Learning from The Well

The Well is an extraordinary community of people. I respect them deeply and learn so much from every time I have the privilege of being with them, listening to their stories. They are all people on the journey of recovery from drug and/or alcohol addiction. They are welcoming, non-judgmental, caring, embracing and kind. Most importantly of all, they offer hope that no matter how far into hell you have been, there is a way out and no matter how badly you have messed up, you are lovable and worthy of a new chance. There are countless stories of those who have gone before, through the “12 steps”, and found transformational grace and and the chance of a new life. The support they give to each other, especially at times of trouble is based on openness, honesty, trust and a genuine love for each other that holds through difficult battles for a better future.  Every story I have heard has humbled me, and each time I am with them, I go away changed and filled with fresh hope. I am so grateful that I can now count several members of the community as my friends. I feel we, as the medical community have much to learn from them.

 

 

After my last meeting with The Well community, which was in Barrow In Furness, I then spent some time with an excellent Diabetologist, Cathy hay, who is employed by Cumbria Partnership Foundation Trust, but works at Furness General Hospital (another example of how we are breaking down boundaries and working more effectively as part of Better Care Together). I was learning from Cathy about how she and her amazing team are transforming how they care for and work with people who have diabetes. Like me, she believes that hierarchical behaviour gets in the way of building good relationships across teams, playing to each other’s strengths and working effectively with patients. She has worked hard to break down the ‘need’ for consultant follow-up clinics, putting the power back into patients hands. They have had a much more proactive approach at working with patients to really educate them and empower them about their own conditions through the fabulous work of the Diabetes specialist Nurses and Dietitians and a team of Psychologists, lead by Elspeth Desert, who help patients learn how to face up to and cope with physical health issues.

 

Group programmes (such as DESMOND, DAFNE or the X-PERT courses) enable patients to build supportive relationships with one another and networks form in which patients are rightly able to become the experts in their own conditions, supported by a team of people who they can draw on, as and when needed – determined by the person with the condition. This cuts the need for outpatient appointments drastically and releases the team to work far more effectively. The ‘Walk Away from Diabetes’ programme encourages those with the earliest warning signs to try and avoid lifelong medication altogether through exercise, dietary changes and accountability with one another.

 

In some ways, the approach is similar to what I have experienced of The Well and it got me thinking about just how transferable this approach could be across health services, in an extremely timely and cost effective way…..(which although sounds potentially a little mercenary is actually really important – we do actually have a responsibility to use the resources we have as well as we can, and our previous models are no longer deliverable, given our financial and staffing pressures, let alone the increased numbers of people accessing services). What if, once people are diagnosed with a long-term condition, we give them the option of a self-directed, learning approach to their condition, in the context of community with others and a supportive network around them? We could save an inordinate number of unnecessary outpatient appointments. It puts people back in charge of their own bodies and conditions, far more empowered to make informed choices and enables care to be available in a more efficient, cost effective and timely manner. Communities of people, facing up to their conditions together, learning together, helping each other, supporting and resourcing each other and finding improved health and wellbeing at every level as a result.

 

Many people across the UK have at least one long term condition. Many of these people also struggle with a mental health problem at the same time, often linked to the condition they live with. A more cooperative approach can break down some of the barriers and enable people to connect, which will improve both their physical and mental health at the same time.

 

We are beginning to see an exciting redesign of our respiratory services along these lines, lead by Pat Haslam, Farhan Amin, Tim Gatherall, Shahedal Bari and the team……I wonder how brave we can be across the board and how much better our care might be together if we did?

 

 

 

 

 

 

 

 

 

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Creating a Culture of Joy in the NHS

A Culture of Joy is the biggest determinant of safe and high quality healthcare! That is such a phenomenal statement that it is worth reading over and over again, making it into a poster, sticking it on your wall and meditating on it morning and night. It feels to be simultaneously absolutely true and somehow beyond belief. I’ve previously blogged here about the need for a culture of kindness in the NHS, and I hold to that – kindness certainly doesn’t exclude joy (!), but a Culture of Joy….. I don’t know, in a day in which 50% of our staff admit to feeling burnt out, can we honestly say we have developed this throughout our health system in the UK? So, what does it take to build this? How do we have a joyful workplace? If it is really the single largest factor affecting patient safety, which research from The Mayo Clinic, The IHI and The Quality Forum tell us it is, then we better sit up, pay attention and do something about it!

 

There are 3 key ingredients to creating a culture of Joy.  The first (and this is in no sense a hierarchical order!) is leadership, the second is how
teams actually function together and the third is personal responsibility. You will see the words incorporated from the ‘culture circle’ in bold!

 

Good Leadership: Here’s a fascinating fact, I learnt from Stephen Swensen, of The Mayo Clinic – The bigger the signature of a CEO, the worse the outcomes for patients, staff and the finances of the organisation!! CEOs are responsible for setting the structures in place that allow healthy cultures to develop. Leaders create a culture of joy by having humility and developing 5 key behaviours:

 

  1. Appreciation – good leaders build joy in their teams by saying ‘Thank You’ – it is one of the things the team at my surgery consistently tells us, as partners. Of course we are grateful, but we don’t say it enough. Every member of a team knowing that they have value is so vital. I remember, as a house officer on a medical ward watching a lady called Jean, cleaning the ward and saying hello to all the patients. I went up to her and said, “Jean, I just want to thank you for everything you do on this ward, every day. The way you keep this place clean helps fight off infections and keeps people well; and the smile and kindness you bring is really comforting to people who are scared or hurting.” To my great surprise, she burst out crying. I asked her what was wrong and she told me that she had worked on this ward for 25 years and no-one had ever said ‘Thank You’ to her. My favourite hashtag on twitter is trybeinggrateful – it costs so little.
  2. Transparency – good leaders communicate openly with their teams. They don’t do ‘special huddles’ in which they invite a few ‘high level’ people to know their secrets. No. They communicate with honesty and openness and this builds trust. And with trust they are able to negotiate difficult situations and requests of their teams, because there is a belief that everyone is in it together.
  3. Ideas – They look to their teams for ideas. One of the things I loved learning about recently is that the CEO of Toyota in Derby, deliberately does not park his car in the special ‘CEO parking space’ right next to the building. Instead, he parks it at the far end of the factory, so that the walk to his office takes him through every department, (a good 30 minutes of his time), so he he can say “hi” to his staff, connect with them and ensure that he is hearing about their ideas for innovation and improvement. Toyota takes 2.5 million suggestions from its staff every year. This simply doesn’t happen enough in the NHS, and I wonder how many CEOs take time at the start of the day, to walk the corridors, listen to patient stories, understand the pressures in the ED, hear the heartbeat of the wards and get a sense of the ideas brewing in some of the most compassionate, caring and intelligent staff of any organisation in the UK. If we are to transform the NHS into a system that is truly safe, sustainable and excellent, we must listen more to the ideas of our teams and in doing so, we will cut waste, undo the reems of red tape and instead find we are working far more effectively and efficiently. To embed this into the culture, there must be psychological safety – that means that no question is too stupid, no idea is too dumb and it is safe to bring to attention concerns a person may have, without a fear of retribution. One great question for leaders to ask is, “what are the pebbles in your shoes?’ – in other words, what matters to you? Or what are the barriers for you here? What’s getting in the way? Great CEOs do not have great answers, they are willing to work with complexity and have great questions!
  4. Career Mentorship – every person needs to be able to keep learning and develop in their role. We all need mentors or coaches at different stages in our careers, and ensuring these structures are in place to support staff as the complexity and pressure we deal with increase, is vital in building joy. People who are developing in their role are naturally safer in their role.
  5. Inclusiveness – To a good leader, it doesn’t matter who you are, what you look like, what you believe, what your sexual orientation or status might be. You need to know that you are welcome and you are loved just as you are. Inclusive teams that do not scapegoat, do not sideline and do not bully are joyful teams. Joyful teams celebrate difference and thrive off it.

 

Joyful Teams:  It’s really important to understand that joy does not mean false happiness. It does not mean that we walk around with fake smiles on our faces all the time and pretend that everything is ok. Joy is much deeper than that. We deal with very sad and difficult things in our workplaces every single day. We break bad news, we hold people as they take their final breaths, we watch people make terrible life choices, we see and carry the hurt of those who suffer loss and each of us has our own burdens we carry from the lives we live outside of work. Joyful teams do not pretend like that stuff isn’t happening every day – quite the opposite. Joyful teams develop three key qualities:

  1. Camaraderie. The high school musical song – ‘We’re all in this together’ is a great theme tune for NHS teams. People need to know that they belong, that they are loved and that people care about them. On good days, we celebrate together, on bad days, we pull together. Joyful teams develop encouragement, support and kindness in how they treat each other.
  2. Purpose. Joyful teams have a real sense of shared vision and purpose. They know what they are there to do and each person knows that they are valued in that team. The posh term for this is a sense of corporate agency. This is our job to do, we are responsible for what happens here and we want to do our work with excellence. 
  3. Trust. It is really important that individuals feel trusted to do their job without feeling like they are always being watched or criticised or that they have to give an account for every action. When people feel trusted, they actually work more effectively and produce better outcomes.

 

Personal Responsibility: in order to create a culture of joy, it is not just the responsibility of the CEO or team leader, nor the atmosphere created by the team as a whole – we each have a responsibility to steward and hold to this culture. And that means taking care of our own needs. We need to be active, eat well, take notice, be mindful, sleep well, forgive those who hurt us and have good friendships. Making sure that we ‘host ourselves’ well, ensures that we play our part in building the culture of joy that is so vital to the providing care that is of the highest quality and safety. There is a personal accountability to ourselves and to those we work with to ensure this is so. There is also personal agency that rises to the challenge that each one of us can set a new trend and make a significant difference to the culture in which we work.

 

In the midst of all we are currently facing in the NHS, for the sake of our patients and their families, it is vital that we build cultures of joy now and cultivate them for the future.

 

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