How to inspire and innovate at work
With persistence, teamwork and strong leadership, nurses at every level can turn good ideas into better patient care
With persistence, teamwork and strong leadership, nurses at every level can turn good ideas into better patient care
Angela Hall has many qualities, but her ability to innovate is one that stands out. The arrhythmia nurse specialist is expert at identifying gaps in service provision and proposing workable solutions to fill them. Her talent contributed to her success in this year’s RCNi Nurse Awards, where she was named overall winner.
But how did she become adept at thinking – and acting – so creatively? After all, for many exhausted nurses, innovation is probably not their first objective as they battle through another understaffed shift.
Ms Hall attributes much of her creativity to the team around her, in particular the medical consultant, Andew Mitchell. ‘He’s very dynamic and constantly looking to improve things,’ she says. ‘And he stands out, compared with other consultants and leaders I’ve known, because of his passion for the job.’
Building a creative culture
An inspiring leader can certainly contribute to building a creative culture, but what can you do to add spark if your own workplace swats away good ideas as if they were picnic wasps?
Maybe you don’t feel that creative or innovative? Does it really matter? After all, the basics of good nursing are immutable – safe and effective patient care provided by skilled, knowledgeable practitioners. If things work, why change them?
Jane Douthwaite is a registered midwife and national coordinator of the Academy of Fabulous Stuff, a social movement and website for sharing ideas and good practice in healthcare. She argues that innovation is essential becasue the context in which services are delivered is constantly shifting.
‘The first thing that comes to mind is funding gaps,’ she says. ‘We’re currently looking at a £30 billion NHS funding gap by 2020, so we’re not going to get anywhere just by doing what we’re doing now.
‘Then we have healthcare burdens – increasing chronic diseases – plus slow economic growth. So something has to change, and it has to be quite significant. I think innovation has to play a part in that, not only from the patient’s point of view of improving the quality of care but also looking at how we can do things that are more cost-effective.’
But are nurses and midwives good innovators? Not as good as medics, suggests Ms Douthwaite. ‘I’d say we’re highly ineffective in terms of encouraging front-line staff – junior nurses – to see this as part of their role.’ As she points out, ‘innovation’ is not often a requirement in a band 5 nurse’s job description.
Talents not recognised
Nurse and academic Cheryl Crocker, who leads the patient safety collaborative for the East Midlands Academic Health Science Network (AHSN), believes nurses are great innovators. She cites many examples, including the nurse-led React to Red campaign, a teaching resource that has brought a huge reduction in pressure ulcers in care homes.
But she says the culture must be right if these kinds of initiatives are to take off. ‘We have seen so many examples where the fundamentals are not there, and that results in frustrated staff whose talents are not recognised and exploited,’ says Dr Crocker, who also chairs the AHSN national patient safety leads group.
‘Front-line staff who are listened to, valued and heard feel safe to be more creative’
Carrie Jackson, head of the England Centre for Practice Development
And that, says Carrie Jackson, head of the England Centre for Practice Development at Canterbury Christ Church University, is why leadership is so important.
‘To create healthy workplaces that encourage sustainable innovation you need transformational clinical leaders who can facilitate their colleagues to be the best they can be – senior nurses who model the way by creating a shared vision with their team, value the contribution every team member makes, and encourage and inspire passion in others.’
She adds: ‘Being able to authentically engage the hearts and minds of every team member to contribute creatively to innovation is important.’
Senior nurses can achieve this through open and transparent ways of working, effective communication, a commitment to learning and ‘an eye for high standards and quality, and role clarity’, she says. ‘Front-line staff who are listened to, valued and heard feel safe to be more creative.’
Turning ideas into innovation
- Be persistent. Good ideas may be resisted, and implementation can take time
- Show leadership. Building a creative culture requires leadership - junior nurses can be leaders too
- Find time to think clearly or join like-minded colleagues in informal huddles and forums
- Know your subject and have a passion for it
- Find allies and champions, and collaborate
- Learn from others; avoid reinventing the wheel
Lack of support
A survey of healthcare providers referenced in an NHS guide to innovation (see ‘Resources’ box below) indicated that while innovation was a priority for most organisations, two thirds of staff respondents felt they were not adequately supported to undertake ‘innovation activities’ – although that proportion may have improved since the survey was taken in 2009.
According to Ms Douthwaite, it is those at the very top of the management tree who must show the way.
‘It needs to start at executive board level,’ she says.
Indeed, the Care Quality Commission now requires healthcare organisations to demonstrate that staff views are reflected in service planning and delivery – and that means more than simply telling staff to come up with ideas.
Ms Douthwaite suggests boards must set the tone for innovation through, for example, a quality strategy that encourages learning, organisational development and leadership programmes – with a clear process for raising and following through on service improvement proposals.
‘It’s one thing having a great idea but you need to know how to implement it and who to speak to,’ she says.
‘You’ve got to know your field. Then you’re respected in terms of what you’re trying to deliver’
Angela Hall, RCN Nurse of the Year 2018
To see your idea through to this stage, you need to become an expert, says Angela Hall. ‘You’ve got to know your field. Then you’re respected in terms of what you’re trying to deliver.’
She gives the example of a new and seemingly effective drug she heard about at a European heart rhythm conference but which was not being used in the UK or in Jersey, where she works at the General Hospital. Encouraged by her clinical lead, she reviewed the evidence, compared the trials and compiled a summary of available information. After close scrutiny and a long governance process, the drug was approved for use in her hospital.
Putting in the time and effort
‘Nothing happens without you going away and putting in the time and effort,’ Ms Hall says.
Remember, too, that trying to change things on your own can be a lonely business. Innovation is often resisted, and you will need friends and allies within nursing and beyond.
Mental health nurse Kate Dale (see box below) was striving to meet the physical health needs of people with serious mental illness long before ‘parity of esteem’ between mental and physical health was a popular concept. But it was a chief pharmacist who listened and encouraged her. ‘When I was absolutely ready to give up, he said, “Don’t, just keep chipping away and it will work”. And it did.’
How one nurse’s innovation achieved ‘astonishing’ results
Mental health nurse Kate Dale has made implementing a good idea her career’s work.
In 2003 she was working as a community psychiatric nurse (CPN) in Yorkshire. ‘I was part of a national pilot study where I took my CPN hat off and started to concentrate on the physical health of patients who were complying with antipsychotic medication.
‘I knew people were just not getting their physical health needs met appropriately. I then became quite passionate about improving things.’
The extent of that passion is recorded in a report published earlier this year by the King’s Fund think tank, called Adoption and Spread of Innovation in the NHS.
‘Over the 2000s, Ms Dale retrained so that she could take blood, carry out physical health assessments, monitor diabetes, and advise on smoking cessation, weight loss and other lifestyle changes,’ the report says. ‘In two years, she carried out regular health checks for 150 patients on antipsychotic medication.’
The initial outcomes were ‘astonishing’, the report says. Ms Dale found large numbers of patients with high-risk cardiovascular scores or undetected diabetes, many of whom had never received support or treatment.
Later seconded to primary care, she worked with GPs to improve the support given to people with serious mental illness.
‘It’s about not giving up’
The report describes how one patient with severe depression was given a standard thyroid test. Two years later, following treatment for a previously undetected thyroid condition, the patient was free of depression and ‘living a happy life’.
Today Ms Dale is a project lead for physical health for the Yorkshire and Humber Academic Health Science Network, and continues to work part-time for Bradford District Care NHS Foundation Trust.
In all her efforts to maintain the physical health of people with serious mental illness she acquired allies along the way. But for the most part it was her own commitment and determination that transformed care.
‘I was a nurse on the ground, nothing special,’ she says. ‘But it’s about not giving up. I can go to bed at night and sleep because I know I have done my utmost to make a difference.’
‘Plan, do, study, analyse’
Also helpful is a framework or template that gives structure to your proposed service improvement and its possible implementation.
RCN professional lead for public health Helen Donovan suggests ‘plan, do, study, analyse’ as a useful methodology.
‘You see an area that needs changing, you plan at a fairly high level of detail what you want to do, and then you do it,’ she says. Further study and analysis of the outcomes follow, and the cycle begins again. ‘It could be something about drug rounds, wound care, the way immunisation clinics are managed – anything – and thinking about what would work better.
‘I think what managers like about this kind of quality improvement methodology is that it focuses on small areas of practice, so it’s not risking great swathes of resources.’
In terms of generating ideas in the first place, she advocates small, often informal forums such as team huddles, journal clubs and Schwartz rounds, where staff can share thoughts, insights and good practice.
There are also plenty of online resources demonstrating how nurses and others have improved services and saved money. Learning from others can help refine your own ideas.
A messaging tool developed by school nurses at Leicestershire Partnership NHS Trust is an example of an innovation that pulls together some of the 'plan, do, study, analyse' principles.
‘Gaining support from senior management is key to giving a project momentum’
Caroline Palmer, clinical lead at ChatHealth messaging service
The nurses recognised that young people wanted to communicate with them in ways other than face-to-face meetings and more in keeping with their lifestyles. They teamed up with a manager in the trust’s communications team and developed a business case, and in 2013 ChatHealth, a secure, web-based messaging service giving young people access to advice and support, was launched.
ChatHealth’s clinical lead Caroline Palmer, who was one of the school nurses involved in the project, says service user engagement was crucial. ‘Find out what they want and why they want it,’ she advises.
Staff engagement was important too. ‘Staff need to feel supported to be able to deliver care in different ways. And gaining support from senior management is key to giving a project momentum.’
She lists other groups and agencies the project team worked with and in doing so highlights the commitment that may be required to turn a good idea into good practice.
Among others in a long list, the ChatHealth team sought to engage health visitors, parents, safeguarding teams, clinical governance leads, teachers and school governors, the National Society for the Prevention of Cruelty to Children, and the RCN.
But it paid off. ‘ChatHealth is now used across more than 30 different organisations nationally, within a range of services,’ Ms Palmer says.
Keeping an eye on the goal
Acting on good ideas, effecting change, service improvement – nurses at every level can achieve these things, and many do so successfully and repeatedly. But it can be tough, and it requires persistence, hard work and collaboration. Keeping an eye on the goal – better and safer patient care within a limited budget – can help focus minds on why innovation matters.
Leadership is key but when the workplace culture has become one where creativity prospers, it gains its own momentum, suggests Carrie Jackson.
‘Enabling everyone to flourish will ensure that innovation is sustained because there is a critical mass of people who believe in the goal and are not reliant on one person to achieve it or are waiting to be told.’
- Academy of Fabulous Stuff An online repository of more than 3,000 examples of ‘stuff that works’ in the NHS and healthcare
- Academic Health Science Networks Established by NHS England in 2013 to spread innovation ‘at pace and scale’. The AHSN Atlas includes case studies of high-impact innovations
- England Centre for Practice Development The centre seeks to create cultures ‘which enable innovation in health and social care practice at the point of care to ensure they are person centred, safe and effective’
- King’s Fund report Adoption and Spread of Innovation in the NHS. See too a blog by the report’s author, King’s Fund projects director Ben Collins
- Creating the Culture for Innovation: A Practical Guide for Leaders by the NHS Institute for Innovation and Improvement (now disbanded). Published in 2010 but remains an informative read
- RCN resource Innovation in Nursing. The college’s specialist forums also use Facebook to share ideas and good practice
Daniel Allen is a freelance health journalist