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Managing a nursing workforce may be tough enough but Maggie Arnold set out to improve the whole trust

Managing a nursing workforce may be tough enough but Maggie Arnold set out to improve the whole trust

Involving everyone has been the key to delivering radical improvements at Gloucestershire Hospitals Foundation Trust, but it was a nurse who made sure they actually happened.

Director of nursing at the trust Maggie Arnold is responsible for the leadership of nursing and midwifery. However, when the trust had to turn around its four-hour accident and emergency waiting target, it was Ms Arnold who marshalled the troops - across all staff groups.

Foundation trust regulator Monitor had found the trust in significant breach of its authorisation as a foundation trust since September 2009. This was because it was persistently missing the target that 95% of patients be admitted to a bed or treated and discharged within four hours of arrival. When a foundation trust is in significant breach the board and executive team are subject to increased external pressure and face being dismissed if improvements are not made.

And so it was a huge vote of confidence that, last May, the trust put its director of nursing in charge of improving its waiting times.

Having worked for the NHS for 33 years, initially as a trauma nurse, then at GHFT since 1995 and as director of nursing since 2007, Ms Arnold did not feel phased.

“I knew that the key to meeting that target was to get everyone involved,” she said. “And the fact that I’d been here for a while and people had seen me in different roles helped with that.”

Ms Arnold had also worked in nursing in the armed forces for six years, which no doubt helped with her ability to pull together a team, identify the most expedient solution and communicate the strategy.

“I knew I had to look at all aspects of the patient experience through the hospital, from arrival in the ambulance to discharge,” says Ms Arnold. “This threw up some interesting findings, such as the fact that we didn’t have enough cubicles. And so we rectified that.”

But Ms Arnold was adamant fixing the problem was not just about A&E. “It was a whole-trust problem,” she says. “Just by going to talk to the people in IT, I came away with fantastic systems. Being a nurse, I prefer people to data, but when I explained the issue to our systems people, they would come up with great graphs to show what was happening. This was great for producing an action plan. And when things improved, it was excellent for reinforcing great practice.”

“We tried different things, such as our own dedicated porters at times of high demand in the emergency department instead of pulling from the portering pool, so we could discharge efficiently. The board was great at just letting me try this sort of thing to see what worked.”

The trust also put up signage and organised a system to show patients the length of wait times in minor-injury units and the emergency department.

Ms Arnold says getting out and talking to domestics and porters, and convincing them they could make a change was vital. Having previously used the positive-deviance technique, a skill acquired from the Institute for Healthcare Improvement, she says this was a useful tool in creating the change in behaviour that was needed.

“I’d used the positive-deviance technique when people weren’t washing their hands because they needed to keep their watches on. We put up more clocks and - hey presto! - handwashing compliance increased.”

The results of Ms Arnold’s work in A&E was that performance improved from 90.5% in the last three months of 2011-12 to 96.1% in the first three months of 2012-13. Monitor declared the trust had made the necessary improvements and was no longer in significant breach of its authorisation as a foundation trust.

Ms Arnold said the quality of care had never suffered but the board acknowledged patient experience was affected by the long waits, so she is pleased she has been able to make a difference. But, she says, it is the staff who must take all the credit.

“They have been absolutely fantastic, everyone has been engaged, and that’s why it has worked so well. It has been a real team effort.”

Jenni Middleton

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Readers' comments (4)

  • This just goes to show what can be achieved when a nurse is in the lead - come on DOH - take note and act as effectively as this nurse by putting nurses at the forefront of healthcare leadership. We are the people who can galvanise the workforce.

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  • So now we know ! --

    Talk to the porters and the domestics ! ---Problem solved !!

    On the way collect pretty pictures from IT and put up some signs !

    What a load of ********

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  • Perhaps Maggie could now turn her attentions to the fact that the her Nursing staff are very unhappy at their Trust being part of the south west pay cartel, in what way is she supporting her Nurses on that?

    Oh and a lot of staff in the trust were hoping the Chief Exec would be dismissed by monitor, it was a happy place to work before he came along.

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  • Got to agree with Anon above. Not sure Maggie did anyone any favours by saving the backsides of the Chief Exec and board of this Trust.

    And I wonder who sent her to the National Nursing press with this "feel good" story? From a trust where the Nurses look defeated by the pay cartel and Consultants whisper in corridors about a vote of no confidence.

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