Moving from an Operational to a Strategic Level
During 2016 I undertook a Florence Nightingale Foundation (FNF)Leadership Scholarship. This report details the blended approach taken, which combined taught sessions, visits, networking and reading. I have explored how this has influenced and informed my progress and leadership journey.
My learning included attendance at:
- Leading Change and Organisational Renewal
- Organisational Development Practitioners Programme at Roffey Park
- ‘The Westminster Experience’
- The Institute of Healthcare Improvement (IHI) Forum,
- A Communication Course run by the Royal Academy of Dramatic Art (RADA) in business.
I also undertook an 8 week Improvement FUNdamentals MOOK and attended an open day at the East London Mental Health Quality Improvement Team
All FNF scholars are allocated mentors for the duration of the scholarship. My mentor provided support, challenge and valuable network contacts. I found the sessions thought provoking and energising. The network opportunities I took included meets and telephone contact with:
- The Deputy Medical Director for Safety at Great Ormond Street Hospital
- An Improvement Leader from Health Care Improvement Scotland
- Two experts in person centred approaches from the University of Ulster and the King’s fund.
- The Nursing Director from Sue Ryder
- The CEO at St Francis Hospice
Additionally I undertook a Study Visit on Integrated Care in Northern Ireland with other scholars and participated in an insight day at the Department of Health
Developing my personal impact has been an integral feature throughout my scholarship and was critical to my appreciation of the value of personal presence. I furthered this learning by reading books on influence, negotiation, executive presence and women in leadership and undertook coaching with a voice coach from RADA.
At the start of the scholarship I changed roles and began working at a more strategic level. My role as Head of Clinical Effectiveness at MC provides an opportunity to influence and lead across services in the four UK countries each with different regulatory requirements and local heath communities. Whilst this is a challenging role, it has been enjoyable and the scholarship has been integral to my effectiveness to date.
One of the requirements of the scholarship was to undertake a patient care improvement project. I was unable to pursue my original idea of introducing ‘always events’ due to the change in my role. However I accepted the challenge of two different projects. Both projects provided opportunities for learning and gave me the chance to explore the benefits of different methodology. They also exposed me to some of the challenges of leading across an organisation with nine hospices and ten community services based in four different UK countries.
The first project was to improve nursing documentation. There was an organisational wide problem with the quality of nursing documentation highlighted in compliance and regulatory reports. This project is on-going and has been slow to progress. There have been difficulties arranging face to face meetings across 9 hospices and this has resource implications both in time and cost. Other challenges included trying to introduce a pan organisational approach when each of the hospices has to fit in with their own national and local health care requirements, network initiatives and drivers. The differences in electronic and paper records added another level of complexity.
It is difficult to balance evidencing care, and maintain a set of records that provides clear contemporaneous communication, whilst ensuring that nurses don’t spend onerous amounts of time documenting. Despite these challenges the group has completed some useful work to date. A set of principles has been drafted to guide documentation and progress has been made on agreeing governance requirements.
The second project was to introduce single nurse administration of controlled drugs (CD’s). CD’s are used extensively in end of life care. This has an increased impact on time taken to administer, but the frequency with which the CD’s are used, means that nurses are able to develop a greater understanding and knowledge of the medication, doses, routes and side effects of the drugs. This project stated with a literature search, to identify previous work in this area. I also contacted another Florence Nightingale scholar who had undertaken a travel scholarship looking at single nurse administration of CD’s in Canada. I designed and ran a staff survey to elicit hopes and fears.
Two hospices were selected to run the pilot. Drawing from learning from the IHI forum and the East London Mental Health QI Team, IHI quality improvement methodology was agreed, using ‘plan, do, study, act’ PDSA cycles. A steering group was identified and a Quality Improvement Project Overview, driver diagram and measures agreed.
The first PDSA cycle focused on testing the measures and assessing how easily they could be drawn and analysed from existing data, within pre-existing governance structures. A competency framework was developed during the second PDSA cycle, tested by a number of registered nurses and reviewed by a second hospice. Further PDSA cycles will be needed as the project is implemented across the charity, to adjust the framework so that it reflects local and national differences.
PDSA cycle three focused on the introduction of single nurse administration in one hospice for oral CD medication only. In this cycle the measures are being used to test the improvement. This cycle is currently in progress and to date is running successfully. A questionnaire to explore the feelings and experiences of the nurses involved in the pilot has been designed .Monitoring of patient feedback is being undertaken for any impact that this pilot may have. A report will be produced after three months and implementation to other hospices planned accordingly.
I have learnt valuable lessons about methodology by testing theory in practice. The group work techniques I gained and have implemented from the Organisational Development programme have been very successful. The IHI improvement work has worked well for the single nurse administration project and I can see the value in future initiatives. It has proven to be simple to use both in understanding and time.
The learning throughout the scholarship has been steep and on-going. At the beginning I was developing a new role, questioning my purpose and how I was going to measure success at a personal level. Knowing that I can make a difference, particularly for patients remains very important to me but is less tangible when working at a more strategic level. I am now beginning to appreciate the value of my role as a ‘bridge’, and understand the importance of people who communicate between the board and front line staff.
I believe the personal effects of the scholarship are complex and not easily measurable. I can identify the skills that I have learned, the tools I have gained, the knowledge and the experience. However the impact of the combination of these is more than the sum of the parts. As a result of the scholarship I am far more confident about my leadership style. It is driven by a belief in the value of person-centredness as a way of being with everyone.