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The Patients First Programme

Supporting Nurse-Led Innovation in Practice

Year 6 (2014-2015) Workshop Evaluation

Days 1 and 2 December 2014

Background Following an extensive application and interview process eleven teams were recruited to the year 6 cohort in October 2014. Jo Odell, the Patients First Programme Practice Development Facilitator visited all eleven teams in November and December to establish a working relationship for the period of the programme. Please see table below for successful teams to the year six programme. Table 1: Teams taking part in year six programme

Caroline Hales, North Devon Hospice, Devon

The effectiveness of SPIKENARD for the management of terminal agitation and restlessness

Chris Fieldhouse Harplands Hospital, Stoke on Trent

Developing and introducing a semi structured interview based on the psychotherapeutic principles of motivational interviewing

Lucy O’Connor St Johns Hospice, Lancaster

Food and Nutrition Support Workers Programme

Jacqueline Jones Llanelli, Wales

The school nurse’s “Rucksack” – Developing a pro-active, visible, young person centred school nursing service

Ruth Magowan Borders General Hospital, Scotland

Person and family centred care in paediatric care in NHS Borders

Jillian (Jilly) Ireland St Marys Maternity Hospital, Dorset

Preparing for life with your baby – from birth to beyond

Orla Watt Downpatrick, Northern Ireland

Enabling Advocacy, Empowering – Parent Action

Maggie Candy Marlborough Court Care Home, Thamesmead

Yoga based interventions for dementia patients in residential care settings

Tom Andrews Hollywell Hospital, Antrim, Northern Ireland

The development of a more person centred approach to medication rounds in a psychiatric admission ward for older people (over 65 years)

Sharon Love Antrim Area Hospital, Northern Ireland

Development of a falls pathway for patients attending Emergency Department

Chris Caws Queen Alexander Hospital, Portsmouth

Improving the patient experience of ambulatory care in the Surgical Assessment Unit

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Workshop days The programme officially started with the first two (of six) full day workshops on 3rd and 4th December 2014 at the NCVO offices in Kings Cross. Twenty five participants from all eleven teams attended both days. The purpose of these two days was for all the team members to get to know each other and to spend time consolidating the theory and practice of change and practice development. See Table 2 below for overview of content of the two days. Table 2: Overview of Content of the first workshop days

Overview of content

Day 1 Key aspects of the day were:

An introduction to practice development

Exploring values and beliefs

Experiences of previous participants

An introduction to evaluation

Day 2 Key aspects of the day were:

Workplace culture

Facilitation

Giving and receiving feedback

Action planning

Day 1 - 3rd December At the beginning of the day, to encourage the new team members to mingle and get to know each other several interactive workstations were set up. These were: A poster wall - each team was asked to bring a poster to describe their projects to the other teams. A selection of the posters on display

Hopes, Fears and Expectations Three flip charts were set up on the wall and each team member was asked to use stick it notes to add a comment to each chart in relation to their hopes, fears and expectations for the project and programme. These were then typed up (see Appendix 1), collated and themed and are displayed below in table 3. These themes will be referred back to on the last workshop day in September 2015, to see if they were achieved or realised.

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Table 3: Themes from hopes, fears and expectations

Hopes

1. To improve patient experience/outcome (n=13)

2. Specific outcomes for the project/workplace (n=8)

3. Meet others/learn from others/ network (n=7)

4. Develop personally (n=6) 5. Other (n=2)

To enjoy the experience

Ideas, fun, help to focus and set a plan

Fears

1. Failure (n=22)

General (n=7)

Time management/not enough time (n=5)

Resistance from colleagues or motivating team/colleagues (n=5)

Specifics of the project (n=5) o Little knowledge on practice

development o Not enough resources. Grows too big o Keeping my job long enough o Residents drop out o Unable to evidence the benefits

2. Public speaking/presentations (n=6) 3. Other (n=3)

Report writing

Getting lost in London

Not creative

Expectations

1. To develop knowledge and skills to take project forward (n=13) 2. Help in practical terms (n=5) 3. Specific benefits (n=4)

Development of robust pathways

Positive benefits for residents, family and carers

To be able to produce evidence of outcomes

To support positive development of the project - open minded 4. Links with others (n=2)

Guidance, stories of other people’s project successes

Develop links and networks with people doing similar things 5. Others (n=2):

I expect some resistance – especially to the admin aspect

Believe it’s a good thing for residents

Time capsule Each team member was asked to complete a rating scale (see Appendix 2) about themselves as a practice development facilitator and seal this in an envelope. Again this exercise will be repeated in the workshop in September 2015 to see if there is any change in relation to the person’s confidence and skills. Values and beliefs clarification One of the exercises that all team members take part in on the first day is a values and beliefs clarification exercise. As discussed by Dewing et al. (2014), this is important as our values and beliefs underpin all that we do in practice. So clarifying beliefs and values and agreeing them with others is the first step in collaborative working. Each team member was asked to complete the following statements for themselves and then these were shared in small groups of 5-6 people.

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I believe the purpose of person centred care is …

I believe this purpose can be achieved by …

I believe the factors that help us achieve this purpose are …

I believe the factors that hinder us from achieving this purpose are ….

Other values and beliefs I consider important in relation to person centred care are … The groups were then asked to discuss and agree on a statement beginning: We believe the purpose of person centred care is …. Each group was invited to represent this statement visually by using a poster or a collage. Below are some examples of what was produced.

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Day 2 – 4th December 2014

The aim of the first session of the second day was to help teams reach a common understanding of the relevance of culture and context. Participants were encouraged to think about this in their own workplace and identify features that make for effective and ineffective workplace cultures and how this can be evaluated. The second part of the morning session was devoted to exploring various facilitation styles. Finally participants were introduced to various exercises that can enable engagement of others in practice development such as claims, concerns and issues, giving and receiving feedback and reflective practice.

Evaluation

Both workshop days were evaluated using a different tool, to introduce the team members to different ways that they could use to evaluate some of the activities within their own projects. Day 1 The day 1 evaluation was a ‘Doodle’ Evaluation (please see Appendix 3 for tool and full text). Each team member was asked to complete a doodle evaluation and this was then typed up verbatim, collated and themes identified. These are out lined below in Table 4. Table 4: Themes from doodle evaluation from day 1

The day has made me more aware of and/or made me think more about… Aspects of the day resonated with participants. Of the total responses (n=39), 10 specified stakeholders. After that, 9 highlighted evaluation, and an equal number the project, its organisation and journey. The other two main themes were engaging people/dealing with negativity (n=4) and practice development (n=3).

I learnt the following things over the course of the day that will help with the project … Total responses were 32, of which 11 felt they had learnt skills related to the project for example facilitation, planning and recruitment, 10 listed specific methods e.g. Claims, concerns and issues and values clarification and 4 had learnt about evaluation.

I liked or found helpful There were 37 responses to this question. Ten respondents mentioned specific methods e.g. claims, concerns and issues and values clarification, and a further 8 mentioned the way the day was delivered e.g. interactive and group work. Also helpful and popular were meeting other teams (n=5), evaluation (n=2) and having time and space to think (n=2).

I have some unanswered questions or may need some help with … Participant comments (n=17) recognised that they had a lot to think about generally (n=5). Some participants mentioned evaluation (n=4) and project planning (n=3), and others mentioned specific aspects of their projects (n=4).

I didn’t like or find helpful … The room was a little chilly in the morning and this was mentioned by 3 of the participants (n=6). Otherwise, niggles were individual.

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Day 2 The day two evaluation was based on a postcard (see Appendix 4 for an example of the tool and full text responses). Each team member was asked to complete the tool at the end of day 2. All responses were typed up, collated and themed. The themes are shown in Table 5 below: Table 5: Themes from postcard evaluation day 2

Today we explored (n=38) 1. Reflection/reflective practice (n=13) 2. Facilitation (n=6) 3. Action planning (n=6) 4. Evaluation (n=4) 5. Giving feedback (n=3) 6. Culture/culture change (n=3) 7. Other (n=3)

It made me feel (n=25) 1. More confident (feeling positive) (n=5) 2. Reflective (n=4) 3. Focussed (forward thinking) (n=3) 4. Enlightened (more knowledge) (n=2) 5. Tired (n=2)

Other (n=9)

Because … (the statements above are generally positive so the reasons have been grouped …) (n=21) 1. A feeling of clarity and confidence to move forward with the project (n=9) 2. Learnt new tools for the project (n=3) 3. Still feeling confused/unsure (n=2) 4. Others (not possible to categorise) (n=7)

My favourite thing about today was (n=26) 1. Action planning (n=9) 2. Sharing stories/meeting other teams (n=5) 3. Activities of the day (n=6) 4. Others (n=5) 5. Don’t know (n=1)

When I get back to work I will (n=30) 1. Start the project! (n=15) 2. Share/discuss with colleagues etc (n=11) 3. Make sure of enough time/prioritise project (n=2) 4. Other (n=2)

I hope this finds you as it leaves me (n=24): 1. Feeling positive (excited, energised, confident, hopeful etc) (n=14) 2. Feeling positive but … (tired, anxious etc) (n=8) 3. Other (n=2)

Where we are staying is (some respondents have talked about the NCVO venue and some about their hotel) (n=24):

1. Good/comfortable (n= 15) 2. Nice but cold yesterday (n=3)

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3. In King’s Cross (n=2) 4. Other (n=4)

The food is (n=24):

1. Good, delicious, nutritious etc (n=21) 2. Ok but … (n=2)

Not bad, plenty of it and good but not enough coffee

Quite good but a greater choice of vegetarian options would enhance the experience 3. Pretty grim (n=1)

Next time I come here, I hope (n=25) 1. To have made progress (n=17) 2. To meet people again and continue learning (n=4) 3. It’s as much fun as this time (n=3) 4. Other (n=1)

Summary of findings Hopes fears and expectations The themes from the Hopes of the participants show correlation with the aims of the Patients First Programme, specifically improved patient outcomes/experience and personal development through the practice development projects. The Fears of the participants focused on failure/resistance from others and the challenge of the lack of time to complete the projects. The Expectations of the participants were focused particularly on personal knowledge and skill development, however there was also a focus on benefits to patients and staff. Evaluation day 1 The doodle evaluation from day 1 highlighted that the key aspects and content of the workshops were highly valued by the participants and that they enjoyed the interactive nature of the days and the tools and methods that were used. Some people commented that they required some further clarification on some subjects but generally, although people felt they had learnt a lot, they didn’t appear to be too overwhelmed. Evaluation day 2 The postcard evaluation from day 2 showed that participants both identified and enjoyed the key aspects of the day and found them relevant to their practice. Participants highlighted at the end of the two days that they felt more confident, reflective and focused. Also highlighted were new tools that had been learnt and how these might be used within team projects on return to workplaces and practice. The evaluation also showed that the venue and refreshments were good and contributed to the wellbeing of the participants. Lastly, participants talked about how they hoped that the subsequent workshops would be equally as fun and interactive with group work activities and that they hoped to make more progress in their projects as well as in their own personal development.

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Appendix 1: Hopes, fears and expectations Hopes

To improve patient care and experience

Networking and sharing ideas so that we can all have a positive experience of implementing our projects

Better outcomes for patients

My hope is that I will develop the confidence to deliver this project to a team who have become apathetic towards change

Hope to improve patient experience/journey

To develop and get on board senior management team

Support and help from like-minded people to implement positive change during uncertain time for the service

To develop a more informed approach to engaging dual diagnosis patients

I hope the SAU to be recognised as an emergency pathway by the trust

Engagement of all staff in the project team and department

To bring on board bedded unit staff to support and help run the project to its conclusion and then to roll out the findings for hospices and palliative care organisations

To build a platform from which to influence change from my new role in the trust

To be able to influence and change attitude towards dual diagnosis through developing a model of working with people

To help midwives, pregnant women and organisation (maternity) to see childbirth more as a social and family experience rather than a medical event decrease fear, increase personal power

For the school nurse service to be more accessible for children and young people and their families

Getting more people to join in/more residents to take part

Enhanced patient experience

Meet like-minded individuals

To improve user experience where I work by person centred approach

Residents will be more relaxed

Reduce anti psychotics

To implement change and change culture and practice of tx of agitation in terminally ill patients

Educate my peers in some small way

Better outcomes and experience for patients

Improve children’s outcomes

To enjoy the experience

Too meet people – learn from them – network

To develop knowledge and skills in project management

To be successful in improving our patients’ experience

Gaining confidence in networking and presenting ideas

Gaining ideas from colleagues

Improve the patient experience

Ideas, fun, help to focus and set a plan

To meet new people and understand more about their projects

Gain facilitation skills that will help me and parent action achieve project aims

Gain knowledge and support from other people for our project

Fears

Our ability to meet project deadlines

Time

Presenting

Time management and public speaking

Inability to make substantial change in practice

Trying to juggle work, study, project etc.

Public speaking

Little knowledge on practice development

So much to do and so little time

Not enough resources. Grows too big

Keeping my job long enough

Time conflicts

Running out of steam

Presentations, speaking out confidently

Too much resistance – not being able to share the info – biggest fear it doesn’t do what we thought

Residents drop out

Doing presentations – lack of confidence

Unable to evidence the benefits

Presentations

Getting overwhelmed and project growing arms and legs

That I won’t have the skills to successfully lead the project

Report writing

Failing

Engaging the rest of the team

Bitten off more than I can chew

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Unable to implement change and get team/organisation ‘buy in’

My fear is that it will all fall flat once we’re back at work and there our enthusiasm will be wasted because the team may be apathetic and resistant to change

Resistance to change from colleagues

Getting lost in London

Not creative

That no one will come to our activities /sessions. That even if it’s a roaring success it will stop at end of programme

Expectations

To gain greater skills to be able to influence practice development and person centred care

Keep us on track, ensure goals and dissemination, help us share ideas with others

Facilitation skills

Development of robust pathways

I expect that deadlines and a more structured informed approach to change will support more robust outcomes

Provide me with the skills and knowledge to overcome my fears and implement my project successfully

Positive benefits for residents, family and carers

To learn ideas and strategies from different groups to improve patient experience

I expect some resistance – especially to the admin aspect

My expectation is that I will be enthused by this group of people and will enjoy hearing about their experiences of developing their projects and will learn something about the process of developing projects within my team

Gain better knowledge and skills of practice improvement

Guidance on starting project and also gain confidence

Develop my personal confidence and thought process

To support development of skills to implement change that is likely to be met with cynicism

To be able to produce evidence of outcomes

Develop my skills in implementing change

Believe it’s a good thing for residents

Guidance on how to start

Develop my skills and knowledge in facilitation

Guidance, stories of other people’s project successes

Develop links and networks with people doing similar things

To facilitate change in culture

To gain a structured approach to changing practice

To learn new ways of facilitation

To use knowledge and experience gained in practice

To support positive development of the project - open minded

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Appendix 2- Time capsule template

Patients First programme – December 2014– September 2015 My progress as a ‘Practice Development Facilitator’ Name;- ----------------------------------------- Date:- ----------------------------------------- How do I rate myself as a Practice Development Facilitator in relation to the following? [using a 0 – 10 scale with 0 as the lowest level and 10 as the highest, please assign a number to each of the following statements]

Statements

Score

1 My knowledge and skills in relation to developing or changing practice.

2 My experience of changing practice.

3 My ability to influence colleagues regarding developing practice.

4 My confidence about working with developing or changing practice.

5 My approach and understanding (attitude) toward person centred care. [0 = not particularly positive or optimistic, 10= extremely positive and optimistic]

Please write a brief reflection [this may be a situation from clinical practice] that demonstrates where you feel you are at the present time in terms of your development. (Continue over the page if necessary)

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Appendix 3: Doodle evaluation from day 1

I didn’t like or find

helpful… I liked or found helpful…

I learnt the following things over the

course of the day that will help with

the project…

The day has made me more aware of

and/or made me think more about…

I have some unanswered

questions or may need some

help with…

Doodling Evaluation

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The day has made me more aware of and/or made me think more about…

To think about our project and practice development theory

To start to think about moving forward with the project and how we will make it happen

Engaging stakeholders

Methods of evaluation

Structure – building a change approach rather than just doing – really helpful with stakeholders – their success and evaluation

Commencing project

Stakeholder involvement

Evaluation processes

Managing negativity

Strategies for getting our nursing teams involved, for involving the people who are most likely to block and obstruct, and strategies for evaluating and obtaining info for evaluation (other than just audit)

Stakeholders - who they are, what they need, what to be expected

It focussed my mind. I’ve had so many things to juggle lately, it was good to spend the day in the teams and bigger group

Who the stakeholders are and their power and interest levels

How to identify and prioritise members’ values and also the same for stakeholders

How to commence the project

It has given me focus and will now attempt to form a symptomatic approach to start the process and helped me identify and evaluate the role of stakeholders

The practicalities of the project

How are we going to engage clients

The main point of the changes that can be made. Plus the ideas I’ve been guided through to make an idea to counter on for an new change

The evaluation process and to think and consider how stakeholders may become more actively involved in data collection and analysis

Mapping the journey, recording everything as evidence

What the outcome will be of our project and how can bring it together. I have been thinking more about the residents

Our project

How to start and address what the plan is

Feel more relaxed about the ‘open’ approach – know how it’s okay to not have a specific outline

Practice development

Team work

How to collect my evidence – different methods etc

Practice development and how it works How to make use of the stakeholders more

How to collect data more effectively

Different approaches to evaluation

The amount of work that will be involved

The projects are all different but we have many common elements

The stakeholders for my project

The time and importance of doing a good job!!

I learnt the following things over the course of the day that will help with the project …

Helpful to take time out and be with the project leads working on the project

Helpful to meet other project teams, share and listen to ideas and shared challenges

Thinking about different perspectives re stakeholders, measurement of success

Structure

Planning

Thinking ahead

And some of the exercises we did, we can use with our team or similar exercise in the morning re values

How building on things encourages participation/learning

Creative ways of approaching problems/challenges

I’m maybe not as ill-informed as I thought

How to recruit parents to the project

The evaluation process exercise

New strategies

Things that will impact on project – internal and external

Evaluation

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The main point and how to learn, demonstrate and structure it

Claims, concerns and issues will be used in every staff meeting to involve the team in identifying concerns and working together to come up with solutions

Top tips from Liz – can we have a copy

How to look at all areas of a project bit by bit breaking it down

How to think and look at the work open-minded and objectively

Practice development background

Emotional touch approach

Approach to developing an evaluation strategy

Claims, concerns and issues

Ideas for stakeholder involvement

The importance of using/involving stakeholders in the project

Some idea about how to facilitate project at ward level systematically and evidence based

How to manage issues and concerns

How to evaluate

Values clarification

To be creative

Claims, concerns and issues

I must not make assumptions (or at least try not to let them influence me too much)

It is important to engage others and make use of their skills to lessen the burden on you

I liked or found helpful …

Exercises around stakeholders and success

Having time to reflect on project with project team

The penguin stickers! No seriously it was great to have space and time to think

Claims, concerns and issues

Values

I liked meeting everyone and I liked the format and the way in which it was delivered – Thanks very much for a good first day

Claims, concerns and issues

I liked the interactive work – using all sorts of art material – very creative

That each project is different (with common aims) and that we’ll all approach our projects creatively and that’s more than ok

Working in teams

All the exercises

The facilitators

Group work

The facilitators

Group work

Values and beliefs

Meeting other groups and talking about their projects

Talking to other people from other backgrounds

Patient centred care exercise – good ice breaker

Evaluation session in the afternoon

Talking to everybody in the room

Team chats working together

The whole day. Very interesting and thought provoking

Having Jo discuss our project made it more focussed

Jo talking about our project direction and tools for engaging staff on our return

Exercise about values

Group work/activities

Evaluation process

Exercises

All information

Values clarification

Explanation of terminology

Examples

Networking

The poster display

I have some unanswered questions or may need some help with …

Still lots to think about but good to start to make a plan

I need time to think now to unclutter my very stimulated mind – I may then have unanswered questions

How to measure our success

I hope to be filled with belief that our clientele will like our project. Maybe the fear that they may not will help us to prepare good advertising

My brain!

n/a

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Questions to ask to measure success

Everything

Asking the right questions

Delivering appropriately framed focus groups

Maybe when Jo can come to our work place to talk to other carers

May need guided in right direction at times re our project

Everything!

Organising a workshop for carers

About right reports six monthly and at the end

Measuring success

We just need help and support along our journey

Developing an action plan

Some of our project has already been started

I didn’t like or find helpful …

Bit unsure on Claims, concerns and issues

The initial theory seemed a little like climbing stairs first thing but it was okay hence the mouth adjustment (has changed the sad face to a neutral face)

Big words aren’t my best friend I sometimes find it difficult to explain so it may come across understanding to make you understand

nil

Nothing

Room was cold at times

None

Room temperature

Room temperature

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Appendix 4: Postcard evaluation from day 2

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Today we explored:

Culture change, evaluation and action planning

Reflection

How to do evaluation and give feedback

Team culture and claims clarification

Cultures and facilitation

The roots of structure and evaluation

Reflection and action planning

Action plans and reflection

Our projects further

Facilitation

Intentionality and some techniques

Facilitation and reflective practice

Reflection and giving feedback

Ourselves

Our reflections

Facilitation and reflection

Reflection and action planning

Feedback and reflection

Reflective practice

Action planning

Reflection and evaluation

Reflection, action planning and facilitation

Reflection

Situational facilitation It made me feel:

More confident

That I am on the right track

Better to know I can give feedback and talk in front of people

Enlightened

That I’m not on my own

More confident in myself

Focused

Reflective and full of action! And my head is full!

We were perhaps going about things the wrong way and we need to review our project

Challenged

Thoughtful, inspired, reflective, knackered

Thoughtful

Fairly confident

Knackered

Reflective

Positive

Enlightened but happy

Inspired

A little exposed but I learnt a lot

A way forward

I am an effective listener

Excited about being able to use a different approach to change with our team

Off loaded

Happier about my level of skill Because:

I’ve got to know my team much better and know I’ve got the right people on board

I still have tools to put in my resource kit

I don’t really like to do that

I understood more clearly how to look at our team and acknowledge different personalities and ways of working

We have shared experiences

My job role is important to me but at the same time, I want to be myself still

I have a clear idea of the next steps in the project

So much info, so little time

I was left feeling confused about how the implementation of our project was going to benefit, I feel there is a better way forward to achieve the same outcome

I need to reflect on my own style, identity and develop different skills in facilitation

The style, presentation and open mind of colleagues all supported this

Time taken to reflect and think helps you to plan and firm ideas

I have undertaken this before and use it whilst at work

It is so intense but so enjoyable you don’t want to stop

We were examining the thoughts behind actions

It enabled me to learn valuable tools to take back

I am starting to see a way forward

It gave me the confidence to begin conversations

It guides me how to go forward with the project

I’ve become aware, through some of the exercises, that we’ve only used one basic approach and this has given me other possibilities

It brought clarity to my foggy mind and gave me encouragement

My favourite thing about today was:

Action planning and feeling that I know what the next steps in my project are

The interaction with different groups and individuals

Being in groups talking about their stories and finding out what else they could have done

Facilitating and interviewing, listening skills

The sticking and gluing this morning after visualising my workplace then making a poster – you (Gwen) would have enjoyed that

Expression with the picture cards as my card was cake and boats. I want to try out something else and sail through

Creating the action plan

Building the action plan

Reconsidering our project and coming up with some new exciting ideas which will result in the same outcome if not better

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Having the time to identify an action plan at the end of the day

Listening to the common reflections

XXX ideas into plans

Talking to other project teams about their challenges and ideas and starting to action plan our project

Having the time to sit and plan our action plan

Focusing

Our artwork

Being creative

We have made a plan, Good reflecting

Finding out about other people’s projects and experiences

Working together in groups. I can be a little shy so this encouraged me to participate

How to evaluate and feed back

Listening to others’ comments, issues and fears and realise they are similar to my own

Exploring culture and getting some useful tools which I can take back to the team

Action planning

Reflecting on the reflection sheet, it was extremely helpful to me

When I get back to work I will:

Write up the project plans and email Maggie

Be focussed on prioritising this project so that I have time to do it properly

Be telling everyone about the project we are taking forward

Have a chat with you (Barbara) and discuss everything we have covered over the last 2 days

Get on with moving our action plan forward and share our experiences with the team

Be looking forward to sharing my new idea of skills to improve a better working environment for the need and care of my residents

Start ticking things off my ‘to do’ list!

Ensure to put dates in my diary

Speak with the head of nursing to update her of my new ideas

Start to work straight away on my action plan. We have identified clear initial steps that we need to take and I feel motivated and keen to get started

Do something tomorrow to keep the momentum going

Follow up our actions

Starting commencing our action plan informing the ward teams and commencing patient involvement

Focus

Have a lot of catching up to do

Be able to commence our project

Spread the word. Start work on our plan of action

Make time ensure commitment to project

Transfer my actions into my diary and ensure that I engage with staff

Discuss what I have learned with my manager and colleagues and take the project forward

Share my knowledge

Try and use some of these tools and others that I can think of to start trying to change our resistant culture and to get the team to ‘buy in’ to this project

Constructively arrange and work against time line planning

Hopefully maintain a positive approach and make advances with our project every week

I hope this finds you as it leaves me:

Happy and excited about our project

Energised and ready for the challenge

Happy and full of ideas

Feeling more confident and positive on how to start our project

Hopeful and enjoying the good company

Energetic and relaxed about how I’m feeling right now

Feeling positive

I feel like I’ve been given a piece of the map now so I am anxious to move forward – at a reasonable pace

Excited due to a new challenge although exhausted from processing lots of new information

I have just finished the initial 2 days training and feel tired but much clearer about how to get my project up and running

I’m a bit worn out as I have been working hard thinking about the project and how to facilitate it

Motivated and looking forward to commencing our project

Tired, excited, inspired and supported

Tired but happy

Motivated and keen to begin the project

I’m sure I will be back soon

Feeling excited and optimistic

Feeling excited about moving forward

More confident to move forward

Feeling excited to progress

Full of enthusiasm (alongside a degree of anxiety)

As I am feeling hopeful and driven forward starting my project but disheartened knowing the uphill struggle I have with the BU team

Feeling a little calmer than yesterday but still apprehensive of the coming months

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Where we are staying is:

Nice and light and breezy (a bit cold yesterday)

Perfect for our needs

Great

NCVO, it’s very light and comfortable

Comfortable

Amazing

Lovely

Just fine – clean, dry

A good central location

Very good

Just perfect, next to the Grand Central Canal

Nice

Premier Inn, Kings Cross

A wardrobe

Noisy

Kings Cross

Fab

A little cold first day

Very nice – a little cold to begin with then it warmed up

A nice comfortable room

Warm

Ok, pretty basic but not bad, very noisy though

OK but smells of cat wee

Bright, airy and clean The food is:

Very nice

Just right – not too heavy but tasty and nourishing

Very nice and lots of it

Delicious and plentiful

Excellent

Fab and tasty

Tasty and filling

Fine – lunch is great – varied tasty

Very enjoyable

Really nice and plenty to eat

Superb even if I do not know what it is

Lovely

Wonderful

Delicious

Ok

Fabulous

Amazing

Great

Lovely and plenty of it

Very good

Lovely

Pretty grim

Not bad, plenty of it and good but not enough coffee

Quite good but a greater choice of vegetarian options would enhance the experience

Next time I come here, I hope:

It will be a bit warmer and we’ll have made lots of progress with our project

To have started from a good foundation and with lots of ‘patient views’ for direction

To have got the project in full swing and have the right people on board

To have spoken to the team and set up the focus groups with parental consent and questionnaires completed and in the process, lose a stone!

We will have some information to share from focus groups and questionnaires to guide the rest of the project

To be able to share my work with you and give you my best knowledge with 100% confidence

To continue building relationships with these great bunch of people and learning more about practice development

To meet up with new ‘old friends’ and can’t wait to see what’s next

I will be positive that it is ‘our’ project and it’s going where we want it to go!

To have achieved my action plan and feel ready to embark on the next stage in the project. I also hope that it is as useful and enjoyable as these initial days have been

We can show some of our planned actions have been done

To have achieved them

To meet up with all the other project teams and see how they are doing

I am focused

We have as much fun as we did this time

The experience continues

Everyone is as friendly and workshops are as informative fun and learning as this one was

We will be well on our way with the project

To look back and actually see that i have moved forward in relation to this project and of course learn more regarding service improvement

I will be able to tell tales about the way we are cruising through the project

Have progressed in my journey

We will have achieved everything on our action list

To have started the project or at least be close to it

To have a lot of good things to tell my new contacts rather than negatives