Wisdom From My Nanna

Last week, I was on the closing plenary panel at The Kings Fund, as we reflected on what we had learned together about ‘PopulationHealth’ across the UK. There were some really excellent contributions throughout the day.

 

Councillor Matthew Brown, leader of Preston City Council, talked powerfully about the new economic models they are using there and the incredible regeneration they are seeing. Councillor Becky Charlwood, spoke about the great work being done across the city of Leeds and how strong relationships enable them to flex around complex legislation. Mayor Andy Burnham spoke with humility and realism about the power of devolution and the challenges they face as a city in Manchester in giving kids a great start in life and ending homelessness. Liz Gaulton, Director of Public Health in Coventry, spoke about how the Marmot principles are radically shaping the future plans of the city in thinking about inequalities and how they face them together. Prof Kate Ardern, from Wigan, talked about how we need to change our relationship with power and work radically differently with our communities. Prof Dominic Harrison from Blackburn brought his wisdom on how we face up to multiple unhealthy risk factors. Perhaps the most important contributions from my perspective were from Carina Crawford-Khan, lead organiser of Citizens UK and Dr Charlotte Augst, CEO of National Voices who asked us to reflect on how “Powerlessness leads to ill health” – that’s a statement worthy of pause and much reflection. Power is the ability to act. Anger without power leads to rage. So, if we don’t radically change our relationship with power, we can never see true population health – rather we have disempowered people who feel angry and unable to be part of the change we need to see.

 

The reality is that all of the things we long to see in society will not happen unless we ourselves are willing to change. In all the uncertainties we face and admidst the brokenness of our political and economic models, how do we stand firm and find a new way through to a way of being together that is socially just for humanity and sustainable for the future? In reflecting on all of this in the final panel, I drew on the wisdom of my Nanna.

 

My Nanna, Joyce, who is 97 years old this year and who still wakes every morning to play Mozart and Chopin on her beloved piano, has always been one of the most important people in my life. In our family, we call her “Yoda”, because she is strong in the force and exceedingly wise! This 5ft tall lady, who taught me to bake, spent hours helping me with my music and can still whip my butt at scrabble and rummikub, is a truly remarkable woman.

 

When I was a boy, we used to talk to each other whilst making ginger biscuits. My Nanna is a deeply spiritual woman and she used to tell me about her favourite bible verses, one of which is from the book of the Prophet Micah, Chapter 6 and verse 8. That verse says – “God has shown you the best way to live – act justly, love mercy and walk humbly with your God”. I think those three statements hold profound and ancient wisdom that we need to draw on in the complexities of what we face together now. What does that actually mean for us in practice, as we try and transform culture, relationships and behaviours? I suppose I think it’s pretty simple.

 

Firstly, as leaders and as people who want to see change, we must act with justice. We must care deeply about issues of injustice in our society and be willing to challenge it whenever we see it. But we must not just care, we must act. We have to be willing to put justice into practice in what we build. We’re beginning to see this, and it’s exciting!

 

Secondly, we must love mercy. I think that means we have to love the principle of mercy and therefore we have to love people with mercy, or as I put it at The Kings Fund, with real kindness. I love what Prof Micheal West says, when he talks about looking at people with kind and fascinated eyes. We did a lot of thinking about the need for a different kind of power. I think we need to unashamedly talk much more about love and the transformative power it holds. MLK said that love on it’s own is anaemic – it certainly can be. Power alone is destructive. But power and love together is a force to be reckoned with! We need this kind of love in the power that we hold to keep mercy at the fore and kindness as our way of being.

 

Thirdly, we need to walk in humility WITH our communities. I replace the word God here, with communities, not because I don’t believe in God (I do), but then Nanna and I used to talk, she would tell me that walking humbly with God means walking humbly with other people – with your community. It is worked out in the practice of every day life and being willing to interact with and be changed by the person you most look down on or despise. Nanna isn’t a fan of people getting too big for their boots. She sticks her tongue out at arrogance and blows raspberries at pride. She’s not into titles or pretensions. As a true elder, she knows humility and walks in it. I have learned so much from her and it has shaped so much of who I am and how I choose to spend my time. We must learn to sit with, be with, learn with and create the future with our communities. We don’t have the right to dream up plans and do them to people. Together with, is the kind of humble, mercy-loving, justice-acting way that we so badly need. Without those under-girding, foundational truths, we will never see true population health. Our guiding principles and undergirding culture will shape what we become together.

 

In a time of so much uncertainty and complexity, we do well to stop and draw on the wisdom of the elders. And so I offer that of my lovely Nanna – in all you do, make sure you act with justice, love with kindness and walk in humility with your community. 

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Building a Culture of Kindness in the NHS

My morning surgery began today with a patient of mine, who works as  Health Care Assistant (or Band 3) in our local acute hospital trust. As we find across the board in the NHS right now, there are pressures in her department with under-staffing and a very high and demanding work load. She started her day in tears, telling me about the sleepless nights, but even more so about the lack of support she is feeling in her work environment. She feels unable to understand why huge fees are paid to find locum consultants, when posts are not covered, but money cannot be found for the absence of staff at her level, when the numbers are down, leading to an increased pressure and low morale.

 

Now, this is not a criticism of the acute trust we partner with every day, because I actually know all too well the situation here, how complex it can be and just how dedicated to caring for staff the leadership of the trust are. However, when we read in the press today about sickness absence for stress among paramedics, and if I were to detail more stories about the number of cases I am currently dealing with as a GP about stress in the workplace for ALL grades of staff in the NHS and social care setting, then we have to face up to the fact that we have a problem. Stress in the workplace and low morale in our teams is not a problem we can afford to ignore. It not only causes high sickness rates, which then increases the pressure on teams, with knock on financial implications to the system; it also causes significant compassion fatigue (i.e. staff are literally less able to care about or for their patients), because they are emotionally overwhelmed, under-resourced and therefore become more numb, disengaged and unkind and this is detrimental to patient care.

 

The problem is actually really complex, but it is, in my opinion, primarily cultural, and particularly affects the lower pay-grades of staff, because they feel and are in fact less able, to influence change. If we do not develop a culture of kindness towards our own teams and have a sea-change within our working environments in terms of how we care for each other, we will only see the problems go from bad to worse. So, how do we create a culture of kindness, a culture of honour, a culture of wellbeing?

 

I would like to suggest six things (all beginning with H – the 6Hs), which are fairly simple, but make a massive difference to how teams function and therefore the morale within those teams:

 

  1. Humanity – First, we must recognise that hierarchy has the inbuilt tendency to de-humanise us. As we get higher in the pyramidal systems in which we work, we can easily lose our humility and compassion towards others as we have to cope with the greater demands from “above us” and if we’re not careful we can turn into slave drivers. Top down, controlling leadership is detrimental to good morale and stifles teams from working effectively.  There is a famous, ancient parable (told in the New Testament) about an unmerciful manager, who owed a huge amount of money to his master/CEO. The CEO called him to account and threatened to fire him. However, he begged for mercy and the master cancelled his debt and gave him a fresh chance. However, this same manager then went and found all the people who owed something to him, and instead of paying forward the mercy he had received, treated his own debtors shamefully, despite their begging and pleading for mercy. When the CEO found out about this, the manager was duly fired. I wonder how often we tolerate ‘bullying’ by managers, because they ‘run a tight ship’, without calculating the cost of this style of management on our teams and the patients we serve? Changing culture is hard. Even if the CEO sets a good culture, any one of us can bring a negative influence in the area we work. We have to make a conscious choice to keep our kindness switched on. As we climb the ladder of responsibility, we must continue to act with humanity. We must also remember that it works the other way round – we can start dehumanising those in leadership positions ‘above us’, or those who work in different teams. We make terribly unfair assumptions about people all the time. A little bit of understanding, kindness and compassion goes a HUGE way in treating each other with kindness instead of suspicion.
  2. Humility – For those in leadership, there can be a tendency to forget that when we were in in ‘lower’ positions, we often felt the same low morale and pressure from those ‘above us’. Leadership requires that we keep our love and compassion switched on towards those who we now lead. This means we must really learn to listen, and that means having the humility to recognise where we have been getting it wrong. If we are not prepared to change, then we are not really listening. It takes courage to create a culture in which we can receiving a challenge from those in our team and be able to make a change and not just use our position to squash the person who dared to speak out. It takes even more guts to admit where we have been wrong, say sorry and move forward differently.
  3. Help – one of the very worst things that can happen in any team dynamic is when we hear the words ‘it’s not my job’. I hear it so often and it makes me sad! We must never think we are above any task – whether that is cleaning up a mess, wiping a patient’s bum or picking up some litter. We must simply help each other out. But we also need the humility to admit when we are struggling and actually ask for help. We encounter terrible and unspeakable trauma at times, or may simply be going through tough personal circumstances. Sometimes, we need the humility to recognise where we are not coping, where we are struggling, when we’re not functioning and ask for help. And when we ask for help we need to have the confidence that we will encounter the humanity of those around us to help us at our time of need.
  4. Honour – Sometimes a situation may not be able to change, but in these situations the very worst thing leaders can do is close ranks, shut communication down and raise the levels of demand. No, vulnerability, openness and honesty, sharing the reality of the situation and communicating clearly why things cannot change currently at least allows the team to pull together and face the situation as one. However, there must be a very clear challenge here – Yanis Varoufakis puts it so well in his book “And The Weak Suffer What they Must” – we have to remember just how crippling powerlessness can be. Like my patient this morning, she has no access to the ‘powers’ or to the ‘purse strings’. She cannot up and leave, she simply can’t afford to, and so she works under huge pressure for very little pay, powerless to enact change, other than to put in place her own boundaries. A cultural shift towards a culture of kindness is to ensure that those with the least ‘honour’ are treated the most honourably. Leadership is about being able to take the hit, not self-protectionism at the cost of ones team. It is absolutely amazing just how far the words ‘Thank You’ can go, to keeping this sense of honour alive.
  5. Health – (by health, I mean wellbeing in its widest sense) – we have to actually care for the people around us. We have developed a culture in the NHS and social care where we will do all we can to care for our patients/clients, but will break the backs of ourselves or our teams in the process, which is actually entirely self-defeating! It is impossible to care for others well, when you are feeling exhausted and broken! I have said it on this blog before and I will say it many times again: we have to develop a sense of the health and wellbeing of the people in our teams. We need time in the craziness and business of each day to stop the mad rushing, be still and take notice/be mindful/be heartful. We all need time to get up off our chairs and stretch and be more active – #runamile every day (it only takes 15 minutes). We need time to connect with each other (do we really take time to know the people we spend an inordinate amount of time with and alongside and check they are actually doing OK?), to eat well, stay hydrated and keep learning, so we don’t feel overwhelmed. Building these as an absolute priority into our daily work routines is vital, especially as pressures increase. The tendency is that when the going gets tough, our health gets significantly worse. We must learn to protect this in the midst of our business, or we will suffer the consequences in multiple ways.
  6. Hope – there is an ancient proverb that says: “hope deferred makes the heart sick, but hope coming is a tree of life.”  Hopelessness takes root when we feel that nothing can ever change and we feel powerless to influence anything. Hope is born when we develop ways of working in which teams can work together on solutions to the problems they are encountering, rather than being dictated to from on high in a unrelational way. Hope is about being able to sense that the future is alive with possibility. It is a life line when things are tough, when the tunnel is long and dark – just a little glimpse of light – and then faith builds that together we can get there.

 

Not difficult. Actually pretty straight forward. We don’t need unkindness or low morale in our work places. We don’t want to be suffering with compassion fatigue because we are physically and emotionally drained and running on empty. We really can create the kind of culture we want to see and experience in the NHS and social care – a culture of kindness – sounds nice doesn’t it?! All it takes is for us to remember humanity, humility, help, honour, health and hope.

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