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PRACTICE COMMENT

'Make a change - even small things can have a huge effect'

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NHS Change Day is about staff making small changes without asking permission. It has captured the imagination of nurses around her, says Kate Pound

If each member of staff on a ward did something differently, the whole ward would change. The focus for me is not about cost improvements or targets, it is about making a difference for patients and staff. The ethos of NHS Change Day is that you don’t have to seek permission - it’s about recognising that you can just do something. Small actions can grow to be big things.

When I was a newly qualified nurse I wanted to change the world. You have ideas about what you want to do, but then you get bogged down in the politics and the targets. NHS Change Day has captured the imagination of the nurses with whom I work. It offers staff the chance to be themselves, the chance to do something they’re really passionate about. The clear message was “do it, and we’ll support you”. There is a real freedom to be found in change. Staff hadn’t felt that for a long time.

NHS Change Day has enabled senior people to connect with frontline teams over a positive message. Often when senior people engage it’s because there’s an issue, but NHS Change Day gave, for example, the chief executive of a trust the opportunity to work alongside a porter.

There are cynics who say “so what?” Dealing with that kind of attitude can be a challenge, but think about the simplest pledge, such as a smile. When you smile, you change the culture of where you’re working. That can have a profound effect.

If the culture in your workplace is one where you feel safe and comfortable, you’re much more likely to speak up if there’s a safety issue that needs raising. So, ultimately, that decision to smile could end up saving someone’s life.

A healthcare assistant decided she wanted to make change by reducing the “did not attend” rates for bladder test studies. She was fed up of patients simply not coming. She looked at relevant documentation to see how other departments had reduced DNA rates. Then she talked to patients. She discovered that, although appointments were booked well in advance, when the time for it came, patients were scared, didn’t have enough information and so didn’t turn up. Her change was to telephone patients five days before the appointment to remind them about it and ask if they wanted to rebook. This also gave them a chance to ask about the procedure and reduce anxiety.

The HCA next looked at ultrasound, which also had high DNAs; the numbers were too great to telephone individually so she put big bright stickers onto every letter, saying: “If you can’t make it, phone us up”. This led to a significant reduction in DNAs.

This HCA wanted to make a difference. As a team, we supported her, but she did the work. That’s what NHS Change Day is all about - getting rid of the hierarchy, so that frontline staff can make a difference.

Kate Pound is improvement lead and nurse at Nottingham University Hospitals Trust and transformational fellow at NHS Improving Quality.

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Readers' comments (2)

  • Let's all go home on time and not work through breaks...a small thing that would have a massive impact.

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  • how about nurses being treated with respect they afford patients, how about nurses getting a break, how about nurses enjoying a cuppa with a patient , if staff are treated poorly they lose the will

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