We are all familiar with the practice of studying clinical errors to avoid causing harm. But how many organisations have a formal process for studying the process of giving high quality clinical care and compassion in the workplace? We all see examples of this being delivered by the health care workforce every day. Should we not be using this to give positive feedback to staff, improve morale and reinforce the positive behaviour as part of our approach to quality improvement?

Adrian Plunkett, a Consultant Paediatric Intensivist, was interested in addressing this question. In 2014, he implemented a programme called Learning from Excellence at Birmingham Children’s Hospital. The scheme’s purpose was to capture and study positive feedback from patients to inform quality improvement. Learning from Excellence allows people to say ‘thank you’ in a way that changes behaviour and acts as a tool for cultural change.

Despite being called Learning from Excellence, we often find that the feedback is not always about being excellent. Sometimes the feedback is about someone just being kind at a key moment when it made a real difference.

When myself and my colleagues David Viira and Frances Hannon heard about this approach, we decided to trial it on the maternity ward at UHP. One of the hardest types of information for any organisation to capture are the nuanced moments during a patient’s treatment, such as when they may be anxious and a staff member sees it and responds with both excellent clinical care and empathy.

We wanted to know more about these fleeting moments of kindness and turn them into hard, actionable data. Our thinking was that if we could study what was working well for patients, then we could do more of it and learn to do it better. Working in partnership with patients, we could use their feedback to inform our framework for improvement.

Once we began work on this, we discovered that we were not alone. Others in the health care field were considering similar ideas. Through a meeting convened by the Q community, we found out about another project known as Always Events®. Launched in 2016, Always Events is a co-production quality improvement methodology which seeks to understand what matters to patients and then co-design system changes to improve experience.

Always Events is a registered trademark of the Institute for Healthcare Improvement, and is now used in many organisations in England as a quality improvement approach.

Working with Always Events lead Helen Lee, we explored our shared ambitions. Together we developed a poster that illustrated points of learning and aspiration for the future.

Learning from Excellence Always Events Poster (PDF)

Our goal was simple: we wanted every maternity patient to be familiar with the Trust’s Learning from Excellence scheme by May 2020. We also expanded Learning from Excellence to include both patients and staff. Having insights from employees as well visitors and patients is giving us a wide perspective about what “excellence” looks like in our organisation.

Despite being called Learning from Excellence, what we often find is that the feedback is not always about being excellent. Sometimes the feedback is about someone just being kind at a key moment when it made a real difference. It is these intimate daily kindnesses throughout the work day that define an organisational culture. Learning from Excellence is about much more than achieving “excellent outcomes”. It is about each one of us personally demonstrating key behaviours such as caring and empathy toward others.

The qualitative data we have gathered from patients, carers, and family members has identified the top three social behaviours they appreciate:

• being supportive
• being kind
• patient-centred communication

Our staff identified the top three social behaviours that they are looking for from colleagues:

• being supportive
• being positive
• teamworking

We are embedding these behaviours into our approach to health, safety and wellbeing. Our mantra is “what we focus on grows.” Our learning and development workshops are modelling civility and intelligent kindness, using real examples from the data. Case studies from the scheme are shared as a way of building staff morale and resilience. Our clinical governance team is using the data to inform and shape how we operate.

As a quality improvement approach, Learning from Excellence begins from the idea that the vast majority of those in the health care workforce look forward to delivering empathy, compassion, and clinical innovation in their role on a daily basis.

Perhaps the greatest benefit of all from the scheme is that it is giving a voice to the experience of patients and staff. We heard this story from a patient following treatment for a chronic condition:

I faced my fear last week and words cannot explain how grateful I am for your help, care and kindness plus support in facing these fears with me. You listened to my concerns and understood them. You reassured me and cared for me when I needed it the most and this helped me realise I was in safe and well experienced hands which alleviated the anxiety. You stayed with me throughout the most challenging time and was my pillar of support, talking to me and keeping a close eye on me. Thank you so so much for being there for me and helping me on my journey to better health. You are truly such a wonderful and friendly person whom is a credit to the nursing profession. Thank you.

This kind of testimony is inspiring for everyone at our hospital, whether they are an employee, patient or visitor.

At a recent Learning from Excellence conference, guest speaker Don Berwick expressed his hope that the health care workforce could be a powerful catalyst for change both within and beyond health care.

‘Health care professionals begin the day with a sense of trust and affection from the populace that gives them a platform for leadership and change.’

Don Berwick, Learning from Excellence Conference, 8 October 2021

Our future plans at UHP are to adapt elements of the scheme to emphasise the value of appreciation and caring for staff as well as patients. By recognising and celebrating ordinary acts of kindness toward one another that make a difference, we are co-producing a workplace culture grounded in the positive behaviours that happen every day across our trust.

If you want to find out more, visit our Learning for Excellence SIG. We welcome you to get in touch to find out about adapting this scheme in your team.

And be sure to join us for an event coming up on 8 February 2022, where we’ll hear from Q member, Jonathan O’Reilly on how Learning from Excellence helped him to transform reporting for a Scotland-based mental health project. Book your place.