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Scholar's Report

Leadership Scholarship

2016/25 - Gerry Bolger

Abstract

I want to firstly thank my employing organisation, Imperial College Healthcare NHS Trust, for supporting me in this Leadership Scholarship. In particular, I want to thank Kevin Jarrold, Chief Information Officer, to whom I directly report to, and Professor Janice Sigsworth, Chief Nurse, who I professionally report to. Both Kevin and Janice have supported me in releasing me to attend the Scholarship sessions, visits and in return the learning I have found over the 12 months.

I also want to thank Professor Elizabeth Robb and Susan Machell, my mentor for their time and support for the 12 months of this programme. They have both been a great source of support both to ensuring I achieved the best, but also to enable my critical thinking. I believe the end of the scholarship is just the beginning of the journey. I am also delighted to have been assigned to the Dame Christine Beasley Scholarship through the London Nursing Network, especially as I have the great privilege as having worked for Christine while she was Chief Nursing Officer at the Department of Health. 

My aspiration was to achieve in my scholarship year was twofold: 

1. I wanted the scholarship to enable me to enhance my leadership ability. For this to happen I wanted to understand what influenced my thinking, if anything, or what barriers/blockers were influencing and having understood that, what I could draw on, to be a more effective leader. 

From the assessment process, including 360-Degree, Myers-Briggs and Leadership style sessions, I was able to understand where I am now, and what I needed to do to reach my potential. This included understanding why I think the way I do, and how I needed to change my thinking to realise my potential, especially as working at Chief Clinical/Nursing Information Officer level, both in knowledge, strategic leadership, adoption and transformation and how I could influence more both horizontally and vertically within my organisation and the wider nursing profession. 

2.  Secondly, for my patient change project, I wanted to make a difference by addressing a significant issue that is about to happen. That is the rapid progression of adoption of electronic patient records in the UK, and what this means to nursing practice. I have titled my patient care project ‘rebalancing the nursing relationship with patients as they access and contribute to their own electronic patient records. What does this mean for nursing practice?’

It aims to learn from others who have mature experience in both the implementation and application of electronic patient records, and have implemented patient portals and have learning in patients accessing, and using their records for their care.  The visits enabled that learning and what can be applied, or not, and what we need to do to change our culture to documentation practice with the change in access to electronic patients records from 2020.

My scholarship was designed around those two aspirations, both in the way I structured the leading learning to the visits I took. The scholarship has both equipped me to and challenged my thinking, allowing me to re-examine what I focus on to be an effective leader. It has enthused me in my project, in that as an organisation, we are now establishing the fundamental steps to ensure the nursing practice standards for documentation are in place and with that aiding nurses to be prepared as their documentation is viewed and accessible by patients. 

My planned visits were to Uppsala Health District in Sweden, an area where there was extensive leadership in developing patient accessible records, one of the first in Europe.  This gave me a European perspective from a state managed health economy and the learning of the health and social care sector on this approach. This compared to my other visit to the Virginia Mason Institute and hospital, which is one of the safest and efficient US hospitals, applying LEAN principles. It was chosen because of its approach but also a major adopter of the same electronic patient health record system that my organisation uses. 

By working with the leaders in both organisations, I learnt from the leaders that their journey’s had one thing in common. The belief that patient’s had both a fundamental right and a benefit from accessing and contributing to their records. While their journey’s were different, the key learning both from these organisations and others I networked with, including nurses from the Veteran’s Association; and nurses in Sigma Theta Tau International – the nursing leadership society, was that there is a need for nurses to use standardised nursing practice for documentations, whether that be NANDA or another recognised language. Secondly, that while there was no clear national, regional, or in any cases professional body guidance on what and how to document, neither organisation had experienced adverse implications. In dialogue with all the people I networked with, they agreed that a lack of guidance was a weakness in the approach.

As such my recommendations are:

Recommendation 1: That the nursing profession should consider both using standardised nursing language as routine – the core standard – and review its language/phraseology in general documentation. 

Recommendation 2: The professional bodies and regulators need to agree core standards for the practice of documentation for nursing in advance of patients accessing records. 

Recommendation 3: Nursing leaders in care providers / care delivery organisations should establish localised nursing practice standards for documentation.

I look forward to sharing both the learning from my visits as well as applying the personal transformation the year has given me.