Inconsistent and Incongruent Messages

The King’s Fund have just released an excellent video to help explain how the NHS works and some of the complex things going on in it at the moment. It doesn’t shy away from making it crystal clear who is in charge of the money, nor the difficulties we’re facing in staffing and resource allocation. Have a watch of it and then keep reading!

 

 

What is particularly important to understand, especially where we are learning to work in new ways together, like here in Morecambe Bay, is just how inconsistent and incongruent the messages are that we receive from the leadership structures of the NHS.

 

So, here in the Bay, we are forming an Accountable Care System, which brings together different health & social care commissioners and providers to work more effectively together. We are forming great relationships, breaking down walls and barriers to work together, whilst tackling significant budget issues as we try and ensure that we deliver care in the most excellent, safe and sustainable way for our population (whom we are trying to include fully in the co-design of the services we provide).

 

One might think, as we are being actively encouraged to reorganise ourselves in this way, that the Department of Health, NHS England, NHS Improvement and the CQC would all be pulling together to support these changes. One might presume that they would ensure the various contracts and ways of paying and assessing us would enable us to do this important work – the opposite is in fact the case!

 

On the one hand we are encouraged to ensure we work more efficiently and “cut the waste” out of our system, but when we do so, the contracts in place are working against us!! we literally being told to work one way and then penalised if we do! It is an entirely schizophrenic existence and creates an extraordinary amount of wasted time and energy.

 

I’m not exactly sure what it is that is causing the disconnect between the different regulatory bodies. However, as they require of us a new collaborative way of working that ensures greater efficiency and improved models of care…..perhaps it could be better modelled and enabled by those in the “centre”. This would give the entire reorganization a great deal more integrity. Cultural and behavioural change is talked about a great deal and we are enacting it despite the perverse drivers working against us. I wonder if the same is true at HQ, Elephant and Castle. This mixed messaging needs to stop and those of us leading systems, working with great complexity, need to be given the permission, support, and enablers to really flourish.

 

 

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Personality Health

imgresWe often talk about physical, mental, social and even systemic health, but we don’t often think or talk about the health of our personalities. Our personalities are shaped by our self-esteem, our values, our truths, our needs, our struggles, our instincts and our gifts. They impact every part of our lives, relationships and interactions with the world at large and although we give some focus to understanding them through tools like Myers-Briggs, the Enneagram and Strengths-Finder, (perhaps to make us more successful), we give little thought to how healthy we are when it comes to this subject.

 

enneagramdisordersNow, what is particularly interesting to me as a doctor are 2 things related to this. Firstly, our personality type is hugely linked to the kind of mental health problems we might be more likely to develop. I wonder how often clinicians see the presentation of a mental illness and are able to talk with the person in front of them about which aspects of their personality might need therapy in order to help their mental health improve? As the whole area of positive psychology develops, it is vital that there are learning environments in which clinical teams can learn about innovative approaches in psychology that avoid the over prescribing of medication, especially in our younger population.

 

14516526_OPiwmgUE_c_large.jpgThe second area of interest is to do with how we can be more self-aware of how healthy we are or when we have reached a point at which we can no longer really help ourselves but need others who love us or care about to to intervene.  Below is a chart (of sorts) which I learned about during a weekend on the Enneagram. It helps to explain aspects of personality health. I recognise that at times I am functioning more healthily than at other times, due to a combination of internal and external factors. I think there are behaviours we can be aware of, or ways in which we are operating in relationships and situations which should serve as a WAKE UP CALL to us. When we notice more negative patterns, we need to take stock of where we are and work out our lines of responsibility to help us back into a more healthy state. However, if we don’t, things can continue to worsen until we reach a point at which we need others to intervene on our behalf and rescue us from our self-destructive and damaging sickness.

 

We can make a comparison with heart disease. For much of the time, our hearts MIfunction healthily. However, through a mixture of internal and external factors, our hearts can become less healthy. When this occurs, our body will fire some warning shots to us, giving us a chance to change before something more serious occurs. This might be signs and symptoms do do with our weight, nutrition, fitness, level of breathlessness, vague chest pains, markers in our blood tests – like high cholesterol and high sugar, rising blood pressure etc. However, if we ignore the opportunities to change and continue with our unhealthy choices, eventually we will reach the point at which we have a significant event, e.g.the start of angina, a heart attack, a stroke, the development of diabetes. At that point we need the help of someone else – we can no longer do it on our own. Of course, we still have choices and can reject the help on offer, but if we do, we risk our own demise and ultimate death.

 

images.jpgMy point is this. If we do not take the health of our own personalities seriously, there are serious and significant consequences, not only to ourselves but those around us and the world we live in. Many of us reach a point when we need help, but might not even face up to this, due to the poor health we are in. In those times, we need those who love and trust to be brave enough to reach in and offer us a life line. We may have even reached the place where we need resuscitation, when all our pride has gone. When we have ignored the red flag, we need those around us who will risk our total rejection of them to love us enough to offer us a way back to health. We need to take the health of our personalities seriously – it actually has a huge bearing on all the other aspects of our health. We also need

 

enneagram-health

 

HEALTHY

  • 1. Level of Liberation – Ego transcended – balance/freedom – i.e you become a gift
  • 2. Level of Psychological Capacity – Ego as particular mode of being – choice of how to be
  • 3. Level of Social Gift – Ego operating in constructive way – sublimating ego

 

Wake up Call – need to listen to internal warning bells

 

AVERAGE

  • 4. Level of fixation – Ego role assumed – falling asleep (not self-aware) – losing contact with presence
  • 5. Level of interpersonal conflict – Ego controlling environment to support self – manipulative/defended
  • 6. Level of overcompensation – Ego inflation, demanding others and reality support it – aggressive defence

 

Red Flag – need of help from others

 

UNHEALTHY

  • 7. Level of violation – Ego willing to violate self and others to maintain itself – abusive/desperate
  • 8. Level of Delusion and compulsion – Ego loses touch with reality – out of control – personality disorder
  • 9. Level of pathological destructiveness – Extreme pathology and/or death

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