How might we improve ward culture

Related: - [[20210809 Work Culture]] - [[Article - Delve Deeper into changing organisational culture and mindset]] # How might we create ward cultures that are humane, recovery-oriented, yet safer for patients and staff? [[24-10-2023]] Creating humane, recovery-oriented, and safer hospital ward cultures is a challenging task that requires us to adopt a systems thinking perspective. This approach enables us to understand how different factors such as policies, procedures, staff training, patient engagement, and environmental factors are interconnected and contribute to the ward culture. By examining the hospital ward as a complex system, we can identify the root causes of problems and develop comprehensive solutions that address these causes, instead of just treating the symptoms. A systems thinking perspective promotes a culture of empathy instead of blame. When negative incidents occur, it's easy to point fingers and assign blame to individuals. However, this approach fails to recognize that individuals often act within the constraints and limitations of the system in which they work. Instead of blaming individuals, we should focus on understanding why the incident occurred from a systemic perspective and identify ways to prevent similar incidents in the future. This approach encourages open and honest communication, promotes continuous learning, and fosters a supportive environment where staff feel empowered to provide the best possible care to patients. By increasing empathy and moving away from a blame-centric perspective, we can create more positive, humane, and safety-oriented ward cultures that benefit both patients and staff. To create a ward culture that prevents negative outcomes like those seen in the Stanley Milgram and the Stanford prison experiments, we need to actively foster empathy, communication, and accountability among healthcare professionals. At the individual level, staff should receive necessary training and support to develop empathy, compassion, and patient-centered care skills. At the team level, it's essential to foster a sense of community and collaboration among staff members. Encourage open communication and regular feedback within the team. At the organizational level, clear policies and guidelines should be implemented to define expectations for behavior and patient care. Establish accountability mechanisms to address any negative behaviors or practices. **Formulations** 1. Plan: Perhaps an MDT Team made up of stakeholders (patients, caregivers, clinicians) can go through design thinking, to investigate this in a systematic holistic manner. Using that report as support for system changes. | | | |---|---| |Predisposing Factors|| |Precipitating Factors|| |Perpetuating Factors|1. Lack of understanding about MDT. 1. We need to understand fully the perspectives of different staff - the challenges faced by staff 2. Under-staffing? 3. Ward culture, psychological milieu 4. We have unwell patients. 5. We are limited by the facility's physical design. (Environmental psychology) 6. Factors related to resistance to change| |Protective Factors|1. There is strong desire and support from management to do something 2. I believe staff have good heart!| | | |---| |_Physical restraints may sometimes be required to prevent harm to the patient or others. However, it is essential to use restraints appropriately and ethically, and follow specific processes before and after their use to ensure their effectiveness._ _Debriefing is an integral part of this process. After the patient is stable and no longer restrained, a debriefing session should be conducted in a calm and supportive environment. This session should explain the reasons for the intervention, what happened while the patient was restrained, and address any concerns or feelings they may have. The aim is to help the patient grasp the situation and process the experience in a non-judgmental manner._ _Apart from debriefing the patient, it is also important to evaluate the incident as a team. The evaluation must determine if the use of restraints was appropriate, if there were any alternatives, and how the situation could be handled differently in the future. This reflection and learning are crucial aspects of continuously improving the care provided and reducing the need for restraints in the future._ _Moreover, regular training and education for staff on alternatives to restraints, de-escalation techniques, and the ethical use of restraints can further help to ensure that restraints are used appropriately and as a last resort._|