She is the high-priestess of workforce and recently gave a lecture at the Queen’s Nursing Institute… and no they are not going to become the King’s Institute.
She has a very charming, understated delivery style and there is a recording here.
She is the workforce Ninja. Don’t debate with her… you’ll be steamrollered with facts and stilettoed with data, all in one.
Prof Leary was talking about the Christmas Tree model of care… she doesn’t like it. I’ll try and explain…
… at the top of the tree are the most skilled and experienced people. Their work is underpinned, backfilled with lesser skilled people as work becomes divided up into tasks… to complete the work.
I would add… the nearer you get to the bottom of the tree, the fewer the skills and that is becoming the entry point of most patients.
Leary says... because you can do the tasks, doesn’t mean you can do 'the work'.
Xmas tree thinking strikes at the very heart of the future of work. To be honest, in the world outside healthcare, it’s already well entrenched.
Think about the first motor cars. Mr Rolls and Mr Royce, Mr Daimler and Mr Benz made every part of their cars and what they didn’t make, skilled engineers did. Fabulous motors for the wealthy.
I wasn’t long before Henry Ford came along and divided up work into components, invented the idea of a production line and cars suddenly were in reach of us all.
We have gone from people making cars with the help of machines, to robots making cars with the help of people.
Healthcare isn’t making cars but you can see where this is going.
Healthcare and nursing assistants are being trained in modules, to carry out components of care and I'm sure they do it with skill and compassion.
Breaking work into modules, constituent parts is the norm in high volume industries.
Visit a busy Michelin kitchen and watch the brigade making a high value plate of food. There’ll be veg’ choppers and sauce makers, cookers, grillers and someone with a pair of tweezers arranging a sprig of cress.
The question is; where we want healthcare to go? The important difference?
Healthcare is a safety critical industry.
Leary makes the point; pilots on a flight deck don’t do much… until something goes wrong...
... at that point we see why they are trained and trained and trained… safety critical industries wouldn’t put a flight-assistant in the left hand seat.
Nurses are on a flight deck, we call it a ward.
Florence Nightingale said something along the lines of;
‘… it’s not just what nurses do, it’s what they are watching out for…’
There's a lot to unpack here.
In a world were there is a global shortage of healthcare workers, managers will have to deskill work. Break it down into components where trained people take-on part of the work of skilled people.
The Christmas Tree effect.
Each of them doing their best. None of them able to see the whole picture. Watching the change in mood is as important as measuring the change
in temperature.
Nurses as case managers, nursing without interfaces?
Leary makes a good case but…
… nurses have come off badly following their industrial action, morale is poor.
The University of Bath’s; ‘Shall I Stay or Shall I Go?’ report tells us job satisfaction from caring for patients dropped to 35% and, ‘Not enough time to do my job properly’ were the highest ranked sources of worry amongst nurses.
When a patient comes to hospital, they bring their whole self. It’s reasonable for them to expect a whole person to look after them.
It’s more than technical skills. They want opinions, compassion and continuity.
Case management by nurses is familiar in a community setting. The extent to which we might see it on the wards… well, why not.
Nursing is a job that involves many jobs.
Many jobs done by many people, however well done, Leary argues, is unlikely to be a job done as well as the whole job.
The future seems to be as much about what nurses do as it does about how many of them are doing it.
Without enough nurses, reductive care is about the only option for the luckless hospital manager.
-oOo-
Listen to Prof Leary's lecture 'Thinking Differently about Nursing Workforce'
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