AHPs were undertaking the Blue Wave of Change Improvement Programme (delivered by Fiona MacNeill Associates) when team reports from the staff iMatter survey were received.
We had been asked to implement our learning by undertaking an appreciative inquiry, linked to one of the AHP strategic intentions. Having considered the iMatter suggested process for facilitating team discussion also we felt these could be merged to allow us to have a deeper understanding of current thoughts and feelings that the team held with regard to uni-professional and wider organisational team working.
The outcome would then be that we would have a shared and agreed action plan to take forward.
The AHP strategic intention we linked this to was;
‘AHPs will work at the top of their professional licence, and empower support workers, volunteers and other colleagues to make a positive difference’
Having prepared the environment and welcomed our team we agreed our ground-rules and split into line managed teams to answer the following questions
The iMatter process first asks us to identify what we do well and by working through the above questions, the UHA team agreed on the following statement;
‘We are a friendly approachable team who are supportive of each other and have a good work ethos’
On reviewing our iMatter team report it revealed that the areas that required improvement, on the whole, sat within section 4 ‘My Organisation’. Having discussed and identified what required to be improved, staff highlighted two main areas that they would like to focus on;
This then impacts on the holistic care of all patients in regard to their physical and mental health; ability to repair, fight off infection etc. This can contribute to increased length of stay, clinical risk and reduced cost effectiveness of overall care.
There was agreement that these frustrations were likely to always be there unless we tried to do something different. We would need to invest time to try and influence this.
Our agreed iMatter Actions were;
As part of the Blue Wave training we were lucky to be in the position that our project was chosen to work through with help from other AHP colleagues.
This involved drawing a 2D model of our idea.
This was scrutinized by our AHP colleagues, each of whom then left us with two pieces of feedback. One thing they liked about the proposal and one question. This proved to be invaluable and allowed us to consider more deeply how we could achieve what we were setting out to do. Having done this we then produced a 3D model to depict our intentions.
The opportunity to spend this preparation time and to have input from other disciplines allowed a more focused discussion at our next team meeting when we decided how to take forward our plan.
Resulting changes were
Each Dietitian identified their own improvement plan for the individual ward they had identified. This became their service improvement objective which every AHP member of staff was expected to have, as directed by the AHP Associate Director. An SBAR report was completed by each member of staff and discussed with their line manager at their 3 monthly review.
Situation
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Hospital dietetic team iMatter action plan – ward improvement work Area for improvement To confirm our value and prove that dietetic input is effective we need to invest time on service improvement work and the provision of training whilst building relationships with the other staff groups. This will allow other health care professionals to have respect for our role and a better understanding of what we can deliver, which will be valued. |
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Background
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It was noted that prescribed oral nutritional supplements were not routinely being given to patients on the ward with patients regularly stating that they were not receiving their supplement drinks and kitchen staff also commenting on the number of supplements being returned from the ward. This was very subjective and anecdotal, time was required to audit current practice regarding the distribution of prescribed oral nutritional supplements to patients and the completion of the supplement monitoring charts. |
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Assessment |
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Supplement audit competed – 11th August 2017 (am & pm ONS) (n=15)
*One patient reported that they had to request ONS from nursing staff (both their morning and afternoon supplements) this had not been offered without promoting. |
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Recommendations |
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Audit and evaluation assessing the impact of the recommendations is ongoing on the ward. |
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The Dietitians presented their work to the AHP Senior Manager and AHP Associate Director. This session also allowed them to promote their professional role and discuss their unique contribution.
Many of the improvement projects are ongoing and some re-evaluation is required to ensure full implementation is maintained before the learning can be spread to other ward areas.
Improving relationships with other HCPs was also an important part of this process. It was therefore vital that we also identified improvements that we could make as a service to help with the ward processes.
We are also working with the clinical nurse managers to refresh and refocus nutritional care in the New Year
Staff have been learning from one another and some of the improvements identified in one area have been implemented by other Dietitians in their own ward area.
Both line managed teams also undertook strengths based training in conjunction with the OD team and are working together to make best use of this learning in future team-working
Maureen Murray and Jane Collier
November 2017