What matters to you? An antidote for burnout

RCVS Knowledge:

This webinar is a recording of a presentation by Angela Rayner and Mark Moreton on ‘What matters to you? Finding joy in work as an antidote to burnout’, which was brought to SPVS-VMG Congress on 13th May 2022 in partnership with RCVS Knowledge and kindly sponsored by Elanco and Citation.

Angela Rayner:

Thanks to RCVS Knowledge for asking us to be here today to talk about our experience with this thing called joy in work. We’re really excited to be here to share it with you, so thanks very much. We came across this framework because we were looking to do something about this challenge of burnout within our profession.

And of course it was, or it has been, an issue for us even before the pandemic, but the last couple of years has really amplified it for us, hasn’t it?

And so it’s one of our biggest challenges I think that we face now. So this is why we’re here today: because we’re still navigating our recovery and the effects of isolation that the pandemic has had on us, and this loss of connection that we have with others. We’re tired. We see exhausted people, due to the workload and the staffing challenges that we have faced and still continue to face. So whenever we’re trying to improve something, I think it’s really important we stop to really understand what it is we’re trying to improve, and so, to talk a little bit about burnout and compassion fatigue, and what they mean. So burnout is an occupational problem.

It’s not an individual mental health issue. It’s a chronic state of work-related stress, whereas compassion fatigue is the sort of secondary trauma resulting from the exposure to suffering of others. And so it’s really important to differentiate, I think, between the two, because while they can cause similar symptoms, the solutions for them are different. This framework addresses burnout, so that’s what we’re going to talk about today.

Here are the signs of burnout. You’ve probably recognised these, I sure do. I was here at one point as well. It’s not a nice place to be. So we see a reduced commitment to our work, often with some intention to leave. Physical stress symptoms start to manifest, with the knock-on impact on our mental health as well. We can feel hopeless, irritable, which also affects our relationships, both at work and at home. And we have an increasingly negative outlook, and we become further and further detached from our work, our colleagues and from our families and friends. And as we become more detached, we see this also linked with lower levels of patient care.

There’s a lot of evidence in human healthcare that burnout is linked to that. And then we start to see more adverse events that cause patient harm as well. So our productivity goes down, you know, our heart’s not in it any more.

So again, we see some attrition; people leaving, either the job or the profession completely. So here’s the risk factors for burnout. They include a mismatch in our workload and the resources that we have to meet that demand; a feeling of a lack of control that we have at work and of appropriate reward for what we’re doing. We have a loss of a sense of positive connection with people and of a sense of fairness as well, but sometimes too, a conflict between our values and the work that we’re doing. And I think what’s really good though about knowing what the risk factors are, is that we can then start to address them.

How does this relate to my team? And this framework addresses these risk factors.  So here are the intervention and prevention levels that we can focus on when it comes to overcoming burnout. And as it is a characteristic of the workplace, this is where we should be focusing. We can have the most impact there, but quite often within our profession, I think historically we focused on the individual building their resilience. How can we make people more resilient?

And that’s helpful, we should do that work, but it’s limited in what it can achieve. And so focusing on the workplace is important, because resilience at work is less about individuals and more about bonds between people and teams. So we focus on the teams because we’re working together to do what’s really meaningful to us. Helping animals is really important to us. Helping people is really important. We want to have those good outcomes. We want to hear from the grateful clients, don’t we? And they’re there, there’s lots of them. And we want to have the education to help us deliver those good outcomes.

This is the positive aspect of working with me. This is compassion satisfaction, and it can protect us against burnout. So we have this challenge of burnout in our profession. And so quite often, as we do, we turn to our counterparts in human healthcare. What are they doing about it? Because they’re facing similar challenges, aren’t they? I think we can all agree with that.

So what are they doing about it and what can we learn from them? And this is where we found the framework. It’s an evidence-based framework developed by the IHI, the Institute for Healthcare Improvement, and it was developed to overcome burnout in human healthcare. So we thought, right, this looks pretty good. Let’s see if we can apply it to our profession. But first, the framework teaches us that joy is more than the absence of burnout, just as health is more than just the absence of disease. It teaches us that we want to have control over our work life and be able to act within our values, and we want to belong.

We want to feel valued and supported by our colleagues, and we want to feel the same towards them. We want to deliver those valued outcomes and we want to feel effective at work. And, quite often, because working in the vet profession is hard, connecting to the reason why we do it – our meaning and purpose – is really important to keep us going, to keep our energy going. But then as well, when we’re working to solve our problems, that we’re doing it together, that the teams who are doing the work are best placed to come up with solutions, because they know the work best.

So here’s the framework basically on one slide, this is all you need to know. So we ask teams, what matters to you? How do you know you make a difference? What does a good day look like? And what gets in the way of that? What are the pebbles in your shoe? What are those things that annoy you, frustrate you in your day? What are the things that get in the way of you being able to do your job in the way that you want to? And then the team commits to this, to improving joy in work.

It’s a shared responsibility, not just leaders’, but we empower the team because they know where to find the solutions, don’t they? And then we use Quality Improvement methods and tools to help us to know whether or not we’re making a difference. And the outcome of that is, patient experience improves. We are more productive and staff burnout decreases.

So this is the wheel of joy, I like to call it: the areas that we want to really pay attention to as we go through this process. And it really is a shared responsibility. So we see here for individuals, that we are responsible for identifying these improvements and measuring our progress, but also looking after our own wellness and resilience, yes?

So to add to that for managers, is the team working together well? Ensuring good teamwork and this whole shared responsibility, shared leadership model of improving joy in work. And then senior leaders on top of that are responsible for a physically and psychologically safe working environment; connecting the team to their meaning and purpose, because we know that’s really important; empowering the team to have a feeling of control at work; and of course, some recognition and rewarding appropriately.

So we’re still in with human healthcare now and we’re learning from how they undertake this framework in a hospital in Brazil, in hospital wards. So we’re going to go visit them and see what they did. So they asked their team, what matters to them? What does a good day look like? What gets in the way? What are the pebbles in your shoe? And you see, it’s just PostIt notes up on a board. It’s not too difficult, is it?

And so they took all those ideas and these ideas for change and they grouped them into themes. And they said, OK guys, who wants to help with this? Who wants to help identify solutions to these problems? And then they shared their achievements and celebrated those. And when we start to look at these themes and how we act on them, we tend to see three core categories of action. Those things that we can fix right now we can do tomorrow. These are quick wins. Do them straight away because it really helps to build the momentum to keep things going. And then there are things that we need to find new ways to do, better than we currently do. And then there are substantial changes that we need to make to the care that we deliver.

So you can see as we move across this slide, that things are going take a bit more time, a bit more thinking, you know, we need more brains on these problems, but it’s the team working together to find the solutions. Collaboration on shifts was also really important to them, so they installed a ballot box at the unit, so the teams could evaluate how well they were collaborating on the shift.

So white balls meant they were collaborating really well. Orange balls, well, something got in the way, we didn’t really work together as we would’ve hoped. And at the end of the shift, each employee chose a ball and put it in the box. You can really easily see, can’t you, it’s a really easy visual of how well we collaborated, and you can measure that. You can measure your progress over time and you can see that they made some really great progress in improving collaboration. And that’s just a simple act of putting a ping pong ball in a box and talking about the results with their team, what’s getting in the way?

They also did a survey on burnout. And what I think is really interesting about this, that I want to point out to you, is that this was in the middle of COVID, this work that they did, this was in 2021. And we can all, I think, understand what kind of pressure they were under, but that’s when this work is really important, and the results speak for themselves I think. Joy increased, job satisfaction increased, people still felt connected to their meaning and purpose, and stress reduced. Equally, eNPS [employer net promoter] score went up and the rate of patient harm went down. So that’s human healthcare.

Mark is going to now tell us about his experience with the vet profession.

Mark Moreton:

So here’s me standing in the corner like Angie’s stooge, which is what usually happens at work. So Angie knows about all this stuff, all the theory, all the amazing stuff that goes on to build these frameworks. And she showed it to me. I thought, wow, this looks really, really, really good, but I don’t really do theory very well , so I got myself a flipchart and I went to a vet practice and I thought, right, let’s do joy in work.

So I went to a big vet hospital, and they’ve got a big team, about 80 people there. And we did our first meeting on joy in work in November 2021. And we basically just asked them as a team, what matters to them? We used this conversation guide on the RCVS Knowledge website, you can go have a look, download this conversation guide to help you ask your team what matters to them. Although it’s not a challenging question to ask, this resource gives you a lot of background. It’s intended to support leaders in the veterinary profession with introducing this framework to their teams.

So we sat down with this big team of people and we asked them, why did you want to enter the veterinary industry and what matters to you at work? And what does a good day in your practice look like? And they just vomited all their information out. And they came up with some stuff that was really important to them. And I think they all realised that actually, they’re all looking for the same thing out of their jobs. Then we went through and we talked, after they’d worked out what mattered to them, why they’d got into this job in the first place, what things they wanted to see on a good day. We then asked them to identify…so then the team identified the pebbles in their shoes, something that got in the way of them having a good day.

And once they’d identified all those things, all the stuff that got in the way and that annoyed them and irritated them, we asked the team to come up with some solutions to their problems.

This is the bit of the framework that actually people seem to find most challenging. The rest of it isn’t really rocket science. But what we tried to do in this situation is, we asked the leaders in the room to just not get involved in any way and let the team develop their solutions. And there’s a couple of things that happen. The leaders want to say, well, we’ve done that. We’ve tried that before, or I’m not sure that’s the perfect solution to the problem, or maybe we could make that better somehow. And what we’ve realised, having done this in quite a few places now, is that this really requires the development of this trial-and-error mindset: like, you might as well try something, OK?

And we are really bad in the veterinary profession at having to get it perfect every time. So you might as well just have a go at something. Don’t worry about it being perfect. That was the biggest challenge in this part of the process. So in this particular practice, they decided that they were going to change two things. And that was it. They felt that their surgical list was really badly managed, and so they decided they’d have meetings with a certain selection of people every day. And they wanted to have a wall of dreams, because they didn’t know whether they were getting new equipment or not, or whether the broken stuff was being fixed, or what was in progress or what wasn’t.

So they decided they’d have a big board where they had their wall of dreams, and all of their stuff was being marked down as ordered, being fixed, been delivered, look in the cupboard, whatever they wanted to put . The surgical rounds thing was really interesting because they’d done them before and then they’d dropped them, and then they decided to do them again.

And because they took this sort of trial-and error mindset, they actually altered the stuff they were doing. So they tried it for a day and then realised, this is not quite right. We need different people there, and we need to do it at a different time. So they were doing Quality Improvement. They didn’t have to write it down or mark data or do anything like that. They just went, oh, it’s not quite right. Let’s do it slightly differently.

Angela Rayner:

And I’ll talk a little bit about measurement now. So, how do we know we’re making a difference? Because we’ve got our ideas for change that we’re now going to test, yeah? So here’s where the model for improvement can really help us, because it’s designed for rapid tests of change, so we can do things really quickly. It doesn’t have to be an audit or a piece of research.

So, just to walk you through it really quickly is, decide what’s your aim. Let’s be very clear about what your aim is, how good you want to be and by when. How will you know changes in improvement? So here’s what you’re going to measure. You might have some process or outcome measures. You might have some data that you want to look at, or just get feedback from your team. Even if it’s something as simple as, is this week better than last week? If it is, fantastic. And then, what changes can we make that will help us achieve our aim?

So these are the things that we’re going to test, we’re going to put in our PDSA cycle. So we’ve got our plan, we know what we’re going to test. Now we’re just going to do it. OK. And then we’re going to get some either measures or some feedback. And we’re going to study that. We’re going to ask the team, why do we have the results that we do? Let’s make some sense out of that.

And we’re going to learn loads along the way. And so then we’re going to act on those results. So either we’re going to adopt it, we’re going to keep going with this change, or we’re going to adapt it. We might need to tweak something, like the rounds, yeah, to get it right. Or we’re just going to discard it and start again.

And that’s OK, because we’ve learned something along the way. And now we know best, what the next step is. And then a little bit about sustaining the work, because to keep moving forward with this work, we need a strategy. Because it’s not going to happen on its own. So, you might pick a few things out of this or just pick one thing to just try with your team.

But ask your team, how are we going to move forward with this? What do you want to do? It could be regular improvement huddles. It could just be 10, 15 minutes over a cup of tea. How are we doing? Are we achieving our aim or not? What’s getting in the way? Or what’s enabling us to do that more often? You can also use a huddle to reconnect with your meaning and purpose.

What’s going well today? What’s working? Oh, what about that cool case I just saw, I want to tell you about that. It’s important to keep focusing on that, keep coming back to it. Because, as I said before, it gives us energy to keep us going and celebrating our achievements. Again, this is all kind of energy work, right? I don’t want to say that too loud, but when we celebrate our achievements, it gives us more energy. It gives us more energy to keep going.

Also again, you might put a board up in your practice for people to contribute outside of a meeting, because you might not think of everything, you know, inside of a meeting; you might be working with a patient and being like, oh, this thing is really annoying me, I’m going to go put it on the board, because you might forget about it between now and the next huddle. Or even put something up that, you know, cool stuff, good stuff that’s happening, or change ideas. So show your work. All right. So you might again have something like this where, here’s the ideas in the pipeline.

Here’s what we’re going to do next. Here’s what’s in progress and here’s what we’ve achieved. And you’re going to celebrate that. Right, over to Mark again.

Mark Moreton:

Thanks Angie. So the feedback. And this is what we were really interested in, because we didn’t know whether this was going to work for veterinary practices or whether this was just human. But the feedback was that the clinical teams in the practice felt it’s been really worthwhile and they want to keep doing it. So they are doing it. They have a meeting once a week where they talk about the things that annoy them, and decide what problems they’re going to fix that week. The head vet said this has given the team a sense of control, which is one of those things that we want people to have, to try and prevent them from burning out.

And they’ve got a real sense of ownership of their role. The management team had a really crappy time during COVID. They felt really terrible. But after the session they said, well, this has actually been a real game changer for us. We feel like maybe things for the team are starting to move in the right direction, which is really nice to hear. So we thought, wow, this is good, didn’t we?

Angela Rayner:

We did. Yeah. And that feedback is pretty consistent; we’ve done this in several practices now and it’s pretty consistent.

Mark Moreton:

It’s pretty good. And it’s meant that we then did go and do it in a bunch of other practices, didn’t we, which has been really interesting, but it’s taught us a lot of stuff, taught us a lot of things that we would’ve potentially done differently rolling these out across different things. So we wanted to share some of those things with you.

I think the first thing, and the most important thing, is when you go into these sessions, I’d really encourage you, if you’re going to do this with your team, to let go of any of the preconceptions that you might think about what needs to change with your team. Because if you go in with a preconceived idea of what changes you want to get out the other end, you’re not going to let go of this and let the team decide. And because of that, I think delivery of the session is really important.

Having somebody who’s experienced and had trained maybe at facilitation of these sessions, I think could be really, really useful. We learned that these sessions threw up problems that the leaders were either unaware of, or they thought they’d completely resolved them, didn’t they? And they were like, but we did that! And so it gave them different ideas about whether they’d actually solved that problem properly, or whether they needed to communicate what they were doing a lot better with their teams.

And what’s really, really interesting is that different practices clearly have very different levels of psychological safety, and psychological safety for this framework seems to be absolutely key. So people really need to be able to say what they want to say. And we’ve achieved that in a few different ways. You know, we’ve blatantly said, come on, you need to be able to tell me what you think. Because I work for a big group I’ve, you know, said some of the things that people are afraid to say, and then that opens the floor for people to then come and give us their own ideas.

Angela Rayner:

And it was just really because we’ve stressed the importance of psychological safety in this process. And there’s been a lot of discussion today around this topic and how really important it is. And so, it’s a topic all on its own. So I just wanted to give you this resource, this book by Amy Edmondson, ‘The fearless organization’, because it not only gives you sort of an evidence base for why this is really important, but also the how-to, the practical aspect of how do we create this within our teams? Because sometimes that’s where, you know, we deal a lot with theory, but also it’s the how do we do it? So I highly recommend it. It’s a really easy read. But equally there are things that we can do tomorrow that create psychological safety with our teams.

If me as a leader, if I’m saying I’ve made a mistake, I can talk to you about my mistakes, or ‘I don’t know’ is also a really good one; I don’t know the answer to that, let’s find out. But also this framework starts to build psychological safety because the team is coming together, they’re sharing their meaning and purpose in their work. They’re learning more things about each other, they’re problem solving together. So it starts to build it anyway and foster that, but we can’t stop there, we have to keep going.

But equally you don’t have to be the boss to be a leader, do you? Anyone can do this. So I really recommend that. So thank you, Mark.

Mark Moreton:

I think what we’ve really found is that when you are going to roll this out into your team or, you know, with your team, this is really about leadership. We found that it’s important to have the leaders in the room to give their implicit authority and their empowerment to the team that these changes are OK, the changes that the team come up with are OK to do.

We had an interesting experience at our own senior leadership group, didn’t we, where ideas were going around the room and actually it took the person in charge to sort of say, it sounds like you guys all think that’s a great idea. Should we do it? So having that person there in the room is important, but it really is about the team’s ideas being the ones that come to the fore.

We’re not managing people, we’re not coming in and saying, well, we’ve got a great idea and now you guys are all going to do that. We’re leading them and saying, right, this is what you guys all believe in. These are the things that matter to you. What do you want to do to make your life better and improve your environment at work? And because of that, I think it’s really important that you make sure that all of the voices in the room are heard, and that does come back again to psychological safety.

Everybody’s got to feel safe. And sometimes you have to tease this stuff out. Sometimes we have to give them another way of putting their voice in, you know, give them another way of submitting an idea. And there are all sorts of things out there. There’s apps out there to do that. There’s all sorts of things Angie, aren’t there?

Angela Rayner:

One-to-one sessions…

Mark Moreton:

One-to-one sessions, yeah, little anonymous suggestion boxes, all sorts of stuff that you can use. And then one thing that I would really encourage you to do, you might come out of this session with two changes that the team think are a brilliant idea. I really encourage you to actually do them. If you say to the team, hey listen, guys, I really want your ideas. I want you to tell me what it is that I can do to make your life better. And they tell you exactly what it is. And then you walk away and you don’t do it, that’s not a good look. They do not want to come back and do these sessions again.

And they probably don’t want to continue working in that environment. So it really is about the team deciding. And as we said at the beginning, that ‘try it and see’, we’ve just been through the ‘try it and see cycle’. It’s got a proper name, the PDSA cycle, but we like it to be the ‘try it and see’ cycle. Because you just want to try something and see; if you leave everything the same, it’ll still be the same tomorrow.

If you just make a change, any change, if you think it’ll be better, give it a try. If it isn’t better, what have you lost? You just go back to how you were today. And so we’re looking at this, aren’t we, as what helps us out as employers, and I’m assuming that you guys are thinking the same sort of thing. So I think what you have to ask yourself, when you think about, you know, should I bother doing this framework or not?

Well, I don’t know how important you think it is to know what matters to your employees and how valuable you feel it is that your organisational meaning and purpose and values are aligned with the meaning and purpose and values of your employees. What would the team benefits of realising that actually you are all in this together, working towards exactly the same goal, how beneficial do you feel that would be for your team?

And we felt it was quite beneficial. So we’re also doing some content analysis. We’re lucky enough to have somebody that works with us who’s a statistician, who’s really clever. And they’ve done lots of analysis on the stuff that we’ve got out of the sessions that we’ve done with 15 practices. And we broke these down and we grouped them into, I think we counted 36 content groups, and the themes were really consistent, weren’t they?

Angela Rayner:

Yes.

Mark Moreton:

So in all the practices, people wanted to feel like they’d achieved something. Do you want to keep going?

Angela Rayner:

Go for it, yeah.

Mark Moreton:

So they wanted to achieve, they wanted to achieve something. They wanted to feel like they were, you know, making something of themselves, being their best self, achieving, you know, a good outcome, making sure that they were actually getting something they could get hold of at the end of the day and go, yeah, look, I did this today.

They’re really, really driven to help. They’re driven to help people. They’re driven to help their colleagues. They’re driven to help the clients and the animals that come in through the door. That’s what matters to them. And they also really want to be appreciated. They want to be appreciated by their teammate, their colleagues, they want to be appreciated by their clients and they want to be appreciated by the dogs coming back in with waggy tails when they’ve made them better.

These are the things that matter to our teams that we’ve done this with. And I think they’re things that we feel would extend across a lot of the rest of the profession as well.

Angela Rayner:

So thanks Mark. So we’re coming to the end of our presentation really, but if you want to get involved, if you want to do this with your team, there are, as we said, resources on RCVS Knowledge. The conversation guide for leaders is brilliant. It walks you through this whole entire process, it tells you what to do, what not to do, things to look out for, things to try. It’s really fantastic.

There’s also a series of articles that have been published in Vet Times to explain this process in a lot more detail. So all these things are out there for you if you want to do this with your team or even, you can incorporate it into one-to-one sessions, even, these questions, so they’re quite valuable things. But I’m a big fan of Neil Young. Anybody know who Neil Young is, or I’m…? OK I’m like, am I going to be the only person? .

And this is some lyrics from one of his songs and what I thought was quite appropriate for today. And when you’re talking about joy in work, you’re allowed to be a little bit mushy, right? So it’s just to say that this is real empowerment work. This is work that lights candles, this. So instead of curing the darkness, we can light candles instead to light our way to something, to something ahead, because we know it’s worth fighting for, don’t we? That’s why you’re here. That’s why you’re here and this can help us. This can help us.

So thanks very much. That’s us. And please feel free to ask questions also, please feel free to reach out and message us via email as well if you run into questions along the way. Thanks very much.

Session facilitator:

If everyone wants to cover their ears just in case OK, it’s all safe. Really useful guys. And I think it is, you know, as I said at the start, there’s so much going on in this profession and actually, you know, look, we’re scientists at our core, you know, we are data-driven evidence-based people. And I think, you know, it’s useful to have the evidence behind some of the issues that we’re facing as a wider profession. So hopefully you’ve found that useful. Obviously you’re going to open the floor up now to questions, and believe me, I’d much rather you guys ask questions than me have to fill for a long period of time. Oh, there’s a hand, brilliant. I don’t know whose hand it was, I felt it was in this direction.

Audience member 1:

Hi.

Angela Rayner:

Hello.

Audience member 1:

I was wondering, you spoke about needing experienced facilitators to run these. How do you go about getting experience or finding someone experienced?

Angela Rayner:

I would say it’s helpful to have experienced facilitators. I’m not sure it’s absolutely necessary. I think, I myself have never had any sort of formal facilitation training. I just cracked on and followed the guide. I’m like, OK I won’t do that, and I’ll do that and I’ll watch out for that.

And so, you know, I studied that. So it’s really helpful to have an experienced facilitator, especially if you have a bit of a challenging environment. If you have a team that’s really struggling, it’s helpful, you know, to get them through, you know, and to move them on, move them forward. What do you think about that?

Mark Moreton:

I mean, I would say that, in the spirit of Quality Improvement, you can just try it and see, and in time you’ll become an experienced facilitator.

Angela Rayner:

Yes.

Mark Moreton:

And your first one might not be as good as you think it might be able to be, but you’ll learn and you’ll get better. And the more you do, the more of these meetings you have in your practice, the more you’ll get out of them. And getting yourself in that mindset of, wow, you know, I just bought a flipchart and went…

Angela Rayner:

Yeah. We said, oh great, there’s a flipchart here today, we should just do one , yeah, yeah. Session facilitator: Go on, someone’s going to have a…look at that. Well done. Ten points.

Audience member 2:

Hiya. How do you allow the practice to make comments without retaliation? I mean, I work for a pharmaceutical company. One of our big things is that, you know, feedback of any type is allowed and there’ll be no retaliation. How would you encourage that in teams where it’s, you know, quite a broken system and particularly, you know, big groups of practices where there is quite a hierarchical system, it can be quite intimidating to do that.

Mark Moreton:

So in our organisation that is mainly the role of the facilitator. So if I’m there, I want them to bring all this stuff out and the leaders are in the room and I’m there to moderate that discussion and to make sure that it is a non-judgmental pleasant experience for all concerned, which can be challenging sometimes. But that I think is the bit, if you’re going to go and do this framework, and you’ve never had to deal with that sort of hierarchical situation and trying to moderate people’s behaviour, it can be a bit more challenging, but I think, yeah, that’s the role of the facilitator in that situation.

Angela Rayner:

Yeah. And also it’s because at the end of the day, this is about improving work processes as well. So focusing on the process, not necessarily a person. So you can make that sort of differentiation, but you can also, if you feel like you have that kind of environment that you’re working with, you can do some work on psychological safety first, which is really important to do that I think first, before then you move into the framework, if that makes sense, OK.

Session facilitator:

Excellent work.

Audience member 3:

Hiya. Did you put any parameters on or boundaries to what could be suggested? So, I love the idea of the team having the power to do it. But if something comes out of that discussion that you’re thinking, I actually can’t facilitate that, or this is either out with your own autonomy or something that could be detrimental to the business. How do you navigate that?

Angela Rayner:

We call them boulders, not pebbles, yeah. And it is sometimes about managing some expectations around what is within our control to affect what we can kind of influence, and what we need to ask for help for. But we do, you know, there are things that will just be completely outwith anyone’s control and we just need to find out ways to respond to it.

How are we going to deal with this thing, yeah? So sometimes you do have to manage the expectations around that, but you can say, OK, well, this thing here is going to take some time, or we need to ask for help with it. We’ll keep it on the board. We’ll keep it there. But we just have to manage expectations that that’s going to take time and we may need help. Does that make sense? Yeah.

But we can also focus on all this other stuff that we can do really quickly. What do you think?

Mark Moreton:

And well, the thing that struck me in all of these sessions that I’ve done, there are some huge boulders. There’s some huge things that people want us, you know, want solved in their practice. Yet they never choose those as the areas they want to improve. People are aware, you know, your team will sit there and go, they’ll all come up on the board: haven’t got enough staff, everybody wants to be paid more money, you know, all of these things that they know are huge challenges across the whole profession.

They’ll put them on the board, but they’ll never sit there and say, right, well, we have to solve that, that’s the only thing that’s going to work. They’ll choose one of the myriad of other things that they can resolve themselves.

Angela Rayner:

Mm-hmm, we’re finding that most things that people come up with are within their own control to change. Yeah. In our experience so far, anyway.

Session facilitator:

If you’re a boss or an employee somewhere that’s never done anything like this, obviously, you know, generally speaking as a profession, this is a bit of a major culture shift in kind of how we approach teams in-house. How do you go home from here tomorrow, moderately hung over, and take those ideas back with you on Monday and start implementing this? What three bits of advice would you give people to get the ball rolling – other than obviously getting in touch with you guys?

Angela Rayner:

I would say, look at the conversation guide, yeah. For leaders, that’s step one. And it’s probably the biggest thing you want to do, because that’s what you’re going to use, that’s your tool for the meeting.

Mark Moreton:

Step two is buy a flipchart.

Angela Rayner:

Yeah. And pens that work, right. And have a good lunch for people.

Mark Moreton:

I’d really encourage people to just try it. You don’t have to make this a massive deal. This can just be the thing that you do at your next practice meeting. Like you get everybody together, you’ve bought them all pizza or whatever it is, and you’re going to sit down and discuss.

And then rather than it just being, right, who’s got the first thing that they would like to complain to me about, you know, just say, do you know what we’re going to do today? We’re just going to talk about why did you want to get into this place in the first place? Let’s see, shall we write it on the board? And just go for it. Run through the framework. You don’t have to sit there and go, right guys, we’re going to do something really formal, now this is a really important thing, IHI have got this stuff, here’s all the data. Just go and ask them what they think.

Angela Rayner:

Yeah. And it is important that we start with positive, yeah. Why we got in the vet profession? What matters to us? How do we know we make a difference? Because that puts us in a positive mindframe for solving problems. When people are in a negative place, it’s really difficult to get them out.

So we have to really work and focus on the positive so that they’re in a better place to think of solutions. So we never start with the pebbles. We always start with positives.

Session facilitator:

Any more for more? Bang on time. Thank you both so much.

Angela Rayner:

Thanks everybody. Thank you.

Mark Moreton:

Thank you.

RCVS Knowledge: You can find more information about Quality Improvement and free resources to help you embed Quality Improvement techniques in your practice at rcvsknowledge.org/quality-improvement