BALANCED WORKING LIVES
STORIES FROM REAL LIFE is also available in pdf format (128k)
3. STORIES FROM REAL LIFE
Introduction
The greatest strength of the NHS is the people who work for it. The White Paper Partnership for Care stated: 'If we are serious about improving health and healthcare, then we have to be serious about supporting, valuing and empowering the staff who deliver care.'
This report is about just that. It is about developing flexible work patterns that fit in with the lives of nurses and midwives. It is about creating conditions which increase job satisfaction, while helping with the recruitment and retention of this key group of staff.
This report provides a snapshot of some of the excellent work taking place in many parts of the NHS to support flexible working practices. The stories detailed here have been gathered as part of a development programme offered by the Centre for Change and Innovation in 2003 for nursing and human resources staff. The aim of the Balanced Working Lives (BWL) programme was to provide the opportunity for clinical leaders and human resources staff to improve their knowledge and skills about flexible working practices.
The programme had a number of different elements including workshops designed to improve awareness of and commitment to flexible working and a Good Practice conference. These have helped senior nursing and human resource staff:
gain an understanding of the flexible working issues for their organisation
learn from what is already being done locally
agree individual and group action plans.
The diagram below shows the components of the development programme.
Why is this important?
Demographic changes mean there will be more older people in the population and fewer younger workers in the years to come. These trends pose real challenges for NHS recruitment. Plans need to be put in place now to respond to these changes. The table below highlights some of the projected changes at a UK level.
Ageing population | 12 million over 65s by 2021 3 million more workers aged over 35 1.3 million fewer workers aged 25-35 declining birth rate
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Changing recruitment | |
Changing families: | |
Eldercare | |
The challenge for Scotland may well be greater as we have fewer migrant or mobile workers compared with England. We need to forge strong links with the local labour market, particularly in rural areas. We need to value all staff, regardless of the hours they work or the nature of the contract they have with us.
Staff and managers have developed ambitious guidelines to help the NHS become an exemplar employer. The Partnership In Practice (PIN) guidelines provide a useful resource the employment and deployment of staff. A lot of work has been carried out to support the implementation of the guidelines locally. The BWL programme is one element of this wider effort. In essence, the BWL programme aims to increase flexible work patterns, speed up the implementation of policy, encourage the involvement of clinical leaders and share best practice. This activity should improve the retention of staff within the NHS and increase job satisfaction. It is based on what people in the service have told us needs to happen to improve recruitment and retention.
What Works - Lessons from the Can Do Approach
Making flexibility work is a balance between the individual, the team and the service
There are many different paths to flexibility and one size does not fit all
Changing patterns of work requires planning, consultation and an open mind
The more staff are involved in how they work, the greater the likelihood of success
There are already many opportunities to learn both within and between organisations
Stories from Real Life
Twenty-Two Ways of Being Flexible
Flexible working has many forms. Work carried out by NHS Grampian identified 22 options for enhancing flexible working practices. The following stories illustrate just some of the ways nursing and human resources staff are working together to put flexibility into practice throughout Scotland.
1) Job Sharing
Job sharing is a type of working pattern where two or more people share the responsibilities for one full time job. The pay and benefits of the full time job are shared on a pro-rata basis.
Janet and I have job shared since I got back from maternity leave. We both work half of the week and we are flexible about whether two days or three. In a way it gives the unit more than the sum of two people. They get two brains for a start, so we are both thinking about problems and discussing them, rather than working in isolation. In addition there is more flexibility for covering holidays etc. To begin with we had to work very hard at communication, but now we think we have got it cracked, as we get to know each other better. Of course we worry a bit about what would happen if either left. Would the next person be as easy to work with? I don't mind being called at home if something information is needed. Janet's domestic circumstances make that impossible, so we just have to be really organised for the days when she is not around. Charge Nurse (Psychiatry) |
2) Part-Time Working
Part-time working is an arrangement where staff work fewer hours per day or days per week than those on a normal full-time contract. It is often defined as less than 30 hours per week. Salary, leave and benefits are calculated on a pro-rata basis.
I love my part-time job. I used to think that people would regard me as a lesser person, or less professional, but its not true. I know it is a bit expensive, because I can't go to half a study day or do half a course. I don't wear part of a uniform! What I find though, is that I have the energy to work at full pitch all the time I am on duty, and that is enough for me. From time to time I get asked to do extra, and sometimes I can and sometimes I can't. If I had to work full time I'd have to give up. My mum needs me and between that and the kids I couldn't do more. However, a day will come when I'll be able to increase my hours and they've already told me they'll want me when that day comes. I really feel part of the team. In the early days they used to work like mad in the mornings and a lot of work was done before I arrived, which defeated the point. Now we've rearranged the work load around the patients, and my availability. Still, there is always plenty to do. Staff Nurse (Care of the Elderly) |
3) Flexible Hours
Flexitime schemes allow your staff to choose the hours they will work within defined limits. Usually there are set 'core hours' during the day. Contracted hours are made up by staff working the core times plus hours of their choice within the flexible time at the beginning and end of the day (core shift period).
I was once told that I couldn't work at the practice because I couldn't do the hours. Some days I might be able to, but I wouldn't be reliable and that is what they needed. I did start, and did those hours, but I had to point out to the doctors that I was busting a gut to get to work in the morning and sitting around inventing things to do for an hour on the days when there wasn't a clinic. It did not make sense. Now, as long as I am always there between ten and four, when the clinics are running, I can fit my other hours around, or save them up to use to cover for the other health visitors on sick leave, or holiday. Just being in control of my working life has made it so much easier. Health Visitor |
4) Team-Based Flexible Rostering
Flexible rostering allows your staff to plan their working times and patterns to match predicted staffing needs over a set period of time. The team know the number and grades of staff required at any one time and between them they collectively devise the rota.
Problems with roster arrangements at Forth Valley Acute Hospitals NHS Trust caused frustration among nursing staff. Shifts were changed at short notice because of sickness absence and staff felt they did not have enough control over when they would be working. It was decided to change to a more flexible rostering system in six of the eight medical wards. Senior nurses led the development of team based rosters in their wards. There was a lot of discussion with nursing staff around the potential benefits, as well as the problems the change could create. Fears were expressed about disruption to service, difficulties in achieving skill mix, staff being 'forced' to do shifts they did not want and nurses with children 'calling the shots'. Clear guidelines were produced at ward level to advise staff of the team 'rules' and ensure fair rostering for all members of staff. This has proved crucial. In the first few months there were teething problems but they were addressed through team discussions and staff were made aware that the roster had to be fair to all. The fact that staff contribute to decisions and know things are worked out fairly makes them happier at work and less likely to worry about home commitments. Staff now feel the benefits of individualised planned rostering that, wherever possible, fits in with the needs of their home commitments. The roster is produced one month in advance and can be changed as long as the skill mix is maintained. This has produced 'ownership' of the roster and staff work with colleagues to make changes that benefit each other. In one 30-bedded ward, staff work a mixture of core and 12 hour shifts, depending on their individual needs. This works well as 'older' staff find the longer shifts more tiring. Staff returning to work after periods of absence are phased back into the workforce using the self-roster. This has been very positive as staff feel they are in control. It reduces the stress that return to work can pose for those who have had long term sickness. Clinical Nurse Manager The night nursing team at the Borders General Hospital orthopaedic ward have successfully operated a team based rostering system for the past three years. They meet on a regular basis to plan the roster which involves balancing on-duty skill mix with requests for time off and holidays. This has worked very well. Staff feel they have ownership of their working life and, in return, they take responsibility for ensuring the correct skill mix. Monitoring has demonstrated that the service is being well managed and staff benefit from feeling that their needs are being met. The benefits of this approach have now spread to the general surgical ward where nursing staff are piloting the introduction of self rostering. This followed discussions with all members of the team and the aim is to achieve similar benefits to those already enjoyed in the orthopaedic ward. The progress of the pilot scheme will be reviewed to determine if it is meeting the needs of all parties before a final decision is taken on its future. Clinical Nurse Manager |
5) Rescheduling of Workload
It is sometimes easier to find staff at certain times of the day or days of the week. The purpose of this technique is to transfer work away from periods when it is difficult to find staff to those when staff can be more easily found - for example during school hours.
When I worked on a care of the elderly ward about 10 or 15 years ago I used to feel sorry for the old people. They were catapulted out of bed at 6 am and nurses ran round taking temperatures, etc. before the day staff came on. Then they had a period when they were ignored, followed by a period of intense activity while they had breakfast thrown at them and were 'smartened up' for the doctor's round at 9 am. We did have a part-time nurse, and people made snide remarks about her arriving when the work was over. You wouldn't see that now. Patients are treated with dignity and the care follows the patients' natural rhythm. It isn't exactly 'The patient will see you now, doctor' but it is heading in that direction. That means that by spacing activities throughout the day, you make it better for patients, and take pressure off the staffing levels at the same time. Charge Nurse |
6) Shift Swapping
Shift swapping is a simple working pattern, which allows staff to rearrange shifts amongst themselves to provide cover for colleagues and to take time off without using up their holiday allowance.
We've always swapped shifts. Usually for special occasions. There was a time when people complained about the rota sheet getting messed up, then we got a white board! We know as a team what cover is needed, and we know who is or is not always easily able to swap, so it works itself out. In fact we have started swapping across the unit, and that lets people move about between wards and find out about new systems. Once it may have been thought of as unplanned or sloppy, but as professionals we now have confidence that we can step into each others shoes relatively easily. Staff Nurse |
7) Voluntary Reduced Hours
Voluntary reduced working time, often referred to as 'V' time, is a scheme which allows employees to trade pay for time off. Staff are given the option of reducing full-time working hours for an agreed period, with the right to return to full time work afterwards. Time can be negotiated as a reduction in the working week, or as a block of time during the year.
One of the managers came and told me we were going to lose one of our best ward sisters. Turned out that the problem was that she needed to spend more time with her son who was having severe behaviour problems at school, and this might take a year or more to sort out. I asked why she was leaving, and was told that unfortunately we didn't have any part time vacancies and we couldn't hold her job open for her, and someone else must have it if she couldn't do it. It was a complete nonsense. We arranged for her to reduce her hours to school hours for three days a week and working from home for up to two days more, with a review date after four months. It went fine. Some suggested we were saving money by not appointing another sister, but by using the saved resources we provided the ward with more IT to support this change, and others that we introduced. Manager, Acute Care |
8) Annualised Hours
Working hours are agreed for the whole of the year rather than for the week. The agreed yearly hours are usually arranged into a schedule, typically as a number of basic rostered hours with a number of hours kept in reserve to be used when the employer and employee agree. Salary is usually paid in equal monthly instalments regardless of the number of hours worked in a specified period or the number of unsociable hours completed.
We were really suspicious about annualised hours when it was first introduced. We liked the idea of flexible working, but it seemed that all the flexibility was on the side of the employer. How much further can nurses flex, before they break under the pressure? However, it turned out that the new system was really popular with nurses. They liked being able to clump their work into one part of the year. It gave people the chance to undertake longer visits abroad or study periods anything that they really wanted to do that would have been restricted by conventional hours. There were times when we did have teething troubles, people being tempted to work too many hours, etc. But it soon settled down. Staff Side Rep |
9) Term-Time Working
Term-time working is an option which allows staff to take time off during school holidays to look after their children. Staff usually work all of their hours during term time and take unpaid leave during the holidays. Sometimes they may prefer to work reduced hours during the school holidays.
Why would you want to do this? Patients don't keep school hours do they? We really had our doubts. However, with staffing levels really low, at one point, having a term time nurse gave the team more support at much less than the cost of an agency nurse, so it was term time or nothing. Then we discovered that the flexibility it gave was really quite useful. We did more of our training and development work in a planned way during term time when we knew that Agnes would be there to help. By moving the workload, and by planning ahead we were able to make good use of her extra pair of hands. It has really meant that she is part of the team, unlike the occasional faces we used to see. And I think with luck that we will be able to recruit her when her youngest goes to the secondary school next year. They have a summer school activity centre, so Agnes will be able to work the holiday time as well. We'll get even more for our investment. District Nurse |
10) Staffing Pools
Staffing pools can be created to provide both a development opportunity for staff as well as a means of meeting ad-hoc, longer-term, temporary staffing needs. This approach can assist in dealing with, for example, maternity leave or long-term sickness.
Having a pool nurse is much better than an agency. The one who comes to our ward most is known to us and knows the hospital. So we don't have to reorientate a new member of staff every time. I was really surprised when it turned out she knew a lot of our patients who had been admitted a few times. Apparently she also gets used by the pool by the community services, and she was able to tell us stuff about some of our patients that we had not found out. The patients liked to see a familiar face as well. Charge Nurse |
11) Compressed Working Hours
Compressing hours is an arrangement where people work their agreed hours over a shorter period of days. For example they may work longer full-time hours four days a week rather than five or nine days a fortnight.
Twelve-hour shifts have an interesting history in hospital care. When I trained as a psychiatric nurse in the 1980s we used sometimes to do a late, followed by a long day, followed by an early. The long day was 14 hours. The argument was always continuous care, but to be honest, it was continuous torture, and I lost count of the number of adverse incidents about lunchtime on the third day. That made me nervous about 12-hour shifts. However, whatever the research says, nurse like them, and we have to give them what they like or they will walk. They like the fact that they are guaranteed a few days off in a row. I suspect some of them have second jobs outside of health and there is not much I can do about that, as long as they are fit for work. And they are fit! They work well and are happy because they feel in control of the work. They also like looking after some one all day long, without having to hand them over, because the patients like that as well. You have to watch out for the rest periods, and make sure that people are not suffering any sickness or absence that could be attributed to the compressed hours. Psychiatric Nurse An examination of flexible working possibilities at the Royal Alexandra Hospital in Paisley found strong support among nursing staff for 12-hour shifts. Working closely with their local HR Advisors, nurse managers gathered information on how this new system might be put into place. Several discussions were held with their teams before the scheme was implemented. A review of the experience gained has shown that it has been highly successful. Staff have found 12-hour shifts beneficial because they are able to prioritise and plan workloads, rather than rush to complete tasks before handover to the late shift. It provides longer time off periods for full-time staff and childcare arrangements are easier to manage as staff are working fewer days in the month. There is flexibility to split 12-hour shifts into two six-hour shifts with a colleague and this has proved particularly popular at times such as Christmas and New Year. Patients benefit from the continuity of care they receive throughout the day and there is no rush to accommodate the late shift coming on duty. The reduced number of staff handovers helps patients feel less anxious and reduces potential stress. The positive impact is also reflected in recruitment and retention rates and staff sickness levels. All of these are showing very positive trends. Manager, NHS Argyll and Clyde |
12) Unpaid Sabbatical Leave
This is where an employer agrees to an employee taking an extended period of absence. This may be to enable them to travel for example. Some employers keep in regular touch with the employee perhaps by e-mail keeping the employee informed of developments in the service.
The global demand for nurses has resulted in many more opportunities for staff to work abroad and widen their experience. However, many go for relatively short periods and an innovative project set up in Grampian is helping to ensure that they are encouraged to return after their career break is over. As a manager at the ICU unit at Grampian Acute Hospitals Trust I have turned to the internet to help retain staff who have left on career breaks. We decided to keep in touch with nurses who went abroad via regular e-mails. The e-mails kept the nurses up to date with what was happening in the unit while showing we were genuinely interested in them This, together with the offer of a salary at the level they would have achieved had they not left, has encouraged nurses to return to us. So far, six nurses who have taken what is in effect an unpaid sabbatical, ranging from three months to one year have returned to the unit. 'Word-of-mouth' advertising has also resulted in nurses from abroad applying to come and work in the unit thereby bringing fresh skills and talents. Manager, ICU Grampian |
13) Transferring Workload
With advancing technology such as tele-medicine it is possible to treat patients much nearer their own home. Discussion with colleagues across the system can result in the transfer of work either into primary care, to community hospitals or island health board facilities.
As a midwife, I used to run a clinic at the hospital, and all the pregnant mums used to trip up to see us here. Now the clinics are done in the local health centre. This means that it is more convenient for them, and to be honest, I'd rather work out here in the practice, where there is a range of things that I can do, alongside the practice team. I quite often bump into former colleagues from the hospital, including medics, who are following the same route and bringing their clinics out to the practice. I don't think that they can move their jobs, yet! Midwife |
14) Time off in Lieu
This is where employees will agree a time with their managers when they can take time off to make up for extra hours worked. It is a way of compensating people who, for example, have to attend a meeting out with their normal shift times.
In the past research has shown that lots of nurses do unpaid over time. This doesn't just mean getting off late, or arriving early and doing your studies in your own time. All professionals do that sometimes. It actually has meant people coming in to do a full day on their day off, and then having their day off at another time. You need to keep an eye on it, because you can end up owing the nurse quite a lot of time. Even so, you could invite him to book a full week off, which is often easier to cover by moving the workload, and you've already had his flexibility to cover for unexpected problems. Charge Nurse |
15) Bank Staff
Staff who already work for the employer and wish to work additional hours can work on a nurse bank. A nurse bank can be suitable for some employees who want to work very irregular hours so as to fit with home circumstances.
I choose to work on the bank because I am able to fit work around family life. I love my job and do not want to lose touch with my career but, as I want to be the primary carer for my children for the next few years, I will stay on the midwifery bank. This does not mean that I do not keep myself up to date - quite the reverse. I can work in many different departments which allows me a good overview and enables me to keep up to date in different areas. I do sometimes feel second class to fixed contract midwives, although this may only be a perception and I cannot say that I am treated badly. However there is this notion that 'you are only here when it suits you..' attitude, which can make you feel an outsider. It is difficult to feel that you belong to a team because you are dipping into different departments. It can feel as though you do not belong anywhere! Staff do not always see past the label of 'bank' nurse. It seems to equate to someone who is on the bottom rung of the ladder, instead of a fully paid-up member of the profession with exactly the same responsibility for their actions as anyone else on duty. When it comes to training opportunities, I have been very lucky. I have friends who inform me of study days and I am keen to go to as many as I can. However, as far a funding is concerned, there is little or no financial help available. So what helps bank nurses feel valued? It helps if they are given equal rights to training opportunities, inducted properly and, above all, treated with respect for their contribution. It may seem easy but, like everything, it has its own stresses. Bank nurses are in need of the same skills and support as anyone else. I have been on the 'bank' twice in my career and this time around I attended an induction programme with all other new starts. This was wonderful, informative and welcomed me into the Trust again. This was in stark contrast to a few years ago when I was tagged onto a couple of study days which were compulsory then thrown in at the deep end with no supernumerary days. This time I was given 7 paid supernumerary days in each department to refresh myself. These were of great help and eased me back into working life, whilst not actually being responsible for a department. This whole process made the transition back to work much less stressful and no doubt brought me back up to speed quickly and of more help to my co-workers. Bank Midwife |
16) Role Review
Sometimes it is possible to transfer certain aspects of a role or types of work from a qualified nurse to another type of employee. It may be possible to reduce workload altogether by stopping unnecessary activity or using new technology to reduce workload by for example printing routine information onto pre-formatted recording sheets, etc.
As a receptionist in our practice, I don't think I've had preferential treatment, but when I got diabetes, I was really pleased to be able to casually ask the nurses or the doctors about things that were bothering me about my condition. They eventually began to laugh and say that I knew more about diabetes than they did. Funnily enough, they are right from one point of view, because they don't have to live with it. However, I'm really pleased because I've been given training and now part of my job is to give advice to newly diagnosed people, who are often a lot like me. They can pop in and ask me for information without disturbing the nurses. I've got lots of leaflets, etc., but the best thing is often the advice I can give. This saves the nurses time. Next I'm going on the phlebotomy course and I'm going to save even more time by taking bloods. Receptionist |
17) Working Beyond Retirement Age
Increasingly staff who may have entered health care as a second profession or who have had a considerable gap in employment may ask to work beyond normal retirement age, either on full-time or reduced hours basis.
It is mad to make people retire if they are still willing to work. I don't want to work at the pace I used to but I am fit and well and I know a lot. All these years of experience have helped. So here I am at 67, still running clinics. The last time I offered to retire after a particularly difficult clinic, they all went pale. I like that! Practice Nurse |
18) Rotational Posts
Two or more wards or areas of the hospital or community can form a partnership and rotate staff between them. Rotation can also take place across organisational boundaries.
Because all the nurses rotate between coronary care, intensive care, and theatres, we have a flexible pool of nurses who can work in any of those areas, and who feel as if we are making a real commitment to their personal development. They don't stay for ever, because they end up as really desirable employees. On the other hand, we never have any difficulty in recruiting, because our programme is so well liked. Manager, Acute Care |
19) Agency Staff
Commercial companies can be used to find staff when other means of filling the shortfall has failed.
I set up an agency because I had children and I wanted to work. I didn't like the way some of the commercial companies worked, the nurses like me needed to get work, and be supported with training and development, and I didn't like the way the NHS turned up their noses at the hours I was able to do. I thought at my kitchen table, I can do better than this. And I do. Agency nurses get a bad press, but they are trained nurses the same as everyone else. They have the same standards as everyone else, and they are prepared to work in places and at times when everyone else has said "No". So they should be treasured. They are not exploiting patients any more than people who supply food or electricity to hospitals. It is just a business. And maybe if the NHS listened to some of the ideas in this book, it would reduce dependence on agencies, as bank and flexible programmes are the answer to support workforce planning. Best value use of agencies in partnership, means that staff and resources are used when it is cost effective. Agency Director |
20) Video or Telephone Conferencing
The geography of Scotland is such that it can take a long time to get from one location to another. The use of video or tele-conferencing can cut down travel and enable you to participate in events. It is also good for consultation.
After I had my hernia, I was returned home so quickly. I couldn't believe I was in my own bed at home the same night. The day after, a nurse phoned me from the hospital. I can't remember her name, but she was very impressive. She asked me all sorts of things, and it was as if she knew me. How could she know I was having constipation? But she asked me about it, and gave me the right answer for it. I could ask her about my dressings. Actually, I didn't have many and it was worrying. The hospital had said that I could take a bath, and I said surely that's wrong, but she said it was OK, so I tried it and it was lovely. I had her number to call her again if I needed to, but I didn't. She mentioned that she was calling on all the patients who had gone home that day. My goodness, that must have been about twenty of us. Patient |
21) Flexible Retirement
This can enable employees approaching retirement to gradually reduce the time they spend at work in preparation for their retirement.
Job sharing is now being used for the first time in the Borders as an approach to flexible retirement. Two senior nurses, who no longer wish to work full time but want to remain in nursing, are going to share a senior post. This will allow the NHS to retain their excellent skills and experience while providing a "step down" to retirement for the individuals concerned. This is another example of how increased flexibility can meet the needs of the NHS and of the people who work in it. NHS Borders |
22) Working From Home
Some administrative tasks can be undertaken from home. Report writing can often be more productive away from the regular interruptions of colleagues or the phone.
I think its really important for staff to feel able to work from home if it is the most efficient way to do some jobs. We all know how difficult it is to concentrate when your working in a busy clinical area. Manager, Medical Unit |
Managing Flexibility - Some Important Themes
1. Leadership Development
Leadership is needed to bring about effective change. The role of the team leader in managing their teams is absolutely vital. Team leaders need to know 'how' to be flexible and have to posses the skills and confidence to plan and implement new ways of working. Inevitably this requires skills in managing teams and change effectively. The Scottish Executive Health Department (SEHD) is currently developing an NHS Leadership Framework to address such issues; for more information contact ashleigh.dunn@scotland.gsi.gov.uk . The Royal College of Nursing (RCN) Leadership programme is a good example of the investment that is being made by the SEHD, not just in nurse leaders but to all healthcare professionals. It is a 12-month programme of learning with a particular focus on developing self, teams, a better patient focus, networking and political awareness. It utilises a variety of different tools and interventions to enable clinical leaders to develop the necessary skills to set and maintain high standards of patient-focused care. The programme is undertaken by clinical staff who have a real everyday experience of delivering patient care, and managing other staff to get the best for patients. Nurses know that as leaders, they must influence policy in this area.
As part of our programme, four of our charge nurses went to sit in on the Health and Community Care Committee the day the Minister was being questioned about the NHS. It was unbelievable, the extent to which he was being questioned about things that we knew were up to us. He was being asked about what we were doing to recruit and retain nurses. I had no idea that he would be questioned in that way by other MSPs. We had arranged to have lunch with him and the convenor of the committee after, and told them about what we were doing locally. They must have heard, because it was covered in the debate in the parliament the next day. |
Champions of Our Destiny - Grampian
This was the name given to a leadership development project in Grampian to support clinical team leaders in implementing flexible working practices. It took the form of a one-day workshop that had a number of aims including:
Identifying the issues and problems
Sharing examples of good practice
Formulating and sharing solutions to problems
Offering a learning experience for a critical mass of sisters and charge nurses.
It allowed a range of approaches to flexibility to be explored in facilitated groups as well as an examination of the practical and behavioural obstacles that staff experience when dealing with change in themselves and others.
Discussions were undertaken in a light-hearted but informative way. Participants were invited to share details of flexible approaches they had experienced and to indicate if there were areas they would like to know more about. This information has been collated and shared. The workshop was highly rated by the nurses who attended and has provided the basis for an action plan to support the development needs of this group.
The Centre for Change and Innovation - develop your team programme is available to everyone in the NHS who has access to a pc, either at home, at work, or through a library or learning centre. It can be found on the website ( www.cci.scot.nhs.uk ) using your Athens password, which you can also get through the site. Examples of the good practice that has been shared to date include:
Change Management
Grampian Health Board - 'Ideas into Action', the vision of the organisational development programme was to lead and facilitate a change of culture in the organisation. A programme of training was put in place to equip supervisors and managers with facilitation and process skills. Thus, training not only built technical capacity in the organisation, it was also the vehicle by which supervisors and managers could discuss the changes taking place, share their experiences and learn to live the new values and behaviours required in the changed organisation. 'Ideas into Action' moved from being just a smart strap line to becoming a systematic method identifying and implementing service improvements.
Creating Great Teams
This work highlighted the challenges faced by accident and emergency teams in Edinburgh Royal Infirmary and the team-based solutions they employed to ensure a patient-focused service. The teams in the A&E department in the Royal Infirmary have to perform and disperse at a much faster rate than accepted management theory on teams suggests is possible. Their success has been attributed to planning, training and a culture that focuses on the patient, making their recovery the number one priority.
In addition to these examples, the CCI website offers a leadership and training consultancy at the press of a button. Nurses can access research and learning modules on:
Creating great teams
Coaching and Mentoring
Work-life balance
Leadership.
Internet-based coaching - North Glasgow
Individual health systems try out new ideas for themselves. For example, an innovative internet-based coaching and development system has been used by North Glasgow Acute Trust's human resources staff to provide leadership development support to 40 staff. Consultants worked with a group of G grade nurse managers to generate development action plans suitable for nurse managers and incorporated these into the existing system.
North Glasgow is no different from any other hospital in experiencing difficulties in releasing staff from training workshops. The benefit of this system is that the action plans are accessible when needed. The coaching system provides information on many different policies and the action plans have step-by-step guidance and good practice information.
A group of 40 nurse managers was able to access the system for a month. The pilot received very positive feedback. One comment that was feedback was:
'It is very useful to have specific examples to help make the right choice in dealing with problems.'
2. Making Good Use of Information - The Agency Approach
Nursing Agencies use a different approach to filling gaps in staffing compared to usual NHS Bank practice. The NHS model searches in very small bank databases to recruit staff. This can automatically exclude large parts of the available workforce.
The agency approach is to 'trawl' for as many people as possible, valuing every contact. Once on the database, effort is spent making each contact available for as many opportunities as possible. There is room for dormant, partially active and fully active contacts. There is one main database, which can be searched by sub groups. This means that although they may hold thousands of contacts on their database, only about 40% of those will be actively employed by them during any one year.
The aim is to gather information about potential employees and hold this in readiness for when they may fit the needs of the organisation. Staff can then be approached on a targeted basis.
3. Evaluation
Evaluating different approaches to providing flexibility is important and these are some of the ways in which teams reflect on how their plans are developing:
Interviews with staff during appraisals, personal development, return to work meetings
Ensuring rostering is a permanent agenda item at ward and unit meetings
Monitoring staff exit interviews and questionnaires
Encouraging an open environment where staff are able to approach senior nurses to discuss any difficulties.
Top Tips For Flexible Working
Managing different working patterns and being alert to the need for change requires team leaders with an open mind who have the skills and competencies to manage their team and the service effectively.
This can be achieved by:
Being clear about the need for flexible working and the benefits for the individual, the team and the organisation.
Making time to review what you are doing regularly and reflecting on whether this is meeting the needs of the service and the team
Assuming shared responsibility for making the arrangements work. The more you involve people in change they more they will work with you
Making quality time for discussions with the team and holding regular meetings
Encouraging good communication - making team members aware of all changes large and small
Developing better systems of information to support your planning
Networking and sharing ideas/problems with your peers in nursing and human resources
Being prepared to redesign the workload and do things differently - flexibility might not always be the answer
Making sure you get the training and development you need to help you gain the skills and knowledge you need
Taking advantage of sources of literature available on the internet and in journals to support your developing plans
An Inspirational Tale
Emma Brunton is a nurse who won the Lloyds/TSB Best Boss of the Year competition in 2003. She provides an outstanding example of the 'can do' approach that can help transform the working lives of staff.
Emma manages a 20-bed ward at Hellesdon hospital in Norfolk, where she is responsible for the 24-hour care of long-term patients with severe mental health problems. On taking up the post of charge nurse, she spoke to each member of her staff to determine which shifts they would prefer to work. She then drew up a shift pattern that accommodated the individual needs of the team. The system had also to meet the strict staffing requirements of the ward, such as having a mix of male and female workers and ensuring that unqualified staff worked with those who were trained.
Emma says: 'I believe I have helped create a happier working environment, which has allowed staff to develop their skills and roles and encourages team working. At the heart of this is a flexible working system which helps meet people's needs, whilst meeting the clinical needs of our clients. Staff sickness levels here are now well below the national average, we communicate better and we are much more patient-centred. And our clients have responded amazingly - levels of shouting, abuse and violence have lowered dramatically.'
The number of sick days taken by staff has halved. Emma adds: 'I gave people what they wanted. If there's no flexibility, people will go off sick anyway. There has to be a fair system or we'll lose good people. If we treat people as we would have them treat us that filters down'.
THE LAST WORD GOES TO THIS PART-TIME NURSE:
'I would say to any manager to value EVERY member of staff, whatever their hours of working may be. We must be more flexible in our approach to working practices so as to allow the full use of the amazing skills and experience on offer from so many people.' |