NHS 24

Royal College of Nursing Working with care Initiative

Working with Care' is part of the Engaging People: Enhancing Wellbeing initiative, set up in 2005 to create a positive and supportive culture within NHS 24. Working with Care was developed by RCN who recognised that, on occasion, people working in the care profession could, ironically, act uncaringly towards fellow staff members. A suite of tools helps to create a more caring workplace, and are designed to be used by work teams at every level. The tools comprise an individual assessment tool, a team assessment tool, an agreed team action plan and a follow-up progress form. The aims are:

1. To allow individuals and teams to reflect on their own behaviour
2. To encourage positive behaviour and discourage negative behaviour
3. To recognise and address behaviour that might foster a climate where antisocial behaviour is tolerated
4. To increase acceptance of strategies for retrieving problem situations and produce a supportive culture

Working with Care was introduced to NHS 24 in 2007 by a Full Time Officer of the RCN who sat as a member of the Area Partnership Forum. The initiative has been delivered by gradually rolling out workshops across overlapping teams, with successive teams being encouraged to participate by word of mouth. Also, by publishing the material on the intranet, a tone of openness and honesty has been engendered, reassuring staff there is no ‘hidden agenda’ and allowing them private study and reflection on the content at any time.

A key part of the process is use of NHS24 staff trained as ‘Working with Care’ facilitators by the RCN and the provision of a portfolio of other forms of alternative or additional support. In NHS 24’s case this includes the provision of Confidential Contacts, the Positive People Company Employee Assistance Programme, individual or group coaching and other team or individual development activities.

To utilise the programme, teams identify an opportunity when they can all get together in person at an appropriate venue for a 3 hour workshop. A trained facilitator, external to the team, is allocated and, wherever possible, the venue is external to the normal place of work.

During the workshop, time is given for attendees to read, reflect and complete first an individual and then a team self-assessment tool. After each tool, a facilitated discussion is held to encourage the sharing of experiences. Discussions focus on the existing positive aspects of the team climate, whilst the objectivity of external facilitation ensures that the team does not shy away from facing up to any less positive aspects. Finally, team members are invited to consider and commit to actions that they will collectively take to improve and preserve positive aspects.

The gradual approach has proved to be very effective as nobody feels the initiative has been forced upon them. Even those who were unsure of what to expect generally found the sessions to be positive. The most common theme to emerge is how highly people, at all levels in the organisation, value face to face time with each other. As a result, many teams reassessed their meeting schedules and arrangements to ensure a more balanced mix of frequency, location, and media. In one case, a team agreed on the need to spend more time together at a more social level and have now developed a pattern of weekly lunch meetings. The increased cohesion and improved performance of this team has been observed and noted by others.

This programme undoubtedly stops people in their tracks and prompts them to think about their own behaviour in terms of the 4 fundamental aims set out for Working with Care.