This article describes the launch of away day events for staff in a neonatal unit. The days have improved staff motivation, teamwork and the services provided to patients and families at the unit.
Webster, D. et al (2008) Arranging staff away day events to improve motivation. Nursing Times; 104: 41, 31–32.
Debbie Webster, MSc, Cert Ed, RSCN, RGN, is lecturer practitioner, Liverpool Women’s Hospital and Liverpool John Moores University; Susan Snowdon, MA, PGCE, BA, RGN, is lead nurse in education; Ben Shaw, MBChB, MA, FRCPCH, MRCP (UK), MD, is neonatal consultant; both at Liverpool Women’s Hospital.
In the work setting, staff belong to formal groups whose collective purpose within the organisation is to complete the assigned work tasks for which they are professionally responsible (Buchanan and Huczynski, 2004).
It is widely accepted that improvements in collaboration, communication and equity within healthcare teams improves the quality of care provided and protects patients (Lingard et al, 2004).
Lingard et al (2004) stated: ‘Team-building involves having a flexible team structure, abolishing hierarchies and cultivating shared decision-making.’
Planning away days
In September 2004, 45 neonatal unit staff from Liverpool Women’s Hospital attended the first of the five sessions of away days at the Glaramara Centre in the Lake District. The aims of the events are to spend time planning how we can develop the neonatal service and to enable staff to get to know each other better.
The days are facilitated by the clinical director, the directorate manager and two senior members of the education team. At least one other consultant and other senior nursing staff also attend.
Keeping an appropriate medical and nursing staff skill-mix back at the unit is obviously extremely important. Staff are given two study days to attend the event, although some work an extra shift that week.
Staff attending the first away day were given only limited information on its purpose, activities or what was expected of them. The only clues provided were in a poster invitation, which said that the event was an opportunity to escape to the Lakes for two days of walking, talking and planning for the future. Forty-five people signed up with very little idea of what to expect.
Launching the initiative
Except on one occasion, the away days have taken place at the Glaramara Centre in the Lake District, with coach transport arranged. The centre is comfortable and in beautiful surroundings far from any town. The lack of distractions ensures participants engage fully with the programme.
In the first year, we arranged two almost identical events a few months apart to ensure as many staff as possible could be included in the ‘launch’ process. Of the unit’s 200 permanent staff (consisting mostly of nurses, advanced nurse practitioners, support workers, ward clerks, secretaries and consultants), nearly half attended the first two events.
We aim to have a cross-section of staff with different roles at each event. Inevitably, the majority are nurses but on each occasion consultants, trainee doctors, clerical staff and support workers have also attended.
Clinical workshop groups
The two-day programme for each event has retained a broadly similar format consisting of clinical workshops, outdoor activities, a creative activity and a game.
The first session is a choice of clinical group workshops. At the first two events these were: bereavement; parents in partnership; infant nutrition; and issues in the low-dependency area. After discussion, the groups fed back their three most important suggested developments with an action plan, timescale for achievement and named person to lead this on return.
Each action plan put forward by these multidisciplinary groups was discussed at directorate and/or trust level. Staff of all grades were thus empowered to plan and implement changes, encouraging them to realise they can make a difference.
Many changes have been made over the past few years as a result. Examples include: not weighing babies at night; having named consultants for infants on the unit for long-term care; making a DVD about the unit for parents; and even purchasing a local flat to provide extra accommodation for families (which had been discussed for many years).
Although some of the developments may have taken place anyway, the concept of ‘timescale’ may have meant they took place more quickly as a result of the workshops. Importantly, staff initiated these changes, making the change process easier.
Outdoor activities have been a choice of walking, canoeing, climbing or gorge scrambling. On some occasions we have employed centre staff or an outside agency to run teambuilding activities.
Outdoor sessions were immediately followed with an activity demanding some creativity. On one occasion groups were sent out on their walk/climb with a plastic bag and instructed to collect items to create a collage that told the story of their group to other teams.
Healthy competition between groups and people operating outside their normal comfort zones (for instance sliding down a mountain gorge) can encourage more lateral and creative thinking than when taking part in workshops on more serious issues.
With no entertainment available nearby, activities are organised for the evening, including reflexology, karaoke and juggling. An outside activity is organised for the second morning to liven people up.
We have attempted to pursue a theme for each event (for example communication, leadership, teamwork). Later in the second day we have used a simulation game to reinforce the chosen theme. These have worked well and often demonstrate how people’s personalities and temperaments affect the way they take part in activities.
On occasions the relationships within and between teams in these games have become strained. According to Evenden and Anderson (1992), this is neither surprising nor worrying. Teams have four stages of development: getting together; getting angry; getting ready; and getting going. At work, team members’ professionalism does not allow them to be openly angry, as they are expected to get together and then get going straight away.
The opportunity to take part in activities that enable people to reflect on their behaviour in a team and the different attributes required for an effective team has been useful. Understanding their differences can help people to work together more positively (Handy, 1999). The key lesson we have learnt from these games is how important debriefing is afterwards.
A non-clinical workshop has been run on some away days. Here, participants work in groups but all brainstorm the same topic, then present feedback and three action points to the other groups. All action points are combined in a ‘wish list’.
Topics covered are: improving communication; enhancing the neonatal unit environment; and facilitating learners. Examples of resulting changes include: increasing ward clerk hours; having bins emptied more frequently; and the refurbishment of waiting rooms and parents’ accommodation.
Benefits of the days
The two-day events cost approximately £6,000 for around 50 staff. This includes transport, meals, accommodation and activities. While some of the outcomes have been tangible, increased staff enthusiasm and motivation is more difficult to measure.
However, a typical comment from evaluation forms is: ‘It’s good to know the management value us enough to do this.’ Although there will always be sceptics, most people say they feel more valued and more motivated after attending the events. Junior staff have said they feel more positive about their role and more able to discuss issues with senior staff or consultants after spending time away from work with them. We believe the cost has been justified by the objective and subjective outcomes.
The away days always start with a session on what we have accomplished since the previous event (on the first one we did a timeline of neonatal care in Liverpool over the past 25 years). Last time, one action plan produced was for staff to visit other large tertiary units in pairs to look at practices in similar units, to give feedback on anything we could put into practice or raise awareness of things we do well. These visits have since taken place.
Other benefits include:
The development of a unit newsletter, following a session on communication;
An increase in the non-clinical support worker’s hours;
The implementation of a pain tool, on which an audit has just been completed.
Many theorists, including some in Marquis and Huston (1996), have stated that people are motivated from within so managers cannot directly motivate staff – in other words, an organisation cannot force people to enjoy coming to work.
Factors such as pay and working conditions, while preventing demotivation, are not enough to positively inspire employees. Those thought to influence motivation include achievement, recognition, responsibility and advancement. We believe away days such as ours are an ideal way of addressing some of these motivators.
Implications for practice
Away days provide an opportunity to empower and motivate nursing staff to plan, implement and evaluate changes in clinical practice. This improves care for babies and their families.
Ownership of changes in clinical practice means staff want them to be successful so they invest in this process.
A broad range of staff working together for a common purpose has promoted communication and encouraged greater team spirit on the unit.
Encouraging staff with different personality types to use these differences to good effect has ensured the success of projects.
Buchanan, B., Huczynski, A. (2004) Organisational Behaviour: An Introductory Text. Harlow: Pearson Education.
Evenden, R., Anderson, G. (1992) Making the Most of People. Wokingham: Addison-Wesley.
Handy, C. (1999) Inside Organizations. London: Penguin Books.
Lingard, L. et al (2004) The rules of the game; interprofessional collaboration on the intensive care unit team. Critical Care; 8: 6, R403–R408.
Marquis, B., Huston, C. (1996) Leadership Roles and Management Functions in Nursing: Theory and Application. Philadelphia, PA: Lippincott Williams and Wilkins.