We’ve all had days that have left a mark, whether it be a routine operation that became an emergency, an upset client in the waiting room or an extended shift that drained us to the core.

Then you have those times when a patient was saved against the odds, leaving us buzzing when we should have been winding down.

All’s well that ends well

Whatever a shift has been like, how we finish it can make all the difference to how we feel about it – and as a result, how the shift affects us both as individuals and as a team.

Unsurprisingly, if we bottle up something that’s happened, the only outlet for our feelings is in our heads. Mentally replaying events can wear us down and wear us out, leading to worry and fatigue that threaten to derail our performance in the days that follow.

Research has shown, however, that facing up to problems that have occurred during an emergency situation, with the support of colleagues and employers, is associated with post-traumatic growth, while avoidance of difficult experiences is associated with greater psychological distress¹. If we acknowledge in the moment the events that have taken place – especially tough ones – we are more likely to put some distance between them and whatever we are going on to do next.

We go home with a calmer mind, better able to rest fully and, consequently, better able to face the challenges the next shift may bring.

Start as we mean to go on

Equally, it’s worth pausing to consciously start a shift well – even when we can see a jam-packed day stretching ahead of us.

Instead of being swept into the day’s business, making a little time to embark on a shift mindfully can set us off on a sure footing. When we show interest in our colleagues’ well-being and rally around a shared commitment, we demonstrate respect for our team, strengthen our relationships and give our energy levels a boost – all of which can pay back in spades in the course of a demanding shift.

It’s also an especially valuable way to break the ice and build bridges quickly when new or locum colleagues are in the mix.

In human health, the Royal College of Obstetricians and Gynaecologists, and the Royal College of Midwives, have a similar set of five questions known as Team of the Shift, designed to be used at the start of shifts. It was developed as part of a project to improve maternity care by focusing on the working practices of the multidisciplinary maternity team.

According to health care professionals in 16 units across the UK who trialled Team of the Shift, it helped to create psychological safety and avoid confusion – both of which led to improved safety. It made clinical escalation more efficient, and positively impacted on the team during times of high workload and low morale. It empowered junior team members and built trust, respect and a sense of unity across the team. Importantly, it was found to be easy to implement and sustain.

Team of the Shift is now promoted and used increasingly widely in the UK².

Rolling Take Five

The Rolling Take Five is a set of five questions for the veterinary professions that provides a structure for checking in with ourselves and our colleagues in this way – and it can have a profound effect. It helps to create a system where people don’t feel alone or worry on their own.

What’s more, it fosters a sense of being “in it together”, which provides a strong basis for figuring out robust solutions to issues.

Investing a few minutes to “take five” can improve communication between shift teams, pinpoint areas for improvement, highlight processes that have worked well, identify support the team need and help build team spirit.

When we encourage our team to articulate what’s taken place and how we’re feeling as a result, we create an opportunity to get concerns or ideas off our chest. By airing what’s on our minds and agreeing tangible actions, we give ourselves the best chance of working effectively as a team and of performing at our best during the shift ahead – or, conversely, of shutting down properly for the day, in order to rest and recharge in preparation for our next shift.

A tool for Quality Improvement

As such, the Rolling Take Five is an effective tool for Quality Improvement (QI) – a systematic and coordinated approach to solving problems using specific methods and tools to bring about measurable improvements.

It also reinforces psychological safety (itself an important element of QI): the feeling that we can ask questions, voice concerns, raise ideas for improvement and speak up about potential or past errors without fear of retribution (see “Top three factors of joy at work – why and how to gain them” in VT53.03 for more on psychological safety).

The Rolling Take Five was developed by patient safety specialist Suzette Woodward, and has been adapted for the veterinary sector by RCVS Knowledge.

It has its roots in the NHS’ “Going Home Checklist”³, which was developed to support health professionals’ well-being at the end of the working day. The checklist encourages reflection, mindfulness and gratitude, which in turn help to create space between work and home, and is increasingly used in the NHS.

An opportunity to learn

The Rolling Take Five has an explicit learning angle, with an emphasis on communication and action. These aspects are designed to help veterinary professionals maximise the insights that can be gained from a shift, and then decompress ready for home. It reminds us to check in on our colleagues and their experiences of the shift – and in this way it helps build a shared understanding of all the moving pieces inherent to delivering excellent care holistically⁴.

Furthermore, it prompts suggestions for improvements that may thread through different areas of responsibility and enhance cohesive working.

Capturing experiences and learnings in the moment is particularly important when temporary colleagues are on a shift, as that particular combination of people may not come together again.

The Rolling Take Five can easily be adapted for use at the start of a shift, when it serves to identify any potential patient safety concerns, strengthen continuity with the previous shift, and underscore a supportive, learning culture.

Questions

The questions are as follows:

1.  “How is everyone today?” A deceptively simple question, this demonstrates a respect for our colleagues and their lives outside work. Honest answers can quickly shine a light on factors that might affect how our team performs that day, or the impact that the day’s events might have.
2. “What did we learn today that will be useful for the next shift to know about?” This invites team members to express items on their mental memo, helping to ease cognitive overload. It enables a range of information from different perspectives to be captured and shared across the team. It allows colleagues to offload anything that might be preying on their minds, and so helps to prevent incidents from snowballing psychologically and affecting team members counterproductively. The choice of words encourages the team to consider difficult events as learning experiences and, therefore, to view them in a constructive light.
3. “What did we learn today that we will take forward for tomorrow?” Articulating and agreeing actions helps the team to find positives in challenging events. It also provides reassurance that practical measures will be taken in an effort to make undesirable events less likely to recur. Equally, this question encourages teams to consider and capture factors that contributed to particularly successful outcomes.
4. “What do we need to escalate for further support in the future?” This encourages proactive communication between teams and management. It deepens understanding of work on the frontline of care, reinforcing relationships across the practice.
5. “What do we need to share more widely than our team?” This helps maintain good communication and teamwork throughout the practice (and beyond, in the case of a practice group), potentially ultimately leading to changes in practice.

Five questions, numerous benefits

These five short questions therefore serve numerous purposes, including acting as a memory aid, discussion prompt, learning opportunity and QI tool.

They reinforce psychological safety, promote communication with management and strengthen team spirit. But perhaps most importantly, they are balm to soothe troubled or overactive minds.

No wonder, then, that this kind of checklist has been made into large posters displayed in staff rooms, lifts and entrances in human health settings, to ensure they are noticed when people are caught up in the heat of finishing work. The Rolling Take Five takes a few minutes out of the day – but it’s a small price to pay for great camaraderie, a light heart and a sound night’s sleep.

Useful free resources

• Rolling Take Five – questions to discuss as a team – bit.ly/rolling-take-5
• Podcast: Patient safety and lessons from human healthcare – bit.ly/PatientSafetyPod
• Features on the importance of team culture – rcvsknowledge.org/QIfeatures
• Free CPD – Getting started with QI – qiboxset.org

“By taking this time, we were able to form a new idea in relation to our triaging process, as well as how we manage our inpatients. This will be discussed with our team for future shifts. The shift had been a difficult one, but taking a moment to reflect allowed us to learn and potentially change future shifts, to benefit not only our patients, but also our team. I left the shift feeling much more positive about our achievements and more bonded as a team.”

Rachael Bacon RVN