18 December 2018

Testing ideas to increase satisfaction: the journey of the Community Children’s Nursing team

Find out what the Enjoying Work team at the Community Children’s Nursing Service (CCNS) has done so far to increase staff satisfaction and engagement. Words by Rebecca Daniels, Community Children’s Matron.

We started the enjoying work project because we wanted to improve our days at work, to improve morale and increase communication across the team. Communication was a key area for improvement identified within last years’ team away day – but we had not had chance to implement any specific actions following this. The project provided the perfect opportunity to work together as a team to make a positive difference.

Examples of the team’s Active Challenge

All of Community Children’s Nursing service was invited to take part in the project. The team is multidisciplinary with nurses, psychologist, administrative professionals, healthcare support workers, dietitians and play specialists. Everyone was encouraged to download the Improve Well App to record the good day measure however this proved to be challenging as community workers were on different shift patterns including office based, home visits, 10-hour night and day shifts on continuing care packages. We have a core project team who facilitated the appreciative inquiry and manage the data, change ideas and feedback to the wider team on a weekly basis during team meetings. The core team comprises of 3 CCNS staff (2 nurses and 1 admin) that are supported by the QI coach fortnightly.

Testing ideas

Our initial change idea was a monthly active challenge which was initially social media based. This worked well in engaging a small amount of staff (approx. 6 staff) with activity during August 2018 where staff took photos and we tweeted to gain virtual medals. We successfully gained gold medals before the end of the month and finished off the challenge in a team game of rounder’s which was really positive for team building and communication. We still struggled to engage all staff with the “good day” measure on the ImproveWell App, which did impact on our baseline data. In September 2018 the team undertook a monthly squat challenge which had less engagement with the team overall. In October, the team focused on Black History month, staff wore cultural clothing on a daily basis and took group team photos which were shared on Twitter.

#60kYourway challenge

This was really engaging with the whole team and resulted in a fantastic celebratory bring and share lunch in which every single member of CCNS participated. In November the team completed a #60kYourway challenge with a visual mountain and air balloons for staff to move their balloon up the mountain as they complete their activity (there are photos if you would like them). This has been the most successful physical challenge as we have managed to engage 12 staff within the month.

Our second change idea was testing CCNS Tuck shop. This generated from the idea that staff wanted a vending machine as the nearest shop to the office is a 20-minute walk. Initially snacks were purchased and cold cans put in the fridge with a price list that reflected cost-price. This was well received and the first PDSA cycle saw us increase the prices and change stock to items staff requested to have within the tuck shop. The Tuck Shop has now become more of a functional shop which sells soup and porridge for those who have not had chance to purchase lunch as well as the usual non-perishable snacks and cold drinks which have proved to be really successful. The price increase has enabled stock to be replenished and profit has been seen after a month of testing. The verbal feedback from staff has identified the tuck shop as wonderful, convenient and sociable, engaging all members of the team. The next stage will be evaluating staff satisfaction and choices through the use of a survey.

Daily management within the team has also been changed with giving band 6 staff more responsibility, changing on take from weekly to daily to manage work load better which has been really positive.

Overcoming challenges

Good Day Measure

Engagement with staff reporting their good day measure has been our biggest challenge. We have removed staff from the App who work different shift patterns (HCSW on continuing care packages) to the office community staff as they were not reporting their measures or engaging within the change ideas. This was partly due to their different work environment as a lot of the project was focused on the office environment and was not impacting on their work directly. We commenced a visual Good Day Measure tool in the office through the use of green and red tokens (we have photos if you would like them). This has helped with staff being able to record their day as it happens and has seen a small increase in staff reporting. Staff have identified they find it satisfying to put in their token, especially if they are having a bad day!

We also identified mid-way through the project that only the core project team were aware of the finer details of the QI project and recognised there was a need to improve communication regards how the project was progressing. This led to the development of our “You Said, We did” board which has helped to share with the wider CCNS team where the project currently is and provides staff the opportunity to share their ideas about next stages.

The overall project is starting to engage more staff with the team as we continue to introduce more change ideas. Staff are identifying new ideas they want to test including monthly creative therapeutic session, mindfulness sessions and developing a celebratory work anniversary board. Staff are feeling more valued because of the time invested into them and having time in our work day to enjoy wellbeing events.

Our next step will be to work on the larger test ideas which are more complex. The main idea is to analyse the current way of caseload allocation and management of visits to reduce travel time and promote more efficient working patterns. We will continue to work with staff about the best way to register their Good Day Measure and how this can work for them.


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