Good examples

Work environment, research and development crucial when child oncology went from personnel shortages to queueing

Carl Johan Östgren, Scapis

Eva Sjödin Eriksson is the unit manager of child oncology at Norrland University Hospital in Umeå. In twelve years, she has managed to turn the unit around, from being one with dissatisfied employees and personnel shortages, to being a workplace where personnel are queueing up to work. The prescription is a new model for working hours, clear development opportunities - and clinical research.

A child is playing around on a scooter in the corridor of Child Ward 3 at Norrland University Hospital. A parent and a nurse are exchanging a few words, and it is clear that families are in focus. Families that are trying to manage everyday life in a hospital, and to turn a healthcare room into a temporary home when cancer means that you cannot leave, yet.

– Patients on our ward are usually in hospital for a long time. Because of that, I usually greet all parents and introduce myself, show them where I am and tell them that they can come to me if they think something works well or less well on the ward, says Eva Sjödin Eriksson, who is the unit manager.

– Most say that they feel secure with us, and that I must have hand-picked my personnel – and so I have, of course, says Eva, smiling.

Eva Sjödin Eriksson is the unit manager of child oncology at Norrland University Hospital 2005. When she took up the position as unit manager, the unit had high personnel turnover, high turnover of managers and great frustration among the personnel. Today, nurses are queueing up to start working on the ward, despite a considerable national shortage of nurses within child oncology. How can this be so?

– One of the success factors is quite clearly our new working hours model, with a reduction in working hours that entails fewer shifts and an hour bank with “buffer hours” that I as manager can use to cover short-time absences due to sickness, child care or holidays. This means I never have to order personnel to work anymore, says Eva.

– But we also work actively with operational development, we have an open climate for new ideas and we encourage personnel to do further training. This means that the personnel are happy and want to stay.

The hub of the unit’s development work is a development team, where each member has a specific subject area. These cover areas such as nutrition, pain, hygiene or medicines. The team members have been tasked to stay updated on their respective areas, and this includes having read the latest research within the area and to monitor new research findings.

To enable them to do so, the team members have earmarked time for development work set aside in their timetables, and according to Eva, this time is not moved unless absolutely necessary.

- No that time is sacrosanct! If it cannot be solved in any other way, then we have to move the time, but the development time is never cancelled, says Eva Sjödin Eriksson.

Sonia Marklund

 The development team’s convener is Sonja Marklund, who is a nurse with a Master’s degree and specialist training in child oncology, and has worked on the child oncology ward for many years. She says that the work on the development team means an incredible amount to her personally.

– Having your own area of responsibility means that you feel you are contributing in a way that differs from the purely practical work, and that makes it such fun! If I hadn’t been able to work with development, I would probably have lost my spark.

Sonja thinks that if you are going to implement change in an operation, then all personnel members must understand why it is being implemented. For this reason, she thinks that the work with the development team, where each person has their own area of responsibility, is so good.

– I have worked here for 17 years, and before this, the general attitude was ‘Do we really need to change this? Surely it’s worked well, doing things the same way always.’ But now there’s a completely different understanding of change and development work, says Sonja.

– Those who aren’t members of the development team often come up with new ideas too, and proposals for things that can be done differently, there’s a whole new way of thinking now.

As an example of a change, Sonja and Eva point to how they have recently been working on developing the unit’s diagnosis discussions.

- Previously, who among the personnel took part in the diagnosis discussions was a bit more hit-and-miss. Often, more people than necessary from a medical angle took part, as we thought ‘It might be good to have heard’. But from the family’s point of view, it wasn’t optimal to get tough news in a room full of personnel, says Eva.

- To find out how best to carry out the diagnosis discussion, we went through what the scientific literature says about this area, and this resulted in a memo that we now work according to.

Having support from research when you implement a change is a security, thinks both Eva and Sonja.

– If you decide to re-write a steering document for the unit, then it is really comforting to know that the decision is based on evidence. In this way, you can show your colleagues that the change is nothing that we have come up with ourselves, but based on what we have read in the literature, says Sonja.

Research based on clinical challenges

Eva Sjödin Eriksson does not just use existing literature in the improvement work on the unit. She also encourages the opposite – turning challenges observed in the everyday clinical work into research. One way that this is done is via Master’s degree work, where personnel members study subjects that are relevant to the unit. In this work, they collaborate closely with the university. Eva thinks it is a clear advantage to keep the research close to the operation.

– What has become so clear in this process is that such a lot of research is carried out, but then when you get to implementation, then there are problems. It is incredibly valuable to have the research close to the operation.

The work for several one- and two-year Master’s degrees has been carried out on the unit in the last few years. Some personnel members validated a scale for warning signals of impaired medical condition in children, and other checked out pain scales for children. In 2015, Sonja and Eva carried out a study of nurse-led health-supporting family discussions, which was then implemented.

– I hope that our study can inspire others on the unit to see that it is possible to do things like this, provided you want to, says Sonja.

Eva adds that the important thing is to utilise the ambitions of new personnel members.

– These are smart women and men, who arrive here straight from education, with ambitions and scientific thinking in the baggage. If we can make sure they are stimulated and engaged, then they will also stay.

What advice do you have for other unit managers?

– Identify personnel members who have the same basic values and goals as you have yourself, and get started. Engage all personnel members, build a stable base with a climate for change, and make sure all decisions are majority-based. As manager, you can be the motor and coordinator of the development, but you all drive it together.