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Empowering your ward

A new qualification was just one way that a foundation trust used to raise the profile and aspirations of its ward managers, as Tricia Kenny and Amanda Eagle explain.

In the current NHS landscape the ward manager role is one that has experienced dramatic change. In addition to a clinical role, they are also required to undertake a range of managerial tasks. In this changing environment, Blackpool Teaching Hospitals Foundation Trust wanted to empower its ward managers, enabling them to step up and develop as leaders.

By supporting and developing their ward managers to respond to the new challenges and needs of their job, it was anticipated that their knowledge and skills would increase, which in turn would impact on patient experience, patient safety and patient quality. Blackpool also wanted to raise the profile of the role and make the job something early career nurses might aspire to.

To make this happen, a dialogue began with Lancaster University’s Faculty of Health and Medicine. The faculty is new and dynamic, with a specialist centre for work-based learning (CETAD) and it was this team that formed a collaborative partnership with the trust.

The trust was keen to develop a robust, accredited learning programme for its ward managers. It was not looking for something off the shelf but a more flexible and innovative solution. 

The collaborative partnership involved the director of nursing, her team, and senior members of the trust’s HR and organisational development team, together with CETAD staff. The partnership culminated in an agreement that the trust’s needs could be met by contextualising the university’s postgraduate certificate in organisational change (healthcare) and dovetailing in specialist clinical inputs from the trust, along with sessions on finance and HR.

It was anticipated that the programme would contribute to the Blackpool Way, which is the trust’s engagement strategy focusing on themes of management style, communication and recognition. The programme was developed around core national clinical leadership competencies, key organisational values and participant self review via a repeated 360-degree skills questionnaire.

Forty ward managers - two groups of 20 - enrolled on the part-time programme. While this was a postgraduate programme, a first degree was not a prerequisite because as a work-based learning centre, CETAD recognises prior learning gained from experience. The CETAD team are experienced practitioners in supporting mature learners, many of whom have often not studied for some time. 

The flexible approach enabled the programme to be delivered in Blackpool via interactive workshops facilitated predominantly by university tutors, with key sessions delivered by trust staff on subjects such as finance, budgets and HR. 

Innovative workplace assessment methods were introduced and included:

  • a group task to analyse the drivers for change impacting on ward managers;
  • the completion of a personal development plan linked to change, the trust’s competence framework and 360 feedback;
  • the production of a change management project proposal;
  • a reflective diary on the ward managers’ experience of leading others through change;
  • the design of an evaluation for achievement of change in a work context;
  • a final group presentation to design and conduct their own evaluation of learning from the programme, including an evaluation of their experience of working in action learning sets.

Upon completion of the programme, an independent evaluation of the learning was undertaken, with the following four themes emerging:

Understanding change

Ward managers have much more awareness of NHS strategy, as well as a wider understanding of change drivers and of the changing landscape in which they operate. They can manage change, they have a more strategic approach and can look beyond their individual ward.

This is clearly evident in the day to day implementation of their role and they can now articulate drivers for change to their staff so they too have greater understanding of the bigger picture and the changes affecting the NHS in Blackpool. The ward managers have more financial awareness, more understanding of budgets and their greater insight to finance enables them to understand how it affects their post. 

Increasing efficiency

As part of their programme the 40 ward managers were tasked with submitting a change management proposal designed to do one or more of the following: increase efficiency, save time, reduce waste, and meet targets. Proposals included:

  • a more robust discharge system enabling it to happen earlier, therefore increasing efficiency, saving time and meeting targets;
  • reduction of waste via a nutrition mission;
  • a timer introduced into a ward dealing with blood and blood products to ensure that the products are used within the 30 minute window;
  • an extension of outpatient service for dermatology patients, enabling them to manage their care at home - thus reducing admissions as inpatients to have their conditions managed;
  • changes in systems to ensure oxygen therapy is administered and recorded correctly to increase efficiency and improve patient care;
  • changes in patient meals, saving time and resulting in patients getting their meals quicker so they are still hot and more appealing and there is less waste;
  • an hourly falls monitor chart to reduce patient falls and to be proactive in the trust meeting its reduction targets.

These proposals are a small sample of those submitted and clearly have the potential to improve efficiency and empower those who can implement their proposals in their areas. The ward managers have good ideas about how to make improvements and efficiencies in their areas and the programme has given the confidence and offered the platform for them to take these forward.

The value and power of the new working relationships and networks that have been formed as a result of the programme cannot be underestimated. Without exception, everyone made reference to the positive impact of supportive peer networks; introducing action learning sets enabled the sharing of good practice, offered the opportunity for discussion and afforded shared understanding of challenges facing others in the same role in different areas of the trust. Ward managers have made links across the trust and now work collaboratively to improve patient care.

Reflective practice

Ward managers are now reflecting on what went well and what did not, enabling them to be more productive in their role. They are aware if mistakes have been made and so reflect to make positive changes. It is also recognised that they are giving priority to reflecting on their role and analysing what they have done. Using reflection in this way is giving them the opportunity to identify areas in which they have performed well, but also to identify where improvements can be made.

The action learning sets facilitated by the trust have enabled ward managers to work together and supported them in finding solutions to problems. The trust is continuing to support these powerful networks and in the fullness of time it is anticipated that they become self-facilitating.

The success of the programme and the lessons learnt in developing it have ensured that the programme will be transferable - the model can be adapted and offered more widely to other trusts.

In completing this programme, participants have achieved a postgraduate certificate so a further benefit of this programme is a group of staff with the capabilities to progress academically - to the final year of a masters degree - and within their organisation.

This is already coming to fruition with one of the participating ward managers being recently promoted to a matron’s post and eight others about to top up their postgraduate certificate to a work-based masters degree. l

Tricia Kenny is marketing and communications manager, CETAD, Faculty of Health & Medicine, Lancaster University. Amanda Eagle is the organisational development manager, Blackpool Teaching Hospitals Foundation Trust.

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Readers' comments (2)

  • Well done team. I love your enthusiasm for change. I'm less comfortable than I was twenty years ago with 'empower' as a useful term, but no matter, you're changing behaviours. I do worry, though, that 'Right First Time', 'Zero Harm' and other safety concepts are absent (forgive me if I've missed it). I believe every frontliner in the NHS should have Jim Reason's 'organisational accident' model and 'clinical human factors' in their hearts as well as their minds. Deterioration prevention should be a key objective. Cure the NHS, Stafford

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  • Good to hear of positive initiatives even in challenging times. NHS Employers has developed some resources which may be useful to organisations seeking to support line managers in respect of staff engagement. We are also keen to hear from organisations with learning they can share. For more information please contact steven.weeks@nhsemployers.org

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