Building and Motivating Teams Breda Athan Senior Matron and Lead Nurse HLIU
High Level Isolation Unit Pre-Ebola Outbreak Maintaining unit ready for admission Average admission rate 1 patient every 2 years Lassa Fever Crimean-Congo 2
UK Response to Ebola COBRA Meeting Plan for Britain to assist in Western Africa Call for Health Care Workers to volunteer to work in treatment centres Army drafted in to build treatment centres and staff accommodation in Western Africa
Key themes Building the Team (s)
Key Features of the HLIU Clear focus delivering expert high quality care Clear objectives and expectation communicated at every level Patient and carer involvement Good People management Proactive staff engagement Team working inter-team working Cross boundary collaboration Continuous learning and development Psychological Wellbeing
Pre Ebola Outbreak
1. Training and Development key to ensuring the team(s) understand aim and objective of the service Maintaining training for ITU/Physio and ward staff Quarterly for senior 11 West staff On-call rota Twice yearly for junior 11 West staff Yearly for ITU/physio staff Training for RAF Patient transfer training with RAF only Dummy run with full cordon and hospital involvement Training with ambulance service
1.2 Standard Operating Procedure for Preparing HLIU (major incident) Activation of Unit 8 hours needed Unit facilities checked Supplies delivered Staffing arranged Hospital prepared Cordon put in place to admit patient to the unit Multi-disciplinary meetings arranged Operations meetings arranged Beds closed on 11 West ward
Trexler Isolator Dirty Zone Nurses Station Clean Zone
2. Caring for a Patient and Families Staffing per shift Two Nurses in Dirty Zone Two Nurses in Clean Zone Infectious Diseases Registrar Infectious Diseases Consultant cover (24 hour) Other support for patients (and families!) Physiotherapists Massage therapists Counsellors Patient at Risk and Resuscitation Team Communications Team
Inter-team collaboration
3. Teamwork: Infectious Disease Team Close working between nurses Close working between nurses and doctors All staff working together to achieve best outcome for the patients
3.1 Wider Hospital Involvement Keeping HLIU running Facilities Catering(for patient and staff!) Supplies Estates Autoclaves Negative pressure system
3.2 Teamwork With the Rest of the Hospital The Ebola patients were in the Isolator for an extended length of time Burnout of staff became an issue Staff from other wards in the hospital were trained and joined the ID nurses to look after the patients Facilities and Estates continued to be very supportive of HLIU Nurses from ITU
3.1 Multi-Disciplinary Team Many specialities in the hospital meet with the infectious diseases team to offer their advice ITU Haematology Hepatology Nutrition Team Haemophilia Renal Pharmacy PARRT Physio
Continuous Learning and Development The Surge Plan Preparing for a UK Ebola Outbreak
4. Background to the Surge Plan The UK only had capacity for two patients at the same time HLIU at the Royal Free only has two Isolators At the time, the HLIU at Newcastle had been decommissioned There was potential for more than two patients at the same time E.g. an infected family of returning travellers NHS England, Public Health England and the Department of Health commissioned the Royal Free to develop a way of caring for more than two patients at a time.
A New Way of Working If there were more than two patients, then the third patient could not be nursed in an Isolator The Isolator protects health care workers by containing infection HCWs do not have to wear Personal Protective Equipment (PPE) Without the Isolator, HWCs would have to protect themselves from infection by wearing PPE PPE has to be put on correctly PPE has to be doffed in a precise sequence to avoid exposure to infection
What PPE? A team of doctors and nurses from the Royal Free sourced and trialled PPE equipment Infectious Diseases Consultants Microbiology Consultant Senior Infectious Diseases Nurses Infection Prevention and Control Team Once the PPE had been chosen, the team formulated procedures on how to don, doff and decontaminate the PPE The PPE and procedures were demonstrated and agreed with NHS England, the Department of Health and the Health and Safety Executive
Healthcare Worker PPE
National Training Training video and posters were developed with the National Ambulance Resilience Unit Public Health England nominated Infectious Diseases Units around the country to become treatment centres along with the Royal Free Newcastle Liverpool Sheffield Staff from these ID units came to the Royal Free for a training day, to then cascade training to others in their units
Cross London Support Director of Nursing at the Royal Free London asked colleagues for volunteers from their trusts Honorary contracts set up Training programme put in place On going annual refreshers
Psychological and wellbeing
5. Psychological Well being Recognition Self awareness Emotionally Honest self assessment Self confidence Self Personal Competence Others in the team socialisation Social awareness Empathy Service orientation Organisational awareness Self Regulation Trustworthiness Conscientiousness Adaptability/flexibility Achievement and drive Initiative Emotional and self control Self Management Relationship Management Developing others Influence Communication Conflict Management Visionary leadership Catalysing change Building bonds Team work Motivation to work as a team was high due to all of the above
Table top discussion On your tables for the next 10minutes From your personal experience of working with teams: How can we develop and build highly motivated teams