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#WeHCMs - Tuesday 25th February 2020 8pm (GMT Standard Time) Escalation

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We all have matters that need escalation, from on call systems, seeking out advice from our managers or making people aware of something good, or something of concern. This week we are exploring escalation across all of health and social care services, what it means to you and how it works in practice.

1) How would you define escalation and when do you experience it?

2) Have you found escalation within services helpful to resolve an issue you’re encountering, or to raise good practice?

3) What do you think are the enablers and barriers to prompt escalation?

4) When escalating, what are your expectations? Or, if you are a manager, what are your expectations of those escalating to you?

5) When escalating is there anything you’ve found particular helpful that would benefit other organisations?

6) If you could change escalation processes, what would be the one thing you’d do?

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#WeHCMs transcript

@wehcmanagers 25 February 2020 20:00		Welcome to tonight's Tweet Chat! Please say hello and let us know where you are! #WeHCMs https://t.co/uM6b01saE8
@agclayland 25 February 2020 20:01		@wehcmanagers Hi - I'm Adam - supporting tonights TweetChat with @Lyse_e #WeHCMs
@evelyn_prodger 25 February 2020 20:01		@wehcmanagers #WeHCMs
@WeNurses 25 February 2020 20:01		Starting now over on #WeHCMs >>> https://twitter.com/wehcmanagers/status/1232394583817904128
@mneil02 25 February 2020 20:01		@wehcmanagers Hi, I’m Marc, Belfast... #weHCMs https://t.co/5gzgKt8ye5
@AgencyNurse 25 February 2020 20:01		Hello - Teresa here ... just popping in for a bit #WeHCMs
@wehcmanagers 25 February 2020 20:02		@mneil02 Welcome Mark! Glad you can join us! #WeHCMs
@wehcmanagers 25 February 2020 20:02		@AgencyNurse Hi Teresa! Thanks fo popping by! :) #WeHCMs
@evelyn_prodger 25 February 2020 20:02		@wehcmanagers Evelyn here from a wet and windy Brighton #WeHCMs
@wehcmanagers 25 February 2020 20:02		@Lyse_e @agclayland Yay!! #WeHCMs
@wehcmanagers 25 February 2020 20:03		Question One: How would you define escalation, and when do you experience it? #WeHCMs https://t.co/sRcEB37oxq
@wehcmanagers 25 February 2020 20:03		@evelyn_prodger Hi Evelyn! Thanks for joining us! First question just posted #WeHCMs
@Emmsyjayne 25 February 2020 20:03		@wehcmanagers Hi I'm Emma at Brize Norton ?? #WeHCMs
@wehcmanagers 25 February 2020 20:03		@Emmsyjayne Welcome Emma! #WeHCMs
@l_outhwaite 25 February 2020 20:03		@wehcmanagers Hi - I'm Loretta. Really looking forward to the chat #WeHCMs
@wehcmanagers 25 February 2020 20:04		@l_outhwaite Thanks for joining us Loretta! Great to have you with us #WeHCMs
@Helen23Wilson 25 February 2020 20:05		Oops wrong # #WeHCMs https://twitter.com/helen23wilson/status/1232396011391406081
@evelyn_prodger 25 February 2020 20:05		Escalation is about seeking support/advice/ action for a significant risk you cannot mitigate or a significant issue you cannot resolve, have been bronze on call for a NHS Community Trust so have experience on both sides in and out of hours #WeHCMs https://twitter.com/wehcmanagers/status/1232395590669131776
@JenJenHutton 25 February 2020 20:05		@wehcmanagers Evening! Jen here settling in for the chat! #weHCMs
@wehcmanagers 25 February 2020 20:06		@evelyn_prodger Would you say it's just about issues or concerns? #WeHCMs
@Helen23Wilson 25 February 2020 20:06		@wehcmanagers When I am not getting a response from the person I need or it requires a “higher pay grade” decision. Could be for all manner of things #WeHCMs
@Lyse_e 25 February 2020 20:06		@wehcmanagers For me escalation is anything where someone is 'stuck' with something and is seeking help from someone with my positional authority to resolve it. It can happen in and out of hours (i.e. in the day job and when on call. #WeHCMs
@agclayland 25 February 2020 20:07		@Helen23Wilson @wehcmanagers Interesting! When i've been on call its also been about keeping me informed so that any later issues can be dealt with more promptly, what do you think? #WeHCMs
@wehcmanagers 25 February 2020 20:07		@l_outhwaite Thanks Loretta don't forget #WeHCMs
@evelyn_prodger 25 February 2020 20:07		@wehcmanagers No, it can be used to celebrate or share good practice but it feels like it is mostly associated with risks or issues in reality, lack of staff being a typical example #WeHCMs
@l_outhwaite 25 February 2020 20:08		@wehcmanagers Oops #WeHCMs
@wehcmanagers 25 February 2020 20:08		@evelyn_prodger Great example here! #WeHCMs
@evelyn_prodger 25 February 2020 20:08		Absolutely, can be used proactively #WeHCMs https://twitter.com/agclayland/status/1232396672669487104
@wehcmanagers 25 February 2020 20:08		@Helen23Wilson How often do you feel you need a higher paygrade decision and in what sort of scenarios? #WeHCMs
@agclayland 25 February 2020 20:09		@evelyn_prodger I often found it helpful, proactively, and also escalated higher to Strategic pro-actively as well - that way there's no "surprises" #WeHCMs
@l_outhwaite 25 February 2020 20:10		@wehcmanagers @Helen23Wilson Sometimes it's about escalating to someone more experienced/specialised rather than someone more senior #WeHCMs
@wehcmanagers 25 February 2020 20:10		@JenJenHutton Welcome Jen! Glad you can join us #WeHCMs
@mneil02 25 February 2020 20:10		@wehcmanagers In its simplest terms, it to me means seeking help when I need it. It could mean to highlight, meaning it can be to highlight positive... in reality, it can mean everything and nothing if we see it too often... #weHCMs
@evelyn_prodger 25 February 2020 20:10		@Lyse_e @wehcmanagers I like that definition but often it is called escalation less in hours I find, often more described as an update #WeHCMs
@wehcmanagers 25 February 2020 20:11		Question Two: Have you found escalation within services helpful to resolve an issue you’re encountering, or to raise good practice? #WeHCMs https://t.co/hZYjDf78ZC
@JenJenHutton 25 February 2020 20:11		@wehcmanagers From my perspective escalation is where a situation needs to be ‘pushed up the chain’. Usually because the team is close to resource limits (time, people) or we’ve run out of ‘levers’ to address matters at our level and we need someone with more power or levers to wade in.#WeHCMs
@evelyn_prodger 25 February 2020 20:11		@l_outhwaite @wehcmanagers @Helen23Wilson Very true #WeHCMs
@Helen23Wilson 25 February 2020 20:12		@wehcmanagers Quite often for approvals in processes such as recruitment. Also if a project requires support to getting off of the ground. #WeHCMs
@evelyn_prodger 25 February 2020 20:13		@agclayland I think being on call made me generally more proactive about “just to make you aware conversation” with someone on call #WeHCMs
@wehcmanagers 25 February 2020 20:14		@Helen23Wilson That's interesting Helen, often escalation is considered in a urgent or 'crisis' situation but you are right so many times we need approval for expenditure, recruitment or to launch a new initiative. #weHCMs
@evelyn_prodger 25 February 2020 20:14		@mneil02 @wehcmanagers How do you define too often?#WeHCMs
@Helen23Wilson 25 February 2020 20:14		@wehcmanagers I do t think we always are able to learn from escalations within services ie what solved the issue, how could it be managed differently next time? #WeHCMs
@JenJenHutton 25 February 2020 20:15		@wehcmanagers Sometimes escalation is helpful but as with some many things is depends on who you escalate to. On the whole (I think) we resolve or at least mitigate most issues. I think the team I am part of are then very good at applying the learning to our on-going practise. #weHCMs
@JenJenHutton 25 February 2020 20:15		RT @wehcmanagers: Question One: How would you define escalation, and when do you experience it? #WeHCMs https://t.co/sRcEB37oxq
@mneil02 25 February 2020 20:16		@wehcmanagers Mixed bag... if it genuinely resolved an issue, great... though I do often wonder “why did I need to escalate that?” Or “what’s stopped the initial person making that decision?” #weHCMs
@wehcmanagers 25 February 2020 20:16		@JenJenHutton Great news, Jen! What do you think has made the very good at applying it? #WeHCMs
@evelyn_prodger 25 February 2020 20:16		@wehcmanagers I have always found it helpful even if it is just to talk an issue through with someone, it can be challenging out of hours if the person you are speaking to is less experienced in the area you are talking about e.g. non-clinician and a clinical issue #WeHCMs
@wehcmanagers 25 February 2020 20:16		@Helen23Wilson Such an important element of continuous learning too #WeHCMs
@Lyse_e 25 February 2020 20:17		@wehcmanagers Usually, but I'm careful I only escalate things that I really think need escalating, there is often a culture in the NHS of #escalation before resolution is tried closer to the problem! #WeHCMs
@agclayland 25 February 2020 20:17		@mneil02 @wehcmanagers Very true, Marc - however, I recall once walking into work and being asked by my boss about a serious incident that occurred but it hadn't escalated to me overnight #WeHCMs
@Emmsyjayne 25 February 2020 20:17		@wehcmanagers Definitely something that is 'above my pay scale' as it were. Making sure that someone at a higher level is taking the risk on situations that I am not best placed to take on myself. I experience this with manning levels, and most days with equipment allocation. #WeHCMs
@JenJenHutton 25 February 2020 20:17		@wehcmanagers People people people. There are some really driven and dedicated people around me that understand the benefit of improvement even if, to others, it might look trivial. The big book of process charts gets pulled out and the relevant ones amended and reshared. #WeHCMs
@wehcmanagers 25 February 2020 20:18		Question Three: What do you think are the enablers and barriers to prompt escalation? #WeHCMs https://t.co/ujbY01QxA8
@l_outhwaite 25 February 2020 20:18		@mneil02 @wehcmanagers Agreed. Sometimes it just doesn't add value & is a distraction or you end up with 'too many cooks' #WeHCMs
@wehcmanagers 25 February 2020 20:18		@Debswakefield Hi Debs. Welcome to the chat - don't forget #WeHCMs
@evelyn_prodger 25 February 2020 20:18		@wehcmanagers @Helen23Wilson Our on call reports were always reviewed locally for locality learning and then more centrally for themes which was great for learning #WeHCMs
@wehcmanagers 25 February 2020 20:18		@JenJenHutton Fantastic! Loads that could be shared then! #WeHCMs
@wehcmanagers 25 February 2020 20:19		@evelyn_prodger @Helen23Wilson This is great @evelyn_prodger - allows themes/trends to be addressed to be preventative in future #weHCMs
@julia_wilson70 25 February 2020 20:20		@mneil02 @wehcmanagers I agree Marc, sometimes by talking things through you answer issues yourself but then questioned why you escalated it. #weHCMs
@JenJenHutton 25 February 2020 20:20		@wehcmanagers It’s an ongoing and organic practise that could be missed if you weren’t looking. Vital for staying effective and efficient though. #WeHCMs
@evelyn_prodger 25 February 2020 20:21		@wehcmanagers Not understanding what to escalate and when, not wanting to disturb a tired colleague on call, fear if unsure of a supportive response, identifying an issue too late because of workload or staffing and thinking you should know what to do can all be barriers #WeHCMs
@evelyn_prodger 25 February 2020 20:21		@Lyse_e @wehcmanagers That does happen at times, part of an unhealthy culture #WeHCMs
@Debswakefield 25 February 2020 20:21		RT @wehcmanagers: Question Three: What do you think are the enablers and barriers to prompt escalation? #WeHCMs https://t.co/ujbY01QxA8
@JenJenHutton 25 February 2020 20:22		RT @wehcmanagers: Question Three: What do you think are the enablers and barriers to prompt escalation? #WeHCMs https://t.co/ujbY01QxA8
@Emmsyjayne 25 February 2020 20:22		@wehcmanagers Escalation can definitely help to resolve situations that are hitting brick walls. I regularly seek guidance by my hierarchy or the appropriate persons (while keeping my Line Mgt informed) to get a task completed or an issue resolved. #WeHCMs
@wehcmanagers 25 February 2020 20:22		@evelyn_prodger So does this need more guidance? #WeHCMs
@Lyse_e 25 February 2020 20:23		@wehcmanagers Enablers are having a clear line of escalation (knowing who and how) but also some parameters within which you can operate, and clarity on what permission you do and don't have to make decisions/commit resources etc. #WeHCMs
@JenJenHutton 25 February 2020 20:23		@evelyn_prodger @wehcmanagers It’s a whole host isn’t it @evelyn_prodger? I’d agree though. Can be really tough. Especially if it’s all ramping up quickly. #WeHCMs
@wehcmanagers 25 February 2020 20:23		Worrying about the response you will get and feeling you should be able to manage the issue yourself #WeHCMs
@mneil02 25 February 2020 20:23		@wehcmanagers Enablers... good culture, commitment to a common goal, shared understanding, and openness to learn and aid development. Barriers - banding (real or perception of decision making capacity)poor experience in the past, poor communication systems, business, other tasks #weHCMs
@wehcmanagers 25 February 2020 20:24		@Helen23Wilson That's true Helen. I wonder if trust is an important part of those working relationships? #weHCMs
@evelyn_prodger 25 February 2020 20:24		@wehcmanagers A positive experience, treating people kindly even when it is your third call and it’s 3am, constructive feedback to individuals about what was good about their escalation and what could improve it, use of a standard tool e.g. SBAR, sharing feedback can all be enablers #WeHCMs
@l_outhwaite 25 February 2020 20:24		@wehcmanagers I think there has to be a culture of support. People should feel that if they need help/advice/air cover they can escalate & colleagues will be there for them, willing & able #WeHCMs
@wehcmanagers 25 February 2020 20:24		@mneil02 Thanks Marc! How do we get to a good culture for escalation do you think? #WeHCMs #bigquestions
@Emmsyjayne 25 February 2020 20:25		@wehcmanagers Barriers are most certainly unapproachable personalities. I'm very lucky that those I work with empower me to use initiative and decide when to escalate an issue without micromanaging which really helps me to do my job #WeHCMs
@Lyse_e 25 February 2020 20:25		@wehcmanagers I also think a framework like SBAR is a great tool/enabler for escalation. I'm a massive fan of an SBAR! #WeHCMs
@wehcmanagers 25 February 2020 20:25		@Emmsyjayne Sounds like there is a lot on Culture here - perhaps something for a future TweetChat #WeHCMs
@wehcmanagers 25 February 2020 20:26		Question Four: When escalating, what are your expectations? Or, if you are a manager, what are your expectations of those escalating to you? #WeHCMs https://t.co/1mkJqPqYKW
@wehcmanagers 25 February 2020 20:26		@Lyse_e Brilliant to have a framework - everyone knows what to expect then #WeHCMs
@evelyn_prodger 25 February 2020 20:26		@wehcmanagers I think sometimes it does, every manager on call will have different thresholds and want different things so I think a standard format for escalation e.g. SBAR and training for being on call are managers #WeHCMs
@Lyse_e 25 February 2020 20:26		@evelyn_prodger @wehcmanagers Ahh we are kindred spirits with the SBAR @evelyn_prodger #WeHCMs
@evelyn_prodger 25 February 2020 20:27		@JenJenHutton @wehcmanagers Absolutely and can be compounded if the person escalating is junior or agency, human factors play a big part #WeHCMs
@julia_wilson70 25 February 2020 20:27		@wehcmanagers Needing support from a more senior person to maybe get a different perspective on a situation #WeHCMs
@evelyn_prodger 25 February 2020 20:27		@Lyse_e @wehcmanagers I really like it, gives consistency and transferable to most situations #WeHCMs
@Helen23Wilson 25 February 2020 20:28		@wehcmanagers Definitely. If you know and trust the people you need there’s definitely less persuasion or explanation required. #WeHCMs
@wehcmanagers 25 February 2020 20:28		@julia_wilson70 Does it always need to be more senior colleague? #WeHCMs
@Emmsyjayne 25 February 2020 20:28		@wehcmanagers My expectations are that they listen to all the facts I can present and make an objective and swift decision. And also to be able to request more information from me. Communication is a two way street #WeHCMs
@Helen23Wilson 25 February 2020 20:28		@wehcmanagers Options of what course of action is required. Or sometimes to show you’ve tried all available options currently open to you #WeHCMs
@l_outhwaite 25 February 2020 20:29		@wehcmanagers Having the necessary info to hand when escalating makes things easier from both sides. So a bit of thought about what that might be, otherwise it can become telephone ping-pong #WeHCMs
@evelyn_prodger 25 February 2020 20:29		@wehcmanagers I want clear information that allows me to unpick the issues or problems and be realistic about possible resolutions, helpful if staff have an understanding that being on call does not give you a magic wand #WeHCMs
@JenJenHutton 25 February 2020 20:30		@evelyn_prodger @wehcmanagers Ah! Human Factors! Those too, we are human, and therefore fallible. #WeHCMs
@agclayland 25 February 2020 20:31		@Helen23Wilson @wehcmanagers Little plug here but I wrote an article on Trust https://www.magonlinelibrary.com/doi/abs/10.12968/bjhc.2018.24.2.61 #WeHCMs
@Lyse_e 25 February 2020 20:31		@wehcmanagers If being escalated to I would want to know what the situation was, any key background, what had already been done to try and fix it, an outline of the key remaining problems and a recommendation or a clear ask...so I would like you to xxx, I need permission to xxx #WeHCMs
@evelyn_prodger 25 February 2020 20:31		@JenJenHutton @wehcmanagers And this applies whether you are escalating or being escalated to, I was never certain that my best decisions were at 3am on my 7th night on call! #WeHCMs
@evelyn_prodger 25 February 2020 20:32		@l_outhwaite @wehcmanagers You definitely need to share that! #WeHCMs
@wehcmanagers 25 February 2020 20:32		@JenJenHutton @evelyn_prodger Perhaps the need for some education on escalation and human factors #WeHCMs
@wehcmanagers 25 February 2020 20:32		@julia_wilson70 Interesting to think about escalation (to someone more senior) distinct to peer support or obtaining professional/expert advice. Good practice to do this before escalating I think! #WeHCMs
@wehcmanagers 25 February 2020 20:33		@Lyse_e Absolutely - does this fit SBAR too? #WeHCMs
@evelyn_prodger 25 February 2020 20:33		@wehcmanagers If I am escalating I want to be clear in my information giving, be sure that my concern or issue is understood and have clarity re actions #WeHCMs
@wehcmanagers 25 February 2020 20:33		@agclayland @Helen23Wilson Systems/organisations certainly move at the speed of trust @agclayland #WeHCMs
@evelyn_prodger 25 February 2020 20:34		@wehcmanagers @JenJenHutton I think this is an area that would be good to explore further #WeHCMs
@wehcmanagers 25 February 2020 20:34		@O6Jaq @Debswakefield Glad you found us Jacqueline! Never too late to join our chat #WeHCMs
@wehcmanagers 25 February 2020 20:34		@l_outhwaite So a framework approach may be an ideal option #WeHCMs
@wehcmanagers 25 February 2020 20:35		@evelyn_prodger @JenJenHutton Maybe another future TweetChat #WeHCMs
@evelyn_prodger 25 February 2020 20:35		@wehcmanagers If I am on call I want things escalated early so I have more opportunity to support, empower and work with but I know colleagues who only want to hear about issues as a last resort #WeHCMs
@wehcmanagers 25 February 2020 20:36		Question Five: When escalating is there anything you’ve found particular helpful that would benefit other organisations? #WeHCMs https://t.co/YpzPf4ARPA
@JenJenHutton 25 February 2020 20:36		@wehcmanagers ...once we have that I will approach ‘top management’ or at least the best guess desk and work it out from there. #weHCMs
@evelyn_prodger 25 February 2020 20:36		@wehcmanagers @JenJenHutton I think it could be a fascinating topic #WeHCMs
@wehcmanagers 25 February 2020 20:37		@JenJenHutton Great to see ISO vocabulary used from the Healthcare Organization Management standards #WeHCMs
@evelyn_prodger 25 February 2020 20:37		@Emmsyjayne @wehcmanagers Clear communication is so important #WeHCMs
@Lyse_e 25 February 2020 20:37		@mneil02 @wehcmanagers The most frustrating emails to receive are those which present a problem/issue but without really telling me why/what they want me to do about it. i.e. do they want my help, or are they just telling me for information....#WeHCMs
@Debswakefield 25 February 2020 20:37		@wehcmanagers I think once all facts established it's quite good to take a coaching approach, talk around the issue and see if the person escalating can come up with solutions, doesnt always work but good when it does #wehcms
@mneil02 25 February 2020 20:37		@agclayland @wehcmanagers And I’ve both done and been asked that... tone, inquisition and seeking to understand can lead to teachable moments that are invaluable... Though, appreciate that may not be everyone’s experience of those conversation #weHCMs
@evelyn_prodger 25 February 2020 20:38		@wehcmanagers We had a call Friday afternoon for all on call so potential issues e.g. staffing were discussed and potential solutions shared #WeHCMs
@JenJenHutton 25 February 2020 20:38		@wehcmanagers @evelyn_prodger Oh for sure! #weHCMs
@wehcmanagers 25 February 2020 20:38		@Debswakefield Whilst avoiding the “what do you think?” Does this just cause anger? #WeHCMs
@Lyse_e 25 February 2020 20:38		@mneil02 @wehcmanagers I much prefer it if someone is clear what they think I can do to help unblock. I suspect usually it's they think I will have access to financial resources to solve a problem they don't....#weHCMs
@agclayland 25 February 2020 20:39		@mneil02 @wehcmanagers Absolutely agree - goes back to culture again, I guess #WeHCMs
@evelyn_prodger 25 February 2020 20:40		@wehcmanagers Locally we buddied up for someone’s first week on call, a couple of us would be a shadow on call across the week so that they could check out their thinking, this made people feel safe, reduced fear, and built confidence, the magic of “what do you think you should do” #WeHCMs
@julia_wilson70 25 February 2020 20:40		@wehcmanagers New managers need to have a clear framework so they know what to provide when they make that call as I want a clear, consise summary of the situation and thoughts about potential solutions.#WeHCMs
@agclayland 25 February 2020 20:40		@evelyn_prodger @wehcmanagers Great idea! Does this work well remotely too? #WeHCMs
@wehcmanagers 25 February 2020 20:41		@julia_wilson70 Another good use of a framework like SBAR Julia. #WeHCMs
@Emmsyjayne 25 February 2020 20:41		@wehcmanagers That can be tough to answer if you don't understand the other organisations business, but then being an outsider may also be a benefit! I think clear and concise communication is something that all organisations csn benefit from #WeHCMs
@evelyn_prodger 25 February 2020 20:41		@Emmsyjayne @wehcmanagers @JenJenHutton And the positivity or negativity of the lived experience will shape future behaviours #WeHCMs
@l_outhwaite 25 February 2020 20:42		@wehcmanagers I always found handover chats & briefings from the ops teams about potential issues a helpful way to prep. People also got into the habit of talking to the person on call if something was brewing #WeHCMs
@Lyse_e 25 February 2020 20:42		@wehcmanagers Surely I can't mention SBAR again @evelyn_prodger?! #WeHCMs
@wehcmanagers 25 February 2020 20:43		@Emmsyjayne So does this go back to the need@for a framework or using a tool? #WeHCMs
@evelyn_prodger 25 February 2020 20:43		@agclayland @wehcmanagers Worked well remotely, knowing you could ring a trusted colleague seems to make a difference even if never used #WeHCMs
@wehcmanagers 25 February 2020 20:43		@l_outhwaite Forewarned is forearmed! #WeHCMs
@wehcmanagers 25 February 2020 20:43		@l_outhwaite We’re these structured or ad hoc? #WeHCMs
@wehcmanagers 25 February 2020 20:44		FINAL QUESTION Question Six: If you could change escalation processes, what would be the one thing you’d do? #WeHCMs https://t.co/N45XlJ639Q
@evelyn_prodger 25 February 2020 20:44		@Lyse_e @wehcmanagers Was thinking the same thing ?? #WeHCMs
@Emmsyjayne 25 February 2020 20:45		@evelyn_prodger @wehcmanagers @JenJenHutton This also opens up the discussion of whether having a negative experience is necessarily a bad thing? I have had to take a one way conversation before for not playing by the rules (that I was never taught ??) but I used that experience to develop my skills. #WeHCMs
@Lyse_e 25 February 2020 20:45		@wehcmanagers I would never want to stop anyone asking for help, but I would ask that people stop and think to be really clear about what it is they want as resolution/help and make a recommendation/suggestion. Usually those closer to the problem have the solution! #WeHCMs
@JenJenHutton 25 February 2020 20:45		@wehcmanagers Good communication is at the heart of good (or less good) escalation & outcomes. That’s a universal regardless of organisation or sector. @Emmsyjayne presents a good point: what works for us might not work for others. But it MIGHT. Not sure how THAT can be shared... #weHCMs
@evelyn_prodger 25 February 2020 20:46		@wehcmanagers I think the key is communication so.....back to SBAR @Lyse_e but I do also think training is important on using SBAR in this situation #WeHCMs
@evelyn_prodger 25 February 2020 20:47		@Emmsyjayne @wehcmanagers @JenJenHutton It depends whether it ends in learning, fear of getting it wrong or overescalating to avoid blame or avoiding escalating at all, back to human factors and you as an individual #WeHCMs
@l_outhwaite 25 February 2020 20:47		@wehcmanagers Not structured. Just something most did out of habit & experience, then passed on as good practice #WeHCMs
@Emmsyjayne 25 February 2020 20:48		@wehcmanagers Frameworks are all well and good, but IMO there is no one framework fits all. Even in my working environment our one CAF doesn't fit our side of business, and that is one organisation. #WeHCMs
@wehcmanagers 25 February 2020 20:48		@l_outhwaite Perfect! Ideal to let things evolve and develop rather than a rigid process #WeHCMs
@wehcmanagers 25 February 2020 20:48		@Emmsyjayne Great - so something evolutionary that works rather than being rigid approach that fails #WeHCMs
@evelyn_prodger 25 February 2020 20:49		@Lyse_e @wehcmanagers So true #WeHCMs
@JenJenHutton 25 February 2020 20:49		@evelyn_prodger @wehcmanagers Similarly I hold a team meeting early in the week to look two weeks (or so) out. Once a month we will look 2 months out. But then something like COVID-19 pops up! Best laid plans and communications... #weHCMs
@Emmsyjayne 25 February 2020 20:49		@evelyn_prodger @wehcmanagers @JenJenHutton Precisely, and you can never predict which outcome it will be until it has been lived. #WeHCMs
@wehcmanagers 25 February 2020 20:49		@evelyn_prodger @Emmsyjayne @JenJenHutton Culture makes such a difference here doesn't it? Fear of blame vs asking for help are two very different reasons for #escalation #WeHCMs
@evelyn_prodger 25 February 2020 20:49		@Emmsyjayne @wehcmanagers @JenJenHutton The joy of working with people #WeHCMs
@Lyse_e 25 February 2020 20:50		@JenJenHutton @evelyn_prodger @wehcmanagers I have a weekly huddle with my ops team and we are now pretty close to cascading this up and down the organisation to the front line teams. Allows for timely escalation of issues #WeHCMs
@evelyn_prodger 25 February 2020 20:50		@JenJenHutton @wehcmanagers At least being prepared for the routine stuff leaves more capacity for the out of the blue issues #WeHCMs
@Lyse_e 25 February 2020 20:51		@JenJenHutton @evelyn_prodger @wehcmanagers It's also a virtual huddle via skype so doesn't rely on everyone being in the same place - useful for multiple sites or community providers. We document it using a shared OneNote file #WeHCMs
@evelyn_prodger 25 February 2020 20:51		@wehcmanagers @Emmsyjayne @JenJenHutton So true, the unspoken rules of team and locality cultures can be powerful both positively and negatively #WeHCMs
@JenJenHutton 25 February 2020 20:51		@wehcmanagers @evelyn_prodger @Emmsyjayne And fascinatingly (sort of) it amazing how quickly it can be eroded. But is so hard to build. #WeHCMs
@evelyn_prodger 25 February 2020 20:52		@Lyse_e @JenJenHutton @wehcmanagers Love this #WeHCMs
@mynameisAndyJ 25 February 2020 20:52		RT @wehcmanagers: FINAL QUESTION Question Six: If you could change escalation processes, what would be the one thing you’d do? #WeHCMs…
@l_outhwaite 25 February 2020 20:52		@wehcmanagers As has been highlighted during our chat, I'd want to see escalation processes focus more on the human factor: comms, relationships, being supportive, building people's confidence, opportunities for reflection & learning #WeHCMs
@mynameisAndyJ 25 February 2020 20:53		Sorry joining very late been working on a revised meal offering for patients #WeHCMs
@JenJenHutton 25 February 2020 20:53		@evelyn_prodger @wehcmanagers Oh! Good view point. I hadn’t thought of it that way! Thank you very much. I’ll pocket that for the future if you don’t mind? #WeHCMs
@mynameisAndyJ 25 February 2020 20:53		Love these chats #WeHCMs
@Emmsyjayne 25 February 2020 20:53		@wehcmanagers Flexibility! That is essential in my line of work. Compromisation and flexibility that doesn't negatively affect the output of your organisation. Rules and frameworks are there for a reason but without flexibility you achieve nothing of worth IMO. #WeHCMs
@evelyn_prodger 25 February 2020 20:54		@Lyse_e @JenJenHutton @wehcmanagers In the hospice we have a daily SITREP meeting, 15 minutes of productive sharing of information and planning activity, also makes staff feel empiwered and part of decision making #WeHCMs
@wehcmanagers 25 February 2020 20:54		@mynameisAndyJ No worries - thanks for joining us! #WeHCMs
@wehcmanagers 25 February 2020 20:54		@l_outhwaite It's interesting that a topic that could be about structures and processes comes back to relationships, culture and human factors. #WeHCMs.
@evelyn_prodger 25 February 2020 20:54		@JenJenHutton @wehcmanagers You are welcome #WeHCMs
@JenJenHutton 25 February 2020 20:55		RT @wehcmanagers: FINAL QUESTION Question Six: If you could change escalation processes, what would be the one thing you’d do? #WeHCMs…
@evelyn_prodger 25 February 2020 20:55		@mynameisAndyJ Glad you could join #WeHCMs
@JenJenHutton 25 February 2020 20:56		Pretty much this! #weHCMs https://twitter.com/l_outhwaite/status/1232408158687170561
@Emmsyjayne 25 February 2020 20:56		@wehcmanagers @evelyn_prodger @JenJenHutton Having worked in both cultures... one of support and one of fear of speaking out I can hand on heart say it affects team dynamics hugely. It also brings into discussion the mental health affects on personnel who feel they are unable to freely share with their colleagues #WeHCMs
@mynameisAndyJ 25 February 2020 20:58		A6 - ensure that the culture is set when setting up. Openness and all ideas are good ideas approach - patient and work backwards is the only rule that should be set - that way you improve culture and openness = Moral rise = staff retention #WeHCMs
@evelyn_prodger 25 February 2020 20:59		@Emmsyjayne @wehcmanagers @JenJenHutton There is also something about the impact of being on call on individuals, how do you manage debrief? #WeHCMs
@Emmsyjayne 25 February 2020 20:59		@wehcmanagers @evelyn_prodger @JenJenHutton I am a huge advocate for stress management, resilience and mental health awareness. It is sad that others fail to even consider the effects on their team/colleagues. #WeHCMs
@wehcmanagers 25 February 2020 20:59		@Emmsyjayne @evelyn_prodger @JenJenHutton You are right. The work of @WestM61 and experiences and learning from @orangedis would support this. #weHCMs
@wehcmanagers 25 February 2020 21:00		Thanks for joining us this evening! We hope you enjoyed the tweetchat as much as we did! Don't forget you can go to http://www.wecommunities.org and see the entire chat as well as complete a CPD log for your portfolios! Check out January's tweetchat too #WeHCMs

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