How we reduced our sonographer vacancy rate from 53 to two per cent
Suzanne Beattie-Jones faced big challenges when she joined the maternity ultrasound service in 2015. As ultrasound services manager, she inherited a team where there was both high turnover and low morale. By introducing flexible working patterns, an audit programme and new training opportunities for her team, Suzanne helped bring down the vacancy rate from 53 to just two per cent.
Sonographers are highly trained specialists. Before embarking on a one to three year sonography training course, most will have become radiographers, nurses or midwives, meaning the overall training programme can take up six years. A national shortage of sonographers compounds this challenge, making it difficult to adequately staff each unit.
It’s also a specialty that requires scrupulous attention to detail. In each pregnancy scan, a sonographer has minutes to conduct a thorough clinical assessment via ultrasound. The sonographer must identify and track hundreds of data points to assess the health of a pregnant woman and her growing baby, all while preparing to explain their assessment to their patients, which could mean delivering good or bad news. Each sonographer must engage their technical skills, clinical knowledge, time management skills and emotions simultaneously to have a successful appointment with a patient. Ultrasound pictures on social media make it easy to think this is little more than a photoshoot, but a sonogram is a complex clinical examination that requires intense concentration.
The job can be emotionally trying, too. While most scans show the baby developing normally, some can uncover abnormalities or even the loss of a pregnancy. When sonographers are doing over a dozen scans a day, they don’t know what to expect, and they have to prepare themselves for any eventuality. It is an especially difficult part of the job, particularly because sonographers work in isolation, so they don’t have much time between patients to gather their thoughts, reflect on their work or commiserate with colleagues.
Improving our practise
I wanted to create a better experience for sonographers at the Trust and improve the experience our patients have when they come for their scan. Getting people to buy into my vision for change wasn’t easy. As a new boss what right did I have to say: “Something is broken, and you need to trust me to fix it?” I needed to establish foundations that we could build on, earn the confidence of the team and sell my dream of efficiency and excellence.
It was clear that our sonographers felt like they were on a treadmill with little to no opportunity, and they aspired to do and learn more. Our colleagues in fetal medicine and gynaecology were keen to support our sonographers, so together we developed a rotation programme for our teams. Our sonographers rotate into fetal medicine or gynae to learn more about conditions affecting fetal development or loss. In turn, trainees in fetal medicine or gynae spend time with us to develop their scanning skills. Through this approach, everyone has a chance to gain a greater understanding of the context of the work we do – how we monitor fetal development, what some of the challenges are and how we support women through their pregnancies. It's a wonderful example of collaborative working across our service.
We introduced a ‘purple card’ we’ve added to each patient’s notes as an extra reminder of what scans they will need, as we found some women were being incorrectly referred for too many scans, while others weren’t getting enough. This has helped staff ensure we’re making the right referrals, and helps empower our patients to keep us on track.
We also introduced regular audits, which give staff the opportunity to review their work, reflect and improve. Initially it was challenging to ask staff to critique their work. We ran team sessions and created our own scoring system – at first we found the national tools difficult to work with and at times, demoralising. I believe no comment is a bad comment and all are equally valid – I encouraged the team to adopt this approach and together, we learned to trust each other. As our sonographers became more confident, we raised the standards of our audit criteria. I’m pleased to say that we’ve fully embedded audits in our department and we can clearly demonstrate we are achieving a high standard of care against local and national audit criteria.
Increasing flexibility and boosting morale
We also made a few changes to the way we schedule scans to ensure each sonographer has more variety throughout their day. Where previously one sonographer might spend all day doing 12-week scans, which risks repetitive strain injuries, we changed the way we book and set appointments so each sonographer performs a variety of scans each day. In addition, we’re updating the records system we use and expect that this will help improve the booking process and communication with our patients.
We also standardised our appointment times, so each scan appointment now has a 30-minute slot. This allows us to offer flexible working options to our sonographers, while also extending our scanning hours. It also allows more flexibility for each scanning appointment – some appointments are quick, but others require more time. We may find that some babies aren’t in the right position for sonographers to perform an adequate scan, so sonographers may send patients to go for a walk or have a hot drink, and return later to try again. It also gives sonographers more time with patients who have received unexpected results and need more support. Finally, it allows sonographers a few moments to reflect on each scan appointment and prepare for the next one.
We also spent a lot of time assessing our equipment, reporting damaged or broken items for replacement and making the case for investment in better equipment for our service. In addition, we’ve made an investment in staff wellbeing. The Trust’s learning and development team ran an ‘In Our Shoes’ session for our team, where we talked about what each of us felt made a great work environment and a great day. We learned a lot about what’s important to us as a team, and what we can do to improve the way we work together. We’ve since held more celebratory events where staff can connect and relax, such as garden parties, which have also improved morale.
Building on our success
Since 2015, we’ve managed to take our vacancy rate from 53 per cent to just two per cent, a fact of which I am immensely proud. We’ve also managed to lower our sickness rates and turnover rates. There is still a national shortage of sonographers and the work remains challenging, both physically and emotionally. But I’m confident that the improvements we’ve worked so hard to make have helped us build a strong foundation. I’m so proud of what we’ve achieved together.