3 Keys for the Future of Healthcare

This week I traveled to London for an interview. The lovely team that I work with have nominated me for the HSJ Clinical Leader of the Year award. Unbeknownst to me, this meant presenting myself before a panel of experts and leaders in the field of healthcare to talk about the work we have been doing. It was a privilege to get to do this. One of the questions gave me an opportunity to explore with them what I have learnt that has the capacity to bring transformational change….another was about the nature of leadership (which I will blog on next time).

 

So, for what it’s worth, here are the 3 key things  which I consider to be vital to unlock the future of sustainable healthcare, just in case they are helpful!

 

  1. Culture Change 

 

Much has been written in the press (and quite rightly so) over the last few years about some of the toxic culture that is at work in the NHS. Sometimes the toxicity is to do with power plays, competition, hierarchy, bullying, low morale and substandard care. But in other cases it is to do with a lack of compassion and care towards those who work in the system which causes the other negative behaviours or leads on to emotion fatigue and poor delivery of service.

 

When I moved into my role as “lead clinical commissioner of maternity services” (we love long titles in the health service!), three and a half years ago, it was just as Sir Bill Kirkup was publishing his report into the University Hospital of Morecambe Bay. It highlighted the failings we had in our maternity and neonatal services that had lead to some extremely sad and unnecessary losses of life. It targeted the negative culture within our teams and directly challenged some of the behaviours. Morale was understandably at an all time low. But there has been a significant change in culture over the last few years. Cultural shift is absolutely possible but involves a willingness to look stupid at times, to persevere when things feel awkward and remain hopeful when the task seems impossible. I believe the secret lies in rehumanising team meetings, connecting at a relational level, being vulnerable with each other, learning from mistakes, challenging unacceptable practice but creating an atmosphere of grace in which people can reflect, learn, grow, develop, change and discover each other with a deeper understanding and eyes that choose to look with kindness. I refuse to start any of the team meetings I chair without checking how people are doing, giving them space to tell a bit of their story. I want to give space for people to encourage each other, say what they love about each other and what they most appreciate about one another’s work. It’s not rocket science. It’s called connection and compassion! I’ve seen it work here in maternity teams, in our health and wellbeing teams and it really can happen anywhere. Without giving it space and time, nothing will change. But where there is a real sense of togetherness and hope, many more things become possible.

 

2. Community Partnership

 

Part of our problem in healthcare is our level of expertise. We know far too much. We “know” what’s good for people. We “know” what people and communities need. We “know” what will make them better. BUT we have not yet really learned to LISTEN. I have found it to be a very humbling and necessary experience to shut my mouth, quieten my need to fix and really listen to the people and communities I am looking to serve and live amongst. When our team hosts conversations to listen to people here around their dreams for this area in terms of health and wellbeing, they don’t talk about extra appointments at weekends or shorter waiting times. They talk about dog poo, safe playing spaces for kids, singing, looking after elderly neighbours, help with exercise and eating well, safe places for people with mental health problems to get together and be understood and many other things. I have found that listening builds partnerships. It creates trust. It means that with our communities, we can co-commission things, and we can do things together rather than the experts doing things to them.

 

If we are going to see the social movement we need around health and wellbeing in this country, we are going to have to let go of some of our “knowing” and be humble enough to learn. We are going to need to partner with people and not do things to them. We are going to need to focus more on prevention than treatment. We are going to need to work differently. Without the vital engagement and listening with and to our communities, we will never achieve the holy grail of a sustainable health service that remains free for everybody. Together, many things become more possible, and we can learn to live in peace.

 

3.  Collaboration

 

Every organisation is strapped for cash. It doesn’t need to be this way, but it is the reality of our current economic model. Collaboration and the sharing of resources between partners and organisations is the only way forward. I love sitting in team meetings that involve healthcare – in its different guises – primary, secondary and community services, with social care, the police, the fire service, mental health teams, the voluntary sector, the faith sector, the city and county councils. Creating new cultures, letting down barriers, discovering shared vision, pooling ideas and resources – seriously good for the soul and definitely the future we are looking for.

 

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Better Care Together – Hope for the Future

iu-4My last post, “Time to Face The Music” was deliberately provocative. We cannot simply┬ákeep on doing what we’ve always done or nostalgically hold onto the ‘good old days’. As previously stated, it simply isn’t sustainable and we’re only deceiving ourselves if we think it is.

 

We find ourselves in a a different (post flood) landscape, a terrain that requires a new way of being together. And we are fast learning, here in Morecambe Bay, that it’s not just enough to break down the traditional barriers between Hospitals, GPs, Mental Health, Community Nursing, the Emergency Services and Social Services. No, we have to go much wider and deeper than that if we’re going to develop a radically new way of working that is sustainable. We need to develop a Wellness Service that is of high quality, able to continually improve and offer compassionate, excellent, affordable, safe and accessible health and social care to everyone in our community. In order to do so, we need every person in every community to partner with us. We need partnerships with education, business, sport, justice, housing and the voluntary sector to name just a few. Old silos must be broken down and centrally driven targets must be re-examined to give communities the ability to creatively flourish together.

 

We need big conversations across the sectors of society about what it really means for us to be well and how we can take better responsibility for ourselves and each other. It is so much more than just physical and mental health. It must include a wider understanding of social and systemic health also (see earlier posts on this).

 

And this is exactly what our team in Morecambe Bay is trying to do.images We’re not always getting it right and we’re learning some really tough lessons along the way, especially that our old habits of trying to fix things die hard! Real engagement takes time, but in the process of doing so, we are seeing 3 core principles emerging out of our focused work in Carnforth that we believe to be important keys to unlock this process in every community.

 

As we listen and engage with local people and communities, firstly we are seeing community leaders naturally rise up to make a difference and help increase the well-being of their area. We have many varied examples of amazing initiatives beginning. Secondly, we are seeing clinical leadership that is evidenced based and responsible, but empowers others to make a change. Thirdly we are seeing culture change beginning to emerge, with a more effective coaching culture and a focus on the wellness of those who deliver the care within our communities.

 

iuConversations really matter and carry within them the dynamic potential to make significant and lasting change, as we learn not only to talk differently, but to act differently as well. In the NHS, we have some expertise, but the true experts of their own lives and communities are the citizens we serve. We must change to be much more in conversation with them rather and lose the role of ‘grandma knows best’!

 

 

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