Excellence reporting in a neonatal intensive care unit during COVID-19 era

Abstract

We are reporting our engagement with the ‘Learning from Excellence’ initiative in the neonatal intensive care unit during the covid era, with enhanced professional and personal stresses in the workforce. It highlights the positive experiences around technical management of sick neonates and human factors, like team working, leadership and communication.

Incident reporting, which in healthcare often represents failures such as errors or harm, has become the mainstay of reflective learning for individuals, teams, and organisations. However, learning can also be from specific and descriptive episodes of excellence. This positive feedback reinforces good behaviours, leads to cultural change, and improved team relationships (Kelly et al., 2016; Plunkett, 2022). In the COVID-19 era, health care workers have been exposed to further stresses in the professional and personal environments, leading to more burnout (Leo et al., 2021). The organisational culture has an impact on the staff physical and mental well-being (Plunkett, 2022). The Learning from Excellence (LfE) initiative was implemented in the Neonatal Intensive Care Unit (NICU) at Birmingham Women's Hospital in 2016 and aims to highlight and learn from peer-reported episodes of excellence (Cawsey et al., 2018). Staff are encouraged to report episodes of excellence using the Trust's ‘IR2’ incident reporting system, which also has a free text section to enable detailed description of good practice. These LfE episodes are reviewed by the governance team to highlight trends and learning, which is shared through individual and team feedback mechanisms. The 2018 LfE data showed that the excellence reporting was embedded into practice, with multi-professional input (Cawsey et al., 2018).

We have further studied the LfE data in the COVID-19 global pandemic, with its adverse impact on staff workload and wellbeing, to understand the effects on the excellence reporting and themes during this period. A total of 363 LfE episodes were reviewed from April 2020 to March 2022, an increase of 120 episodes from the previous 2-year data. Episodes were reported from across the multi-speciality team with maximum input from nurses, midwifes, and advanced neonatal nurse practitioners (Fig. 1 ). The main themes of excellence referenced family centred care, communication, professionalism, and leadership, with a small number relating only to specific COVID-19 themes (Fig. 2 ). Interestingly, the excellence feedback on ‘individual performance’ was mostly from junior staff (band 5 nurses and tier 1 doctors), while feedback on ‘team performance’ was from those in more senior positions (consultants, band 6/7 nurses).

Graph 1.

Professional role reporting excellence.

Graph 2.

Thematic data from LfE reports.

LfE reporting is more embedded into the workplace culture in our NICU, which is evidenced by the increased number of excellence reporting episodes, compared to previous years. Contrary to the belief that COVID-19 may have negatively impacted on LfE reporting, this data exhibits that staff have continued to engage with the LfE process despite increased work pressures. It may be that COVID-19 has contributed to improved LfE reporting with professionals actively engaging to support and encourage colleagues in challenging times within the busy work environment. Education on the benefits of the LfE initiative will be essential to maintain this high level of engagement and encourage extended recognition of those in non-clinical roles who also contribute to the effective functioning of a busy NICU. Practice of appreciative enquiry on excellence episodes also has the potential to lead to quality improvement and innovation.

Funding

No funding.

Declaration of competing interest

There are no conflicts of interests for the manuscript ‘Excellence reporting in a neonatal intensive care unit during covid-19 era’.

Handling Editor: Dr B Boyle