>>Natasha Phillips: We’ve been running the exemplar ward programme for a long time now
at UCLH. The programme’s about measuring and understanding and rewarding when a ward
has nursing excellence. But in order to do that, we need the wards to go on
a collective journey as a team through having decision-making devolved to their local level.
>>Rebecca Mortimer: Shared decision-making really is at the core of the exemplar accreditation
programme. It doesn’t matter what bands or grades or roles you are – anyone can lead on this work
and we’ve seen that through our health care assistants, our housekeepers, our ward clerks,
and our nursing teams that people are leading in lots of different ways to make a difference.
>>Sonia Thomas: The great thing about exemplar ward is that it gets the wards and the nurses
thinking about change and improvement. To make a good change or improvement,
you always have to collaborate and communicate outside your own division. I think it’s giving
the confidence to the nurses to pick their own projects, to then go to stakeholders, to
use process maps, diagrams, learning all these new things that they didn’t have before.
>>Ashley Laurier: I think the benefits for staff is the ownership of their project.
It’s something that they want to improve, that they think needs to be improved and because
they’ve made the decisions, it’s really given them a sense of something they’ve
done themselves, something they can own. >>Jay Jay Empaynado: I was involved in
the exemplar campaign with the “gloves off” campaign project so we tried to save more
gloves. So they asked me to do something about imparting knowledge and imparting this kind of
campaign for safety of the patient and safety for all the staff as well. It’s very important for us
nursing assistants to be involved in this kind of project because we are the front-liners – in
the ward and in the clinical area. >>Rebecca Mortimer: One of the recent
ways in which we’ve really helped embed shared decision-making is the launch of our digital
healthcare records. We have workstations on wheels on the wards and all the nursing staff
have access to an exemplar dashboard where they can see real-time data on every single patient.
So they can see how they’re doing as a team toward their exemplar accreditation standards and
decide as a team what they want to work on. So it’s very powerful, that real-time data.
>>Sonia Thomas: The exemplar programme is great because it gives you real-time data
so how do I use that to improve the standard of care in my ward and how is it easy to access?
So I came up with the idea of a tube map. Each exemplar pillar is named after a different
tube and each measure is a tube stop. So during handover, it’s right there, it’s live, it’s up to
date. We update it every month using separate pins to go underneath the measures. Green being “good”,
white being “great”, and yellow which we always strive for is “exemplar”. So straight away
visually you can see how the ward’s doing. >>Sarah Jordan: So the benefits for patients
being involved in the exemplar ward programme and shared decision is that patient safety is
really the most beneficial thing. Everything we do around harm-free care and improving things
generally on the ward affect patient outcomes and patient satisfaction and also staff satisfaction,
knowing that they’re doing a really good job.
>>David Grewcock: What we’re trying to do in exemplar ward with the quality improvement work is to give more
control and autonomy and agency to frontline staff and to some extent that means letting go a little bit and
trusting staff to understand their local agendas and to work towards them in a systematic way
and that’s what quality improvement really helps with. It gives you confidence and structure to
work to so I think that’s really important. >>Sarah Jordan: The advice I give is to start with
knowing everything, and that might show originally as lots of red markers on the metrics and lots of
things to improve but that’s okay because that’s where your base is. Then picking small things to
focus on with the team per month and making those small changes and then you can celebrate those
victories with your team and once you’ve achieved one measure that might be really good, you can
then focus on something else and help sustain it. >>Sonia Thomas: Highlight certain members of
staff to take the lead. Lots of Band 5s and Band 6 nurses are fantastic at
taking that lead – it doesn’t have to be the ward sister, it doesn’t have to be
management. Our healthcare assistants are very engaged with the quality improvement work we
do on the ward and that’s how it should be. >>Natasha Phillips: I don’t think we’d have
11 accredited wards today if we didn’t have the culture that is shared governance. So the advice I
would give someone who wanted to implement a local accreditation scheme or shared governance – which
I think they should do together – is be rigorous, be patient, and set long term goals and make sure
everyone from board to ward is signed up to the process. So engage, engage, engage.