The leadership strategy that changed the way others – and my team – saw our department
RCN Nurse of the Year 2019 led the transformation from ‘just outpatients’ to outstanding
- Matron Taurai Matare brought together three separate teams to create a one-stop eye care centre for patients
- She empowered staff to change a bullying culture and enables team members to develop leadership skills through hands-on experience
- After persevering for years, she lobbied successfully to gain funding for more staff, and more skilled staff, in the department
A ‘one in a million’ matron who specialised in ophthalmology almost by accident has developed her unit into a one-stop shop for eye patients, offering gold standard care provided by a highly skilled nursing workforce.
Taurai Matare’s passion for patient care, innovative ideas for transforming the patient experience, determination to overcome obstacles, and dogged insistence that her trust put her department on its priority list saw her crowned the RCN Nurse of the Year 2019 at this year’s RCNi Nurse Awards on 3 July.
Earlier in the evening, Ms Matare, also known as Tara, was announced winner of the Leadership category, which is supported by RCNi journal Nursing Management.
Creating a unified, multiskilled team
Ms Matare moved to Whipps Cross University Hospital for a role in orthopaedic surgery, but on arrival was sent to ophthalmology instead. ‘I loved it,’ she says. ‘Helping people to see – what could be better than that?’
In 2004, she was asked to use her strong clinical leadership to bring together the separate eye casualty, outpatients and theatres to create a single, modern eye treatment centre on one site, and manage the nursing and healthcare support staff.
‘I’ve written so many business cases to justify my need for staff and had so many thrown back, but I’ve never given up’
Taurai Matare, ophthalmology matron and RCN Nurse of the Year 2019
‘My vision was to have staff trained to deliver extended clinical roles and work flexibly as a team across the different elements of the integrated centre,’ she says. This was supported by the training and development programme she created. ‘It was crucial when we were recruiting to let nurses know that if they came to us, they would be developed in all areas, as only a handful of staff transferred over to us from the previous services.’
The judges, chaired by RCN deputy president Yvonne Coghill, were impressed by Ms Matare’s passion for her specialty, which drove her 14-year mission.
Ms Coghill says: ‘Ms Matare’s vision to provide excellent care for eye patients and her commitment to achieving that vision despite the barriers in her way is remarkable. She has never let up, despite disappointments, and the statistics show that she has achieved her goal.
‘The judges were especially impressed with her determination to develop her team and the way in which she has turned every member of the nurse workforce into a leader.’
Ms Matare admits it was challenging to secure the workforce she needed from her NHS trust, Barts Health. ‘I’ve written so many business cases to justify my need for staff and had so many thrown back, but I’ve never given up, even though in some cases – my emergency nurse practitioners (ENPs) – it took years.
‘When Barts was over budget and consultants PWC were brought in, I asked them to help me write a business case for ENPs. They did, but it still got thrown out. We were the fourth largest eye casualty in London and we were trying to run the service without ENPs. But I kept with it.’
What really worked, she says, was using a PDSA (Plan, Do, Study, Act) cycle that demonstrated that an ENP-led service reduced breaches of the four-hour wait standard to zero.
Another success was her business case to appoint and develop ten healthcare support workers.
‘We couldn’t recruit nurses and had to start thinking outside the box,’ she recalls. ‘I had to convince senior management I could train healthcare support workers to take on some roles the nurses were doing. Now I have successfully had them banded as ophthalmic technicians – it did not happen overnight, but we pulled it off.’
And the people who have been recruited stayed. ‘We have a zero vacancy rate in our eye theatres,’ Ms Matare says proudly.
Raising our profile
Another ‘real challenge’ has been ensuring ophthalmology was not overlooked in favour of higher-profile inpatient services – a challenge overcome by persistence and sheer determination.
‘We see as many patients in a day as A&E. I had to highlight what we do and sell our service at every meeting’
‘It is very difficult for people to understand a specialist service in a district general,’ explains Ms Matare. ‘People think “it’s only ophthalmology” and “it’s only outpatients”. The trust leadership is dealing with acute services, so we had to demonstrate the care we were giving is equal to the wards.
‘We have casualty and surgery. We see as many patients in a day as A&E – 300. I had to highlight what we do and sell our service at every meeting. Every time a new director starts I go to see them to tell them what we are doing. The majority come to see what goes on.’
Leading by example
Ms Matare has been lauded at her trust and further afield for the supportive culture she has created out of a fractious one where people were bullied. ‘In the past some consultants felt nurses should not question them,’ Ms Matare recalls. ‘This compromised patient safety. It developed, festered and was difficult to challenge. It took a lot of work to change the way people thought.’
A range of programmes empowered staff to be able to challenge in different situations, regardless of their band or qualifications, and know where to go for support.
‘And we have sustained it,’ says Ms Matare. ‘We continue to motivate staff to achieve those goals for our patients. I was bullied myself, but you have to separate being a victim and being a leader and lead by example, so the team sees it can challenge and say “we will not accept this behaviour”. And while this was going on I still had to think about my plans and developing the service.’
Ms Matare’s passion for staff development has created a culture in which everyone is a leader. The chair role at the monthly nursing meeting rotates through staff at all bands. Ms Matare explains: ‘Everyone has the opportunity, with the support of everyone else, to lead the meeting and others to take minutes. Staff are proud to carry out these roles and learning these skills gives them such confidence.
Developing staff to step up
‘Everyone is exposed to management and leadership. I don’t do interviews anymore. The band 7s interview the band 6s and the band 5s interview the ophthalmic technicians. The director of nursing chairs the trust’s safety huddle at 11am, which is usually attended by band 6 and above, but we send a range of staff to deliver our feedback, including band 3s.’
This, she says, makes her vision sustainable. ‘If I left tomorrow, my team would step in and step up because they have the skills and knowledge, and through experience have had opportunities to build confidence that they are leaders.’
‘Within months we were up and running, thanks to her skill and efficiency in writing clinical protocols and navigating trust red tape’
Sudeshna Patra, consultant eye surgeon, who nominated Ms Matare
Consultant eye surgeon Sudeshna Patra nominated Ms Matare for the RCNi Nurse Awards. ‘I remember the zeal with which Ms Matare developed nurse-led postoperative clinics and injection clinics,’ she says. ‘Within months we were up and running, thanks to her skill and efficiency in writing the clinical protocols and navigating the trust clinical governance red tape.
‘In 2010 she was the first and only nurse injector in London, independently performing clinical assessments in retina clinics and devising management plans. Since those early days, Tara has developed her team so that we currently have nurse practitioner-led emergency eye services, an expanded team of nurse injectors, nurse-led diagnostic and pre-assessment clinics and a practice development nurse.
‘She also showed great courage and resilience in leading the nurses through a period of prolonged bullying. Her greatest strength is her refusal to give up.’
Passing on knowledge and skills
Amid all these achievements, what is Ms Matare most proud of? ‘That I was able to share nursing knowledge with my staff and give them the skills they need to sustain the service,’ she says.
‘My staff will continue to innovate and empower their colleagues. For me that is the achievement’
‘It is not about me – after me, this department will continue to be great and give excellent care. My staff will continue to innovate and empower their colleagues. For me that is the achievement.’
She is also particularly proud of bringing students into the unit. ‘They are the future of nursing and we want them to be attracted to our specialty,’ she says. ‘In the past we had none – we were seen as outpatients and it was thought students needed to be on a ward to learn the skills they need. But we invited lecturers in to see what we do and they realised what a great experience students can have here.
‘Now we have six or seven universities sending students here. And we have two newly qualified nurses waiting for a vacancy to join the team.’
For Barts Health NHS Trust chief nurse Caroline Alexander, Ms Matare ‘epitomises everything she could hope for in a nurse leader’.
‘I am hugely proud that Tara has been named the RCN Nurse of the Year 2019,’ she says. ‘She is a real champion for improvements at the trust. Her positivity, drive, creativity and unwavering dedication are unmatched and have led to real changes at our eye treatment centre at Whipps Cross. She really is one in a million.’
In the future Ms Matare is looking forward to working overseas with Vision 2020, the global initiative to eliminate avoidable blindness, training ophthalmic staff around the world and helping them set up their own units.
Sharing what we’ve learned
But for the moment her goal is to share the learning from the department with other trusts. ‘I’d like to go and teach and train them,’ she says. ‘I especially enjoy speaking at conferences about how we challenged and changed our unit’s culture.’
Being the RCN Nurse of the Year 2019 is certain to give her a platform to do that. ‘My mum was a nurse. Growing up, I watched her and aspired to be one too,’ she says.
‘To be the RCN Nurse of the Year is a dream come true. It means the world to me that all the work I have done over the years has been recognised. I feel that I have reached the pinnacle of my career.’
What patients say about the eye treatment centre
Patient feedback has been excellent. Comments collected on International Nurses Day include: ‘Love, love, love all the nurses here. Tara you are an amazing clinician’; ‘All staff were just amazing, caring, friendly, polite and very helpful’; and ‘Everyone so calm and smiling – thank you for making a potentially worrying time easier’.
Matron Taurai Matare (also known as Tara) says: ‘I always bump into patients who remember me treating them and give me a hug. It gives me such a sense of satisfaction. We have not had a complaint for two years.’
Support means patient satisfaction
She credits the team culture and some specific initiatives for delivering high levels of patient satisfaction in a unit that is under significant pressure due to rising demand.
One of those initiatives is the Patient Floor Facilitator role. ‘Every day one of the ophthalmic technicians is out with the patients, helping them with anything they need,’ Ms Matare explains. ‘Most are older people, and sometimes they are confused as to which consultant they need to see. Some might not have heard their name called. The facilitator can check where they are in the queue and explain to them any delays and make sure they are seen. They can help them call a cab. Other trusts are interested in this approach.’
Some patients are so pleased with the care they receive that they volunteer in the eye treatment centre. Cynthia has been a patient for six years. She has macular degeneration that is treated with regular injections, and recently had a cataract removed.
‘The department feels like a family’
Having a procedure on your eyes can be extremely worrying, but Cynthia says the quality of care she receives puts her at ease. ‘I have such confidence in the care and the staff here always do whatever they can to help. They made sure I had a white stick and a special cup for when I make tea, a pair of shades for sunlight. They really look after you here.
‘The department feels like a big family. Everyone speaks to the patients and introduces themselves. It is so friendly, and I’m sure every patient who comes here for treatment would say the same.’