Nurses in Barcelona adopt the culture of dialogue to define their professional future

5 Apr
Glòria Novel and Núria Cuxart

Asking ourselves questions, reformulating questions, rethinking the way we want to be, what we need and how we want society to know and see us. This is, without doubt, a difficult exercise to carry out as individuals but it is even more difficult to do this as a profession.

Agreeing with each other is by no means easy. Training, method and a desire to do so is needed. Having these premises clear, we initiated the RESET project at the Official College of nurses of Barcelona (COIB).

Guided by the company Diàlegs, specialised in mediation in health, we initiated an unprecedented process of participation in the nursing profession during which we went out into the territory to find out what the concerns, needs, wishes, complaints and proposals of nurses in the province of Barcelona were.

The process lasted the whole of 2017, after which our corporation was given the commission to develop the strategic lines on which the college members of Barcelona want us to work along with thousands of ideas that they would like to process.

The difficulty of the project was considerable. Apart from the geographical distances that existed and the difficulties in getting nurses involved, there was the added difficulty of coming up with a dynamic that had to be participative so as to facilitate environments of conversation, discussion and consensus among the hundreds of female and male nurses who have different professional realities and therefore varying priorities.

The Diàlegs company took on the challenge of making it possible by means of a process lasting 12 months during which participative methodologies were used to define the profession as it is today and that of the desired future. The framework for the project was based on the principles, values and methodologies of mediation, which led to a broad and necessarily inclusive view of the differences and susceptibilities of the nursing community.

The RESET project was carried out in three different stages: in the first stage, open debates were set up in circles of group discussion. The circles enabled a comprehensive collection of very valuable data which formed the basis on which to develop the following stages that consisted of two days of consensus: one to agree on the diagnosis of the situation the profession finds itself in now and another to define the future, with the aims and lines of action to be developed.

As a result of these three stages of the RESET project, 52 group discussion circles with 925 participants were set up, that is, with people who participated one or more times. 3,762 ideas were collected as well as some proposals for the future, with nine thematic areas and 65 lines of action decided on by agreement. The level of satisfaction was very high and the participants showed a high level of interest in continuing in the project, repeating participations in the three stages.

It must be said that the key to the success of the process was the large number of people that committed themselves to the project right from the start. We are referring to what we called the Driving Group made up of 208 people (with representatives from all over the territory, all positions and susceptibilities) who worked from the start both in the co-design of specific aspects as well as in the diffusion, organisation of group discussion circles and participation in the events for consensus.

Beyond the results of the RESET project, which are, in the end, a commitment to change with implications for the upcoming years, we still have much to learn and this can no doubt be extrapolated to the professional disciplines in health in which we are organised through colleges. We need to continue asking ourselves questions both in and out of the college organisations to positively drive change and development in all the aspects which bring us together as professionals. Continuity in the culture of dialogue is one of the most important challenges that came out of this fascinating process. This was the message that the nurses who worked in the Reset Project gave us. Therefore, from the COIB, this is our commitment.

Post written by Núria Cuxart Ainaud, director of programmes at the COIB, and Glòria Novel Martí, founding director of Diàlegs.

Real Time Delphi relating to chronicity

2 Jun
Monguet JM 2015
Josep Maria Monguet

The Real Time Delphi method, which implements the functionality of the Internet to make the Delphi Method more flexible, efficient and transparent, has been used by the Agency for Health Quality and Assessment of Catalonia (AQuAS as per the Catalan synonym) to identify the indicators for evaluating chronicity care and for the management of the areas of improvement in this field.

¿What is the Delphi method? It is a structured communication technique which is based on a panel of experts who answers questionnaires in two or more rounds. After each round, a facilitator provides a summary of what the experts have said in the previous round. Successive rounds are intended to reach a consensus on the subject. The Delphi method is applied to make predictions about the future and, in general, for any issue when a scientific approach is not possible. When the Delphi method is online (Real Time Delphi) the responses of the participants are calculated automatically and many variants of the method can be entered in a controlled way.

Health Consensus

The Health Consensus application that facilitates the participation of professionals through a methodology of online consensus developed by the company Onsanity from research done at the Universitat Politècnica de Catalunya (UPC) in Barcelona was used to identify the most appropriate indicators.

The work was carried out in the years 2013-2014, the first prototype of the system was applied twice, first in Catalonia, and a second version in the context of all the Spanish health system. The Health Consensus application for the selection of indicators allowed for the collecting of contributions from more than 800 health professionals, including clinical profiles of management and planning. An initial list of 215 indicators was progressively reduced through successive rounds of consensus until it was reduced to 18.

Not only did this experience allow the the identification of indicators, but it also showed various aspects that are interesting for research  and innovation:

  1. It is possible to pool the tacit knowledge of a fairly large group of professionals, putting together experiences and different points of view.
  2. The professionals underscore their perception that the contributions that are made, are highly valuable in the construction of the model subjected to consensus.
  3. The online system is accepted by the professionals who expressed a high satisfaction level during the participation process.

The experience was published: Monguet JM, Trejo A, Martí T, Espallargues M, Serra-Sutton V, Escarrabill J. Assessment of chronic health care through and Internet consensus tool. IGI Global; 2015.

Post written by Josep Mª Monguet (@JM_Monguet), UPC Professor.