Can a learning health system approach improve workplace wellbeing?

UCLPartners have been supporting Chase Farm Hospital to embed a learning health system approach, along with the Bedside Learning Coordinator Role, as a mechanism to build a culture of continuous improvement, which inspires, informs, and involves staff. Their approach involves making improvement easy and accessible by embedding improvement into daily work, proactively capturing insights on how to improve patient care, efficiency, and staff wellbeing, as well as visibly sharing learning and celebrating success. This has included interventions such as biweekly Learning Forums for staff across the hospital to share learning and problem-solve together; and two Learning Co-ordinators whose role it is to be the ‘eyes and ears’ of the hospital, facilitating improvements.

In this blog Dr Mike Nicholls – Emergency Physician at Auckland City Hospital, New Zealand, and PhD candidate – offers reflections on these approaches following a recent visit to Chase Farm. His PhD research focuses on improving staff wellbeing with quality improvement in Emergency Departments.

As I was leaving Chase Farm Hospital (CFH), London, after a recent visit hosted by Nima Roy (Improvement Advisor), she asked for some feedback about what I’d seen. I struggled to provide anything more constructive than “keep doing what you are doing”. This is despite recently e-listening to “Thanks for The Feedback”, which posits that the purpose of feedback is threefold: acknowledgement of work done; rating of how things are going; and suggestions for improvement.

I visited CFH as part of preparation for research related to workplace wellbeing and quality improvement in emergency departments in New Zealand. From the USA (Surgeon General Advisory Sounds Alarm on Health Worker Burnout) to the UK (Supporting nurses and midwives to deliver high-quality care), and from Emergency Departments (EDs) to entire healthcare systems, the wellbeing of healthcare workers is acknowledged as critical for the workers themselves, the retention of staff and provision of high-quality healthcare.

Staff burnout in EDs in New Zealand (NZEDs) is high. We have a problem with staff wellbeing, retention and, by extension, the ability to provide the best care possible.

What can be done?

Assuming healthcare workers are committed, compassionate, highly skilled and knowledgeable staff who come to work to do the best job possible, we theorise that if staff can work to their capacity in a context and culture that facilitates such high-quality work, this may nurture wellbeing.

While frontline staff understand that some things are largely outside their control (e.g., overall health budgets), there are parts of their work that they can, or should be able to, influence. When problems that affect delivery of healthcare are identified by staff, patients, or patient representatives, there is an opportunity to improve. A responsive learning system is required.

An ideal learning system ensures that:

• staff and consumers are heard – problems encountered at the frontline are acknowledged; in partnership with stakeholders problems are examined  by those with healthcare quality expertise, in a system that meaningfully supports quality improvement (QI) in complex systems.
• stakeholders are informed, empowered, and involved in solutions development
• a positive psychological approach is taken by deliberately acknowledging this work as challenging, meaningful, and rewarding.

Addressing three factors highlighted by staff– improving the culture of our departments, providing professional development opportunities, and improving the ability to provision HQH- may synergistically improve healthcare and staff wellbeing in a virtuous cycle.

Health Quality and Safety Commission (HQSC) of New Zealand states that:

“All health care workers need to engage in quality and safety improvement efforts appropriate to their role and their sphere of work. Simple quality and safety tools should therefore be part of everyone’s skill set in health care.”

Is this the NZED reality? Would greater QI capability using evidence-informed systems improve care provision and, by extension, staff wellbeing? Our research aims to answer these questions.

Such a learning system is an example of a Positive Participatory Organisational Intervention (PPOI). PPOIs work at all levels of a system: Individual, Group, Leadership, Organisation (and Outside). Nima and her colleagues at CFH, with assistance from Emma Mordaunt and the team at UCLPartners, have been using the Bedside Learning Coordinator (BLC) role to help capture insights across their hospital, forming a key part of their learning health system. The role was originally developed at the NHS Nightingale Hospital in London during the first wave of the COVID-19 pandemic, when rapid improvements in complex systems required such considered approaches. We modelled our research proposal on their work.

So, what feedback would I now provide Nima? I would like to acknowledge the excellent work being done by the CFH team. I think they are at the forefront of enacting these concepts. Their system has improvement built in, and they have a growth mindset that encourages action, reflection, and learning. Nima, Amy, Alessandro, and Kim at CFH, and the team at UCLPartners, thank you for your hospitality. So….Keep doing what you are doing!

Find out more

Find out more about our Learning Health System work and the Bedside Learning Coordinator role.