Carla Rawlinson, a dual registered learning disability and mental health nurse, is Clinical Lead at St Peter’s Hospital, a specialist neuropsychiatry hospital in South Wales, that is part of the Iris Care Group. A key part of Carla’s role has been to consider how the hospital could fully embrace and embed the principle of Safety-II across everything it does. Safety-II places value on the expertise of the frontline and prizes situational awareness, flexibility and adaptability to ensure the best outcomes.
When things go right
Experience shows that 98% of the time things go right, but most organisations focus on the 2% of things that go wrong, as a way of learning and preventing future risk. However, a growing body of evidence suggests that by also focusing on the 98% of things that go right, people become better educated on what best practice should look like, which further promotes and embeds good working behaviours.
In the last couple of years within St Peter’s and across the Iris Care Group, there has been significant attention placed on developing initiatives to ensure that we are not just recording and addressing the things that go wrong. We are also putting equal emphasis on encouraging best practice; actively recognising all the things that people do right and providing praise, encouragement and positive reinforcement.
The care provided to patients at St Peter’s is underpinned by the principles of relational security, but staff need to feel safe too. If staff feel safe in doing their job, they're less likely to be stressed and more likely to work well in a positive way.
A key factor that makes people feel safe is the relationships they have with their managers and colleagues; they need to feel that these relationships are positive and open, that they're supportive, and that they're validating.
A new initiative
The work undertaken at St Peter’s, in partnership with Dr Andrew Hider, Clinical Director at Iris Care Group, led to the development of a new programme across the group. This initiative encourages an environment where everyone feels comfortable to tell each other when things are going well, and when things can be improved, to ensure the best practice care is provided.
Staff are encouraged to:
- See It. Be proactive and constantly keep an eye out to ensure plans are being followed correctly.
- Say It. Tell people when things are being done well and explain what was good about their actions. Equally, if something is not being done correctly they shouldn’t be ignored; colleagues need to be told and helped to understand what should have been done differently.
- Send It. Share praise, make sure everyone else knows when someone has done a good job. If something has not happened correctly share that too, not as a means of shaming, but in a positive manner to ensure that lessons are learned.
There’s an app for that
To support and embed this new initiative, Iris Care Group has launched a new Staff Recognition App that lets staff acknowledge their colleagues’ good work. On a monthly basis the senior management teams review the recognition posts and choose the ones that exemplify Iris Care Group’s core values best to receive personal rewards. The team at St Peter’s have engaged well with this.
Working together
To narrow the gap between other disciplines and the unit staff, and encourage greater mentoring between the multidisciplinary teams, Carla introduced a programme at St. Peter’s where each team is allocated a month to develop and deliver awareness raising and educational activities that they feel will address common care delivery issues. It also offers opportunities to provide coaching in the moment. They create their own posters to advertise the sessions they run, and there has been a lot of interest and uptake.
Everyone is encouraged to suggest solutions for common problems. This has created greater cohesion within the teams. In changing the way that the group took education to the staff, there's now more confidence within the multidisciplinary team that safety issues will be more appropriately managed by everyone across the hospital.
Celebrating diversity
Further activities have been organised to promote this more open culture. A recent event to recognise diversity within the staff team as part of celebrating overseas workers in February saw a high response rate to a survey about which countries staff hailed from. Patients and team members then joined together to enjoy activities that involved flags, maps, music, national anthems, fashion and food from the countries that were represented. Three team members even wore coordinated clothing so that when they stood together, they created the national flag of Nigeria!
Positive results
At St. Peter’s there have been real benefits from implementing all these new initiatives
- Our multidisciplinary team feel that there's a clear process to be followed to ensure that staff are working within prescribed care plans and that staff feel supported to do that.
- People are less afraid of making mistakes. They know there will not be ‘blame’ rather that they will be supported to develop the skills and knowledge to ensure mistakes do not happen again.
- Staff feel less stressed and safer. Our staff turnover has been reduced along with the need to use high levels of agency staff. A stronger, more consistent team has allowed us to provide better continuity of care which in turn has benefited our patients.
This approach is not revolutionary, but what has allowed this programme to be so successful at St Peter’s is that it is not a simple one-off campaign. Carla has led a series of initiatives that support the same goal. Staff receive ongoing feedback about Safety-I and Safety-II principles, so it has become something they are familiar with and fully understand. Staff have been willing to actively support the initiatives because they recognise the benefits, not only for patients, but for themselves too.
