Thread by @MarkOneinFour

Welcome back to my live tweeting from #quality2021! The final session I'm covering today is "The Role of Leadership in People Wellbeing: Addressing Front Line Burnout Through Culture and a Systems Approach". It runs up to 17.30 (18.30CEST). I'll be tweeting throughout

Our speakers for this session on burnout and how to avoid it are Ingrid Gerbino, Virginia Mason Franciscan Health; USA and Wendy Korthuis-Smith, Virginia Mason Institute; USA #quality2021

And we're off! Gerbino and Korthuis-Smith are explaining the approach that the Virginia Mason Institute method takes to people management and to prevention of burnout. Korthuis-Smith is asking the audience about factors they recognise in burnout #quality2021

Poll attendees have been asked to vote on covers perceived lack of connection with others in workplace; lack of mutual respect; misaligned personal and organisational values; lack of autonomy/resources; suboptimal workflows. Lack of autonomy/resources was most voted #quality2021

Gerbino is saying burnout is a huge problem. in this session the pair are focusing on leadership strategies to reduce it. Gerbino stresses the impacts of burnout, especially during the pandemic stresses we're living through as professionals and citizens #quality2021

Gerbino is saying that healthcare professionals are facing almost PTSD level effects from their work during the covid-19 pandemic. Half of health professionals felt exhausted over the last 14 days. Only 1/3 said their work felt it had meaning #quality2021

Korthuis-Smith says there is a strong imperative to take a systems approach to burnout. This requires understanding from perspective of workers how the different domains of their life interact #quality2021

Korthuis-Smith says there are three defining work system factors (external environment, healthcare organisation, front line care delivery) that are mitigated by individual mediating factors. Learning and improvement can act upon both of these domains. #quality2021

Korthuis-Smith says that interventions work and that burnout is not inevitable. Says individual interventions can help or mitigate burnout but only system approaches can reduce its arrival and these approaches require leadership #quality2021

Korthuis-Smith likens the path forward to building a house: a foundation of culture and learning and leadership engagement and strategic alignment. The pillars holding up the roof are respect for people and continuous improvement #Quality2021

Gerbino says improving things is an intentional act that requires being enacted at all levels. A culture of respect for individuals needs to run through everything and everyone in an organisation #quality2021

Now a video of a roleplay. A member of staff is taking details from a patient who collapses. The staff member calls clinicians, who assess the collapsed patient but are dismissive and belittling to their colleague who concludes 'that's the last time I call them' #quality2021

The implication is if we are awful to our colleagues our organisations will be less effective because we don't work together. Another video shows how different the situation plays out with compassion between colleagues. The interactions work better as does the work #quality2021

Korthuis-Smith says that it is important to speak up to disrespect, even if disrespect is unintentional. Showing how we speak to each other and the impacts it has is important. In their approach they consciously provide tools to staff to make this easier #quality2021

Korthuis-Smith says it's important to give people space to re-establish self-control, especially during the pandemic pressures. People get caught up in the moment. Interactions need to be emotionally safe for those involved, finding the right time to raise issues #quality2021

Korthuis-Smith: Virginia Mason Medical Center began their journey by surveys to understand deficiencies in communication and respect. Developed 10 foundational behaviours of respect, then training (from which the videos above came). They then monitored and refreshed #quality2021

Korthuis-Smith says 'better never stops'. This was not a one shot intervention but an ongoing commitment to getting better at things that are necessary. Improvement work needs refreshing over time as situations change #quality2021

Gerbino is sharing work that Barking Havering and Redbridge Hospitals undertook after reports of a culture of bullying bhrhospitals.nhs.uk/the-pride-way/ #quality2021

Gerbino is now talking about a clinician autopause when a serious event happens, Sychronised Ongoing Support for families and caregivers creates space for caring for the clinicians rather than forcing them further into the elevated emotions of the situation #quality2021

Korthuis-Smith says it's important to balance team needs and improvement. Too much focus on improvement can become stress in itself. The danger is we fall into a maintenance stage, servicing the things that actually need to be changed getting more tired all the time #quality2021

Gerbino is sharing a slide of a 'lets work on it' board where ideas are shared by staff. Ideas from these boards are then tried and tested by a innovation team. They also use easy to send email technology to send ideas to the leadership team. Reduce friction #quality2021

When leadership teams choose ideas, says Gerbino, they are then placed into a PSDA cycle (england.nhs.uk/wp-content/upl…) and then evaluated and trialed. This shows that challenges can be addressed, not just problems tolerated #quality2021

Surrey and Sussex Healthcare NHS Trust engaged staff in developing better PPE for staff who could not wear other PPE. Staff worked to innovate, studying processes and created innovative decontamination method, says Korthuis-Smith #quality2021

Korthuis-Smith acknowledges that many leaders get promoted because they are fire-fighting problem solvers. Says that this is not as good as enabling others to solve problems as a team. Says that it's vital to be able to discuss failure, not be a know it all #quality2021

Korthuis-Smith says being present is important, not a distant bod in office. Listening to and being with frontline is also vital. Being honest and open also important and not making everything a priority all at once, forever. If everything is important, nothing is #quality2021

Korthuis-Smith says coaching, thinking in systems, framing problems and being accountable are also important. Aligning all of the working bits of a system is vital, too. #quality2021

Korthuis-Smith says covid-19 has been pushing teams beyond their tolerance. Says management huddles daily seem super important and leader rounds also. Rapid PDSA cycles also massively important when things are volatile and changing, while improving standard processes #quality2021

Now we're into questions from audience. 'How do you find the time to do all this work to reduce burnout when you're burned out?' Gerbino says that's the job of being a leader and being with your team, not just 'doing your important work in your office'. Make space #Quality2021

Korthuis-Smith says that this space making and time spending needs to be a specific strategic priority. Your team needs time to think. Says we will need to address the need to avoid burnout, it won't be a choice #quality2021

Another question: 'Where do you start when your team is already burned out and in crisis?' Gerbino says this is the place to start. Talk to each other as a team acknowledging just how hard stuff is. Get going solving problems together. Maybe idea harvesting to start #quality2021

Korthuis-Smith says focus on demand and capacity initially. Getting a good map together with your team and spotting small things you could try. Doing less is better than doing more. Leaders may have space to pick those focuses and priorities in dialogue #quality2021

Gerbino says it's important to capture ideas, aligning them along a timeline to say 'we'll not do this right now, but we'll do it later'. #Quality2021

And that's the end of this session and my live tweeting from #quality2021 for #beyondtheroom today! I'll be back 11.00CEST (10.00UK time) tomorrow morning for Insights from the London Nightingale field hospital and more across the day. Hope I've been of use to you all out there!