Mentor your staff through change to deliver sustainable turnarounds, says Tina Cookson
When you are delivering turnarounds, expectations are for a quick result, but to deliver real and sustainable change, clinical staff need to understand and accept the challenges and own the recovery process.
Coaching and mentoring staff through change can take longer, but is more sustainable.
At our trust, most of the clinical staff felt demoralised by poor media coverage. Self-esteem was low and they needed and wanted action and to be part of bringing back pride for nursing and the hospital’s previously good reputation.
My approach was a combination of being visible as a director of nursing, having one to ones with all the matrons and ward managers so I could understand their personal and professional challenges, and asking nurses what decisions were needed. It was about leading and learning, rather than over-auditing and criticising.
Through high visibility and role-modelling behaviours, showing the decisions I would make and what I would do, I then got them used to taking back control and making their own decisions. Keeping central control is not good for sustainability. A clear accountability framework with both support and challenge is evidenced to work well.
To boost self-esteem, create the idea of the wards or whatever environment nurses work in as “centres of excellence”. Enthuse nursing leaders to feel like there will be no mistakes “on their watch”.
Sometimes I see people auditing and measuring but to no real end, so watch for that. Agree with your team that something needs to change, and check back in with them if it doesn’t happen to find out why or if they need additional support. Make sure they know they must be both responsible and accountable.
Focus your effort on where care delivery happens – and engage staff to ensure they feel able to challenge managers.
Make sure staff see nursing and medical leaders working together. Role model the importance of multidisciplinary working at executive level.
Don’t forget to take examples of good practice back to your team, not just the bad. It’s easy to forget to be visible and provide support in the well-performing areas as well – it’s a trap I fell into until staff told me off.
The impact of doing this at James Paget is that we are now compliant for all previous major and warning notice concerns. We have more to do, but staff have regained their pride.
Tina Cookson is interim director of nursing at James Paget University Hospitals Foundation Trust , which she is in the process of turning around following poor Care Quality Commission reports. She has worked in the NHS for over 30 years, holding senior posts in PCTs, community and acute NHS trusts.
What you can do to improve communication
- Organise one-to-one meetings with all your team regularly
- Value appraisal – it’s quality time with your team
- Ask your team what three things they would like you to focus on to support them
- Agree an action point, and check back to ensure it is happening or if you can offer more support if it isn’t
- Encourage communication across disciplines and prioritise patient safety
- Role model the organisation’s values