Walking with pebbles in your shoe – why a change in thinking is key for quality improvement and staff wellbeing

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As a forensic psychiatrist and national improvement lead for mental health at The Royal College of Psychiatrists, East London Foundation Trust’s Chief Quality Officer, Dr Amar Shah, is a leading expert in positive change in the workplace. We ask him for his thoughts on change brought about the pandemic and what the future holds

Leadership has undergone a transformation recently. There’s a growing understanding that empowering staff to develop their own solutions to improve care is more effective than top-down decision-making. Not only do people feel a sense of ownership, those who actually do the work are often the best placed to find the solutions. Amar Shah is committed to shifting the balance of power in healthcare.

“As senior leaders, we’re never going to understand the context of working environments to the level we need in order to be able to say what’s going to make a difference,” Shah believes. “You know, which things are getting in the way, and which are actually helpful.

“I think the first step is to believe there is a way of leading that yields greater dividends for us if we can equip our people – staff, patients and service users – with the tools they need to be able to make changes.”

Joy in a joyless world

And this change in thinking is more important than ever. The long-term mental health implications of the pandemic on NHS staff are a huge worry. But while it might seem counterintuitive to chase joy at this terrible time, we need to think optimistically. “Joy may not be the right word to use right now,” Shah says. “But there’s no doubt that we need to be paying attention to it. I heard someone much wiser than me say that you can’t give what you don’t have. And actually making sure that our people have space to take some time away from work – even when they’re in the work setting – to find little moments that help them recharge and reconnect and have a moment of lightheartedness amongst all of the difficulty, can actually help maintain energy during what’s been a really long, challenging, difficult process that’s likely to continue for many months to come.”

One of the good things to come out of COVID-19 is the proof that when we need to be adaptable, we can be. Even in a huge organisation like the NHS. “Lots of teams have had to radically change the way they work, whether it’s working remotely, or whether it’s changing their service delivery model. It’s that process of agility and reflection that I think is really important. As well, of course, as thinking about how we can make sure we’re looking after ourselves and those around us because that’s going to be really key for the year ahead.” 

‘We’ve probably seen about a decade’s worth of digital transformation in a year.’

Sharing responsibility

“Top-down approaches to change probably haven’t worked as well during the pandemic as giving people closer to the point of care the autonomy to really think about what’s going to make a difference. They’ve come up with their own theories, tried them out, and adapted as they go using data, whether it’s quantitative or qualitative, to get a sense of what’s working and what’s not. What we hear from improvement practitioners across the UK is that the organisations that really invested in helping their people apply quality improvement before the pandemic have found that their teams are probably more well equipped to remain agile, hold onto possibilities and solutions.

“There’s something very powerful about teams having a way to understand and influence the system they work in…shifting the power balance around solving complex problems in healthcare through quality improvement where we senior leaders recognise that we don’t have the solutions. So we really need to use the biggest asset we have, which is our people.”

Ultimately, a year of transcendental change may have altered our way of thinking. “It’s easy to end up focusing on the things that are challenges and barriers. What we should also do is think about the things that are positive, and optimistic – and actually helpful. We can do this while trying to tackle the pebbles in our shoe, the things stopping us from having a better experience at work.”

And these are considerations that need to be thought about long-term. “So many teams right now are facing big backlogs and long waits that require a radical redesign of their process. That’s perfect for applying quality improvement.

“In the process of recovering, we don’t want to end up with services that look like what they were in 2019. Actually, we should be learning from the last year and coming up with better solutions, better service models that meet the needs of our local communities. So, there is a real opportunity to use quality improvement and try out new ideas to create a better service for patients and experience for staff.”  

What happens next is what counts. We have a chance to shake things up at the same time as making life better for both healthcare workers and patients. The pebbles might annoy us sometimes but how we choose to shake them out is entirely up to us.

^{Photo by Nathan Dumlao on Unsplash}

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