is true if your point of difference is being the lowest cost option – you still have to pursue that end fanatically, doing more than anyone else is willing to do to cut costs.
The secret to being different is that you have to do the work that others are unwilling to do.
Report from the International Centre for Health Innovation that aims to identify:
Considers the philosophical motivation for personalization as a necessary and important building block for the personalization of health systems. The report then examines existing trends in personalization among consumers as well as lessons learned from other industry sectors and organizations that have achieved personalized models of service delivery. Using this data, it suggests a model for a personalized health system, illustrating the transition from the current system to a potential personalized end state. Finally, the report proposes 10 steps individuals, health providers, health system, and policy makers need to undertake in order to create and accelerate the personalization of health systems.
NHS England has set up an independent advisory group to improve governance around the care.data programme.
The group will be chaired by Ciaran Devane, chief executive of Macmillan Cancer Support and non-executive director of NHS England.
Background and methods
Innovation can improve patient care, but health-care managers’ use of evidence when considering change in hospitals is not well understood. We systematically looked at decisions about technologies available to help fight infections in hospitals.
We selected nine NHS hospitals across England of different size and research experience and, through191 interviews and 27 different technology examples, aimed to find out which decisions were made, who made these decisions and how the decisions were made. We were especially interested to learn about which forms of evidence were used by managers and looked at factors within and outside the hospital that may affect evidence use.
Findings and conclusion
We found that different professional groups of managers looked for, and used in decisions, different forms of evidence from each other, including research and own experience. For example, nurse managers looked at a wider range of evidence than doctors in management roles. Doctor managers and non-clinical managers were concerned with evidence that helped their own decision-making, whereas nurses were also concerned with providing evidence to others to aid decision-making. Many factors within and outside the hospital helped or hindered the use of evidence. For example, infection outbreaks sometimes highlighted the need for evidence but, at the same time, added a time pressure to make decisions quickly.
A lot of existing evidence held centrally in the NHS was not used in actual decision-making but, instead, evidence from suppliers and evidence gathered at the hospital level was used.
This study provides a learning opportunity for how policies intended for system-wide change can be implemented.
Department of Health –
Fair Deal is a non-statutory policy setting out how pension issues are to be dealt with when staff are compulsorily transferred from the public sector to independent sector providers of public services. This guidance gives information to contracting authorities, bidders and providers about the application of the new Fair Deal policy where the relevant public service pension scheme is the NHS Pension Scheme.
Care Quality Commission (CQC) –
The CQC commissioned The King’s Fund and Manchester Business School to explore whether the new approach to inspections provides a better analysis of the performance of an acute hospital. This is an interim report and the full report is due to be published in May 2014.
All companies claim that their strategies are customer driven. But when “customer” means any number of entities in a company’s value chain—consumers, suppliers, retailers, even internal units like R&D—managers tend to lose focus, and their firms become vulnerable to competitors who have clearly defined who they serve and how.
In this article, Robert Simons of the Harvard Business School presents a framework that can help companies develop strategies that are truly customer-centric
Delay in confronting crises is deadly. Corporate leaders must have processes for learning of important safety issues. Then they must seize control immediately and lead a systematic response. Crisis management is the ultimate stress test for the CEO and other top leaders of companies. The mantra for all leaders in crisis management must be: “It is our problem the moment we hear about it. We will be judged from that instant forward for everything we do—and don’t do.”
When we talk about “professionalism,” it’s easy to fall back into the “I know it when I see it” argument.
For Emily Heaphy, an assistant professor of organizational behavior at Boston University, and her colleagues, this isn’t a cop-out. The notion of being seen as professional may be central to how we define success in the U.S. — and, consequently, how and why certain people aren’t able to attain it, depending on how well they adhere to social norms. In particular, Heaphy and the other researchers set out to study “one potential culturally bounded workplace norm — that of minimizing references to one’s life outside of work.”
The Report looks at the big societal issues that are shaping the business and well-being landscape; gender equality, fairness, resilience, psychological contracts and work-life balance.
Contributions have been made from world-leading businesses and experts, including:
Framework to help pharmacy professionals to improve their skills in carrying out consultations with patients and in delivering public health messages. It represents a national programme of change in pharmacy and will apply to more than 60,000 pharmacy professionals across England.
Additional Items
Snapshot view of organisations providing secondary health care and how they are complying with the Data Protection Act. The report summarises key findings from 19 audits carried out primarily with NHS Trusts by the ICO. The audits looked at how personal data is handled by the organisation, and fit alongside NHS information governance guidelines.
Additional Item
This document has been produced by Monitor, NHS England and the Trust Development Authority to encourage debate about the about how the NHS can change its models of care to provide better services in the future.
The report includes transformative options that local health economies may wish to consider. You can read the report here.
NHS England and the Medicines and Healthcare products Regulatory Agency have jointly issued two patient safety alerts to help healthcare providers increase incident reporting for medication errors and medical devices. They require providers to take specific steps that will improve data report quality; and will see the establishment of national networks to maximise learning and provide guidance on minimising harm relating to these two incident types.
Girish* is a client of mine who runs a 500-million-dollar business. He gets stellar reviews and is seen as a high potential successor to the CEO.
But he has a friend problem.
Several of his direct reports are close friends and he doesn’t hold them accountable in the same way he does his other direct reports. Often, they don’t do what he asks. And they aren’t delivering the results he expects. It’s hurting his business and his reputation.
When I speak with others on his team about the situation, they see it clearly and resent Girish’s friends. They don’t understand why Girish allows his friends to take advantage of him. And they feel demotivated and disengaged by Girish’s apparent unfairness.
But when I speak with Girish about it, he doesn’t see it at all. He’s filled with empathy for his friends’ struggles, which makes perfect sense since he cares deeply about them. But he’s blind to the damage they’re doing to him and the company.
There’s plenty of research supporting the idea that having friends at work makes you happier and more engaged. But here’s what the research doesn’t address: friendships at work are tricky, especially when you’re the boss.