Philosophy or fairy tale?

Ward philosophies became popular in the early1990s. Ward sisters and their ‘F grades’ (and, ifyou were lucky, the rest of the ward team) gottheir heads together and tried to come up with aparagraph that reflected what it was they weretrying to achieve. They usually included a selec-tion of words including: holistic, seamless,patient (hopefully), family, individual, excel-lence and multidisciplinary.

This was then typed up, sometimes laminat-ed, and posted on the ward wall (I speak in thepast tense but in fact this is still the case in somewards today). Over the days and weeks it gradu-ally blended in with lists of doctors’ page num-bers, notices about the next ward ‘do’ and thosetelling you what you should and should not do(‘Don’t leave your dirty coffee cup’, ‘Do washyour hands’, ‘Will the night shift please put thedirty linen out?’, etc.).

Eventually if you ask the nurses if the wardhas a philosophy, they will have a vague notionthat there is one and may even be able to giveyou some of the random words, but that will beit. Ask the ward sisters and with a bit of luckthey will have more of a notion of its essencebut if they are honest they will admit it has beensome time since it was updated. There will bereally good reasons for this and I am not tryingto be unkind. The essence of what it says willstill hold true, all of the words will still reflectwhat the team is trying to achieve but there maybe some words missing as the professional andnational agenda changes. When you are up toyour eyes in it, the least of your worries iswhether or not the ‘philosophy’ is up to date.

However, there is a large but. Ask the wardsisters if they have achieved the principles inthe philosophy they may be able to give you ananswer, but it is unlikely they will be able toprove what they say. The ward philosophy is afantastic idea; it is a vision and without a vision

how do you know what direction you are goingin and how do you know that the whole team isheading in the same direction? But, if you donot support that vision with objectives andaction plans then how will you achieve it, howwill you know you are making progress and howwill you know when you have got there?

And that is the essence, that is why, sixmonths down the line, no-one on the ward cantell you where the philosophy is, let alone whatit says.

Work by Borrill et al. (2001) clearlydemonstrates that effective teamwork has apositive impact on patient mortality. So wehave to ensure that our ward staff are workingeffectively as a team and in order to achievethis, they need a common goal. So why not usethe ward philosophy, but ensure it is supportedby measurable objectives and action planning.This will bring the philosophy to life and makeit a real working attitude for the whole team.

Of course there is more to building an effec-tive team than having a vision and objectivesbut we have to make a start and why not start byusing something that is already common prac-tice and may just need a bit of tweaking?

References

Borrill C, Carletta J, Carter A, Dawson J, Garrod S, ReesA, Richards A, Shapiro D, West M (2001). Theeffectiveness of health care teams in the NationalHealth Service. Aston Centre for Health ServiceResearch, Aston Business School, University ofAston, Birmingham.

ALISON WELLSSmartwork Consulting

Address correspondence to Alison Wells, 35Grenfell Road, Leicester LE2 2PA. E-mail:smartworkconsulting@ntlworld.com