Inspiring staff, inspiring change

We all know that staff care deeply for patients, but what role does this have in motivating staff to also tackle environmental challenges for the NHS and the community that they serve? Global Action Plan and Barts Health NHS Trust have led two behaviour change programmes which shine a light on the answer to this question. Here, Caroline Watson shares success stories from Barts Health NHS Trust programmes on air quality and sustainability

Barts Health Cleaner Air for East London
Each year in the UK, the equivalent of 40,000 people per year die due to poor air quality. A recent report on the effects of air pollution, produced by the Royal College of Physicians and Royal College of Paediatrics and Child Health, estimated that this costs the UK health economy around £20 billion a year. Cited in the report as an important example of best practice, Barts Health Cleaner Air for East London showcased the role healthcare providers can play in inspiring staff to improve critical aspects of public health.

The programme was developed as a unique cross-collaboration between Barts Health NHS Trust, its four London boroughs, the Greater London Authority and Global Action Plan to tackle poor air quality and help patients and staff breathe cleaner, healthier air.

The Barts Health Cleaner Air for East London programme incorporated a ‘Protecting Patients’ initiative to advise vulnerable patients about simple, practical actions they could take to protect themselves from the effects of air pollution. The initiative was designed around the ‘Trusted Messenger’ behaviour change framework (whereby a message is delivered to a target audience from someone they already know and trust) so a ‘train the trainer’ approach was adopted with key Barts Health clinicians and community health staff. Embedding the training so that staff felt confident enough to deliver it themselves, empowered them to share their new-found knowledge with almost 3,000 patients.

Ultimately, the project was about patients using this knowledge to change behaviours that would reduce their exposure to harmful air pollution. The results bear this out – with all those interviewed or surveyed reporting at least one behaviour change as a result of the advice given by Barts Health clinicians. The significance of this should not be understated - it is estimated that if the Barts Health Cleaner Air for East London programme was embedded in the care pathway on a national scale, it has the potential to change the behaviour of over two million patients. By reaching out to at-risk groups and informing them about prevention, pressure on the NHS could be eased by working towards a more sustainable, self-managing health community with fewer emergency admissions.

We know that patient well-being is a key motivator for NHS staff, and empowering staff to know that they could make a difference was crucial to the success of this initiative. 85 of the trained clinicians in the Protecting Patients project said they had improved their knowledge of air pollution and felt more equipped to give their patients advice to reduce exposure.

Cleaner Fleets, Healthier Streets
The emphasis on patient benefit as a driver for motivation among staff was also evident in another project within the Barts Health Cleaner Air for East London programme. Cleaner Fleets, Healthier Streets worked with Barts Health NHS Trust and their ambulance fleet subcontractor, ERS Medical. Global Action Plan trained the fleet drivers to adopt fuel efficient driving behaviours. Insights gained from driver surveys showed 25 per cent of them and their families suffered from asthma, so tailored messages were created addressing their motivation to improve the health of their families, communities and patients.

During bespoke training sessions, drivers pledged to ‘Drive Down Pollution in East London,' and as they took to the road each day, branded air fresheners hanging from their mirror with this key message reminded them of their promise. Another incentive was the opportunity to be crowned ‘Most Fuel Efficient Driver’ and gain pole-position on an EcoDriving Simulator Leader Board.

Telematic software allowed instant visibility of individual driver performance and, in the first month of engagement, drivers showed a 63 per cent improvement in driving behaviours. They were also encouraged to switch off their engines on NHS Sustainability Day. Patient well-being as a driver of staff motivation was also clear from our work with Barts Health NHS Trust on our award-winning sustainability programme, Operation TLC.

Creating healing environments
Operation TLC is a staff engagement programme which helps staff take actions to cut energy waste from healthcare buildings, whilst improving patient experience and staff wellbeing. The name TLC stands for Turn off equipment, Lights out, Close windows and doors, helping aid recall of the actions people are asked to take. Talking with nurses prior to the programme revealed that providing the best quality of care for their patients was their prime motivation. As a result, we explored how the energy saving actions could assist with best patient care – leading to the name Operation TLC and the tagline ‘creating healing environments’. The TLC actions not only cut energy waste, but also make the hospital wards more comfortable and restful, for patients and staff alike.

Positive feedback for Operation TLC came from the wards, in some unanticipated ways. For example, the introduction of quiet times was implemented to give patients a chance to rest in a darkened room with no disturbances, but it also gave visitors a break and nurses noticed that the quality of interactions between patients and visitors improved when they returned. Staff reported that quiet times were beneficial for them too as they had time to catch up, reflect and plan for the rest of the day while their patients rested.

The programme was pioneered by Barts Health NHS Trust and shows the huge potential available to NHS trusts. A patient survey analysed by the Trust’s Clinical Research Unit and Queen Mary University of London identified that patients experienced up to a third fewer sleep disruptions and 25 per cent fewer privacy intrusions in a small patient sample. Implementing the programme has also successfully enabled the trust to cut energy waste and save £425,000 per year on energy bills.

We were delighted when Operation TLC won an HSJ Efficiency Award and a Guardian Sustainable Business Award, as it raised the profile of an initiative which has now been adopted in eight NHS trusts. As highlighted in the Carter Review, the NHS could save £125 million per annum on energy costs, and Operation TLC contributes towards realising this ambition whilst simultaneously benefitting patients and staff.

Top Tips – for motivating environmental action
Here, Global Action Plan provide their top tips on maximising staff motivation and environmental action, based on our programme work at Barts Health NHS Trust:

Increase confidence through training: As with our Protecting Patients project in the Clean Air programme, clinicians felt more confident once they had received training. Adopting a ‘train the trainer’ approach is a good way to empower staff to own the message and embed the behaviour in workplace culture.

Clearly link benefits to patient well-being: From our Operation TLC research among nurses, we know that delivering the best quality of care is a huge driver of NHS staff motivation. Seeing benefits to patients, such as longer rest times, helps re-inforce why the action is important.

Don’t make assumptions: Just because something has been done a certain way doesn’t mean it’s necessarily the best way. For example, our Operation TLC work has resulted in unused equipment being decommissioned. Don’t underestimate the benefits that behaviour change can bring.

Degree of personalisation: Research and then tailor messages to increase the relevance of the action and its impact to the audience. For example, the ERS Medical drivers were inspired to act after linking their driving with the health of their families and communities.

Branded reminders: Messaging repeated on merchandise serves as a helpful reminder to encourage the behaviour. Global Action Plan gave the ERS medical drivers branded air fresheners which acted as a daily reminder of their pledge to ‘Drive Down Pollution in East London’. Operation TLC materials include posters, door stickers, pens, checklists, labels on lights and machines – all of which make remembering the behaviour (turning lights and machines off, closing doors) as easy as possible.

Recognising and celebrating success: Operation TLC has won awards from Guardian Sustainable Business and The Ashden Award and that external recognition is very energising. Staff will also respond positively to a public, ‘well done.’ When participating wards reach the final phase of Operation TLC, boxes of tea and chocolate are sent to them to thank them for their work. Individual contributions are also applauded through personalised posters that feature a staff photo. These simple actions go a long way to reinforce the positive messaging and inspiring continued behaviour change.