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Louise SteadDirector of Nursing and Patient Experience

&Sarah Maidment

Senior Sister Paediatrics

Royal Surrey County Hospital

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Culture

· · Much talked about · Incalculable · Immensely powerful · ·

· · · · best care, anywhere · · · ·What sort of culture do we want?

• A learning culture

• A caring culture

• An open culture

• A safety culture

· · · · best care, anywhere · · · ·How do we measure culture?

If the aim is to improve the quality of care, or the efficiency of a

service, then a culture approach should inquire into what those

terms actually mean to participants and how they would assess

themselves against those and other definitions. It cannot be

safely assumed that these things are already known, or that

participants share similar definitions and judgments.Tim Scott, Russell Mannion, Huw Davies and Martin Marshall

DOI: 10.1111/1475-6773.00154Issue

Health Services ResearchVolume 38, Issue 3, pages 923–945, June 2003

· · · · best care, anywhere · · · ·How do we measure compassion?

• Friends and Family Test

• Complaints and compliments

• Assessment pre appointment

• Staff Friends and Family Test

• Observation

· · · · best care, anywhere · · · ·Our responsibility

“There is a moral, professional and social responsibility on everyone in the NHS to know what they are doing and how well they are doing it. If you can't answer the question you shouldn't be doing the job.”Sir Bruce Keogh, NHS Medical Director

· · · · best care, anywhere · · · ·Leonard Cheshire Behaviours

• You don’t walk past

• If you are not proud of it you shouldn’t be doing it

• Never say something about someone you wouldn’t say to their face

• Have you got the passion and compassion to do the right thing

· · · · best care, anywhere · · · ·Leadership

• You cannot do it well if you don’t care about the people

• If people share your commitment and values they will mirror your behaviours

• Public scrutiny

· · · · best care, anywhere · · · ·What makes a good leader?

• Inspirational

• Integrity

• Lead by example

• Make people feel safe to speak up

• They build team relationships by being positive and making you feel you want to follow them

· · · · best care, anywhere · · · ·All of us want to be good at our jobs…but how good?

• Quite good

• Good

• Very good

• The best in our field

• The best in the world

Talent helps…but it won’t take you as far as ambition

· · · · best care, anywhere · · · ·Raising concerns

• We all have policies to ensure staff feel safe to raise concerns – Francis has ensured that but that is only half the story

• It’s quite easy to get approval if you ask enough people – seek the criticism not the praise – how can I make this better you may get a great improvement

· · · · best care, anywhere · · · ·What am I doing well?

• Find out what is good about your ward and dramatize it like a cartoonist - talk it up

• Give away everything you know that gives you opportunities to get ideas from other people

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How are you going to make the culture on your ward/ department great?

• We all want to be proud of where we work

• We are hailed as a great ward, our metrics are good, the DON brings visitors to look round, nurses clamour for our jobs

Simon Pawlin

· · · · best care, anywhere · · · ·What am I doing well?

• What are you going to do to make it that high achieving ward

• Talk it up and challenge those who don’t

• Don’t expect the board to lead the way they are trying to run a hospital, it is your ward

• Not everyone wants to make a ward great but at least they want to make a difference

Not all of you work on wards like that

· · · · best care, anywhere · · · ·Ward reputation

• A wards reputation is generally built on the attitudes of one or two key people, aim to be one of those people

• Advertising, marketing, selling your service; many would say this is not about care or compassion or culture, but it really is

· · · · best care, anywhere · · · ·Most people are looking for a solution

• What is the answer to developing a great culture?

• I have no magic answer but a word of caution, not many people are prepared to make the sacrifices to get there.

• People confuse being liked with being great, they both have merit but are not the same

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How can you take on the whole ward – you are just one person

• If you find staff not demonstrating the attributes you want take issue with them. You are a great ward you only want the best

• Patient feedback is a very strong tool usethat to your advantage

• Objectives and clear guidance is key