During my current secondment to the Emergency Department in DGRI, I recently had the pleasure of reviewing a patient who I will call Jane and who required admission for an acute health issue. Jane was very apprehensive and reluctant to be admitted which is quite understandable. However, on exploring this further to reassure her, I discovered that much of Jane’s apprehension surrounded her experiences during a previous admission to hospital. Jane had been a patient in a very busy general ward and she had required frequent assistance but English was not her first language. Jane was very conscious that her communication and understanding had caused her some challenges and she stated she felt “slow” because of this language barrier.
Jane described in some detail, that she had felt very uncomfortable pressing her buzzer when she required assistance and she explained that she thought the staff on the ward were wonderful and caring but they appeared, in Jane’s words:
“too much, too busy busy, too small time.”
Jane’s perception was that by requiring assistance, she was contributing to what she considered to be an already unachievable workload for busy staff. Jane was clear that staff had been efficient and had never expressed displeasure when she requested help but the speed at which staff interacted with her and assisted her, coupled with her self-awareness regarding her language had all made Jane feel “a nuisance”.
After spending some time reassuring Jane, I came away from this consultation having been touched considerably by it.
Because, all too often, I have been one of those nurses on a busy ward, rushing around to get my work done and trying to juggle many different ‘plates’ in the air. It’s so easy to get into this mind set in a healthcare environment which demands so much from staff to deliver optimal services with the limited resources we currently have and a potentially depleted morale.
BUT, and this point is crucial…
Who do we forget about when this work culture is put under the spotlight?
Where does our most important element, our patient, feature in this busy work schedule?
Of course, looking after our patient’s effectively is the reason we are all so busy but is that thinking doing our patients’ an injustice? If we had the chance to ask those who utilise our services and who we interact with during our hectic shift, how they view the busy environmental culture within our wards and departments and what they think and feel about our workload, what would they say? Ask yourself honestly how many of your patients’ or clients have said to you they “don’t want to bother you”? When I think of this, I am certainly left wondering whether I have given my patients the perception that I was too busy for them. Have the patient’s I’ve interacted with during a busy shift been left feeling as though they didn’t want to ‘bother me’ or worse, they didn’t want to be a bother to me? Like most people in the NHS, I came into this profession to care for people in the best way I can but are we achieving this if this is how our patients could be feeling?
A significant quote comes to mind when I consider this…
How have you made someone feel today?
Its certainly a juggling act between making our patients feel listened to and valued and managing the hectic workload. Arguably, that juggling act has been no more challenging than it is in our clinical areas and departments today in the face of financial pressures, tight staffing numbers and a seemingly increasing need for our services.
SO, how on earth do we begin to address this? Ask yourself some very simple questions…
- The problem is we are too busy but we need to make time for our patient.
- The solution is to free up time from our current schedule – what do we do consistently and regularly which we could look at?
- We perform many handovers during a busy shift, what would happen if we made these more efficient?
- How do we give this a try?
How do we give this a try? When we come up against a question like this but our heads are full of everything else going on in our busy working day, we need a strategy to give us some direction. Think of this strategy as being our ‘work-place problem-solving’ SatNav!
The destination in our ‘SatNav’ is symbolised by the question mark in this diagram and it brings us back to the question in our problem-solving steps – How do we achieve more efficient Handovers?
This diagram leads us to the outcome by asking key questions:
- WHY do we want to achieve more efficient handovers? – To release time to care for our patients.
- WHERE do our handovers occur? – In our care area and in other departments.
- WHEN do these handovers occur? – When we transfer patients and when we change shifts.
- HOW do these handovers occur? – Are they structured, formal enough and does everyone use the same approach?
- WHAT is handed over? – Do we communicate accurate clinical details in the right way to ensure the receivers clearly understand what we want them to?
- WHO are essential participants for our handover to occur? – Which staff groups do we need at which handovers?
The key questions asked in our problem-solving approach provide the foundation for NHSDG’s current Handover Strategy;
WHO?, WHAT?, WHEN?, WHERE? & HOW?
By choosing just one handover process, which occurs at any point in your departmental working day, and answering these simple but crucial questions, you can begin to develop the structure for your departmental handover protocol. A simple protocol document is available either in electronic or paper form, which you can adapt to suit your specific area and handover needs. What’s more, you don’t need to do this alone, assistance is available from myself or Jean Robson as NHSDG handover leads or from members of the Patient Safety & Improvement Team or the NHSDG Handover Group to support and guide you through every stage.
Some tips which will help you to achieve success are:
- Start small and plan well
- Engage all your colleagues in the process
- Build up gradually & extend what you learn
- Expect challenges & address these as they arise
- Use continual evaluation to continually develop & improve
- Never think you’ve finished – its always evolving!
By making this frequently occurring element of our workload much more efficient, we will release considerable time in our day to give back to our patients, relatives and colleagues.
The added ‘Brucey Bonus!’ (and here’s a blast from the past!!) is that a more structured handover will improve the accuracy and safety of clinical communication, which will enhance cohesive, collaborative and consistent multi-disciplinary team working.
The handover group are planning information sessions on 24th November 2015 to share existing developments from departments working on their handover processes, to learn new ideas relating to improving your handovers and give support in promoting optimal handover practice which is essential, valuable and time-saving.
So, to return to our original thought, look once again at the title of this blog:
‘Time to do the right thing?’
Do you see the question “Is it time to do the right thing?
Or do you see the question “Do we have time to do the right thing?”
The focus of this blog has been the latter. Are we giving time? Are we allowing time in our day to ensure that we do the right thing by our service users and their relatives as well as our peers and colleagues?
I leave you with one final point:
Think of your last work interaction with a patient, relative, colleague or client. During this, did you give them time and have you left them with the perception that you had time for them? If not, what do you need to improve?
Did you make time to read this?
Further information is available from Barbara (email@example.com) Jean Robson (firstname.lastname@example.org) or Amy Sellors, Patient Safety & Improvement Team (email@example.com).
Barbara Tamburrini, ANP & NHSDG Lead Nurse for Handover at NHS D&G
01387 246246 Ext 32983