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!

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More from @MarkOneinFour

9 Jun
I've been live tweeting all day for #beyondtheroom from #quality2021 (internationalforum.bmj.com/europe/program…). In the thread below are links to the threads of my tweets from each of the talks and workshops on quality improvement I attended if you want to read back at your leisure (1/5)
Read 5 tweets
9 Jun
Welcome to the next session at #quality2021 (internationalforum.bmj.com/europe/) "Optimising the medication pathway: Meeting the WHO 2022 target of 50% fewer medication errors and clearing patient backlogs through automation". It runs through to 14.15GMT. Thanks for joining me
This is the abstract for the session. Basic summary: using automation to reduce medication errors internationalforum.bmj.com/europe/2021/03… #quality2021
Kirran Walsh of BMJ is introducing our session. First up: Rachel A. Elliott, Professor of Health Economics at the Manchester Centre for Health Economics; United Kingdom. Elliot is setting the scene in terms of economic impact of medication errors #quality2021
Read 50 tweets
9 Jun
Hello! The next session I'm live tweeting for you from #quality2021 (internationalforum.bmj.com/europe/) is "Creativity as core in QI - using the Arts to empower and build co-production". It will run until 13.00GMT. We're hearing from Polly Bowler and Leanne Sedin about work at @NHS_ELFT
Amy Price is introducing the session. Says we'll be hearing about the East London Foundation Trust's #ELFTin1Voice projects. Polly Bowler is Head of Arts Therapies for ELFT’s Bedfordshire & Luton. Says improving lives is the aim of what they do. #quality2021
Bowler is talking about the 1Voice choir project, which is run in partnership with Sing Tower Hamlets community Choir. She stresses that the project is open to all, and helps to bring together people and provides a way to discuss difficult things #quality2021
Read 24 tweets
9 Jun
Right, first session of today at #quality2021: Quality Improvement at National Scale: The theory and results of two national collaboratives using QI to address human rights issues and safety in mental health. Amar Shah is welcoming us to the session.
We're being joined for this session at #quality2021 by Ajibola (Aji) Lewis, Sal Smith and Kate Lorrimer. Shah says patients in hospital for mental health reasons experience same risks as other hospital patients, but with other risks to their safety related to their mental health
Shah says that there is relatively little work that's been done about patient safety in mental health settings. Says there is a tension between autonomy and reducing risk which is often present in mental health situations #quality2021
Read 28 tweets
9 Jun
I'm live tweeting for next three days from #Quality2021, International Forum on Quality and Safety in Healthcare Europe 2021 ofr #beyondtheroom. I start at 11GMT with "Quality Improvement at National Scale: using QI to address human rights issues and safety in mental health"
For wondering what QI is, it's not the smug telly programme about telling people they're wrong about stuff. QI stands for Quality Improvement. Here's a good intro to the whole approach in health health.org.uk/sites/default/… #quality2021
Other sessions I've got for you today are

12.15GMT Creativity as core in QI - using Arts to empower and build co-production

13.15GMT Optimising the medication pathway: Meeting the WHO 2022 target of 50% fewer medication errors and clearing patient backlogs through automation...
Read 4 tweets
8 Jun
Sitting outside in the dark. The fox cubs have been and gone. There is a cat on the roof. The silhouette of a cat sitting on a flat roof
The fox cubs are back. They move on tip toes. The vixen is grumbling to herself. She looked at me through the gate and we nodded at each other in a most neighbourly fashion.
Last week I stayed in a youth hostel on the South Downs and, honestly, I've seen more wildlife and stars since I got back. The world can be quite remarkable, really. Even during all of this horror.
Read 6 tweets

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