Yellow hats are not just for builders

As a founding member of the Q Initiative I was privileged to hear about Improvement Labs, and meet people with expertise in this methodology.

It sparked the idea for using this improvement science method to support organisations seeking to develop support systems for staff, in recognition that their caring work is hard emotional labour.

Emotional labour is outlined in this TEDx. Essentially it is the requirement to present a role- appropriate emotion for the job which elicits an appropriate response in another.

For healthcare professionals this can take many forms:- suppressing grief relating to a personal bereavement in order to manage the needs of the dying patient and their family; being kind and compassionate when dealing with tasks from which many would recoil, and being caring when not feeling cared for.

Being compassionate requires the ability to engage with emotions and to respond actively and genuinely to them

Because caring is seen as easy to do if you are attracted to a caring role, the effort it takes to do this consistently is not explored and often invisible.

Hence the title “Yellow hats are not just for builders” - everyone understands that builders need to wear protective hats, but little thought is given to the protection staff might need when engaged in hard emotion work.

Being compassionate requires the ability to engage with emotions and to respond actively and genuinely to them. Although delivering compassionate care for patients is a priority which unites policy makers, patients/carers and practitioners, how to support staff so they can consistently achieve this aim, attracts less prominence.

Our work aims to change this.

We designed this Improvement Lab (which was funded by the West Midlands Patient Safety Collaborative) in partnership with Vicky Green (Bromford Housing Association) and Jocelyn Bailey (USCREATES).

Everyone understands that builders need to wear protective hats, but little thought is given to the protection staff might need when engaged in hard emotion work

We then sent out the flyers and were astounded by the response. The lab had been designed for 10 teams, yet we had over 30 teams of three people apply. This indicates the level of concern in organisations to address this issue.

Our previous research had demonstrated the importance of participating organisations being at a state of readiness, and so drawing on our experience in earlier projects, developed an organisational readiness checklist for teams to complete prior to attending.

This resulted two teams withdrawing, as they were not confident the timing was right for them. A few more were unable to attend on the day, and so we ran the Lab with nine teams.

What is an Improvement Lab?

It is a method to help explore difficult organisational issues and develop potential solutions to be tested using service improvement methodology.

There are many approaches and our design was fairly simple (though challenging to execute). We worked with a graphic artist who captured the main components (Picture 1 below).

The Improvement Lab involved:

• An introduction to emotional labour.
• An “Insight safari” – teams visited seven stations which provided detail of the following interventions:

1. Restorative Supervision
2. Schwartz Rounds
3. Samaritan’s approach to supporting their volunteers
4. Mindfulness
5. Leadership skills in compassionate care
6. Group supervision
7. Creating learning environments for compassionate care

• The teams developed a shortlist and then revisited stands to talk to experts who had used the particular approach.
• Teams selected or developed a bespoke approach and prepared an implementation plan
• Peer review and challenge from the group
• Refining of action plans and one minute pitch.

A poster summarising each of the seven interventions provided information relating to the headings in Box 1.

We also gave teams the opportunity to question people with expertise in each of these interventions, to enable a practical “warts and all” view of the challenges and lessons before choosing which approach they felt would best fit their organisation/team context best.

Evaluation

We asked people to put green/red/amber coins in a container indicating their confidence levels about implementing a support system before and after the event, which we counted.

This showed a decrease (to nil) of red coins and an increase in green- though still many yellows. We also asked them to complete evaluation sheets and a summary of the narrative feedback is captured here:

On completion of the lab all of the teams had developed a clear plan for action to introduce a staff support system in their organisation.

All those involved agreed to be contacted in three months, to update us on progress, and help us refine our techniques for future workshops.

We are looking forward to the results, as this approach has huge potential to deliver ’bottom up’ improvement, which is more likely to be sustainable.

Yvonne Sawbridge is senior fellow of Health Services Management Centre and Dr Alistair Hewison is the research lead for nursing at University of Birmingham