I became a ward manager in December 2012. The ward that I was appointed to had been without a manager for six months and around 20% of the staff were off work on long-term sickness. Almost all the staff were on sickness monitoring and at the end of sickness meetings I would review the mandatory training. Mandatory training figures improved when I started but after six to 12 months as people were removed from sickness monitoring the mandatory training figures worsened. I realised that it was because I was not reviewing their training regularly with them. I felt it would not be beneficial to meet with them every two months to just go through their training, so I decided to include a one-to-one meeting at the same time. This was implemented at the start of 2014, using a standardised document I developed. During the last three years the document has been reviewed and updated regularly.
The document has six sections including: health and happiness, a review of the last twelve months and future career aspirations, 12-month action plan, mandatory training, documentation, and communication/governance. These are broken down further in the document.
Aims and objectives
- To review the effectiveness of a bi-monthly one-to-one in place of the annual appraisal
- To demonstrate the benefit of the one-to-ones in my area
- To implement and evaluate the one-to-one approach in other practice areas to see if it has the same effectiveness
- Compare to other areas which use annual appraisals
- Share the data with other managers
- Review other areas where the one-to-one approach has been adopted, 10 to 12 months after the implementation and compare to previous results
Activity and outputs to date
I obtained lots of data about my area prior to one-to-one being implemented and current data from 2017 including sickness levels, vacancy levels, ‘chat back’ (a trust wide staff survey), stress risk assessment data, patient feedback, friends and family test data, staff feedback and comments, questionnaires, training figures, complaint levels, infection rates and internal quality review audits.
Five areas offered to take part in this implementation and evaluation project. These included one ward, one outpatient area, one non-nursing area (medical illustrations and clinical photographers), an education department and the nursing outreach department who visit all wards.
I developed and distributed three questionnaires to all staff in each area to ascertain their views on the appraisal process and communication with their line manager. I then analysed the results and met with the manager of each area to feedback the findings. I then made recommendations regarding how best to improve on the issues identified by the staff in each area.
The non-nursing department
The staff in this area considered communication with their line manager as their main issue. By having the regular one-to-ones in this area, the manager would be able to identify issues much earlier and improve communication. By using the template I created, this manager could ensure that all appraisals use a structured format and they are done more regularly.
The manager of this area reported that the staff reported unhappiness due to them feeling like they are doing the work of more senior managers. It was felt that the band 6 staff were not working to their role, which was creating friction with other team members. The band 5 and band 6 competency lists I created to use in one-to-one sessions can be used to more effectively manage staff who are not fulfilling their role.
[...] the staff reported unhappiness due to them feeling like they are doing the work of more senior managers
I advised the manager of this area to use the competency list for his staff so each staff member is clear about their role prior to implementing the one-to-ones in this area. Their perception may be that they are doing the band 6 role but they are unclear about what exactly the band 6 role entails.
The staff in this area considered communication with their line manager as their main issue
From reading the results from this area, the staff reported that they were unhappy with change, which related to a new manager in post for the last six months with new ideas. They felt that appraisals are important but that they were not being done effectively. The staff in this department also felt that communication with their new manager was an issue. One of the staff suggested that appraisals should be done more often and they needed positive feedback as well as negative.
[The staff] felt that appraisals are important but that they were not being done effectively
I suggested that the manager from this area introduce the one-to-one approach and take responsibility for this themselves. I suggested that the ward vision be discussed during the one-to-one so that the staff have a shared understanding of it.
One of the staff suggested that appraisals should be done more often and they needed positive feedback as well as negative
This area had an excellent stress risk assessment. All indicators were green, however, they had struggled to retain their band 5 nursing team. Staff in this area felt that appraisals were useful and important but did not like the paperwork involved, and felt it was too hard to understand. They also identified issues with communication with their manager with three staff members giving low ratings for this. Two of those three staff also said they were uncertain if their manager inspired them and gave low ratings for the number of times they have received feedback in the last year.
Staff in this area felt that appraisals were useful and important but did not like the paperwork involved, and felt it was too hard to understand
I suggested to the manager in this area that implementing the one-to-one approach could improve communication with their staff.
The outpatient area only returned two lots of questionnaires. I plan to chase the manager of this area to get the stress risk assessment completed before analysing the results from this area.
I have wanted to implement the one-to-ones in other areas for a long time and have met a lot of scepticism from other managers who have all commented it is a great idea but there is no way they would have the time to do it.
By analysing the results from my area and sharing this with other areas, I am hoping to show that it is worth investing in. I would then like to implement it in a lot more areas.
A lot of managers seem to look at short term goals, manage daily pressures but do not have a long-term plan
I found it frustrating during the project as people at first seemed to be enthusiastic and want to be part of the implementation but when they were asked to do small tasks, I had to chase them and ask multiple times. I do not understand why, when the benefits are clear, that people seem reluctant to take part. A lot of managers seem to look at short term goals, manage daily pressures but do not have a long-term plan.
Reflections on impact
I obtained a great deal of data about my area prior to one-to-ones being implemented and current data from 2017 including sickness levels, vacancy levels, chat back, stress risk assessment, patient feedback, friends and family test data, staff feedback and comments, questionnaires, training figures, complaint levels, infection rates, and internal audits.
I compared the data prior to implementing the one-to-ones and can see significant improvements in many areas.
Whilst one-to-ones cannot be held completely accountable, there have been some significant improvements since their introduction. We now have low sickness levels, high level of clinical skills and excellent retention rates. Staff that do move on, go on to higher grade and have good career progression. We have low numbers of pressure ulcers and infection rates; less missed doses of antibiotics and improved discharge numbers. We have low numbers of complaints and good patient satisfaction levels. The one-to-ones have helped me get my message across to staff and my vision for the ward.
My vision is about independence and encouraging patients to do as much as possible for themselves.
We won two awards in 2016, one in recognition of our high standards and clinical excellence, and another Chief Executive award for Best Team.
Since I started the one-to-ones I have an improved relationship with my team and communication is much better. The team feel that they can approach me and I have a better understanding of what motivates them and what their career goals are. I can also share my vision for the ward, so that we are all working towards the same goal.
I have always placed an importance on staff development and get great fulfilment from seeing my staff go on to more senior roles. The one-to-one approach allows me to review their action plans regularly and encourage them to book on to training and use the skills they learn.
The way forward
As part of this project I invited different types of teams throughout the hospital to become involved in order to demonstrate that one-to-ones can be successfully applied to different areas. Whilst parts of the one-to-one approach may need adjusting to better meet the needs of each area e.g. mandatory training, the principles are widely applicable.