InterventionsPositive psychology techniques asking staff to note down reflections with results presented as tables or word clouds at handover meetings• Reflection on why we have done well• What we do well as a team• ‘3 Good things’ –3 positives experiences from the last working shift, done for 4 days and repeated over the year (Seligman 2005). Written down on a card and collated

BackgroundEmergency medicine clinicians thrive in clinically challenging environments but external problems, beyond the control of the department make the job difficult. There is a tendency for staff to receive feedback about problems. In the UK there are immense pressures to achieve the 4 hour access target. It is a challenge to keep the team positive while experiencing periods of quite public ‘target failure’. The aim is to use techniques of positive psychology in a large ED where pressure and stress is commonplace and managing patient safety can be challenging

Secondary interventions

Sharing positive feedback• Thank you cards and Friends and Family board• Patient survey comments• Social media feedback Staff specific• Employee of the month• Encouragement of Social investment – staffs raising money for charities via cake sales or sporting challenges

DiscussionThe reflections sessions are very quick – they take place during our departmental morning handover and we were able to show staff that the things that made them feel they had had a good shift were simple – a smile, a colleague feeding them chocolate at a low moment, a satisfying patient interaction, a tidy clean environment, getting a break on time. Getting positive feedback from patients is very powerful for staff morale. We are managing to maintain a highly functional team despite significant pressures.

Conclusion & perspectivesThere is now a feeling of ‘we know we can survive and succeed’ but it is fragile. There has been a lower level of complaints and a significant number of compliments given to the department resulting in a virtuous circle of feedback. A lot of process change was done before these interventions started but staff resilience in the face of severe pressures in an ED is more likely if they are happy than by making them shave minutes of a process. We are looking at how to improve resilience and maintain the ability to keep improving patient care.

Happiness- The secret ingredient to excellent performance and improved patient safety? Dr Katherine Henderson, Mr Chris Mitchell, Guys & St Thomas NHS Foundation Trust London (UK)

The belief underlying this is that happy staff care about their patients without being told to ‘show compassion’, they go the extra mile for their colleagues because that is what makes a good working environment. The objective is to maximise patient safety and good care through having a happy confident team rather than multiple patient safety memos reacting to eventsContact Dr Katherine Henderson katherine.henderson@gstt.nhs.uk

Team investment• Celebrating success- Trust funded tea party for making 6 months of the ‘target’, lots of cakes, visits from Trust senior management. ‘Whoops’ for good performance or great feedback at handover• Social events – Christmas party, summer party- Senior staff participation!