Nursing managers have been urged to get better at sharing solutions to problems with each other and to stop “reinventing the wheel”.
Professor Janice Stevens, Health Education England’s director for the Midlands and East, claimed the NHS was “terrible” at sharing ideas.
“Every problem we’ve got in the NHS, every challenge to care, somebody’s solved it. Yet we nobly go on reinventing wheels,” she said at a conference for deputy nursing directors.
“I can’t tell you how many infection control packages I’ve seen, training programmes I’ve seen – please share,” said Professor Stevens, a former nursing director who has also held posts at the Department of Health, working on healthcare-associated infections and mixed sex wards.
“I think we owe it the NHS to stop investing wheels”
She advised the audience that if they were trying to solve a problem, not to set up a steering group or development project.
Instead, she urged them to look for existing solutions and “use your social networks to find out if somebody’s solved it”, noting in particular the power of social media. “You can send out a tweet today saying has anybody got a tool for X,” she noted.
“Don’t start with looking in, start with looking out and find the solutions and adopt and adapt, rather than starting from scratch,” she said, adding the majority of people wanted a tool or framework that they could “tinker” with and adapt for local needs.
“The look up and out before you embark on anything is absolutely essential, because I think we owe it the NHS to stop investing wheels,” she said.
Professor Stevens was speaking at the inaugural Nursing Times Deputies’ Congress in London on 16 October.
In her keynote speech – titled What does a good Deputy Director of Nursing look like? – she highlighted 10 areas that she thought could help nurse managers, based on her experience.
“We have to be very data assurance savvy… nursing has created an industry out of audits and standards”
As well as sharing ideas, she called on nurse managers to engage with the frontline and question in detail what was happening.
“One of the things about being day-in-day-out in an environment is the fact that you normalise stuff,” she said. “It’s really hard and you can get to the stage where you don’t see the obvious.
“Mixed sex accommodation classically shows how that can happen. It doesn’t mean we don’t care, it means we got used to seeing people being mixed in bays,” she said.
“What I didn’t do well enough [when I was a deputy nurse], was the deep questioning… I didn’t think deeply enough about what’s the two or three or four questions that I really need to know the answers to that will help me know whether we’ve really got a problem or things are running well.
“I often see on walkabouts, when execs go around and they don’t focus in enough detail or they ask really silly questions about the wrong things,” she said. “For me, remaining close and sitting down next to a patient and having a chat to them really helps you know whether the messages are getting across to staff and then you can think about what else needs to be done differently.”
Professor Stevens also called on senior nurses to be “data savvy” in order to be “properly assured” of the quality of care in their ward or service.
“We have to be very data assurance savvy… nursing has created an industry out of audits and standards,” she said, describing an incident in which she had been asked to visit a problem ward by a trust chief executive after regulators disagreed with performance scores.
“I went to one organisation that had developed 120 indicators of nursing practice… but interestingly they were all green,” she said. “They weren’t indicators, they were just statements of things that should happen.
“Half a dozen indicators – powerfully and properly assessed and assured – would have told the board that ward had a problem,” said Professor Stevens.
She added: “We audit for England, I think, a lot of nurses. There’s something for me about how you become really savvy and understand the absolute indicators of quality and safety.”
She highlighted infection control as an example of using data on several different related factors to give a broad indication of quality.
“The absolute number would be the number of infections, but the key things that prevent infection are the hand hygiene and the line insertion. So, they are the things that have to sit behind, that will give reassurance that my numbers are right.
“Get as data savvy as you can,” she said. “If you looked at mortality data, do you know how to read it, do you understand it – for me the savvier you get.
“The NHS isn’t very good at project management and I think project management is a very simple skill that you can learn”
Professor Stevens said it was “okay” to have “dips and variation” in performance, and that she would be “very, very worried” if things appeared constantly good. She advised the audience to devise measurements so they were “properly assured” rather than “reassured”.
Meanwhile, she advised the audience to learn about improvement techniques that were backed with evidence in order to get an innovation or new way of working widely adopted and sustained.
She highlighted, for example, techniques on “narrative, how you tell a story to get people to mobilise rather than comply”.
“You can be as good as you need to be if you don’t understand the principles of how to get real improvement, and learn some of the tricks of the trade,” she said. “They’re not difficult and they’re not complicated, but you need to learn them.
“If you don’t know that there’s a tool that can help you understand whether a really key piece of work will sustain – the chances are it probably won’t or it will be more luck that judgement,” she said. “Using and accessing improvement techniques are really, really important… bits to your kit bag.”
She added that for changes where there was an established evidence base, such as pressure ulcer prevention, it was best to attempt “large-scale change” rather than testing something on one ward.
“We absolutely know how to prevent pressure ulcers,” she said. “It’s basically making sure the elements of the skin bundle are complied with. First you’ve got to mobilise and excite people in a way that they want to do it, but then you’ve got to make sure people are doing the skin bundle – it’s really that simple.”
In addition, Professor Stevens advised nurse managers to learn about the principles of project management, for example by taking a Prince2 course.
“This is really, really important,” she said. “The NHS isn’t very good at project management and I think project management is a very simple skill that you can learn, you can do an online package.
“If you’re asking somebody to do a piece of work, ask them for the simple document and a Gantt chart, and hold them to account against that,” she added. “Otherwise, people go off at a tangent.”
“The reality is that myths get created and I think it’s our role as a leader to myth bust”
Professor Stevens also advised nurse managers to “walk the patch or talk to teams” in order to “myth bust”.
It would help challenge “rubbish out there that’s stopping something happening because somebody misquoted”, she said.
“The reality is that myths get created and I think it’s our role as a leader to myth bust. The keeping close and listening to what people say about why they can or can’t do something is really important,” she said. “Just check what people have been told, because those disconnects can be terrible, and so you get myths.”
Another important message, she said, was the ability to spot future leadership talent or potential. She said it was best to get people “into some of the knowledge of leadership as soon as they can… that recognises their leadership ability, but also starts to use them as leaders”.
“It doesn’t matter what level you are at – you know if you are a newly qualified staff nurse you may be supporting some healthcare assistants,” she noted.
However, she warned nurse managers to spend the majority of their time with team members who were “energy givers” and would help implement change, rather than trying to influence those who were obstructive or negative, which she described as “energy sappers”
“I can’t think of the hours I’ve spent with people that suck the life force out of me,” she said. “It’s better to make sure you’re giving your 80% to those people that are energy givers and it’s amazing.”
“I don’t think we, as nurses, look after ourselves properly often enough”
On a similar note, Professor Stevens urged nurses in leadership roles to “look after you” and be a “bit forgiving of yourselves”.
“Even if you are really positive, not everything is going to go to plan… stuff in the NHS at the moment – it’s relentless,” she said. “It’s how you deal with it, because people will take their cue from you.”
She added: “I don’t think we, as nurses, look after ourselves properly often enough. I don’t think you can afford not to give yourself an hour every so often…
“You must be selfish occasionally, because it will make you a better leader,” she said. “Never think of giving yourself time as wasteful, it’s essential and it will aid your survival in this rather challenging world.”
She told the audience they were in an “amazing position” as nurse leaders, because their role meant they could “absolutely” improve care for patients while also helping their staff. “For me, even on those days that it’s relentless, the privilege of doing what we’re doing is amazing,” she said.
Janice Stevens’ “10 tips” that could make a difference to nurse managers
- Deep questioning – thinking about questions that will help you understand what’s really going on
- Data savvy – learning techniques to understand and gain assurance from care quality indicators
- Sharing ideas – asking colleagues elsewhere about solutions and not reinventing the wheel
- Project management – a very simple skill that you can learn to keep progress on track
- Improvement techniques – getting new ideas adopted, spread and sustained at scale
- Myth busting – check what frontline staff have been told because disconnects can be terrible
- Time management – give more time to the energy givers than the energy sappers in your team
- Succession plan – talent-spotting for the next crop of nurse leaders and giving them responsibility
- Look after you – being selfish occasionally because it will make you a better leader
- Recognise potential – as a nurse leader you are in an amazing position to improve patient care