Team work makes the dream work by Alison Howie

Part 1- Forming to Storming A new team a new start…again.

Hello, and welcome to part 1 of my Team Work Blog.

My name is Ali Howie and I work as Team Lead (West) in MSK Physiotherapy based at the Galloway Community Hospital. I have worked in healthcare for 27years and wow what a journey it’s been, never more so than in 2020.

I have had the opportunity to work in a variety of teams in a variety of Health Boards and business’. Every team and every outcome has been different. But when everything comes together and you achieve your goal, there really is no greater feeling, of achieving something as a group. The lift you get is euphoric,  and being able to enjoy that lovely phase of Adjournment, when we can congratulate ourselves, and look back on our journey with a smile, and a feeling of achievement and pride.

Unfortunately, that feeling is not always guaranteed, and there have been many times when the team never performs or reaches its potential. There are various reasons for this which we shall explore in this Blog series. Within Health and Social care, particularly at this time, new teams and new goals are being established. There are a lot of services which are pressing the restart button and maybe, hopefully, looking to redesign our services. The rules have changed with COVID. This means New Teams are forming, and the journey of team development begins.

The one thing I feel is at the heart of good healthcare is Team work, and I truly believe that ‘Team work can make the dream work’. The phrase is attributed to an American- John Maxwell, and is often used but rarely achieved. 

He said “Teamwork makes the dream work, but a vision becomes a nightmare when a leader has a big dream and a bad team”.

If we can’t work as a team to provide safe and effective healthcare at a time of need, then we don’t score a goal, and often head home defeated. Worst case scenario, someone gets hurt and patient safety is compromised. Sometimes we have a bad day, but if the team isn’t performing, we have to find out why?

In health and social care we don’t often have the luxury of setting up a completely new team with all the right skills and dynamics. More often we work on upskilling and developing a team to perform. Barriers to team development, such as loss of staff (retirement, maternity leave, new jobs, long term illness, secondment), lack of training opportunities, time restraints, poor strategy and leadership. All these can stop a team from developing, as they don’t work together long enough to reach the performance phase. But, there is lots we can do to make things work.

In 1965 the Psychologist Bruce Tuckman coined the phrase “forming, storming, norming and performing” … describing the 4 phases of team development, and later added the fifth stage of “Adjourning”. This model of how teams develop, is widely used, and follows the stages of development. The goal being to get to the performance stage where a team can work independently and achieve their tasks. A highly efficient team can almost run on its own but still needs to go through the stages to achieve this. How long it takes can vary depending on a number of factors.

In all services not least health and social care, this model can be seen over and over again in all the Teams working simultaneously, 24/7, 365days a year to provide health and social care to our population.

So why am I sharing this with you and writing this blog?

Well, I have recently joined a new team –by being part of the NES nMAHPs digital Leadership course. I am learning leadership skills in the context of digital innovation, and looking at how digital technology can enhance our healthcare systems and efficiencies. The project for this course is to integrate MORSE into MSK Physiotherapy practice. This involved setting up/forming a Super User Team working closely with IT- forming -which is where the Blog comes in. 

Will we achieve our team goal of Morse Implementation? 

And What will myself and the Team learn along the way? 

As part of my course I have to challenge myself to try new ways of sharing information and communicate my learning to the teams I am part of. Writing a blog was one way, I felt I could communicate what I was leaning, to everyone working in D&G. So after much pondering, procrastination and delays (as I am very nervous about writing this) I decided to do a 3-part piece on Team work. 

I truly feel it is the most important part of what we do. Particularly in these challenging but exciting times of change on the back of COVID 2020.

I have always loved Team Sports, and in my younger days, was always playing Hockey, like football there are 11 players and a ball with the addition of sticks. There are rules, time limits, penalties and everyone on the pitch has a specific positon or job. If you are not into hockey think of it like football, the beautiful game. 

Working in a team in the NHS is just the same as being part of a sports team and it’s a good way of demonstrating how teams work and perform. Refer back to Tuckman’s Model.

Stage 1- Forming: A new team.

When we have a new team it generally begins life in the forming stage. For my Journey I felt a little like someone had packed my suitcase and bought tickets and given me them and off to the airport- not really sure what I was doing where I was going or why I needed half the things in the bag… So initially trying to figure out the purpose of the team was key. You always get a little worried about how well you will gel with the other members of the Team. Keeping an open, positive attitude is really important here. Assumptions and your ladder of inference can impact your initial relationships and perceptions, and be a barrier to progress.

Make sure you Know or have an idea of what the Goal/Purpose of your team is. If we don’t know where we are going, how can we plan the route? So spending time meeting the team and trying to see who has what skills and what skills we needed took a while…On reflection pre planning and more information would have been better but we formed and eventually after discussion decided on task.

Purpose: To implement Morse use in MSK Physiotherapy practice to improve patient safety by real time information sharing.

Stage 2: Storming

Sometimes it is very difficult to get past this stage. Being open honest and learning to trust each other is a key factor here. Understanding each other’s skills and attributes and how these will help achieve the goals/task in hand is crucial. If the Team can’t agree and unite then they can’t move forward.  I know in the past, projects have fallen here, as no one takes the steering wheel. If no one is quite sure what is happening and what their roles are. They don’t know who they can trust, and the loud annoying person is rubbing everyone up the wrong way. No one says anything, and the Team Captain does not seem sure of themselves. It turns out that everyone is confused. As the initial stage develop it also turns out that there is very little variation in the team, everyone seems to want to be in charge but no one wants to do the work!!

Luckily for me with this new team there was generally a good variation of personalities and skills.  There was a lot of resistance to the task initially, and criticism of the process, which was expected and at this stage good points were highlighted about clarity of communication. It was productive allowing everyone an opportunity to speak and not avoid conflict or disagreement. Ideas come from discussion that is open and honest not closed and narrow. Some members are much quieter, and took time to make their voices heard, as often an extrovert can put an introvert off from being open. This is something I think worked well by allowing and encouraging everyone to have their point of view. So this stage has taken a little longer than I would have hoped, especially with travel restrictions and restart of services. Time is often the most difficult resource to manage, being patient is a key trait as there is no definite timeframe for people to form and Norm. But norming was fast approaching thanks to a number of TEAMS meetings, emails and communication between the Team. Getting to know your team mates is really important.

So after 4 months since initial start of this new Team, we are almost in Norming stages.

Going back to the football analogy I mentioned earlier, I thought it would be fun to think of the scenario of a new football team … Luce United, and think of its relevance to the team/s you/we are part of!!

Here’s a wee story about a Team, A new Team, A football Team – Luce FC. Chapter 1:

                Team Development: Luce United (stage 1 and 2)

Luce United have been set up by a group of friends who have recently retired. They had always dreamed of owning a football club and one of the syndicate’s Uncle Sani used to be a football manger- they ask him to set it up and gave him a blank cheque!

Uncle Sani’s been out the game for a couple of years “but nothing much will have changed” he thinks.  l’ll call the contacts and get things going,  no problem. 3 months later Sani turns up to the stadium and waits to welcome his new team to the first training session.

Eventually 25 men of varying sizes, shapes, ages and nationality turn up.  Sani’s’’ friend Jim was a coach with one of the big teams back in the day ( Jaggy Thistle FC), so he had arranged everything and assured Sani it was all in Hand. 

5 of the players could not speak English, 3 were injured, 3 had holidays booked so could not stay for the whole session, and no one liked the strip, no one had received the training plan or fixture list and they didn’t know what league they were to play in. Everyone knew of Jim through friends and a couple of them had played together years ago.

After some introductions, it transpired that Jim had signed 3 Goalies, 6 strikers and no Backs or sweepers. So they didn’t have all the skills they needed to play. There was a match arranged for 1 week’s time and half the team were on Holiday and the Manger had also booked a trip away. No one was willing to compromise and cancel their trip and they ran out of time so didn’t make any plans for the next session.

At least they all knew how to play football and all had experience, there was enough players for a team and reserves but they needed to work together to decide who was doing what positions, what training they needed and a proper training schedule.

 The following Thursday a second training session was held. 3 folks had not turned up they said it was a shambles, and did not want involved. Some of the players said they should be captain and would sort it out. 

What a disaster. 

How can Luce United come back to become a Team that will be able to perform.?

Where do you go from here? Luce FC is definitely not off to a good start!

Every team needs a leader to steer the journey, they may not make all the decisions but they need some form of direction. This group had none and when that happens in health an social care it can go badly wrong and at worst end up in patient safety being compromised.

The Tuckman/Leadership model shows how directing and coaching are required in these initial stages to influence the development of the team. Sometimes members of the Team don’t want to be there, it lowers morale and prevents the team being able to rely on each other or develop trust. Negativity and conflict don’t help but regular review and discussion do. We need to ask why teams are not working and constantly review our process’ to improve our understanding of each other. If there is no goalie in the team (a key role) that’s a major problem. This happens a lot in healthcare, where someone in the team is lost or off and is not replaced. The inevitable result will be an own goal or a defeat. Morale becomes low as there is a skills gap, not everyone steps up to help out, mood drops and the established performing team regresses. This can be particularly quick if the team was not performing well before the loss.

I know from my experience in my current journey, understanding the role and complexities of the IT Team has been the most challenging part. There was a large skills and knowledge gap on our part and lack of understanding of the process of coding and digital writing. Once we established a language and translation process we were able to move forward. But new skills take time to acquire. Being patient and recognising your training needs has been a big aspect of our initial stage of development. 

We have also lost a couple of team members, so having a slightly larger team to start was beneficial, as we have been able to continue without having to recruit any new members and are still moving forward. In any team it’s important to have flexible skills so not only 1 person is responsible for 1 task, then any loses will not jeopardise the project. 

If we look again at Tuckman’s Model, we can try and relate to the initial stages of team development.

What will happen to Luce United??   What will happen with our Morse project??

So after reading part one, I hope you will take some time to reflect about your team and yourself. If you feel your team is not performing, think about the football team – where do you see the problems? and most importantly what are the solutions?? Write them down and bring them up at your next meeting or share your thoughts with a member of the team or team lead. If you are performing, take time to celebrate, congratulate and appreciate the feeling of being part of something that’s fun, effective and gives you a buzz. Share your tips with your networks and influence positive team work within the organisation.

Reflecting without taking action will have no impact on performance.

We can’t control all aspects of a team, staff move on, equipment changes and technology improves but ultimately we need to know what our teams purpose is, what our role is in the team, have the skills to fulfil our role and be able to be flexible and understand everyone else’s roles in the team, so we can fill in, support and cover.  Open and honest communication and knowing who is in our team is vital for initial success. 

Embrace your Team and although there is no I in team there is a me, and great team work does make the dream work.

Have a very very Merry Christmas and Happy New Year although it won’t be our usual parties with hugs and kisses. But we can wait till next year and keep in mind the need to keep everyone safe and avoid unnecessary risk. 

See you in January for Part 2…What will Luce United be up to in 2021?

Alison Howie is MSK PhysiotherapyTeam Lead (West) at Galloway Community Hospital for NHS Dumfries and Galloway

A pool, a pandemic and a baby by Jennifer Rendall

The Covid-19 pandemic has been a huge challenge to health services across the board – the Community Midwifery service has been no different.   During this time we were aiming to keep pregnant women safe, provide all necessary contacts with women and families (whilst decreasing any potential exposure to Covid 19), to ensure that all pregnant women receive all the maternity care they require. We have also been continuing to implement The Scottish Government “Best Start 5 year plan” – with particular emphasis on improving the continuity of care women receive during pregnancy, improve access to antenatal education, increase breastfeeding outcomes and give some choice about place of birth. 

“During the review of maternity and neonatal services, women and midwives both expressed a desire for greater continuity of carer to improve relationships. In addition, evidence shows that midwifery continuity of carer models have proven benefits in terms of improved outcomes for women and babies. These include a potential reduction in preterm birth and miscarriages, a reduction in medical interventions during birth and an increase in natural births. The benefits for midwives include improved relationships with the women they care for, increased autonomy and increased job satisfaction.” – Scottish Government (2019).

In essence this means that we know women have better experience and better outcomes when they have a known care provider during pregnancy and labour. This makes it a top priority when we are re-structuring our service. 

Planning for a community midwife to be present at the birth of a woman on their caseload is no easy task – if only births were predictable this is something we would have all our staff working towards. When this is in a home birth situation it involves an on-call commitment which covers a 4 week period.  During this time 2 midwives must be on-call and for us that involves staff from across the region.  The reason for this is that we cover a vast rural area. Women are made aware that some members of staff may need to travel therefore they should give us as much notice as possible when they go into labour. Women give birth at all times of the day and night, but a home birth is only safe when they reach full term – this is classed as being beyond 37 weeks gestation but as lots of women know only too well this can stretch out to 2 weeks beyond the magic due date.  Having said all of that when all goes to plan it can be a wonderful experience for all involved.

In the early period of the pandemic we had concern about how our NHS would cope with the “worst case scenario” predictions – it was something none of us had seriously contemplated before – what if we had no beds in a labour ward, what if we have no staff to provide the care for a woman in labour.  The only thing which was clear from the outset was that we had to do all we could to ensure that the place which must always have staff was the labour ward.  A labour ward has a completely unpredictable workload and schedule, as all women know labour is a completely unpredictable event.  The homebirth service “naturally” felt like something we could suspend, and instead the community teams from across the region provided on-call support for our acute colleagues, ensuring that care for women in labour, by a skilled practitioner was achievable.  

As more information became available during the pandemic and the staffing situation became more stable we began to look at the possibility of restarting our home birth service. As a management team we looked at what changes we might need to make to keep both families and staff safe. From July we again started to provide the home birth service region-wide.  

The reasons why a woman may wish to opt for a homebirth are numerous.  Research shows that the home-birth is safe for “low risk” women.  They can feel more relaxed in their own comfortable surroundings, which in turn makes the hormones required for labour flow better.  They don’t need to worry about travelling to hospital which will reduce the stress hormones and lessen the chances of labour stopping, which in turn lessens the chances of interventions happening.   However, it is a big decision for some women, particularly the further away from a hospital setting that they live. 

Gemma who lives in Wigtownshire requested a home birth early on in her pregnancy so we were delighted that this would now be possible. This was her second child and she wanted to deliver at home in a birthing pool. Gemma, her husband Guy and their midwife Lynne worked together to ensure that everything was in place and the community midwifery team worked together to provide 24/7 on call cover to ensure that this could happen. On Saturday the 17^th of October Gemma went into labour at home and delivered baby Ciana with the support of her midwife Lynne. Ciana’s big brother Enzo woke in the morning to find that his little sister had arrived. 

It feels like a good point to hear some words from the people in this relationship.

Gemma Calderwood:

Being pregnant throughout a global pandemic was different. It was a very lonely time for people at best but going through the ups and downs of pregnancy without having family and friends to share it with was hard and I felt for all the women out there going through it too. 

Living in Stranraer it was an hour and a half drive away from our hospital in Dumfries. So having a homebirth was the simpler option for us, of course we were concerned if something was to go wrong, time wouldn’t be on our side but Lynne and the other midwives were able to explain any worries that I had, they were prepared for just about everything too. They brought everything they would have needed up to my house a few weeks before I was due. I wanted a homebirth with my first and ended up getting what I felt was an unnecessary induction. It was a very negative experience which ended in an episiotomy. I was so groggy due to all the drugs and the long drive home after left much to be desired. It wasn’t the euphoric experience I had hoped for and I didn’t want to go through the same again. 

I had a smooth pregnancy, and was praying I didn’t go too far over my due date. I was determined not to have a second induction. 

At 40 weeks 1 day, Lynne had me booked for a stretch and sweep. I wasn’t holding out much hope though, I had a few with my first and he didn’t budge.

Throughout the day I was having these twinges but they didn’t really feel like anything. 

I messaged Lynne that evening and told her it was probably nothing and she said to go for a bath and relax. 

10pm – Lying in bed I was starting to get twinges so I put my timer on my hypno-birthing app. They were every 7 minutes for about a minute long. I was breathing through them but they were completely bearable. Then one really strong surge came that made me grab the headboard and POP! My waters broke! this was around 11pm, I instantly started shivering, I called Lynne and she said she was on her way from her home which is about a half hour drive. Lynne arrived and I was happy for her to check me and she said I was 4/5cm but could be stretched to 6.   I was using my hypo-birthing app to help me concentrate on breathing through my surges. The second midwife Hillary had came in at some point and she was lovely too. 

About 1am I was feeling a lot of pressure. Lynne told me to go do a pee and see if that would make some space for baby’s head to come down, I got a massive surge when sitting on the toilet and she encouraged me to get in the pool as she thought I was close. The pool was amazing, the gas was amazing. This was next level. After about 10 minutes enjoying the bliss 😂 I leaned over the pool and felt an urge to push. From what I remember I didn’t push for long 3, maybe 4 surges. Second last surge was the oddest sensation and actually panicked me a bit. Everyone reminded me not to panic and I reached down and felt the top of baby’s head. I gave another push and thought ok that’s baby’s head out now. 

1:36am I eagerly waited on the next surge to come and when it did I pushed my baby out and pulled her up to my chest. It was the most surreal moment of my life. I was so happy and smiling from ear to ear.

I had skin to skin then went into my own bath, cuddled up on my own sofa and had my own tea. The midwives stayed for a bit, did their checks and left us in our own little bubble.

Best part was my little boy waking up, running into our room in the morning and meeting his little sister.

Having Lynne throughout my whole pregnancy and birth was so important and special to me. She knew about the birth I wanted so when I was in labour she could help me in the best way possible. I trusted her and she kept me calm and guided me through my labour. I could not have asked for a better experience.

Midwife Lynne Ritchie:

As midwives we feel really privileged and it gives us great job satisfaction to be present at the birth of a baby. The experience I had with Gemma and her family was lovely. Continuity of care allowed me to form a really good relationship with Gemma and get to know her, her fiancé Guy and their son Enzo. I saw her at the clinic for her appointments and was able to discuss parent craft and understand her wishes and expectations really well. I was excited when Gemma decided she would like a home birth. Gemma wanted the use of a pool at home. A homebirth assessment was carried out and everything was put in place. Care in labour and birth is more challenging as it is not easily scheduled! As I only work 22.5hours a week I was concerned that I wouldn’t be present at the birth. Fortunately, I was lucky enough to be oncall and at the delivery which was lovely and relaxed. Gemma and Guy were delighted to have the birth she hoped to have in the pool at home. I think this illustrates how much we try to provide individualised patient centred care with very positive results.

The morning after Gemma’s home birth I got a text from Lynne.  She was delighted and excited to report that the home birth had been a beautiful experience; the experience that she and her patient planned together, a patient whom she had grown to know well, and had helped to achieve her “perfect birth story”.  At the end of the day as midwives that is our business.  As we move towards full implementation of the Government Best Start 5 year Plan for Maternity Services, we really hope that this is a scenario we will be able to see replicated for Women and Midwives across our region. 

Jenny Rendall is a Senior Charge Midwife for the Community West Team at NHS Dumfries and Galloway

Tech neck, fingerless gloves, asynchronicity and the woman who moved to Crete by Helen Moores-Poole

Working from home part 2: could digital nomads be a SAM solution?

In June I wrote a blog about moving to a system where some of us are working from home https://dghealth.wordpress.com/2020/06/19/working-from-home-home-working-flexible-working-navigating-new-watersby-helen-moores-poole/

It touched a chord, with people throughout D&G getting in touch. 

Six months on things have moved on apace and people across the world have found ways to adapt…

There’s the woman whose home was a small cramped flat, so upped and moved to Crete and now works from there instead. An interesting thought, especially as another dark Scottish winter heads our way. 

Then there’s my husband. Mr P excitedly discovered Desk Dog, the new initiative from Brew Dog where you rent a desk in the pub for the day. Yes, honestly – heat, wifi, £7 for the day inc bottomless coffee and a pint of IPA at home time! He’s trying to persuade our local to do the same.  https://www.brewdog.com/uk/locations/bar-experience/desk-dog

Back in D&G however some of us are struggling, Teamsing away in the back bedroom and dreading the thought of being home alone this wintertime, Covid-the-Thief having stolen so much from us already this year. So what new practical hints ‘n’ tips can we share since last time and could a remote, or distributed, workforce be one answer to the recruitment challenges we face in D&G?

A quick chat with home working and shielding colleagues and a scour of the internet and I’ve compiled the best of what’s out there into the 12 points for thought below.

Top tips for ‘Winter Wellbeing’ working from home

1. Home energy bills are predicted to rise in homeworkers this winter. Home Energy Scotland have some helpful tips for those working from home which include replacing light bulbs with LED bulbs, using autoswitch websites to continuously get the best deal on utility bills and buying a draft excluder! They also have grants available and lots of tips on winter warmth. More here: https://www.homeenergyscotland.org/stay-warm-for-less-while-working-from-home/

2. Dress for warmth and comfort but still avoid pyjamas – sorry! Never one to miss a trick, the fashion industry has a new category for 2020 “Work from home wear”. A quick peruse and for the men it’s all about smart jumpers, linen trousers and leather birkenstocks  https://www.johnlewis.com/content/fashion/men/working-from-home-menswear 

and for the women Estee Lauder lipsticks, cashmere joggers and loungewear- obviously! https://www.whowhatwear.co.uk/work-from-home-outfit-tips/slide5  

Yes that’s all a bit tongue in cheek and personally, I’ve just invested in fingerless gloves and a cosy polo neck that looks presentable for Teams calls but whatever lights your fire. Clothes can be a big part of your identity, wear what makes you feel good whatever that is, but if you’re cold you’ll hunch, and that leads to tech neck.

Shared by ‘Proper Manchester’ on Facebook: this pretty much sums up Mr Ps heating policy!

3. Think about your posture. A physio colleague highly recommends this website which has lots of simple exercises if you’re suffering from Tech Neck. Don’t forget your Occ Health colleagues are there to help too. https://www.posturite.co.uk/help-advice/useful-resources/advice-sheets

4. Keep moving: Think about investing in a standing desk or gym ball to sit on.  Neither of these are meant to be used all day or to replace an ergonomic desk assessment but they might help break the monotony or help you get a change of position. My standing desk was £11 and I personally find it helpful. https://www.amazon.co.uk/dp/B08HC998XR/ref=cm_sw_em_r_mt_dp_XeSLFb7Y5GM16?_encoding=UTF8&psc=1

5. Look after your mental health, it can be lonely at home. The local staff support details are on the red button on Beacon and below if you would like someone to talk things through. It includes links to apps like Sleepio and Daylight to help with sleep or anxiety. Headspace is also still offering NHS employees 3 months free use of its app if they register before Dec 31^st which should take you through til Spring. See here: https://help.headspace.com/hc/en-us/articles/360044971154-Headspace-for-the-NHS

6. Set up a Wellbeing Action Plan: There is a generic plan on the Turas website but it’s lengthy. Alternatively, Mind have a free working from home Wellbeing Action Plan which is excellent. It helps build resilience, identify past coping mechanisms and triggers and gives a framework for a conversation with your line manager about what they might do to support you. Really great. See here: https://www.mind.org.uk/media-a/6020/22078_work-from-home-wap.pdf 

7. Maybe try a Light box. The evidence from NICE is inconclusive for these. They come in 2 types, sunrise simulation to help you wake up and a daylight simulation light which may increase feelings of wellbeing. Starting at about £30 have a look here, see what you think: https://whichtobuy.co.uk/best-sad-lights/

8. Make yourself a Happy Wall! One enterprising colleague in the west has created the montage below, love it – great for positive visualisation or practising mindfulness or quite frankly cheering you up when you’re feeling a bit cut off ‘n’ blue.

9. Stay Social, eat well, get outside. There are ‘blue zones’ in the world where there are a higher percentage of healthy centenarians than anywhere else – Okinawa Japan, Sardinia Italy. These happy super agers all have a healthy, low meat/high veg diet, daily exercise especially in the form of gardening, a purpose in life and strong social ties. Yes, we tell our patients to get outside and take a daily dose of vitamin D but do we? We heard about the Covid stone, the weight the average person put on during lockdown from comfort eating, lack of exercise and feeling disconnected and lonely. How do we stay connected? Virtual coffees seem to work better with just 1 or 2 others but we still haven’t really cracked this part.

Shared on Twitter from anonymous source, if I could credit I would: Suggestions to boost positive neurotransmitters, mindlessly scrolling/ repeat watching of news not included!

10. Manage your workload before it manages you. How would it be if all Teams meetings in the whole of the IJB started at ten past and finished at ten to? How good would that be? No more dashing from one to another and built in time to nudge you to take a break … it’s a thought.

11. Know yourself. Are you a separator or integrator? Separators like home and work life to be completely separate and can resent working from home so clear boundaries/ workspace are the key here. Intergrators don’t mind putting in the washing in between meetings and working half an hour extra later but can find themselves working all hours to the annoyance of family. Are you a morning person or night owl? Can you work in a asynchronised way? Our 9-5 work model is a hangover from the industrial revolution – clocking on and off times in the factories. Do you have to be at your desk 8.30 – 4.30 to support colleagues everyday or is there room for flex with some days starting later and finishing later if that’s your more productive time?

12. Get some flow and lose the time confetti. Flow happens when you are completely absorbed in a task and creates feelings of wellbeing as well as being a highly productive state to be in. It can’t happen amidst distractions and interruptions. Being in a digital world can lead to an immediacy where the expectation is that people will immediately answer that email, Teams call etc. Multitasking like this prevents flow and can create time confetti ie. tiny bits of time leaving us feeling overwhelmed, overworked and less productive. Can you delegate a task and then trust someone to go away and get on with it, judging performance by output not presence? My email sign off gives my core hours when I’m freely contactable, not the hours I actually work to help protect some undisturbed flow time for complex treatment planning etc. Ditto some use the ’Do Not Disturb’ dot on Teams.

Which brings us to ask the question… what about next year and the year after? Is home working here to stay in D&G? And if so, how do we make it better, working for us not against us?

The distributed workforce: a view of the future?

Steve Glaveski at Medium.com has outlined 5 levels of remote work. It’s too detailed to go into here but for anyone interested in the future of remote working, the link below is well worth a read. In D&G we rapidly moved to Level 2 by recreating our office work at home. The challenge now is to keep on moving, finding new and better ways to connect our teams and work together – to adapt and embrace the medium so that we are not just recreating the office at home with all of the downsides and none of the pluses, but working in a new way.

View at Medium.com

Glavesky cites Matt Mullenweg, the cofounder of WordPress (the platform behind this blog) who consciously designed his company to have a wholly remote or distributed workforce – distributed being his preferred term as no one works from a base. His Ted talk is here: https://www.ted.com/talks/matt_mullenweg_why_working_from_home_is_good_for_business?language=en#t-267040

It’s a short but fascinating watch. Matt employs ‘digital nomads’ i.e. people with no fixed base. As long as they have good wifi, his employees live all over the world, which means his potential recruitment pool is global. So far so good for a non healthcare setting you may say but it makes you think… 

… Can I see the day in the future when we, as a speech and language therapy team in NHS D&G, recruit an SLT to work wholly digitally, whose sole job it is to support patients in the community using Attend Anywhere? And if we do, does it matter where they work or live or if they have never actually worked ‘on the ground’ in D&G? Could they live in the north of Scotland, the south of England or abroad? Can I see a time when the DGRI residences are booked online for a couple of nights the way we book rooms in the education centre so that therapist could come in for face to face training or monthly clinics for a few days or to keep up their competencies? They’d need support from someone based centrally and we’d have to build in that time to connect and continuously reconnect as a team but certainly all of this suddenly seems so much more thinkable. A change? Definitely. An improvement? We’d have to see… but the answer to some of our current recruitment difficulties? Potentially, maybe, yes? 

… And if it could work for us, what about other AHP, nursing, medical, managerial, logistic and support roles? Could they be digitally blended too? Dialling into clinics, virtual post treatment support and project management meetings? 

We tread carefully, what about the personal touch, this still feels all a bit dystopian and we have genuine concerns about patient and employee safety, governance, standards of care. One size will never fit all but in the future there are conversations to be had, bugs to be ironed out, risk assessments to be made. Distributed working has its challenges but we are only just beginning to think about its potential benefits and how we might harness it to work to our advantage in Dumfries & Galloway. Interesting times indeed.

Helen Moores-Poole is an Advanced Speech and Language Therapist for Mental Health and the IDEAS Team at NHS Dumfries and Galloway

Links:

Staff Support:

The woman who moved to Crete:

https://www.theguardian.com/business/2020/sep/20/wfh-not-office-working-from-home-2020-radical-change-effects-lockdown

Random useful things I like:

Managing remote teams: 

https://blog.stephsmith.io/best-practices-managing-remote-teams/

https://getlighthouse.com/blog/10-tips-manage-remote-employees/

Comprehensive blog on remote working top tips: https://www.cipd.co.uk/knowledge/fundamentals/relations/flexible-working/remote-working-top-tips