 There you are Claire you should be able to take it away, right? Can you hear me okay? I can hear you Super Okay. Well, thanks for that. That's super red Pardon me one one thing Claire before we get started Somehow I completely forgot to introduce you. So let me do that first That's really important. So people know all about You so I'll just let everybody know who you are So Claire Wood is a practicing clinical midwife in the UK who has worked the majority of her 35 years on a consultant led labor ward Claire became increasingly concerned for healthcare workers welfare in the workplace and commenced as part of her PhD an Insider participatory action research study in 2018 The qualitative study aimed to explore how clinical and non-clinical Colleagues on the labor ward can find paths towards enhancing their individual as well as their collective well-being preliminary findings focus on the factors which healthcare workers report as influencing their well-being and To the impact of the study as related to the methodology Claire was supported in the study by funding from the Royal College of Midwives Ruth Davies Research Bursary 2018 and from Fellowship funding from the Faculty of Health Social Care and Education Kingston University and St. George's University of London UK There you have it. Welcome Claire. Thank you very much red for that Can I just have a query about the slides because I can't see anything to move them on from my end Okay, I have I can see the first slide but not the Okay, let me just double check that you have the presentation You do have the Presentation Claire. Yeah, I've got the present. Well, I've got one in front of me But it's not giving me the arrows. Let me just Okay, no, I haven't got a bear with us for a minute a way of moving them forward Did I just start chatting red? Well, oh, yeah, if you go Hello everybody I Am a straightforward clinical midwife. I have obviously. Oh, thank you red I can see the slides now. I can see the arrows. That's super Okay, perfect. Okay Yeah, I'm a clinical midwife. I'm not in any academic institution. I just was interested in trying to enhance our well-being at work and It's it's actually sort of historic in some ways because it was a few years ago Obviously that I became aware that I felt something needed to be developed to support people But obviously it takes a while to get to study underway So the other thing is although it is about colleague well-being on a labor ward a busy labor ward in a hospital It's ultimately for the women because there's lots of evidence to suggest that if we are feeling good we being Doctors receptionist theater personnel if we if we feel good within ourselves, then that cascades out to our Care of the women and to their experience. So although it is about us. It's it's about The care we provide as well and the quality of that I'd like to just say a little bit about participatory action research actually I Mean, I don't know how how much you all are familiar with it But anyway, if I just say a little bit about it normally say you were doing something about Well-being you might do say 20 interviews of different people see what made them feel good at work and then You would write it up and then hope that the impact would follow from people reading what you find and Participatory research as it suggests is more about Involving everybody who might be affected by by whatever you're doing in that research so that they are Co-participants with you. You're not the the research you're initiating it, but you're you're not You're only supporting it. You're trying to let it happen In tandem with everyone who who might be impacted by it and the inside of it is Obviously that if it's initiated by someone from within the setting It's it's got a slightly different bottom-up aspect to it So it was known as a well-being project just for simplicity As it says there the setting was one East Midlands consultant led labor ward and the aim of the study was to develop a caring Collegial environment in which healthcare workers develop paths to enhancing their individual and collective well-being How did we do it? I'm not going to go into a massive amount of detail because it would be too much But basically we asked people everyone on the ward what made them happy at work And then we put the stories and for everyone to see which I'll show you in a moment So everyone could read their stories and then we use that information to try and Action something about that with using that data before the end of the study Sorry, that's the difference in action research as well that the you don't just take the information and it's finished You actually do something with it as you go along So these are roughly the amount of people who were invited to take place It was over a year and a half. So there were a lot of people going in and out of the environment You can see there's a mix as doctors as theater staff and these statistics healthcare assistants housekeepers domestic Colleagues and reception colleagues because If you're doing something participatory then you want Everything we do all our behaviors impact on the next person that we work with so if a healthcare assistant Is particularly helpful or kind then that makes you feel good And obviously and from the negative point of view as well. So it's it's all about us working together So in terms of the study activity, what did we do? What did we find and How does that affect what we're going to do in the future? So that's what I'm going to go through. I was available in the setting for 900 hours roughly over an 18 month period and I was basically Hanging about Because I felt that healthcare workers didn't have a lot of time to give me long interviews about what made them feel Good at work. So I would sit around and whenever they were free I would talk to them or they would approach me sometimes individually sometimes in groups and If the activity was high on the ward, I provided drinks and cake and all the things that we like and Answered phones did just did jobs to keep the place running and then when it was quieter There was a chance to actually continue with the study So as I said before we displayed the courts widely for all the occupational groups who were involved to see and we Established three action groups. One was a health care action group. One was a theatre action group And one was a coordinator action group and they developed from the data that we got about Areas where where people felt particularly good or felt that they could be some development So this was one of the displays This was the biggest wall display as you can see it's absolutely covered in PPE and this was an ongoing thing It's very difficult to get a Place to actually put information up in most clinical areas but These things that you can see on the wall are all quotes from interviews or from questionnaires Which is the way that the data was collected online questionnaires hard copy questionnaires and just interviews in passing or informal settings And and because not everybody accessed this room. We also had mobile boards This is one of them that this week I often would have a board in the sort of handover room in the hub of the labour ward and would Feedback all the data that was coming through so on this one in the middle It's saying hello to the new colleagues. There were the new group of doctors arriving that week and This was basically to to Share some of the the information that we'd had and some of the accounts that people had given so on the left it was about names because People were saying that what they really liked was when people remembered their names addressed and by the names and it made it much more personal for them Which might seem odd but we've got a very large team So quite often people are in and out sometimes for short periods and it's sometimes quite difficult to Be aware of everyone's name, which is unfortunate on the right hand side We've got particular clinical instances where people felt great with the team work Their well-being was affected by thinking that or witnessing seeing Terrific responses to acute incidents and they were pleased to see that we all work well together And there was a good outcome for the woman that that made a lot of difference to them So what we found about what made health care workers feel good Was thematically analysed We did it. I started about a few months into it maybe a year and There were six other midwives who analyzed the data with me I Did hope that some of the other health professionals would do it as well But there were only midwives who were comfortable doing it and this I'm afraid it's a bit of a fancy thing But it's it's basically has put the data that we got into themes and if we start from The red triangle What people were saying made their well-being Enhanced was on the right hand side there's physical nourishment So there were a lot of comments people saying that if they had something to eat to drink if they'd a bit of a rest That made them feel good at work particularly in 12 hour or overnight shifts Professional nourishment related to Satisfaction of individual motivators which I meant to understand as People felt if they were good in their role if they felt that they offered something That how they wanted to work was fulfilled that that gave them professional nourishment and If using those skills that they'd accrued in their role then made a difference to team working So they maybe was an acute incident Incidents where they went into theater and they could see everybody working well And that they were able to do something purposeful within that team that made them feel good But as you can see the majority of Comments came from Emotional nourishment, that's what really seemed to keep people going at work And I won't be able to go into it all of them because obviously they take too much time but So the sub themes were basically joy in work people enjoyed being at work. They loved their colleagues. It was a lot of that Appreciative communication so that was Positive feedback and gratitude so people Colleagues loved giving Positive feedback to other people and they loved receiving it So it was great if somebody said gosh, you were marvelous today, you know, well done you And also gratitude people saying thank you and sometimes going out of the way to say thank you Following them up maybe on Facebook or something and finding them and saying you made a difference to my day and That was very much appreciated that sort of back and forward of of gratitude and feedback Welcoming behaviors again that what was particularly if people were new Somebody remembered their name said hello to them in the corridor Smiled at them. It made a terrific difference to them and you forget when you're in an environment That you used to how intimidated it can be for new people Positive environment was just basically that feeling that the ward was open to people It would welcome people it didn't recognize and the colleagues caring was was really the biggest theme That people Love to help each other right and they loved to get that support when they needed it and They really appreciated seeing seniors role modeling so they set the tone of the ward and how we work how we behave and They they love to see people helping each other out Belonging was was a thing that I think I'm probably going to develop more These are these are preliminary findings but these bring together the What basically makes people go to work and be happy at work So in terms of making the future better One of the strategies as I said Was starting some action groups and I'll just give you a little bit of detail about one which was is about the healthcare assistant action group and I'll explain why we started this group. So on the left I'm sorry. There's quite a lot on this slide, but on the left Were the elements that affected health care Assistant well-being and things that they wanted to develop So the first one on the left top is it was a desire to expand activities within their role and as Andrea here is saying it's not that we want to do a midwives job It's that we want to help them. We know our responsibilities, but they wanted to do more They felt able to do more and they wanted the role developed the next one down was about Actually, I might just stay on that one. I'll stay on the activities one So on the right side through dialogue between different healthcare assistants and other colleagues that they worked with we did we had a number of meetings in the action group and Eventually their role developed such that they were going in and supporting more births They were going into theater more and they were being involved in more admission activity Which hasn't been the case on our labour ward as a rule and Karen here is saying a few months ago one of the healthcare assistants was down in the dumps now She's doing all sorts. It's helped her frame of mind. So it encouraged that person's enthusiasm And the midwives also responded to the project and were inviting people to share their experiences And also the healthcare assistants took on a lot more patient or women related initiatives and more initiatives to support staff so that they Did things like put new furniture and Fabrics and fridges and things in the Start in the Staff setting room and put more pictures in the women's waiting area just to make the place nicer So in the next one down is competence in theater documentation. They like to go into theater, but as Sarah here says They used to dread it Because they they didn't always they weren't always familiar with the vocabulary and they were expected to document it So we developed together in the group a scribing framework Which basically had all the things that you might want to document at theater like what time certain personnel arrived What time the surgery started what time the baby was born Etc and then all they had to do was was find that On the list and put the name and the time and the date So that was just facilitating and also they then became used to the vocabulary and were more fluent in it the next one down was team working they wanted to do more team working and Just over the period of time of them letting people know what What they were looking for towards their well-being and work Just cascading that information out And made us all a bit more proactive and Becky's saying here the morale of the ward improved improved teamwork people were talking more and helping each other and Pat at the bottom is saying that the gratitude um became more prevalent such that When she did an initiative for soft lighting in the bathroom for the women Um, she she was thankful that and she really appreciated being packed and somebody noticing what she'd done and thinking it was good So that's just a brief summary of what happened in one group um Another group was the theater group as I said and one of the initiatives from that was to have some theater hats That is me. Sorry. I didn't get permission for anyone else's photograph sadly so that's me and my hat and the idea of that was that if you're in a busy theater and um You maybe don't know the colleagues from theater very well because they rotate the midwives rotate into theater and the woman will go into a sea of people and the partner who she's not familiar with so it was just for everybody really to Recognize each other and feel comfortable with with each other so We then had an evaluation Towards the end of the study towards the end of the 18 months and I've got five different points Which are the the main points from 62 interviews and 96 questionnaires over that period of time So one of the main things was the atmosphere of the ward changed It was never a miserable place um, but There was an element of increased positivity people felt more optimistic the morale and the culture Uh was enhanced. This is what what people were reporting. They felt there was a Happy a vibe about the place And also, um colleagues showed increased caring behaviors. They did always look after each other, but Um, there was more an awareness that maybe there would be a newcomer in a room and it would be great to anticipate that they might be struggling before Uh, um coming out to ask for some support and that maybe just knocking on the door, you know, can I do anything useful? Would would would stop them getting anxious So there was a lot of feedback of people showing more caring behaviors and also to Towards the women thinking of of ways that we might improve her experience The other main things that came out of it was there was improved Interdisciplinary team working Karen here said there was more teamwork. Nobody said this is how we want to work now It's just people started talking about what they they'd seen on the displays, you know, the currency of the conversation and um started to act differently And again here people anticipated that they sort of felt that yeah, I get it that the um If we feel better then that is going to have an an impact on the women And we we will behave in a different way And as Catherine here has said it's not considered a fluffy thing to think about someone's well-being It's got a direct impact on people um, and also, um, it was a bit of a byproduct, but It came out strongly in the evaluation and and and also informally all the time people would say Oh, it's great having you here. Just the just my being present people perceived me as free So that they would come along nothing to do with the study just talk about something that was bothering them and, um Really appreciated someone who was available rather than feeling they were maybe interrupting a clinical colleague who Who might be busy? So, um, and they loved getting cake and tea and don't we all so, um They were the sort of main points But as I say, I'm still doing the analysis and putting it all together So just thinking about why some of those outcomes might have occurred Um one on an anonymous questionnaire someone said maybe thinking about how we feel encourages self-reflection and makes us behave differently towards our colleagues Um, you know through the data understanding where people are coming from Seeing that simple things can make a difference that people just gradually started to adopt behaviours and Kate one of the senior midwives um became aware that her uh behavior towards new starters made a big difference to them a lot of new starters said gosh It's great when these senior people say hello to me and how are you doing? And um Kate has recognized that her behavior changed in response to that This was just a slide to sort of summarize what we did the the sort of which could be applied anywhere and it's not new as such it's uh, it's part of action action research but um It's just about what makes us feel good at work was Fundamentally about identifying what made us feel good and then magnifying that so building on it a lot of action research is problem solving and um from the literatures that I um access prior to starting I um Sometimes when the problem solving was identified there would literally be hundreds of problems that colleagues identified within an area and I felt that when people's well-being was already impacted Negatively that maybe underlining all the other things that were wrong. Um, maybe wouldn't Um increase the well-being. So that's why we came at it from a positive psychology point of view and building on what was good so just going round um starting with the yellow Start here and the smiley we identified what made us all feel good included everybody and a lot of comments were from um doctors receptionist all across the board and things like gratitude and feedback consultants appreciated that every bit as much as everyone else and it made us aware that they are they too are human beings and and need to Need that to nurture them just the same as everyone else um So we displayed the stories we kept including everybody We identified colleagues who were enthusiastic to made a difference and started the action groups and then Got together to to work out what we would do we fed back what we were doing and People fed into that and then just kept going kept going kept going and um, it's still going There's lots of different initiatives have come from it This was a model that we saw to develop which took the things that I said earlier about professional and um emotional and Physical nourishment together so we kind of I'm developing this and I think I need a lot more activity between the different groups But basically you've got an individual in the middle who is happy with the work happy with what they contribute to the team But for that to be joyful for that to be purposeful They need an environment which is compassionate towards them So all of the things that we've mentioned earlier about Welcoming people giving them something to eat and drink having a good vibe Um giving feedback and gratitude looking after each other All of those things Um Sorry, I'm just looking at the time all of those things we brought together So we eventually give you a sense of belonging um and willingness to to go into the To the working environment So how did participants get on with participatory research? I'll just give you a minute to read this slide So, um, it seemed to be well received people Didn't find it difficult to access um the study So in conclusion, um this We felt that healthcare worker well-being was fueled by emotional professional physical nourishment But emotional nourishment was was um dominant really And we felt that the increased Awareness of the impact of our behaviors on our colleagues Encourage more positive behaviors. So it's a sort of upward spiral And we use the action groups to Take the data forward and to do positive things with practical outcomes And as another thing was that we were surprised at us to how much Someone being extra in the environment made to to people's feeling about that day So what we can do in the future? Focus on meeting basic human needs in the workplace and that would be any workplace It's all we're all human beings in whatever workplace we're in Um ask the question as to what makes people feel happy at work and do more of it And provide protected time for small groups of people to get together And work out what would be good to Um accelerate or extend in the area And then maybe think about having volunteer rules For colleagues. We've got um volunteer rules for women of patients more widely in the trust But maybe think about somebody just hanging about looking after Um each other really I think um Yeah, that's my last slide and that is um, that's my contact A bit would be delighted if anyone wants to get in touch. So so that's me Are you there red? Nope, she's not well, um I don't know whether anyone's got anything that they would like To say in response or if there's any questions at all Let me just see what's on the comments You're not alone Claire. Oh, hello. Hello, Linda. I don't know. Reds disappeared. Yeah, I see that that's fine. I'll I'll just um Okay, until she gets her her sound back. My voice is a bit like yours because it's so early in the morning for us But anyway, there were a few comments made um More comments and questions really I think read yourself one is about the importance. How important is to have a respectful sense of belonging? Which I think you brought out nicely Oh, I'm back Oh, oh, please Sorry Sorry about that. That's because I was logged into um another room. So it took over my sound But uh, wow Claire. I loved that presentation. Thank you so much for all of the Time and effort that you've put into an area that is so often so overlooked and so so important It really makes me feel like um You've kind of created a new profession and being the carer for the cares On the ward and I like how you added in about um, you know, maybe going forward There is a this is a volunteer position but I would like to say, you know, this could even be a paid position because Though the more kind of I mean the results that you have are just outstanding. So it's obviously such an important thing for all of us Yeah, well, um, it it actually started because I I was a participant in a birth project um about trauma around birth and the invited doolers and women midwives anyone who was involved in in birth Um to talk about their experiences and find out how it impacted on on our well-being And one of the facilitators was a psychologist who said that when when she speaks with with her clients that she has a debrief Which I think someone's written something about but I haven't quite read it yet. Um That you know, when once they've had a session they get debriefed with a supervisor I think every month Just listening to things that have been traumatic to their client and I thought well That's interesting because we're seeing things every day that are obviously joyful, but we're also seeing very um emotionally draining things and We really don't quite get that depth of support for each other. You're expected to just Take a deep breath and and get into the next situation really so I felt I really wanted to acknowledge us as as human beings Yeah, this and that goes right along with what Andrea was commenting. She said It would be great if we could always have someone available Who we could debrief with after an incident. Yeah, yeah Yeah, no absolutely right. I mean it's done informally and sometimes formally but and also what's What's draining or or emotional to one person isn't the next so it's feeling that you've got somebody who won't say well You know, that's an everyday thing. You'll get used to that um You know the sort of apprehensiveness about newcomers just being able to support them would be good Yeah, and it's so true in our work as midwives. I mean our ability to be able to debrief And release our own trauma so that we can walk into the next room as a as a queen's let And not carry our fear in with us that it dramatically affects Our results with women for sure. I see that in my own practice all the time, right So um coming to the questions um There was a few comments during your Um presentation. There was a lot of there was some people were excited about your Theater hats that was such a brilliant idea that really makes it so easy for To feel that sort of teamwork and I can imagine it also for the women who are coming in Absolutely, it was so nice to be oh, there's claire. She's a midwife. They're so and so I would love to see this rolled out. It's brilliant. Yeah Well, that was actually self-funded in the end. Um and there were um over 50 people paid paid for their own and um It's such a shame because covid came along and then obviously we couldn't have the cloth hat Uh, but but that'll be reintroduced But yeah, I know and also from from a point of view safety because it's hard to quickly get the anesthetists Eye or or ear if you don't actually know, yes, which one is the anesthetist? Yeah, that's right So just doing a time check as well for us. We have six minutes. So keep the questions coming for claire Um, Liz was commenting cannot overemphasize the importance of respectful sense of belonging Um Linda I loved my working day both as a midwife and as an educator and missed all of those colleagues But the labor ward can be a terrible place for greeting moaning So I agree that taking a positive slant is far more likely to encourage positive thoughts than looking at the negatives right Yeah, yeah Sorry, I've just seen jesse here is jesse. Hello. Sorry I'm sorry if I didn't make that clear. Yes. I am an insider Person I've worked on that unit For most of my work in life really so I was very familiar to people um, and I think that's probably one of the um Influencers of it that um, I was not coming in from outside And and was a strange person and needed a while to get into it into the situation for people to trust what I was doing um People took a little while to cotton on to exactly what it is you're doing, but um beyond that I I was not perceived as a threat. I I wasn't building my career around it. It was not about um, the research primarily it was primarily about making a difference in the Setting and then hopefully making differences in other settings, but it it was um It I think it was quite a strong part of it that I was very familiar with with how the place worked and therefore could adjust um on a day-to-day basis The sort of attitudes and what was happening and when I should Should just stay quiet and when that could be more more Um Well, you know, I don't know what say make my presence felt more Yeah, it's wonderful that you had that really in-house approach it really shows in the quality also of the research that you were able to to do with having that relationship of trust on the ground So uh jesse then says really interesting We talk so much about how difficult it can be to influence Workplace culture and this methodology clearly works