Here is my latest vlog on using the 5 ways to wellbeing to help change the culture of the NHS.
Here is my latest vlog on using the 5 ways to wellbeing to help change the culture of the NHS.
Here is the 4th vlog in a mini-series, exploring the 5 ways to well-being from the New Economics Foundation to help transform the culture of the NHS.
We live in a political climate in which it appears that those in power do not listen to the voices of the ‘multitude’ (e.g. with the current protests around the NHS and education), but press ahead with their own agendas regardless. This is not only true of the current government, but a symptom of the way in which our entire political systems are set up. Here in Morecambe Bay, we need to recover the power of people movements and decide together what kind of future we want. Here is an invitation to come and be part of the emerging conversations about health, well-being and the health system around the Bay.
Here is my latest vlog on changing NHS culture through the 5 ways to well-being:
A few months ago I wrote a blog suggesting the right approach for the junior doctors was one of subversion and submission. But I think I was wrong. It’s not that I’ve changed my mind on the power of subversion and submission, it’s just that this entire spectacle surrounding the junior doctors, the ‘7 day NHS’, the strikes and the media reporting there of actually affects us all at a profound level.
This situation exposes something far deeper than just an argument between Jeremy Hunt and the BMA and is far more important than discovering who has the strongest will power. Infact, the BMA have made a major error in targeting Jeremy Hunt so vindictively, because in the final analysis, this isn’t about Hunt at all. Jeremy Hunt can be replaced in a moment, and is likely to be succeeded by a far more robust Boris Johnson, who will simply pound his fist more visciously. To make Hunt the scape goat narrows this debate to something far too insignificant and actually strengthens the government’s ability to do exactly as they please.
Sadly, however, all this proves is how defunct our current system of government has always been. What the government really want is a discussion about how we can improve patient access across the weekend timeframe. However, what they did was to decide this is necessary and went ahead to try to fix what is incredibly complex. There was no discssion, no real engagement, no conversation, no asking of the deep questions. Just because we want something, doesn’t mean we can have it! Just because we think something is a good idea, doesn’t mean everyone else will agree! The entire process of enagement and change management is not understood at all. In the first place, the goverment could instead have said to all the hospital trusts across the country what their hopes and intentions were and then waited to see if this was workable, in what way and how much it would cost. But you cannot simply act like Pharoah and expect the brick makers to make ever more bricks with less and less resource available – otherwise, you face an exodus!
What this entire debacle demonstrates is just how far free market capitalism has gone in its use of people as biopower to drive the system. The junior doctors of the NHS are nothing more than fodder to make the machine run. It doesn’t matter at all to the government that their lovely idea of a ‘7 day NHS’ is both unaffordable (due to chronic underinvestment in the health service) and unstaffable (due to a combination of under-training of staff across the board, and free market forces which work against people remaining in the UK). What this exposes in its most blatant form, is the chronic and shocking abuse of power, because of the very structures we have in place and the foundations upon which our society is built – namely violence, debt and control. And so, we see the human being reduced to what Hardt and Negri call ‘naked life’.
The system, to which we must all bow doesn’t care for the needs of the people who work within it. It will force them to submit. Why should doctors (many of whom work for less than the minimum wage, when on call) be allowed time to rest at weekends? Why can’t everybody have routine care through the weekend, just as from monday to friday (even though most of our top clinicians think we need better emergency care and not routine access)? Surely our economy needs this kind of health service? And actually, whilst we’re on it, isn’t it a waste of time, allowing teachers to have weekends off as well? Don’t we need our children to work harder, or at least be given some sort of babysitting service, so we can get more for our pound of flesh from their parents? If we are to have a 24/7 health service, why not a 24/7 education service? Our shops are already open practically 24/7. In this commercial world – shouldn’t everything else follow suit? No, no and NO!!
This is why we need a revolution of solidarity and resistance. We need a people movement who will stand together and be brave enough to say that there is a different way to see the world and a new way to live within it. Our naked life itself, although currently abused, can become for us our greatest power. Our naked life can expose the truth of just how abusive our systems have become. Our naked life, when combined with the indestructable force of kenotic love, becomes the very agent of change that we need.
So, what next for the junior doctors? Should they strike next week, including for emergency care? Are they ready for the media (who have lost the art of journalism) to turn against them? Are they ready for the storm that will ensue? Well, lives have already very sadly been lost. How many more can stand under the strain? What if the public turn against their heros?
It is time for something deeper to take place. It is time for solidarity. It is time for those of us in senior positions to cover shifts and show our unreserved support. It is time for the public, not just teachers, but across the board, to stand with the juniors. As my friend, Julie Tomlin showed me, we have to learn from the arab spring that one march alone will not do it. March after march after march may be needed. And singing too!! Let songs be heard on the streets! And to really demonstrate the power of naked life……how about naked marches?!! (I grew up in Coventry, and so the story of Lady Godiva is in my blood – nakedness overcame oppression once before!). Or maybe the staff of the NHS should all turn up to work with no clothes on?!! How about people stripping off at least to their underwear to expose both the fragility and the power of naked life?!
There is a different way for humanity. We can free ourselves from the oppressive yolk that seeks to divide and rule us. Perhaps, the Junior Doctors could be more creative and expose the deep structures of oppression that lie beneath the calls for this ‘7 day NHS’? Now is the time for subversion, for exposing just how unjust our systems are. But subversion alone will not suffice. We need solidarity and resistance. So, who will stand and march with the Junior Doctors (naked if need be?!) for an altogether different future?
In the USA, doctors have the highest rate of suicide of any profession. In the UK, a similar picture unfolds. Why is it, that 69% of all physicians suffer with depression at least one time in their career? It could be because of the high workload, high stress, high demand, an increased sense of professional isolation coupled with a growing powerlessness to effect change to the systems that often work against the real healing of people.
I think all of those reasons are there for sure. But I also think that as doctors become increasing slaves of a system, they lose touch with themselves, the things that make them unique, and are expected instead to act like robots, or cogs in a machine that get people just well enough to return to work and be of benefit to the economy. We have managed to disconnect clinicians from their own sense of humanity. But the art of healing is so much more holistic and profound than the science of clinical medicine.
If I were to design a health centre, it would not look like any of the places I work in. They are all far too clinical and are probably not very conducive to healing. For starters, there would be a whole lot more natural light, with beautiful artwork (I have some amazing pieces in my room now, by a brilliant local artist, Emma Hamilton) and sense of a continuum with the landscape. There would be places for people to talk with each other around tables where food and drink could be served, isolation broken and community restored. There would be places to encourage exercise or mindfulness through colouring. My room would have a piano in the corner and it would be filled with art, poems, quotes and there would be huge windows with magnificent views of the sea.
And my consultations (which could be conducted outside whenever possible!) would use not just my clinical knowledge, but would reflect more of who I am. Even now, I spend a lot of time laughing with my patients. Laughter is so good! It is healing in and of itself. There would be time for music. I would sing to my patients (they might well leave faster!)……Every doctor I know has talents, gifts, hobbies, and hidden depths that are rarely used when they encounter their patients. I wonder how much more effective we might be as healers, if we reconnected with the God-given sense of who we are and what makes our own hearts sing.
I love the story of the Obstetrician from Pittsburgh, who sings to every baby he delivers. What a beautiful thing. What might we all do more of as clinicians, if we thought of ourselves as healers? What spaces might we create? What might our consultations become? I wonder if we did this…..would we be less depressed and more happy in our work? And might we be more effective in gifting wellness to our communities?
I’m not a great meetings person. I just generally find them tedious. I lose concentration easily, I get distracted, I end up thinking about a whole lot of things that maybe I shouldn’t be thinking about or eat far too many biscuits and then feel bloated and guilty at the same time! Meetings and me don’t really mix….but I have to go to a lot of them, in fact, I now have to chair many of them and so I’ve been on a bit of a journey about how meetings can be made better.
My main beef with them, it turns out as I’ve reflected on why I dislike them quite so much, is not that they don’t achieve anything. Nor is it that I’m involved in conversations I don’t care about – actually I don’t go to any meetings in which I don’t deeply care about the things being discussed. So what is my problem? My problem is that meetings, and I don’t think this is unique to the NHS (but this is where most of my meetings take place), are so often devoid of any real human connection. They lack care for those attending the meetings. It’s so easy to get so focussed on the stuff, the business, the discussions, the problems, that we forget that there are other human beings in the room, each of whom arrive in the room (or virtual space) with many different emotions, stories, dreams and realities that may be really important, but we don’t know because we don’t give space to those things.
So, as I believe culture change has to start with me and the teams I work with, I am trying, somewhat awkwardly at times, to have different kinds of meetings! When I chair, I refuse to let us get on with ‘business’, until we have taken time to connect with each other. Using a simple technique from the ‘art of hosting’ I give space for a ‘check-in’. A check in is really simple, it’s just what it says on the tin. There are usually 2 questions and they can vary from meeting to meeting. Often, I just ask: How are you? And what do you love about your job? It is so important to know how each other is doing, so we can create teams that care for each other. People don’t have to be honest, but when they choose to be vulnerable, it opens up a space that is incredible and invites the entire team to go a bit deeper. And giving space for people to focus on the positive aspects of their work automatically changes the dynamic of any meeting from the start. Another of my favourite questions is: What do you love about working with the person on your left? (And if there’s time another round of ‘And what else do you love about working with the person on your left?). It is so healthy for a team to learn to appreciate one another but more than that, to actually tell each other that they are valued. You can get to know one another over a period of just a few weeks so much more and you end up actually caring about one another’s lives and wellbeing.
Secondly, I learnt a trick from a great friend of mine, who recently finished an MSc at the University of East London. In the department of positive psychology there, a bell goes every 25 minutes of a lecture and everybody stands up and has a stretch. Research clearly shows, we don’t concentrate for any more than 25 minutes. And so now, in my meetings, every 25 minutes, my alarm goes off and we all stand up and stretch and get the blood flowing round our bodies. We’ve become so conditioned, like Pavlov’s dogs, that if anyone’s phone goes we all start to stand and stretch! Plus, it is great for low back pain!
The other thing, I have introduced is 2 minutes of meditation/mindfulness at the start or in the middle of a meeting. Using a very simple technique, I encourage everyone to find a comfortable sitting position. We then breathe in through our noses for the count of 4, deliberately breathing a sense of hope, peace, love and gratitude. We then hold this and hold our breath for the count of 8 (people count at their own pace) and then breathe out to through our mouths for the count of 8. When we breathe out, we deliberately breathe out stress, bitterness, anger, distraction, or anything that stops us being able to connect. And then we continue. The first few times I tried this, we had some giggling (mainly from me), photos being posted on twitter (!) and general weird feelings…..but we have pushed through and it’s amazing how good it feels to just stop and be and let the busyness just wash over us for a couple of minutes.
I can hardly say the above is a revolution, but I can say that I genuinely enjoy the meetings now. I know my teams better, I am more connected to those I work with and I am more able to focus. Connecting, stretching and some time to be still……it’s exactly the medicine that NHS teams need right now, and probably a whole bunch of other organisations also!
One of the hats I wear is to be the Clinical Lead Commissioner for Maternity Services in North Lancashire and I chair the Maternity Commissioning Group for Morecambe Bay. Over the last few years, Morecambe Bay has been under huge public and governmental scrutiny due to some sad and significant failings at UHMBFT, our acute NHS Trust. This lead to the in-depth and wide-ranging “Kirkup Review” through which we have learned together some sobering and important lessons.
In 2013, we carried out what is called a ‘Picker Survey’ in the Bay and had a startling reality check. 44% of the women we aimed to care for told us that they did not feel treated with kindness or respect. It was a devastating figure for us to hear. So, learning from the ‘Leeds Poverty Truth Challenge’, we learned that we needed to allow ourselves to really listen to what women were saying to us, to hear their stories and let the impact of those stories begin to change us. One of the great advocates for women, compassionate care, kind listening and careful communication in this area is Mel Gard, a Doula, who facilitates our ‘Maternity Services Liaison Committee’ (MSLC) around the Bay. The MSLC is a group of women and men who use our services, which Julia Westaway must be credited for facilitating so well. Over the last three years in particular, they have taken the time to build relationships with those of us who commission and provide services and in effect ‘speak truth to power’. Mel and many others have brought to us stories of times when listening and communication skills have been excellent within our maternity service and times when they have been clumsy at best and detrimental or abusive at worst. This has begun a culture change and a survey carried out in 2015 has seen this startling figure reduce to 26% (we know this is still far too high, but it is a vast improvement).
It is only in encountering the ‘other’ that we are really changed. Alan Alda says this, “Listening is being able to be changed by the other person.” There is no point in hearing the stories and impact of poor communication on our patients if it does not fundamentally change us and our practice. In the NHS, we’re so used to being the experts that we sometimes think we have the right to tell people what they should do, rather than really listening to them and understanding what is important to them, the person who is the expert in their own life and situation. It is partnership and not dictatorship that we need. It is a willingness to learn together rather than an arrogance that knows how to ‘fix’ things that we must develop. So, together with the MSLC we have devised an entire learning exercise for all those who work within our maternity service. We are going to allow ourselves to encounter the ‘other’, on their terms, not ours, and let the impact of their stories transform us. So, in the next couple of weeks, women from around the Bay are going to film and tell their stories in a variety of ways and this film will then be used as a learning tool for every person who works in our service around the Bay, including cleaners, the nursing auxiliary team, midwives, obstetricians of all grades etc in some wide-ranging attitudinal and communication training. Amazingly, we have just won a national grant of £65000 to help us do this really well, thanks to the exceptional work of Lindsay Lewis, our lead manager and Sascha Wells, our Head of Midwifery.
The idea is straight forward. By hearing the real life stories from around the Bay and allowing ourselves to be impacted by them, we will then use some reflective conversations, and techniques from the ‘Art of Hosting’, to allow the power of real listening to change us and transform our practices. I am so grateful for the women and men who have been brave enough to tell their stories. I am grateful to our senior team that we have been willing to be humble and be impacted by these stories. I am grateful for relationships and partnerships that are being established between those of us who provide services and those who use them. I am grateful for the tenacity of people who want to see our cultures change. I am grateful for ‘The Leeds Poverty Truth Challenge’ and its far reaching consequences. I am grateful for the opportunity to break down barriers and find positive ways forward. I am grateful for the transformative power of listening and the change that can happen when we really encounter another human being. Better Care Together is so much better when we work together with those we are trying to serve.
Stanley Hauerwas said this: “I was smart, but I had not yet learned to listen.” The NHS is full of really smart people. When we learn to listen, our ‘smartness’ will become real wisdom, and with wisdom, we can bring real, lasting change.