Working Well Handy Guide
Introduction
This Working Well Handy Guide is designed to be used by teams and individuals to help them build staff satisfaction and wellbeing using a Quality Improvement (QI) approach. It is bite-sized and practical – ideal for the COVID-19 landscape. It has been built on East London NHS Foundation Trust’s (ELFT) learning from supporting 48 teams over 5 years.
How to navigate:
- The graphic at the top of each page has clickable text that helps you navigate the sections of the guide in sequence. Start from the left and work towards the right as your improvement effort progresses.
- Each step in the sequence has a ‘Try This‘ clipboard. This is a ready-made activity you can try with your team to apply the theory.
- Be sure to see all the resources for a section by pressing ‘Click to see more…’.
Welcome message from Dr. Amar Shah – Chief Quality Officer
Table of Contents
Below is a brief summary of what is covered in each section of this guide.
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Your local QI Coaches and Improvement Advisor are here to walk you through this guide and help you apply the methods. Click here to find these people in your directorate.
Identifying a Quality Issue (Working Well Handy Guide)
This is about paying attention to the sentiment of the team to identify emerging themes or recurring issues that are negatively affecting staff or the functioning of the team.
This is about paying attention to the sentiment of the team to identify emerging themes or recurring issues that are negatively affecting staff or the functioning of the team. *The Institute for Healthcare Improvement (IHI) have developed a framework for Enjoying Work projects that starts with asking staff, “What matters to you?” Click here for a guide to that conversation.
Here are some more tips on how to identify a quality issue with your team:
Example from ELFT’s Enjoying Work Community
Our Community Health Services ran a ‘Shaping our Future’ workshop that identified the quality issue around staff wellbeing. Click here to read their story.
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Your local QI Coaches and Improvement Advisor are here to walk you through this guide and help you apply the methods. Click here to find these people in your directorate.
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Understanding the Problem (Working Well Handy Guide)
In this step, the team seeks to drill-down into the opportunity there is to improve their experience and wellbeing, valuing and hearing from as many voices as possible in the team. Here you will find information on Appreciative Inquiry, leadership, measurement and the hierarchy of needs.
Appreciative Inquiry
Appreciative Inquiry is a tool that can help your team to identify their strengths and apply them to tackle complex problems. Click here for the step-by step guide.
Click here to watch a puppet show about how Newham Child and Adolescent Mental Health Services (CAMHS) ran an appreciative Inquiry as part of their Enjoying Work project.
Anyone can be an Enjoying Work leader
Watch this 3-min video by Professor Don Berwick (President Emeritus at the Institute for Healthcare Improvement) about how to lead teams during Covid-19. Here is a summary of the key points of this talk. We encourage you to reflect on these in your role as a leader at the current time, and in particular how you are role modelling and promoting wellbeing at work.
Measurement
One core principle that can help any improvement effort to be meaningful and relevant is measurement. Before starting any work, measurement can help a team understand why this effort is meaningful and what specifically to focus on. As changes are tested, measurement will also help identify whether the changes that are being made are leading to improvement. Measuring and sharing the data can help keep people engaged in the effort and help tell the story of the improvement. It’s important to keep your measurement simple and relatable. Try to embed the data collection into an already existing process. Better still, use measures you already have.
Three top tips for measuring for improvement (Dr. Amar Shah, Chief Quality Officer at ELFT)
Collection methods:
- You can ask these questions during team huddles
- You can use free online survey tools like Survey Monkey, Microsoft Forms, Menti
Feedback Loop:
- Share the data back with the team as soon as possible
- Use the data and discussions from that data to plan test of change
Click to download individual resource
What matters to you and where do we want to be?
Find out how to use Maslow’s Hierarchy of Needs to draw out what matters to people in your team and help focus what you want to achieve together.
Maslow’s Hierarchy of Needs
Maslow’s hierarchy of needs is a motivational theory in psychology, it is often shown visually as a five-tier hierarchical pyramid. Needs lower down the hierarchy must be satisfied before individuals can attend to the needs higher up. It can be a really helpful tool to think about your own and your team’s hierarchy of needs and how you will adapt to fulfil these when working in different conditions.
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Your local QI Coaches and Improvement Advisor are here to walk you through this guide and help you apply the methods. Click here to find these people in your directorate.
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Developing a Strategy and Change Ideas (Working Well Handy Guide)
In this step you will will bring together everything you have learnt as a team about how things are and where there is opportunity for improvement. This will inform your strategy about what will have the greatest impact on staff experience and wellbeing.
Nominal Group Technique
Find out how to use one of the most popular group engagement techniques in quality improvement, the Nominal Group Technique. This is a quick and easy way of generating ideas in a group in a way that allows everyone to be heard.
Top Tips from Enjoying Work Project Teams
Below are some top tips for looking after yourself and your team which some of the 40+ Enjoying Work project teams from across ELFT have tested out. These might be things that you want to test with your own team.
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Your local QI Coaches and Improvement Advisor are here to walk you through this guide and help you apply the methods. Click here to find these people in your directorate.
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Testing and creating feedback loops (Working Well Handy Guide)
The majority of time during a QI project is spent testing ideas at a small-scale as quickly as possible. Successful tests can then be run under different contexts and scaled up if appropriate.
Plan-Do-Study-Act (PDSA) Cycles
PDSA cycles allow you to test your ideas and learn what works or doesn’t work then adjust your approach. The idea is to start testing as soon as possible, don’t wait for the best conditions. Run a small test e.g. one staff member, *for one hour and loop back to review what you learnt from the test. In most cases, you will need to adjust your change idea through a number of PDSA cycles before it starts to work reliably. The key is to have a specific question you want to answer from the test and a prediction of what *you think will happen.
Key concepts on how to test ideas. (Dr. Amar Shah, Chief Quality Officer at ELFT)
Example:
Have a look at two PDSA cycles run by one team around the possibility of working remotely in response to the COVID-19 pandemic.
Also see this example around how we have used PDSA to develop the Personal Protective Equipment (PPE) ordering process at ELFT>>
Further Resources you might also be interested in:
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Your local QI Coaches and Improvement Advisor are here to walk you through this guide and help you apply the methods. Click here to find these people in your directorate.
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Implementation and Sustaining the Gains (Working Well Handy Guide)
At this stage you will be taking steps to embed successful change ideas so they become business as usual. This is something you do throughout the life of your improvement effort.
The six steps for adopting successful ideas into routine practice. (Dr. Amar Shah, Chief Quality Officer at ELFT)
Try This:
Follow the steps in this one-page guide which gives you a quick overview to what implementation is and how you might go about it.
Click here for more information on the implementation process.
For a real-life example of implementation, watch ELFT Forensic Admin’s Enjoying Work project presentation.
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Your local QI Coaches and Improvement Advisor are here to walk you through this guide and help you apply the methods. Click here to find these people in your directorate.
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Storytelling (Working Well Handy Guide)
One of the best ways to keep the momentum going in your team as you try different ways of improving wellbeing and satisfaction is to share stories regularly within your team and the rest of the world about how you are getting on. Over the years ELFT has seen how storytelling about Enjoying Work has inspired other teams to want to change, sparked new relationships with other Trusts and partners and had a huge impact on service users’ experience of care. So we tell stories in order to:
The value and impact of sharing stories. (Dr. Amar Shah, Chief Quality Officer at ELFT)
Storytelling
A good improvement story engages people’s curiosity, emotions and imagination. It does not have to be a full summary at the end of a piece of work, be focused on success, be supported by data, a long account of an event, an answer to big problem nor does it have to take a lot of time to capture and share. A story can be an account of part of an improvement effort, a summary of someone’s experience, something that informs a debate or raises awareness of a subject, a simple picture, video, soundbite and the like.
Try This
When your team decides to do anything related to improving their satisfaction and wellbeing, Tweet about your intention and aspirations. Click here for more information on how to tell stories and the various formats they can take.
Here are some examples from teams who have used these tools and techniques as part of the Cohort 3 and Cohort 4.
Illustration from Enjoying Work Cohort 2 Learning Set 5
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Your local QI Coaches and Improvement Advisor are here to walk you through this guide and help you apply the methods. Click here to find these people in your directorate.
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ELFT Employee Wellbeing
Find a simple summary of how the ELFT Employee Assistance programme can support you with your physical, emotional, financial, social and environmental health.
Care First 0800 174 319
Please direct any queries to Elft.employee.engage@nhs.net
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