NHS or IHS?

The commonwealth fund (an influential US think tank) recently declared the NHS to be the best healthcare system in the world, for the second year running!

https://www.theguardian.com/society/2017/jul/14/nhs-holds-on-to-top-spot-in-healthcare-survey

 

Many think of the NHS as the Jewel in the UK Crown, more popular, as it is, then our own Royal Family. Andrew Street (professor of Health Economics at York) tells us why, and compares it to the US Insurance-based System:

http://theconversation.com/why-the-british-love-the-national-health-service-66314

 

We spend less of our GDP, per head of population, than almost any other developed nation and yet continue to have the best service there is.  It clearly is not unaffordable. It is something to be extremely grateful for! Why on earth would you spend over 18% of your GDP on health, as our friends in the US do, and still not be able to provide great health care for every person in your nation, no matter of their ability to pay? I do not understand why the NHS (or any “social model” of healthcare) is vilified from the other side of the Atlantic Ocean, when it is the most cost effective and clinically safe health system that there is anywhere in the world.

 

So, I’ve been wondering – why keep it to ourselves? Why just stop at a National Health Service? Why not go International (but not in an awful old-school Imperial Way, but rather a life-giving, loving kind of a way?). We have some of the best public health knowledge there is. We are learning to work creatively and differently with our population for prevention of illness and self-care. We know how to manage complex systems and budgets and we are able to adapt to new challenges relatively quickly. We know what it is to limit our spending and not allow it to get out of control and we know how to regulate corporate giants who would love to turn it into a profit-making machine.

 

The issues of global justice, when it comes to healthcare are insane. We keep talking about wanting to ‘lead the world’. Well – that old style of imperial dominance is thankfully dead and buried and will never be recovered. But we can humbly offer what we do know onto the table and see if we could all learn together about how to have a more globally just health care system. Why stop at the NHS? Why be satisfied with only a National Health Service? Let’s stop wasting time, money and resource on space exploration, projects which destroy the environment and building ridiculous weapons. Instead, let’s imagine a world with an International Health System in which we really get to grips with the kind of issues that are needlessly destroying millions of human lives every year. The possibilities of an IHS are endless and there are multiple ways it could be stewarded. If every nation contributed 8.9% of its own GDP towards it (as we do in the UK), I wonder just what might be possible and how much more connected we might become as a family of nations. Do we still dare to dream these days?

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Continuously Learning Health Systems


Learning requires humility. It requires us to accept that we don’t know everything, that we get it wrong sometimes, make mistakes and need to own up to them so that we don’t do the same thing again. Learning is a vital part of all we do in health and social care, if we are to create truly safe, sustainable, compassionate and excellent services. But humility, although vital, is not enough on its own. There are things we need to put in place to ensure our organisations are continually learning, and not only so but that we actually implement our learning and incorporating it into new ways of working so that we change as a result.

The IHI and Allan Frankel have come up with a really helpful and pretty straight forward framework which enables us to do this. It requires 3 basic ingredients:

 

1) Leadership commitment

2) Individual responsibility

3) A shared learning culture for quality and safety

 

Leadership is absolutely vital in setting the right structures and support in place for learning to take place. It requires:

 

-transparency with the public, patients and staff

-vulnerability about weaknesses

-openness about what is being learned and what is changing as a result

-ensuring we are learning with and from our patients not just within our clinically teams. (Some of the most powerful learning we have done in Morecambe Bay has been from women using our maternity services. Our attitudes, communication skills and expertise have all improved dramatically as a result).

-commitment to the psychological safety of staff in developing a culture in which no question is too stupid and no concern is dismissed

-genuine care for each member of staff, creating a culture in which every person can be mentored, coached and encouraged

-time given and protected in which learning can be fostered

 

Personal Responsibility

Who are you?

In my role as a coach/mentor or trainer I have found that we have become far too obsessed with ensuring that people have the right skills but not necessarily paying too much attention to who people are, what their character is like, what their strengths and weaknesses are and how they are developing as a human being. Our medical/nursing and other clinical schools are filled with people eager to learn but who often have no idea about who they are and who, not what they would like to become. Knowing who you are as a person, hugely affects your clinical practice and we do not give it any way near enough attention. I am personally a huge fan of the Enneagram. For me it has been transformational to understand as a type 7, not only what my root need is (to avoid pain) what my root struggle is (gluttony) how I do under stress (become a falsely happy control freak) but also, what my invitation is (towards sober joy and deeper understanding), how to become a more healthy version of me and therefore a better gift to my family, my team and all the people I’m trying to serve. It has helped me to recognise when I’m doing well and when I’m not and to understand how to bring my core strengths to the fore whilst also recognising where I need discipline and boundaries to function from a more healed place. We each have a responsibility not just to be good at stuff, but to be good at being us. And  being us is more than just knowing how we function (e.g. ENFP in Myers-Briggs) but to get below the surface to the core of what makes us tick, that makes us human. Knowing who we truly are enables us to be better, kinder, more humble, genuine, compassionate people, who put aside the need to beat others down and learn to appreciate them so much more. When you really know the team you are working with, they become your friends, you understand the little idiosyncratic things about them with a whole lot more patience and you can also challenge them when they are not behaving in a way that is conducive to good care and you can also receive that challenge back when you are out of line. I wish that we were more interested in caring about who we are rather than only in what we can do. This has got to be a part of the culture of joy I have blogged about previously.

How are you?

Personal responsibility beckons us to be more honest with ourselves and others about how we’re doing emotionally/physically/mentally. It has been a transformational practice in our team to simply check-in with each other and talk about where we’re at. In this way, we can carry each other when needed and treat each other with kindness and compassion. But our individual agency, must also cause us to recognise when we are at a wall/ceiling/limit personally or professionally. We must simply own up when we don’t know something or are out of our depth or need help. We cannot pretend to be able to have a competency that we don’t have. We need to be self-aware and humble enough to accept when we don’t know something or have become unwell and ensure that we take it upon ourselves to find out or get the help we need. This is learning to have an internal, rather than an external locus of control. An external locus, always looks elsewhere for the answer. An internal locus takes responsibility to find out and keep learning. We need to develop a core value, that learning is really really important and we will prioritise ensuring that we keep making time to do so, through whatever form that takes, especially reflective practice. Yes there is some dependency on supportive structures and time being given, but there is also that sense of motivation that comes from within that we take ourselves and our roles seriously. It’s one of the reasons why I’m such a fan of a combination of problem-based learning and a solutions-focussed approach. If we do this ourselves and foster it in our teams, the care we provide will be beyond stellar!

Why are you Here?

We talk about the law of two feet in our team. You are responsible to know why you are here, or if you need to be somewhere else. That might even mean a job change, but more often than not it means having some good boundaries, knowing whether or not you really need to be at a certain meeting or somewhere else, if you should be doing what you are or if you need to ensure other things get the right focus. And what about yourself? Have you taken time to eat well, stay well hydrated, exercise, sleep well, maintain health in your relationships? In teams that care for each other we need to help each other to know why we are there and why we are important.

 

A Shared Learning Culture

 

It’s amazing to me that so many of our learning environments are still so teacher-based. Adult education is so much more empowering than this and it’s high time our clinical learning environments (both preclinical and in every day life) reflect this. They should also be more inclusive and we should be learning with and from our patients far more than we do. Although the above graphic applies to classroom settings, it contains many lessons for us.

 

With leadership and personal agency holding true, a culture then develops in which continuous learning is the norm. Learning environments, fuelled by kenotic power create a space in which an organisation can begin to truly flourish. It creates a net of accountability, teamwork, improvement and measurement, making the entire system more reliable. It is vital that we create this as one of the core principles upon which we build our future health and social care systems.

 

 

 

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New Year’s Resolution

Tweet I’ve been thinking about making a New Year’s Resolution. So, this year, taking my role as lead for health and well-being seriously, my resolution is simple. In 2016 I want to improve my well-being and encourage others to do the same.   The New Economics Foundation have done some amazing work on how we can [Continue Reading …]