Thanks everyone for showing so much interest in the Start Well> End Well Approach.   We’re pleased to be able to share with you our end of year project report and project journey.

Its been a busy year, working to understand, share and enable teams to adapt and adopt practices which help promote psychological safety & teaming at North Bristol Trust. Along the way we’ve had lots of questions and discussion which has helped us to develop guidance, editable resources, case studies and training.

As we move forward we are beginning to learn about the people, the time and the situations where it really flourishes, as well as which bits of the approach are easier to establish and what practice and skills need nurturing along the way.

To help us with this, we’d love to know if you’ve used the approach, how you’ve  adapted it and how it’s going.

Journey Map (PDF)

Q Exchange End of Year Report (PDF)

Q Exchange 6 Month Mid Year Supporting Materials (PDF)

High Level Project Overview
Following the successful Q Exchange award submission announced in January 2021,  the core Start Well, End Well (SWEW) team have established a rhythm of meeting bi-weekly to progress with the project objectives. Our initial aim was to share SWEW both internally within the organisation and nationally, alongside evaluating how it is used and its impact on teams.

Although this is still our focus, the core SWEW team have realised two things over the months

1. the current context in an acute NHS setting following the height of Covid-19 has impacted our internal implementation strategy, making us realise
2. that more time and effort is required on this particular aspect of the project, working at the pace of adopting/interested teams

The spread of SWEW outside the organisation however, has occurred thanks to the Q Community and through the delivery of external webinars.

The core team having taken stock of the situation, has planned a strategy going forwards and have identified both quantitative and qualitative measures that can be used to support the evaluation of both the use and impact of SWEW.

Progress
There are key milestones which mark the progress of the SWEW project and these include:

Raising Awareness/Communication of SWEW both internally and externally

• Oct 2020-Jan 2021: Created a short video explaining the purpose of SWEW
• March 2021: Delivering a SWEW webinar with NHS England/Improvement to over 100 attendees followed by our first attempt at a Community of Practice.
• Sept 2021: Delivering an Internal presentation during Bystander week, demonstrating how SWEW fosters psychological safety within teams.

Further Development of Documentation

• July 2021: Finalising the SWEW support package incorporating feedback from early users of the approach. A sharing agreement was also added to the support pack liaising with the legal team in our organisation.
• Oct 2021: Through sharing the support pack it became apparent to the team an additional documentation guiding teams on how to use SWEW was required. This led to the creation and finalisation of an Implementation Guide, which incorporates early learning from its use.

Engaging with teams internally

• Mar 2021: Following the communication and raising awareness of SWEW inside the organisation, Senior leaders in a large Division (Surgery) launched SWEW across a number of clinical areas.
• Aug 2021: Learning that further intensive support was required to support this launch in the Division, the core team designed and delivered 3 SWEW events, with the view to engage early champions of SWEW.

Evaluation Plan

• Firming up a clear evaluation plan for the months ahead, identifying suitable and realistic measures combining both quantitative and qualitative data with a focus on behavioural and attitudinal changes SWEW enables within teams.

What have we learned so far
Through its early use, the core team have had many useful insights that have contributed to our learning; the following are some of the main ones:

1.  Clinical teams adopting SWEW find that Step 1 (Checking-in) is the easiest as it links to existing routines. This has led to the core team suggesting different ways to facilitate Step 2 (Peer-to-Peer PITSTOP) and Step 3 (Checking out) which includes doing this with individuals or with a smaller number of people in the team.

2.  We learnt that teams required resources to help them use SWEW alongside support from the team and this led to the creation of the Implementation Guide which is a comprehensive piece of documentation including early case studies and a section on Top Tips.

3.  We have realised we need to focus on working closely with a smaller number of teams, using a coaching and appreciative inquiry approach to support them using SWEW. This in turn will allow us to collate more robust data to evaluate its use.

4. Using the expertise of the Clinical Psychologists in the core team, PITSTOP training has been developed.

What could others learn from your experience of working with a range of stakeholders

1.  Early adopters need a lot of support, we have realised this now. This takes time and is important when considering the project plan

2.  It is important to identify who the Executive stakeholders are within the organisation. Our organisation has had a lot of change over the last few months and we have lost sight of this slightly, having realised this now we have outlined a plan to engage with this category of stakeholders.

What are the next steps for your project over the coming months?
Data/Measurement- We have now identified the different types of data we will use to evaluate the SWEW approach and over the coming months we will collate the quantitative data, to identify trends/patterns and we will also focus on collecting qualitative data to help us build case studies. Combined, this information will help us understand how SWEW supports teams foster psychological safety, team working and well-being.

Sustainability- We will be looking at ways we can make the SWEW resources we have created more accessible internally and to guide teams to collect information following its use, to evaluate the impact of using the SWEW approach.

The SWEW core team are planning to regroup, identify the project needs for the coming months, to then further shape team/individual roles and responsibilities.

We would like to lay the foundations to build a SWEW Community of Practice within the organisation and amongst the early adopters. This is a new concept in our organisation and will therefore require some focused attention.

We will continue to share our SWEW journey internally, with the view to engage and establish Executive level sponsorship and externally to build a wider SWEW Community in Health and Care.

How can the community get involved in your project?
We have been very grateful with members who have engaged and shown great interest in our project and would like this to continue:

We would like to hear and learn from other members of the Q Community who are also measuring the impact of initiatives that also look to foster psychological safety in the NHS.

We would like those using SWEW, to continue to provide us with feedback to help us understand how, when and why SWEW works and/or does not work, as an approach.

To suggest where else we can share our SWEW Journey.