Shotts Ambulance Station

Re-booting frontline A&E Management – Encouraging front facing direct line management to improve staff engagement and patient care

Through the recent Imatter questionnaire and latterly staff surveys, it became apparent to me that we had lost engagement with staff due to lack of communication, time restrictions, increased call volume, meal break randomness and consistent shift overruns, most of which I as a Team Leader, have no influence on. Staff clearly felt abandoned and unmanaged, increasing staff sickness and disillusionment that studies have shown has a direct influence on the patient experience as well.

My approach to address this therefore had to be significant and meaningful, but also realistic and within my boundaries as a Team Leader.

I started by trying to understand why staff become disengaged and produced this simple table below as a guide for moving forward my own understanding and an acknowledgement to how my staff actually felt after lengthy honest dialogue with them.

After working through the details above, I started from scratch again on building new relationships with all staff on station. I have also been improving, albeit slowly, the station facilities over a number of years. This has included painting walls/doors, replacing anything that’s broken and tired to improve the hygiene factors in which the staff spend their time. This has had the physiological effect of showing that people did care about their environment which led to a slow burning effect on improving staff engagement.

On an individual basis, a day off the road was organised so staff could have one to one meetings with me to cover all aspects that were within my scope of management. This included i-matter, new clinical practice updates, training concerns or any practices/skills that hadn’t been used regularly. We discussed what was happening through the Division regarding changes to management structure, which had bypassed most of the staff on station. We covered all the old and new clinical pathways that had been introduced to clear up misinformation that had previously caused multitudes of cross wires, resulting in staff having no confidence in referral pathways and only a small amount of patient referrals. We also covered the correct procedures required for leaving patients at home as per our Strategy’s guidelines.

Staffs’ mental health was also discussed and pathways for any issues raised covered and discussed in detail, as the importance of this subject cannot be under estimated. Ongoing and regular one to one talks even on shift handovers always include “How are you getting on since the last time we spoke?” as mental health issues can change drastically in a short period of time.

I also introduced positive reinforcement and encouragement for any good work, regardless of how small, to show the team they were appreciated and not taken for granted. From my own point of view, I continue to have a positive mental attitude regarding all aspects of Service workings admitting when things are not working properly, listening to staff concerns and where possible producing action plans for moving forward. When staff feel they are being taken seriously and action follows, then a change in culture is inevitable.
Although this may sound very obvious and simple; in reality I discovered that staff had not experienced this type of direct management before.

With this type of proactive management and the knowledge that the team can rely on me to answer queries timeously by phone, email or indeed the continuation of one to one support (when I have my scheduled time off the road), it will allow staff to gain more confidence that support is genuinely there and I’m not just paying lip service. Over a period of time this will also give staff reassurance that they are being listened to.

Of course not all staff are open to this kind of front facing management, but it is a work in progress and hopefully we can get everybody on board when they see the benefits of engagement.

I realise that the big staff issues regarding work load will always be ongoing, but I feel that we are addressing staff support issues far better than before.

I have found that it takes considerable effort and work in my own time to support my team to a level that makes a difference. With the support of my line managers, I hope to increase my scheduled management time to enable me to continue to do this whilst maintaining a good work /life balance, as I feel we are making great progress and have become a far more productive station as a result.

The following are some staff comments, in their own words, regarding how this change in management style and new approach to old issues has affected them individually.

"Whether on duty or off duty and even on annual leave, our Team Leader can always be contacted and relied upon to offer support, guidance and practical advice. This provides us with the confidence to carry out our duties knowing that we are up to date with the latest guidelines and clinical knowledge" - Stephen Graham, Paramedic

"Coming into the service as a VQ student I immediately felt welcomed into the team at Shotts. All the staff have been supportive and interested in my training and progress to become a qualified technician. My team leader has taken a very proactive role in supporting my learning and regularly goes out of his way to offer advice and practical skills sessions to myself and other students on the station. I feel this support has been vital in giving me the skills and confidence to progress onto my paramedic training." - Adrian Gibaut, Ambulance Technician

"At Shotts Station our Team Leader's door is always open. He is approachable and makes time to keep staff informed. He provides a great support base, with on the job or emotional support and seeks out further assistance if required. I have confidence in his abilities to assist with any issues or queries. He takes pride in all his work with a great work ethic and does what is best for each member of staff.” - Stefanie Barr, Ambulance Technician

"If we continue to manage as we have always done in the Ambulance Service we will continue to make the same mistakes over and over again, however small changes can have great success if we actually listen to staff and be prepared to be honest regarding our own shortcomings, then everyday will indeed be a school day.” - Martin Fraser, Team Leader, Shotts Station