Welcome Cultivating Compassion Main title slide page Co-brand logo here Welcome Cultivating Compassion Vicky Romback & Dr Lindsay Aikman

What a Difference a Year Makes… ‘People First’ 3000 Improvers QI project work in teams ‘15s 30m’ ‘Kata’ Continuous Improvement Team behaviours

Who are we? The Glenbourne Unit Acute Mental Health Unit in Plymouth One male and one female ward 19 beds each Place of Safety Suite Proactive in embracing QI ethos and methodology for some time

Welcome Why Cultivating Compassion? Main title for slide set Optional sub title or name “a healthcare organisation’s culture is a critical factor in the development of its patient safety climate and in the successful implementation of quality improvement initiatives.” Organisational culture: variation across hospitals and connection to patient safety climate (Speroff et al. 2010: 592)

Welcome A Framework for Safe, Reliable, and Effective Care Main title for slide set Optional sub title or name A Framework for Safe, Reliable, and Effective Care IHI White Paper

“We did nothing ‘wrong’” Learning from deaths Welcome “We did nothing ‘wrong’” “Allow us to grieve”

Supporting people we care for AIM PRIMARY DRIVERS To increase the overall outcome measures by 50% (aggregate) by April 2019 Self-compassion Supporting the team Supporting people we care for Systems and Processes Self-care / self-awareness Building resilience / role modelling / giving permission Tuning in to distress / responding to distress Embedding / training / communication

Supporting people we care for AIM PRIMARY DRIVERS To increase the overall outcome measures by 50% (aggregate) by April 2019 Self-compassion Supporting the team Supporting people we care for Systems and Processes Self-care / self-awareness Building resilience / role modelling / giving permission Tuning in to distress / responding to distress Embedding / training / communication

Measurement Baseline measures Data collection on change ideas Compassion focused measures Compassion for others (Pommier) Self-compassion (Neff) Professional quality of life Warwick-Edinburgh wellbeing scale The Future Scale (Snyder et al.) Data collection on change ideas Mindfulness for staff Incident huddles The SCORE survey

Who was involved in the project? Welcome Main title for slide set Optional sub title or name All staff invited to complete measures (130 pax) 43% response rate compassion measures 76% response rate SCORE survey Monthly working party – rotating membership Minutes shared back to team via brief video On going work in smaller pockets of people (connects to multiple other projects)

PDSA Testing ramps: Incident huddle DATA FEEDBACK TO FRONTLINE STAFF Cycle 1E: Sharing feedback more widely Practice supervision Cycle 1D: Planning attendance in advance Cycle 1C: Input from various staff roles Cycle 1B: Preparation Cycle 1A: Logistics: Suitability for ward & facilitator availability

Example… Wider system Issue Actions Smoking in garden Planned garden sweep for buried lighters Co-ordinate between wards Patient who swallows solid items as a coping mechanism - only in hospital environment Formulation session to help staff feel less stuck Liaise with recovery unit re high likelihood of swallowing behaviour continuing there Other re-ablement options making a return to the community possible? Person-specific

Qualitative feedback on the incident huddle Feels like you’re problem solving as a team It empowers us more to feel like we’re making a difference Good to chew it over and realise that we’ve done everything we can Qualitative feedback on the incident huddle I’m more mindful of what’s happening on the other ward and them us Whatever we’ve implemented has helped us better manage future similar incidents

PDSA Testing ramps: Staff mindfulness DATA FEEDBACK TO FRONTLINE STAFF Cycle1E: Staff being more comfortable to use on wards for selves and patients Cycle 1D: Make own videos to meet unit’s needs Cycle 1C: Planning ahead for most helpful videos Cycle 1B: Getting a bespoke tablet and speaker, build in to work day Cycle 1A: Informing staff about apps

Qualitative feedback on using mindfulness in the workplace When everything is spiralling, it helps to ground you. Job role can include lots of heavy emotive topics and can be draining, so can be important to have some space from that. A nice cleanse. Qualitative feedback on using mindfulness in the workplace If it’s too prescriptive it doesn’t work. Work isn’t the right place to do it, it makes me feel emotional and tearful and I try not to open that side of myself whilst at work. When your head is full and you have just received a lot of information it can be nice to just stop.

Wheel of Awareness, Siegel 2018

Challenges & Barriers Acute clinical environment Change ‘below the water level’ is slow Staff struggling to prioritise themselves Shifts and rotas

Discovered the power/flexibility of video Unintended consequences Welcome Main title for slide set Optional sub title or name The compassion-measures are an intervention in and of themselves Discovered the power/flexibility of video Enforced mindfulness!!

Simultaneously going fast and going slow Learning Simultaneously going fast and going slow

Welcome What next? Extend the project Keep up the good work! Main title for slide set Optional sub title or name