Hugh Masters Associate Chief Nursing Officer Welcome

2. Leading Better Care – Delivering for PatientsUnlocking the next stage of the journeyWelcomeFollow the conference on Twitter at #LBC2013

3. Hugh Masters Associate Chief Nursing Officer Welcome

5. Michael Heppell International Speaker, Success Coach and Best Selling Author How to be Brilliant!

7. Midget Gems

8. Susan Chisholm Lead Diabetes Specialist Nurse NHS Tayside

9. Leading Better Care: An Experience Susan Chisholm, Lead Diabetes Specialist Nurse Tayside Diabetes Specialist Nurse Service

10. Autumn 2012 – It’s a disaster! LBC: The right time

11. Tayside Diabetes Specialist Nurse Service 1986-2013 • 1986 - 1st Specialist Nurse for diabetes • 1997 - 4 DSN’s: diabetes pop 6,500 • All DSN posts Grade G, 2 H posts • Health Visitor/District nurse/Practice nurse

12. What do we do? • Out-patient specialist service • In patient service • Telephone advisory service • Community support/ home visits • Patient education programmes • Health care professional education

13. DSN Team: 2013 • 2012 - 11 posts, diabetes pop >20,000 • Lead DSN (2009) • Senior DSN • DSN • Diabetes Nurse

14. “A sense of humour is part of the art of leadership, of getting along with people, of getting things done”. Dwight D. Eisenhower 34th American President

15. LBC: 3 Day programme • Protected time/self analysis/reflection • Networking: building and establishing • Affirming what I do: increased confidence • Senior nurses: faces to names • Talk the talk

16. LBC: Putting it into practice • Project: Patient experience • Team Vitality • Pink book/Evidence

17. 2013: PLAN • 4 Senior DSN: request LBC programme • 2 senior DSN: Pink book in progress • Confidence and competence

20. Angela Carlin Senior Charge Midwife NHS Greater Glasgow & Clyde

21. My Senior Charge Midwife experience using LBC Leading Better Care – Delivering for Patients 20TH February 2013 Angela Carlin

22. LBC – My Thoughts At Last… a resource tool to help me… Engage with policy change Develop myself to an advanced level of autonomy Utilise critical thinking Participate in a higher level of decision making Give myself permission to put problem solving techniques in place Influence values and to establish a culture of productivity to improve care Develop my team to embrace measuring quality outcomes Lead on safety issues and redefine roles and responsibilities to enhance the patient experience Realise that this will be a transformational journey for me!!!!

23. LBC - Learning What was my own leadership style? What kind of a leader I needed to be? How could I could build on the skills I had learned previously?

24. LBC – Permission To take time out to reflect and develop an action plan that facilitated fulfilling my ward vision as well as working towards delivering on the quality agenda To reflect to look at the patient journey to make adjustments to improve their experience where needed To refresh Chance to re-visit issues with my team in order that we could plan, discuss and be visionary to finding solutions to long term issues To enhance knowledge Utilise workforce, workload planning from the NES toolkit Vision of what I needed to change in order to achieve improved quality Provided me with confidence when discussing/ negotiating with my Lead Midwife on ward requirements To apply the knowledge of workforce planning to appropriately delegate workload right to deliver safe, effective and person-centered care

25. LBC – Role Development LBC let me understand… that I shouldn’t feel constrained - I already had the skills for the job, I just need to give myself the permission to apply them more effectively LBC gave me the tools… to put into practice my knowledge and experience as labour ward sister and Community Midwifery Team Leader LBC increased my self awareness… to lead the team more effectively by becoming more informed and responsive to future programmes and initiatives LBC developed my confidence to reassure me that I could be a more effective SCM, who was on the right path, it showed me how I could keep on the path and without taking the scenic route

26. LBC - Personal changes Improved communication style I now talk WITH rather than TO my staff Implemented daily verbal updates To reinforce and discuss our vision To discuss the requirements to perform our ward measures To ensure they were aware of what local or national initiatives we would be implementing making the team more informed and involved in planning for the ward and the care we provide Introduction of a 2pm huddle To act on the permission I had given myself to move the ward forward for implementing quality improvement initiatives’ such as RTC, Better Together To tap into the resourcefulness of the team to make successful improvements and time to fulfill everyone’s needs. Less firefighting Reduced change management issues resulting less of me firefighting and instead allowed me to support the team through the embedding process of change

27. LBC – Light Bulb Moment LBC EXERCISE (1)….. What activities are carried out in your ward/team that do not add value to patient care? • Then…… LBC EXERCISE (2)….. Consider ways to shift the balance of work so that more time is spent on direct patient care, without employing more staff. Think about the staff you have and how you might deploy them in a different or better way. • Think about your own area of practice……

28. LBC – Ward Changes Utilisation of the NMWWP Learning Toolkit My “Bible” – applying the toolkit allowed me to effectively change the skill mix within my ward, whilst keeping within my budgeted establishment Combining LBC learning and the NMWWP toolkit Allowed me to engage in quality improvement initiatives e.g. RTC activity tracking Enabled me to apply PDSA to improve safety, efficacy and person centered care within my ward e.g. breast feeding Improvements Utilised NA workforce in a different way to meet the standard 10 steps for UNICEF accreditation to become baby friendly certified to achieve compliance for our NHSGGC breastfeeding Clinical Quality Indicators Developments NA’s received UNICEF Baby friendly breast feeding training NA’s now support women and midwife colleagues with breast feeding to achieve the standards set

29. During team huddle time it was suggested we should add to our team!I reflected and thought this chap might meet the bill. However I realised he’d cause too many interruptions……! So I Introduced the Housekeeper Role

30. LBC – Further Developments • Redeployment of Workload • identified the staff group that I would utilise in a more effective way • Releasing Time to Care • gave evidence to demonstrate that NA’s needed released from daily house keeping duties to redirect their time to the bedside • ensured timely assistance for Mum’s whilst reducing interruptions for midwives to concentrate on direct patient care that only they could provide • Implementation • Discussions with Lead Midwife, • 6 month trial period a newly developed housekeeper/clerk role • Result • A ‘Win Win’ result was achieved!

31. LBC - Impact • As a ward we haven't looked back. • We have consistently achieved 100% for our monthly breast feeding CQI’s since May 2012 • We have maintained our UNICEF Baby Friendly accreditation • Success was recognised last year with the housekeeper/clerk receiving a nomination and award for her contribution to patient care in the NHSGGC Facing the Future Awards • House keeper role is now being replicated with success in most departments and sites with the Women and Children's Directorate and beyond

32. LBC – My Thoughts At Last… a resource tool to help me… Engage with policy change Develop myself to an advanced level of autonomy Utilise critical thinking Participate in a higher level of decision making Give myself permission to put problem solving techniques in place Influence values and to establish a culture of productivity to improve care Develop my team to embrace measuring quality outcomes Lead on safety issues and redefine roles and responsibilities to enhance the patient experience Realise that this will be a transformational journey for me!!!!

33. LBC - Outcome • I’ve loved it. • It was what I was waiting for, a personal challenge, I enjoy developing my team and people in general – so by developing myself through LBC this had a beneficial effect for everyone not only myself.

34. LBC - Update Implementing and integrating examination of low risk new-born babies into midwives daily remit, an area previously undertaken by paediatric colleagues Continual review of staffing workload and remit this time focusing on MCA and Nursery nurse roles Benefits from this service improvement: Improved patient experience through continuity of care and carer. Reduces discharge delays for families through improved planning and communication. Enhancement of midwifery skills to improve confidence and problem solving abilities, thus allowing participation for the person centered journey

35. LBC – My Top Tips • Intermittently observe each grade of staff and what they do • Modify where appropriate However: • Adopt the NES NMWWP Toolkit as your “Bible” • SCM/N need to develop a personal ward action plan to help maintain the momentum for change management and ALSO to support sustainability

36. My thought for today!

37. LBC taught me that to be a successful SCM/SCN …….was NOT to waitfor the storm to pass...... but to learn “THE SKILLS” to dance in the rain!

39. Linda King & Mhairi Buchanan Senior Charge Nurses NHS Lanarkshire

40. Supporting Senior Charge Nurses to Lead Better Care Linda King Senior Charge Nurse Mhairi Buchanan Senior Charge Nurse

41. Aim • Support Senior Charge Nurses to work effectively within Leading Better Care role framework • Testing two models to identify if one had greater impact than the other. • To inform NHS Lanarkshire Board with regards to future investment

42. The Pilots JANUARY – APRIL 2012 10 wards Additional Band 5 Registered Nurse 10 wards Additional Band 2 Clinical Support Worker MEDICAL, SURGICAL, OLDER PEOPLE’S CARE, MATERNITY/NEONATAL

43. Linda King Frustrations Before Pilot Challenges Role modelling During Pilot Adapting Person Centred Staff development I realised how much I achieved and the value of the pilot. Looking forward… Now Frustrations

44. Mhairi Buchanan Frustrations Before Pilot Challenges Feeling valued During Pilot Leading a new team Attitudes and behaviour Visible and accessible I feel like, for the first time, I’m a Senior Charge Nurse the way it’s meant to be! Succession planning Now Professional development

45. Future Investment in supervisory role 22.5 hours per week. Phased roll out Report to NHS Board November 2013 Combination of additional Registered Nurse & Support Worker hours Research and Evaluation – impact of investment

47. Gladys Haining Alzheimer Scotland Dementia Nurse Consultant NHS Dumfries & Galloway

48. Leading Better Care. A Personal Perspective. Gladys Haining 20th February 2013

49. Improvement Project?

50. So many targets, yet another to consider! Let’s be SMART here!