NHS Lothian Evaluation and top tips on evaluation

Transcription

1 Contributing to the Organisation s Objectives NHS Lothian Evaluation and top tips on evaluation Juliet MacArthur Sue Sloan

2 Outline of the session What is the role of the SCN in evaluation of Leading Better Care? How as a SCNs can use evaluation to connect / receive support from their NHS board NHS Lothian approach to evaluation (to date) 3 Top Tips on evaluation

3 What is SCN role in evaluation? Making sure participate in local and national evaluations (return on investment) Focus on leadership and its contribution to organisational agendas Self evaluation celebration of personal and team development How to do this yourself When to do this with your team

4 The evidence on nursing leadership Cummings et al (2010) Leadership styles and outcome patterns for nursing workforce and work environment. International Journal of Nursing Studies 47:

5 Relational-focussed leadership vs. Task-focussed leadership Impact on: Staff satisfaction with work Role and pay Staff relationships with work Staff health and wellbeing Work environment Productivity and effectiveness Relationship or people focussed leadership practices contribute to improving outcomes for nursing workforce, work environments and effectiveness of healthcare organisations.

6 Why is this important for evaluation? Getting the message across investing in leadership is vital (and needs to be sustained) Framing your evaluation to emphasise the linkage of leadership to outcomes where applicable, give examples of changes in leadership approach. Reflecting on own leadership style Emphasising emotional skills responding to staff by tuning into emotional needs leads to completion of tasks required to achieve common goals.

7 Conclusion of systematic review These results present an important moral imperative to ensure that our healthcare organisations are led by individuals and teams who display relational skills, concern for their employees as persons, who can work collaboratively to achieve a preferred future for themselves, their employees, their patients and their organisations Cummings et al (2010: p381)

8 Self evaluation Becoming a leader is synonymous with becoming yourself. Everything a leader does reflects who he or she is. Bennis (2003)

9 NHS Lothian Impact Evaluation Logic Model Outcomes Short term end of programme Intermediate 6 months later what has changed? Self assessment Long Term 18 months (?) what has been sustained? CQIs, Scorecard data, staff survey

10 Intermediate Outcomes Cohorts 1, 2 & 3 (approx 123 participants) 6 months follow up session 2 approaches 1. Achievements and changes within the 4 role dimensions and specific domains (n = 23) 2. Most Significant Change (n=29) NB: only 19% & 24% of cohorts

11 Role Dimensions Education and Development Framework for Senior Charge Nurses (Scottish Government/NES 2008) 4 Role Domains, 13 Capabilities, 91 knowledge and skills statements Ranking of top 5 knowledge and skills in each of 13 capabilities Examples of change/developments in practice Outcomes Recognise and sustain core knowledge and skills & share examples

12 Most Significant Change Technique Developed by Rick Davies (1996) Encourages reflection Builds up a shared understanding about an initiative Converts tacit knowledge into explicit knowledge Identifies shared and not so shared values Identifies unexpected changes Helps understand complex changes that cannot easily be enumerated

13 1. During the last 6 months what do you think has been the most significant change in the way you work, that can be attributed to your participation in the LBC Programme? Beginning (situation before the change) Middle (what happened?) End (situation after) 2. Why did you choose this change in particular? i.e. Why was it significant for you? 3. What difference has it made already/ will it make in the future? 4. Do you think this change is sustainable? What will influence this? 5. What evidence can you offer that you have made this change?

14 Evaluation Tools

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17 Overall Findings Increased: Role clarity Confidence Self awareness (action learning influential for some) Networking supported problem-solving Awareness of bigger picture Change in attitudes stronger focus on positives For some significant change in leadership style (from task to transformational) Recognition of the need for evidence and impact of audit

18 Role Domains what are seen to be the most significant knowledge and skills? 1. Safe & Effective Clinical Practice 1. Clinical Leadership leadership skills to communicate, motivate and mobilise 2. Evidence based practice leading practice development with team 3. Continuous Quality Improvement identifying need for change and leading innovations 4. Patient Safety preventing HAIs Examples: Engagement with staff ++; Releasing Time to Care; Score Cards ++; CQIs, Band 6 development; safety walk rounds; protected mealtimes

19 Enhancing the patient experience 1 Co-ordinating the patient journey - Investigating shortfalls in service provision 2. Maintaining clinical expertise - Ensuring each patient s care is based on best practice 3. Promoting person-centred care - Creating a climate of mutual trust, establishing partnerships and encouraging choice and participation Examples: patient stories; scheduled 1:1 meetings with relatives; nurse surgery for relatives; pre-admission/day of surgery; work scheduling to increase continuity

20 Managing the Performance of the Team 1. Role Modelling - Enabling and developing leadership skills in other members of the team 2. Facilitating Learning and Development - Application of the KSF processes 3. Managing the Practice Setting - Organising work flexibly and efficiently Examples: delegation++ ( letting go ); shared vision; change in leadership style; scheduled meetings++; team involvement in CQIs; NWWP changes to skill mix

21 Meeting Organisation s Objectives 1. Networking - Engaging with the right people to ensure success 2. Service Development - Knowledge of Government and NHS Policy and how to apply to own area of work 3. Identifying Service and Political Drivers - Articulating vision and motivating others to achieve Examples: Encouraging involvement in wider organisational meetings; shadowing other disciplines: networking; supporting staff to see bigger picture

22 Most Significant Change Leading service developments Addressing patient safety issues Embracing audit and score card recognising need for evidencing practice Networking Appreciating organisational drivers Managing relationships individuals, teams and line managers Empowering and engaging with staff Self awareness & change of leadership style

23 Case Study 1: Leadership (Charge Nurse 15 years) Beginning: Chaotic Leadership Style Middle: Mist started to clear reflection on goals End: Confidence in skills and style of leadership Difference?: working smarter not harder: work/life balance improved Sustainability?: Yes, because I have changed

24 Case Study 2 Attitude to audit Beginning: Very negative extra work & irrelevant to practice Middle: The light came on End: Achieving implementation everyone aware of how we are doing Difference?: Providing an accurate picture to make patients and visitors feel safe in our care Sustainability?: Yes, it is now the norm

25 Case Study 3 Relationship with Manager Beginning: Very difficult felt angry and ineffective Middle: Clinical supervision believing in myself and my ability End: Largely in control of the relationship. Difference?:Renewed confidence do not rise to the bait. Calm. Sustainability?: Empowered by my knowledge and skills

26 Case Study 4: Recognising own behaviour Beginning: Autocratic leadership + external distractions (staff side rep) Middle: Explored own feelings, attitudes and behaviours End: Ongoing personal exploration (coaching). Given up staff side role. Working with team recognising their expertise Difference?: Team now leading meetings. I stop, think and listen more. Sustainability?: Yes, because the genie is out of the bottle

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28 Hester s Story - evidence Evidence based clinically effective care HAI audits Patient Safety Programme C.Diff and MRSA Improving the patient experience Improved hand hygiene Reduction in HAIs Managing the performance of the team Staff meetings Development of Band 6 role Ability to challenge staff Improved relationship with manager Weekly planning meeting multidisciplinary, all charge nurses, chief nurse Meeting the organisation s objectives Patient Flow 18 Week Target SPSP Sense of role clarity Reflection regroup thoughts rather than react

29 Top Tips 1. Don t evaluate too early 2. Give people structured time to reflect and report (create a process to do this) 3. Capture people s stories and link to the role domains

30 Contacts