Insights into improvement #7: Improvement Science and Nursing

December 8, 2015

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How improvement science can support senior nurses in everyday leadership and management

Co-founder of wdid Liz Ward is a nurse of 24 years experience. She offers her insight into the benefits improvement science, such as Lean, can give nurses in leadership and management positions.

Through my experience of leading national improvement programmes, and through many assignments with wdid clients, I have seen many nurses progress from being good leaders to being amazing leaders – through their use of improvement science. The nurses in question (and I would have been the same in my nursing days) often don’t realise that by applying these new techniques they are not only improving processes, but they are also developing as a leader. This can be seen as implicit development of leadership competencies, through practical improvement.

What is improvement science?

Improvement science is a term used to describe systematic methods and tools proven to help teams, organisations and systems improve. They are a group of methods used by some of the world’s most successful organisations. Included are methods from sources such as industrial engineering, product design, Lean thinking, Six Sigma, continuous improvement and clinical microsystems to name just a few. The key elements are structured problem solving cycles (such as PDSA – Plan, Do, Study, Act), understanding of variation, strong measurement, strong engagement and flow.

The traditional view of improvement science

Improvement science and methods are often seen to be useful to people undertaking projects or in improvement departments. They are seen as something those ‘people over there’ do or keep rattling on about. At best they are seen as a specialist field, at worst they are seen unnecessary. They are very rarely seen as an important part of a senior nurse’s management competencies.

So how does improvement science support leadership development?

Nurses tell us that the transition from being a clinical leader into a management role is very difficult; and one that they often feel under prepared for. Most talk of how they have received training, support from their organisation and lots of guidance on what they should achieve. They also describe how they are often very clear of the standards they want their team or department to achieve.

What we see is a particular dominant skill set and attitudes emerging from nursing – one that is not always helpful long term. It is that of the ‘fixer and doer’ or the classic firefighter. A skillset that, while undoubtedly useful, does not help an aspiring nurse leader move their team to a place of more stable, consistent, planned and high quality care.

I can see a lot of the ‘fixer and doer’ in myself when I think back to my ward management days. I thought I was doing the right thing as, after all, I was copying the behaviours of those more senior than me. But on reflection I was actually just fixing the same problems over and over again, not supporting the development of others – and wearing myself out in the process. Most of the time I was actually just fixing the same problems over and over again, not supporting the development of others; and wearing myself out in the process.

So how do we develop and support these dedicated nurses to break this fire-fighting cycle? Can we give nurses a set of complementary leadership competencies that help move teams on and get to the root causes of problems? In using the term leadership competencies we mean much more than the classic competencies such as communication and negotiation skills. We mean leadership competencies from the field of Lean and improvement science. Competencies such as flow, root cause problem solving cycles, practical use of data and measurement, promoting innovation, co-production, reducing variation and de-personalising change to name just a few. These skills provide a process for a new nurse leader to engage with their team, to listen to their patients and, most importantly, to make sustainable change.

The answer to break the firefighting cycle is with improvement science. Our insight is simple but effective. It is all about the HOW not the WHAT. Something we believe often gets lost in the common NHS culture of ‘JFDI*’. We need to equip aspiring nurse leaders with the skills and competencies on HOW to get change done. We need to help them with proven method to engage their teams and de-personalise change. We need to stop just telling nurses WHAT should be done.

The interesting thing is that Nurses have a set of skills that give them a huge advantage when looking at using improvement science every day nurses use a structured problem solving approach with their patients. They are constantly assessing, diagnosing, planning, treating and evaluating patients. They plot control charts in the form of patient observation charts and they are taught to view patients holistically. These are all core skills in improvement science. The difference is they are applied to processes rather than patients.

In summary

These great nurse leaders need to be given the confidence to develop the  team to take collective professional responsibility – not to try and do everything themselves. We need to support nurses to stop fire fighting and get away from the ‘JFDI’ culture so that changes and improvements are effective and sustained and so that nurses don’t feel like they are continually addressing the same issues and eventually get disillusioned. This can be done though the meaningful introduction of improvement science into nursing. Moving it from being seen as a niche skill to being a valued nursing competence.

I hope you found this useful.

*JFDI  – ‘Just F****** Do It’