Chapter 3 Create a Positive Working Environment

Plan ahead 

Team objectives 

Communicate effectively 

Know your team well 

Set meaningful objectives with your team 

Find out what your team wants 

Develop a team action plan 

Be a good listener 

Focus on understanding what people are saying 

Feedback with sincerity 

Thanking staff at the end of the shift is not enough 

Use general feedback as an opportunity for others to learn 

People receive feedback even if you do not give it 

Know your staff well 

Focus on strengths, not weaknesses 

Devote equal time to every member of your team 

Be involved in all appraisals 

Never talk disapprovingly of others 

Your manager(s) 

Talking about problematic staff 

Look for the positive in others 

Get your staff to take more responsibility 

Allow your staff to do more for their allocated patients 

Have a system for dealing with patients’ visitors 

Make your ward welcoming 

First impressions always count 

Be careful with patient confidentiality 

Deal with conflict 

Disciplinary action 

Don’t allow disagreements to get out of hand 

Bullying or harassment 

Not all conflict is detrimental 

Implement clinical supervision 

Why have clinical supervision? 

All your staff should have access to someone more experienced 

Clinical supervision courses 

What motivates a nurse to want to do well and to achieve more when they are at work? More money perhaps? Well, money’s always welcome, but nurses have probably not chosen their vocation to earn lots of money. They have entered the profession for a different reason: to be able to make a difference to people’s lives. So why have so many become so demotivated? The answer probably has a lot to do with the fact that they feel less able to make that difference in people’s lives.

Helping your team feel they are making a difference is an important element of the ward manager’s role. And poor leadership can leave teams feeling low about their ability to achieve anything. Work becomes unsatisfying and frustrating. When individuals feel unempowered, they can lose confidence in themselves and lack self-esteem. Much of the research shows that increasing people’s self-worth and confidence at work in achieving things is a great motivator. Teams under constant stress are rarely able to motivate themselves over a long period. They need a motivating environment and it is the role of the ward manager to create that environment.

Plan ahead

Any group of health professionals working together can be viewed as a team. To be able to work together effectively and make the most of each others’ skills, they need to be working towards the same goals. Your job is to create a motivating environment to enable your team to flourish. Take a good look at your team now:

1. Are there any problems with lateness and/or sickness?

2. Are any of your staff displaying inappropriate or unprofessional behaviour (e.g. flouting the uniform policy, sloppiness, defensiveness or showing an uncaring attitude)?

3. Are there problems between some members of the team who don’t get on?

4. Are there individuals who persistently moan about things?

5. Are problems continually being discussed without any effective action ever taken?

6. Are they not particularly bothered about what is going on elsewhere in the organisation?

7. Have any cliques formed within the team?

If you answered yes to any of the above questions, it’s a sign that you should probably be doing more to create a positive working environment. Behaviours like those are common in many working environments, but in poor working environments can take on a life of their own and interfere with the team’s productivity.

Tackling individuals about these problems may not make much difference unless you have team objectives, communicate effectively and ensure you know the particular strengths of each individual within your team. These three elements are mentioned in most leadership and management textbooks, but tend to be submerged in various models, theories and jargon.

Team objectives

What are your team’s aspirations? What do your team want to change or improve on your ward? You probably know what you want and where you are heading, but have you any idea what your team want? Have you sat down with them all and asked them?

Some ward managers will say how they share their vision and goals with their team and keep them fully informed. This is a very ‘top-down’ autocratic approach. It would be far better to work with your team and establish some clear goals about what you want to aim for together. You may think that your main aim is to ensure patients get good quality care with proper discharge planning, but the main aim of your team may be to get home on time and stop having to stay late after each shift. This is not going to make for effective team working. For a team to co-operate with each other and work hard, it is better to agree your top priorities together.

Communicate effectively

Some think that being an effective communicator is to keep the team fully informed through regular meetings and perhaps using a communication book, which staff have to sign to prove they have read (and to cover themselves from staff saying ‘no one told me’). This is effective one-way information giving, not effective communication. Effective communication should be two-way and that involves really hearing what others have to say and giving feedback.

Spend time listening to what your staff have to say. This sounds easy but it isn’t. People tend to take the easy way out and give advice, opinions or relate a similar experience of their own and say what they did.

In addition to listening effectively, try and ensure that everyone receives regular feedback on how they are doing. Tell your staff when they have done something well and when they have not. It does not take as much time as listening but can reap rewards in terms of staff performance.

Know your team well

Once you know the individuals in your team, you can enable them to work on their strengths and to be aware of each other’s weaknesses. Try not to focus on improving a person’s weaknesses unless it involves clinical competences that need to be met. Focus on their strengths; that way they can only get better. Everyone has different strengths that they can contribute to their team.

Make it your personal plan from now on to focus on the three issues described above. It takes up too much time and energy to motivate each individual and will rarely work if you do not have a motivating environment. Focus instead on creating a positive working environment, which is the essence of being a good leader.

Set meaningful objectives with your team

Some managers spend many hours with their staff facilitating discussions about their values and beliefs. From these, they produce a written mission statement or ward philosophy. It used to be the ‘fashionable’ thing to do. The ward philosophy would then be laminated and put up on the wall at the entrance to the ward. Some still do this. Does anyone ever read these things? I’m not so sure.

However, your team does need to work towards some sort of shared vision in order to be able to work well together and work hard. This ‘shared vision’ can be written down in the form of agreed priorities or objectives reflecting everyone’s views on what constitutes a good working environment, and ultimately good patient care.

Find out what your team wants

It is a good idea to set shared objectives each year with the team. Ideally, it would be nice to get all the team together at once, but impossible when you have to cover a ward 24 hours a day, 7 days a week. So conduct two separate meetings with half the team attending the first one and half attending the second one. It is important that every single one of your staff is involved, so even three or four meetings may be necessary to allow for sickness, annual leave and emergencies.

At each meeting, ask your staff where they all want to be as a team in a year’s time. Ask them which aspects of work they are dissatisfied with and what they would like to change. Values and beliefs may also be discussed and debated as your team aim to clarify what their mutual goals are. Remember to really listen to what they are saying and try not to impose your views. You may get a list looking something like the following:

to get off work on time

to have enough pillows for all the patients

to reduce the paperwork required on admission

to stop being hassled by the matron and bed manager about the bed state

to know more about what is going on in the rest of the organisation

to get more staff on the team

to have food available when patients return from surgery or get cancelled

to be able to get proper breaks off the ward at night.

Be careful to make sure the goals are congruent with the organisational goals. If, for example, your team would like to set up a post-discharge telephone helpline for patients and it is not part of your organisation’s contract with the purchaser, then it cannot be part of your yearly objectives (although it could be an objective to add to the business plan next year).

You may prefer to start your meeting by getting the group to brainstorm ideas about what they want. Write each point up on a whiteboard or flipchart, then discuss and agree which are the top three or four priorities. Alternatively, you could ask everyone to identify his or her own top three personal priorities and get each one of the team to put a mark against each of these on the whiteboard or flipchart. Once everyone has done this, you should be able to see at a glance what the team’s top priorities are, i.e. the objectives with most marks against them.

Develop a team action plan

Once the main objectives have been agreed, your next step is to agree actions to achieve them. If, for example, the team’s main objective is to get off work on time at the end of each shift, possible actions could include:

reviewing the handover system to make it shorter, e.g. taped handover

giving health care assistants (HCAs) more training to take on extra roles

changing shift times to coincide with busier periods

putting in a business case for an extra member of staff.

Make sure that the meeting is solution-focused, not problem-focused. If you allow the team to focus on the problem, discussions tend to go around in circles and can easily devolve into whingeing sessions. By looking at possible solutions, you are focusing their minds on what they can do, not what they can’t.

Ensure the actions are SMART, i.e. Specific, Measurable, Achievable, Realistic and have a Timetable. The final agreed action plan should then be reviewed regularly with the team together. Some of the objectives can even be incorporated into induction programmes and performance appraisals.

Having a set vision of where you and your team want to be in a year’s time is crucial to effective team working. It is an essential but frequently overlooked part of good leadership.

Be a good listener

Few health care professionals have had specific training in listening skills. Sometimes rather than getting someone to talk, they can end up achieving quite the opposite. Your staff need to be sure that you really understand and are interested in what they are saying.

Focus on understanding what people are saying

Sometimes when listening to others we do not really hear what they are saying. While the person is speaking, we tend to:

think about a similar experience that we have had ourselves

try to see things from our own point of view

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3. Manage Staff Performance
4. Look After Yourself

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