At the start of the project the author identified three SMART objectives that would provide evidence of achieving the overall aim of promoting reflective practice within frontline staff. The outcome of these objectives was discussed in the previous chapter and this chapter provides an opportunity to review the process of evaluation and what the author’s perceptions of the impact of this project.
63
Once the author was able to identify a named key person to support the coordination of groups for each unit there was a clear impact in the likelihood of the group taking place. In addition, the author took responsibility for ensuring that the service was contacted the day before and the day that a group was planned, this provided an opportunity to liaise with the managers of the unit to discuss potential barriers for that group and what can be done to minimise them, for example on one day a number of staff were in mandatory training and out with residents on goal related trips/activities making it difficult to use staff from other units to free staff to attend the group during the shift. On this occasion, with discussion with members from the off-unit clinical team the author with the manager was able to redeploy the off-unit team members to cover the unit for the groups. This action was commented on within the group and created an immediate sense of value, both for the group and the efforts that the manager was making to ensure staff could attend.
Whilst these elements were not explicitly stated as an objective within the project, due to the number of difficulties in assessing the sense of being valued, it is clear to the author that the groups are creating a structure that provides a supportive forum for the frontline staff. However, the fact that these objectives were not included within the project does present a weakness. The author identified that there is a need for a tangible outcome from the groups to help show that they are beneficial and if there was information to evaluate the sense of support/value that was perceived by those attending the group this could be used to create tangible and visible data for the frontline staff, senior managers and the board. At the start of the
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project the author was aware of possible change fatigue within the service and a sense of burden from the perceived recent increase in demands due to impending inspections, therefore whilst a staff survey might have added value to the project it may have come at a cost and given that survey response rates tend to be under 50% the author tried to access feedback at the end of each group. A
recommendation is to ask explicit questions about the reflective groups within the next annual staff survey and that these questions become an integral part of the staff survey, highlighting that change in one area of service provision/delivery will
influence changes in areas that might initially appear unconnected and a leader must have the ability to adapt as these links become apparent.
Another area where the project could be strengthened is exploring the impact for the residents in the service. At the start of thinking about the project, the author
identified in the literature the role that staff influence the quality of social interactions and other elements associated with quality of life for residents (Hatton et al., 1999; Hatton, Emerson, et al., 1999; Robertson et al., 2005) and therefore, if staff are more engaged and active within their role it is understandable to expect that this will have a positive impact for the residents. Given that this is a novel project in the Irish context, a service providing dedicated working time from a Clinical Psychologist to promote reflective practice in frontline staff, it was considered by the author
inappropriate at this stage to explore the impact for residents, but would be worthwhile identifying a means to evaluate from the residents perspective in the future.
65 5.4 Recommendations
A number of recommendations have been generated through the process of reviewing the project:
1. In the role of leading the change there is a need to check and review analysis that are completed, in particular when there is notable change in
support/resistance.
This checking is often done informally but a formal process may allow the leader to identify if there are patterns of influence and to better equip them to not only respond to the fluctuations but also to potentially predict them.
2. Identify a means of extending the objectives to include a measure of the sense of support/value/benefit for the frontline staff from the groups
It was apparent that staff at all grades found the lack of an immediate tangible outcome difficult in terms of being able to continue their support for the groups, as reflected by statements from staff within the group. Whilst the author has identified why a measure of value was not used within this project, to help with mainstreaming it must be considered. One option available is to find a way to integrate feedback into the annual staff survey and the author will need to liaise with the HR Director to assess viability of this option.
66 3. Feedback on the impact for residents
As highlighted above the author started this project thinking about the impact of staff interaction on quality of life for residents, however, this is and will be a difficult area to assess directly. However, it is recommended that time is spent considering how to include feedback from residents within any future developments of this project.
4. Training is developed for Nurse Managers/Team Leaders to become actively involved in facilitating their unit reflective group
The Author raises the question of succession planning, an important element for any leader to think about within any project. Initially, this was considered to have been addressed through the change in contractual arrangements with explicit reference to staff support and the assumption that these terms and conditions would continue if the author were to leave. On reviewing the process and reflecting on the challenges, one big area was that sometimes having a set date and time for the group is not practical for the and the services they are providing. If the Nurse Manager/Team Leader was equipped and confident to facilitate the groups then it could become more flexible, in that a day may be identified and that the group then takes place at a time that day guided by the demands of the service. Those that are facilitating the groups could be supported through a reflective session with a member of the Clinical Psychology Department.
5. Expand the reflective groups to create a space for senior staff
The Author has already been approached by other Nurse Managers requesting that they are provided with their own forum for facilitated reflective practice given that they may face different challenges to the frontline staff and she believes that this will
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be of benefit to the frontline staff, the service and the residents. If these groups are created it will help to address the resistance created through not knowing what is happening. Given the time commitments associated with the current structure of the reflective groups there is a need for the author to share some of the responsibility and this will be supported through developing skills in others to facilitate the unit groups, freeing time to facilitate a senior group and a group for those facilitating the unit groups.
5.5 Conclusion
The process of introducing reflective groups for frontline staff created a number of challenges for the author, made easier by their personal interest in staff support. In order to implement the project the author made use of both their formal leadership position as well as the network of identified informal leaders with the service. The experience highlights preparations are very much the foundation of the project and must not be underestimated, nor should the value of continued and relentless
communication with stakeholders throughout the duration of the project and ensuring that there is communication on the outcome. As part of this process the author hopes to present information about this project to all the staff in the service where the groups were established and to the senior management team and the company board.
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