Encouraging staff engagement and demonstrating value
Jamie Doyle, Head of Nursing for Acute Services, NHS Fife
NHS Fife aimed to embed this new care assurance approach into their governance structures by implementing the EiC Care Assurance Visits (CAVs) guidance. Care Assurance Visits were chosen as an initial step as they were seen as an easy transition from their existing care assurance practices.
Initially, staff were hesitant to engage with the new resources, viewing them as “something extra to do”. In response, NHS Fife conducted a tabletop exercise where staff could ask questions about the approach and receive guidance on how to use the resources effectively.
Since then, staff have started using the approach and have responded positively. They appreciated to the opportunity to interact with different members of leadership they may not usually get a chance to interact with. They also welcomed having conversations about aspects of their work and care quality that had not been addressed in previous care assurance mechanisms.
“I think the staff really liked it because they were speaking to maybe people who they have never seen before. And some of the questions, especially about their well-being and things which has never really been asked before, when we've done [previous care assurance visits]. It's all been very much the tick box where you go in and you're either clean or you’re not, or the place is tidy or it’s not.”
The EiC resources encouraged more detailed information gathering, with free text boxes allowing for nuanced responses rather than simple ‘yes/no’ questions. These conversations helped build rapport with staff and encourage open and honest communication, distinct from an inspection.
“The big thing is they didn't feel it was an inspection. They felt it was more of kind of a visit and showcase.”
Whilst the CAVs were recognised as distinct from inspections, staff found them useful during inspections. Staff could share their completed CAV reports and demonstrate their knowledge of their local care context to inspectors while highlighting ongoing efforts to improve weak areas.
“Also they feel more empowered to when they say oh there’s been an increase in falls, they've got the data there to say well actually your vacancy is this or that.”
Other teams have inquired about when they might expect to have a CAV with NHS Fife leadership and after they have occurred, staff have shown initiative by developing improvement plans without prompting.
The CAVs identified areas needing improvement, such as patient experiences, which led to the addition of more TVs. Another improvement addressed communication issues between staff and service users, with coaching provided on compassionate communication and techniques to reduce staff stress.
“There was only like 1 TV because the surgeons didn’t want people to have the TV because they wanted them up out of bed but that was like an old-fashioned method. So, we quickly burst that and we got the TV's up and going and we're still getting discharges and things like that.”
Gathering feedback from service users and relatives was also seen as a positive outcome from using the CAV resources. They were happy to engage with those conducting the visits and appreciated the opportunity to provide their views, identifying areas of good practice and opportunities for improvement.
Following the initial use of the CAV guidance, NHS Fife plans to expand its use of the approach to include Quality of Care (QoC) reviews within hospital teams. Clinical Nurse Managers will lead these reviews in the upcoming year, which will be subsequently reviewed by the Heads of Nursing and the Nursing Director for final assurance sign off.
Despite initial hesitancy, NHS Fife successfully encouraged staff buy-in and demonstrated the value of the resources. By providing a space for staff to raise questions and receive guidance, staff concerns were addressed, and they ultimately found the approach beneficial. This has led to positive changes in care delivery and the integration of the EiC Quality of Care guidance into local assurance governance structures.
Quality of care review guidance
