Managing Performance Concerns and Nurses in Difficulty. Patricia Reid Chief Nurse

Transcription

1 Managing Performance Concerns and Nurses in Difficulty Patricia Reid Chief Nurse

2 Our Workforce To really embrace the full and challenging definition of a good quality patient experience requires a high quality workforce NHS Constitution

3 Our Workforce Need an efficient, compassionate workforce that is adequate, skilled and empowered Need the right behaviours! Encouraging and reiterating the right individual staff behaviours is vital..as feelings and impressions are as important as the quality of the product

4 Our Workforce However, sometimes things go wrong and a healthcare professional may find their practice called into question

5 What can go wrong? Poor clinical practice - frequent mistakes, not following a task, lack of skills, inability to cope with instructions given Unable to handle a reasonable volume of work to a required standard Poor supervision of the work of others when this is a requirement of the post Acting outside limits of competence

6 What can go wrong? Poor punctuality and unexplained absences Consistently failing to achieve agreed objectives A health problem Unacceptable attitudes/behaviours to patients/colleagues

7 What can we do to prevent this? Staff and managers should understand the factors that may contribute to performance concerns personal factors systems and process issues the work environment harassment Inadequate education and training Poor leadership from line manager

8 What can we do to prevent this? Good human resources practice will help prevent performance problems Effective recruitment, induction Clarity about skills and experience training and support Clear definitions of roles and accountabilities Appraisal (supervision/ongoing feedback) Training line managers in effective staff management

9 Getting the culture right Established strong association between aspects of staff engagement and satisfaction and indicators of the quality and costs of care Individual staff wellbeing is best seen as an antecedent rather that as a consequence of patient care performance Staff wellbeing is a function of good leadership Board a duty to concentrate on the humanity of patient care and not just the timeliness of its delivery Patients knowing the values of the Trust and seeing those lived out every day. consistently from Board to Ward

10 Getting the environment right Right number of staff with the right skills at the right time Optimum organisation of care Empowered staff to make decisions Rich learning environment Encouragement to raise concerns

11 Getting it right first time - students Good Planning on arrival with clarity regarding expectations on performance Monitoring progress against plan weekly with full review at the halfway point Appropriate challenge throughout you can refer and fail!! Ensuring adequate supervision and a good learning environment is key

12 Getting the Leadership Right Strong, skilled leaders with first hand knowledge of the system Leading at the bedside provide visible leadership at the place where patient care is delivered Compassionate care at ward level - visible to patients and visitors Leaders have the time and ability to lead and are held accountable to do so Enhancing professionalism develop knowledge, skills and evidence in our relentless pursuit of excellence

13 What else can we do? Proactively seek and root out poor behaviours and performance!! Highlight poor leadership

14 Case Study : Root out poor performance 2 wards with performance issues (attitude) Both wards had reasonable quality indicators Both wards had the poorest patient experience scores

15 Case Study : Root out poor performance 2 wards with the highest patient experience scores 2 wards with the lowest patient experience scores Used a Quality of Interaction (QUIS) to enable us to observe, assess and judge the quality of the interaction between staff and patients on our inpatient wards

16 Case Study: Root out poor performance Quality of Interaction Staff interaction with patients and relative During personal care, lunchtime, early evening when visitors are present Observers are able to follow guidance to ensure similarity in rating

17 Case Study: Root out poor performance The Cup of Tea: Positive social Basic Care Neutral Negative

18 Case Study: Root out poor performance The 2 wards with the highest patient experience scores delivered a high percentage of positive social care The 2 wards with the lowest patient experience scores delivered a high percentage of neutral care

19 Leadership is key! What did we do? Reviewed our approach to managing performance Complexity of healthcare means a single solution is unlikely to be successful Moved one poor performing nurse to a good performing ward a transformation in performance!!

20 Leadership is key! The underlying difference between high and low performing ward managers was found to relate to leadership capability The management style of the ward sister was found to be central to the effective organisation of the ward and maintenance of the standards of care, patient experience and performance of staff

21 Leadership is key! Developed the role of the lead nurse for clinical leadership Works and integrates with a clinical team to develop, support and direct the ward manager to improve the effective organisation of the ward and their leadership skills

22 Revalidation will help The process whereby registered nurses and midwives are required to demonstrate to the NMC that they continue to remain fit to practise Promotes greater professionalism and improves the quality of care through reflection on the revised code of conduct Reinforces a culture of demonstrating capability

23 Revalidation for nurses All nurses and midwives will be revalidated every 3 years at the point of renewal Accountable for their revalidation and required to gather evidence based on the criteria in the code of conduct Have met the required CPD hours Have sought and received third party feedback which has informed their reflection (patients/peers) Have sought and received third party confirmation that they are fit to practice (employer)

24 Internal Revalidation for Band 7s Start with the leaders Band 7 revalidation model Internal leadership course Achieve key KPIs Appraisal Peer and patient feedback

25 You ve got it right..but. poor performance will always exist to a greater or lesser extent. so.. make sure you adopt good practice in managing performance

26 Principles of Good Practice The overriding principle is patient safety This must be the primary consideration and action must be taken to ensure that patients will not be at risk whilst an assessment or investigation is carried out.

27 Principles of Good Practice Clear policy for local investigation Avoid unnecessary or inappropriate exclusion of practitioners Fairness, consistency and objectivity of investigation process Timeliness of investigation

28 Leadership is key!! The best leaders don t come down harder on people whose performance is lagging; they come to their aid.so Get your leaders right!