My Learning Journey and Clinical Governance
As some-one with a lengthy career in health, I have had governance in my roles as both a nurse, doctor and in strategic leadership.
My first experience of governance was being the COSHH representative on ITU and being part of the implementation team for closed suction systems in the early 90s. We followed pre-prepared written policies, developed education programmes for people to be informed and demonstrated evidence of successful change being embedded through ongoing audit.
I had the support of the team leaders and used my positive personality to sell the changes and had easy topics to disseminate so negotiation was minimal and change was easy.
My next career move was to a research sister and the development of the nurse practitioner role which led to more governance conundrums. Many people felt nurses should not be undertaking roles with clinical examination and differential diagnosis which was outside our traditional competencies and core training. Interestingly the debate is ongoing today, thirty years later!
In order to establish the new service model which was transformational in nature, the business case for the role was established by the consultant and I was recruited. My job description included these new areas of development and I was supported by the Consultants to run a number of ‘nurse led services’. I did not think of my role as governance, however it was important to demonstrate the service outcomes were not detrimental to patient care and that the addition of nursing to the medical team freed capacity to undertake the work they needed to do. Medicines prescribing limitations were problematic and I was on the pilot MSc in Advanced Nursing Practice at Essex University to further evidence the capabilities needed to undertake this role.
Policies and protocols were written, proformas designed, new pathways communicated to GPs and wider teams and audit underpinned practice. These included demonstrating how accurate my digital rectal examination and detection of abnormalities was compared to the medical team, the volumes of patients seen and how waiting lists were minimal with the new services. We published our findings which showed safe and effective services and monitored any concerns and identified gaps and led to the potential for research – https://pubmed.ncbi.nlm.nih.gov/11119092/
On reflecting, I recognise that despite a solid evidence base of safe and effective practice, that we did not appreciate the possible unintended consequence of specialist roles removing nurses from the wards or the boundaries that professional identity confer.
Moving into primary care, occupational health, forensic healthcare and out of hours care, alongside training as a doctor, my roles included performance management of individuals and services, supervision and appraisal, disciplinary investigations, serious incidents and case reviews, root cause analysis and quality improvement building from audit to educational frameworks, policy development and implementation of services. https://pubmed.ncbi.nlm.nih.gov/20851355/
Governance therefore was at the heart of everything I did, as a golden thread, ensuring that our patients were safe and that we were current in our practice and that our staff were competent.
How Passion Based Learning enabled me to Discover My Purpose
Although currently leadership and training opportunities are available to me, my initial career pathway had little formal leadership or management education. My learning journey explored new topics through trial and error, with a leadership style where I wanted to befriend the world, avoiding confrontation and achieving success despite lack of delegation and goal orientated behaviours.
My values were always shining bright and I believed that we all came to work to do a good job. If things went wrong, our systems had let us down. I recognise that I demonstrate values based servant leadership, with psychological safety and creation of ‘a just culture’ as principles of practice throughout my career but now this has become on-trend.
As I have become a strategic leader and a healthcare entrepreneur, understanding leadership, management, followship and skills in governance are passionate topics and I try and ‘do something better every day’ as part of my routine.
I have needed coaching, undertake many courses including the FMLM Tomorrows Strategic Leadership course which I highly recommend: https://www.fmlm.ac.uk/tsl and explore new ideas to discover how to be better today than yesterday.
My new ventures, The Maslow Foundation and Nurture Health and Care Ltd mean that I continue to have an exponential learning curve and now include philosophy to my passion-based learning journey.
My inspiration comes from being able to support amazing people and enabling them to be the very best they can.
My current exploration is to shift away from the ‘one Job Description fits all’ to enabling people to focus on things they are naturally good at and build teams that cover the entirety of workload sharing accountability. How we can demonstrate this within a governance framework which embraces culture and values is yet to be discovered.
Sharing Our Passions and Purpose to Create Safe Systems
Within Health and Social Care, the new patient safety strategy, Just Culture and our wellbeing and equality priorities have created the right environment for a new direction. We now need to create the learning cultures to tackle change and support our institutions to be the best they can be.
Passion-based learning is meaningful and by sharing our ideas with others we create collaboration. Through asking for help, co-creating and co-innovating and learning organically through action and reflection, we can deliver the new generation of services to the best of our ability.
Education, will need to motivate and provide the information to inspire change, but with our workforce who are tired and fatigued with exposure to yet another e-learning course and fearful of failure, we need to offer education in a different way. Social entrepreneurship, systems thinking, cognitive and human factors to understand ourselves and others, with situational awareness to be able to manage risk and uncertainty will prepare us for an ever-changing environment. This should be fun and practiced so no longer a certificate and Multiple Choice Questionnaire but real life participation.
The resulting interpersonal skills of empathy, respect, cooperation, negotiation, leadership and social awareness with hard work, doing something better every day and tolerance will form our new competency set.
People need to be encouraged to understand learning styles, ensure everyone has their perspective acknowledged and amplified if needed, adopt learning mindsets, share mistakes, successes, unlearning and enjoy celebration of our progress. Governance will naturally flow from these teams, without a policy or procedure written or an audit being undertaken.
By creating a purpose-inspired learning community in health and care, we can all align and share narratives and experiences to understand our world and make a difference.
