Crisis Resolution/Home Treatment teams in Bedford reflect on their Enjoying Work journey

How do you start an Enjoying Work Quality Improvement project? How do keep team members engaged? How are ideas generated and tested? Learn more in this piece by Emma Myers, Assistant Psychologist and QI Project lead in the Bedford CRHT team.

What issues did the project aim to tackle when you first started with this?

The first difficulty we encountered was the turnover of staff in the team, as two of the original project team moved onto new roles; therefore we had a brief pause near the start of the project before we gained momentum again.

Our main difficulty was getting people to rate their day. We were getting 1 or 2 people rating each day and this was only 11% of the team! We have 14 staff logged onto the app and felt that the 1 or 2 replies were not giving us an accurate reflection of the team’s joy at work. At the Improvement Leaders’ Programme training, I spent time with the Willow Ward Enjoying Work project team and we came up with lots of ideas on how to increase engagement, and from that it was agreed that we at CRHT would try diary reminders and then a WhatsApp group. We were finding that the reminders from the ImproveWell app were popping up at 16:30 and as many of the team work up until 20:30 these reminders would get missed. With the use of the WhatsApp group, reminders were later in the day; we found that the numbers of staff rating their day went up to 5 or 6 on the days from Monday to Friday.

What tools did you use to collect your baseline data and feedback from the team?

We have used the ImproveWell app to gain our baseline data and this was recorded throughout October 2018. We decided to keepusing the app becausenot all the team were in the office to complete a different way to display their good or bad day, so we thought a way to rate their day “on the go” would be more beneficial for the team in the community.

What change ideas did you test and what did you learn from them?

From the first QI project team meeting*, we generated lots of ideas which were put into categories to help us form the driver diagram. We typed up the change ideas and then at the next QI meetings asked the team to vote on their top 3.

Change idea 1 – Roles in the office

Team members wanted to know what they were doing each shift in advance, instead of finding out on the morning of the shift. We tested putting an allocation list on the white board at the front of the office. From this we have learnt about the need for structure and also flexibility in the team during each shift, and it appears to have helped with communication in the team, especially highlighting a shift lead.

Change idea 2 – Office environment

We as a team found that there was a difficulty in communication between team members and we wanted a large table in the office that the team could gather around for meetings. There were also physical barriers to communication in the office with privacy screens that were between each computer. We removed ALL privacy screens in the office (I got excited using the screwdriver) and now we have a more open and welcoming space to work in. We now need to tackle the tidiness of the office with regards to paperwork, to keep the office looking open and ready to work in.

Change idea 3 – Team meetings

The team felt that we were not getting enough time to talk about other issues that were present, and at the last away day, we were not able to allocate enough time for a team meeting. We have implemented monthly team business meetings which give time for management to update on any changes, time to update about QI and time to discuss any difficulties that need to be discussed between the wider team. We have learnt that this is helping to facilitate better communication and open discussion within the team, and we can see this is needed to maintain enjoyment at work.

Kanban – before

Kanban – after

How has the Kanban board been helping communicate with the team?

We are using the Kanban board to visually communicate with the whole team about the progress of the QI project. As we are a community based team, and are in and out of the office all day, we can use the board to keep people up to date. We have also used the board in the meetings to move change ideas between the different columns. We also have a DON’T FORGET column to remind people about rating the app and the newslettersand the number of ratings and % of good ratings on the board for each week, so there is a constant update on the team’s data.

What’s next?

We attended the QI forum meeting in Bedford during January and this has helped us to focus on what we need to do with the project. We are achieving over 90% good day ratings and our original aim was for over 60% by 31st March 2019, so this aim may need to be revisited! We are also going to look at maintaining the gains by auditing some of the processes we have put in place, and we also have plenty more change ideas from the team that we can look at implementing.

*The team is also formed by a CRHT manager, two clinical leads and a senior doctor.

If you want to learn more about this project, visit LifeQI – Project code: 113776