Keeping on, keeping on – how can we stay optimistic about our healthcare system?
22 September 2023
Bev reflects on recent news and how our mission couldn’t be more relevant than it is today.
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The last few years have been, and continue to be, tough for people who need healthcare and for those who work to deliver it. I was reading a piece in the Guardian recently, many of you probably saw it. It relates to the story of Martha Mills’ care at King’s College Hospital and some unforgivable errors that, had they been avoided, would mean Martha would have been alive to celebrate her 16th birthday, eating her favourite birthday dinner of roast chicken.
Of course, the cases that make the news are the catastrophic ones. But there are millions of smaller interactions every day that tire people out, wear down their goodwill and optimism to keep going and do better, and damage people’s (professionals’ and patients’) confidence in the system: the inaccurate referral letter, the mistaken prescription, the sharp word of someone who might have already done a 12 hour shift and come into contact with a bolshy colleague or anxious family members seeking information which is buried deep in one of the myriad of IT system.
Of course, the cases that make the news are the catastrophic ones. But there are millions of smaller interactions every day that tire people out, wear down their goodwill and optimism to keep going and do better…”
Sometimes, it feels hard to maintain optimism about our healthcare system. Martha’s mother describes how the doctors treating Martha didn’t want “an over-involved googling mother who might make a fuss on the ward and challenge them.”
She goes on to say how the NHS has numerous initiatives about listening to patients and their families. She concludes that more agency (she says on the part of patients – I would argue on behalf of all people) to challenge a culture dominated by hierarchy, status and overconfidence would make our NHS a safer place for everyone. So how on earth can we make that happen, even in the small spheres of influence that each of us has?
First, it’s not just about patients and families. The dreadful case of Lucy Letby was characterised by doctors (ostensibly the powerful agents in the system) failing to have their voices heard. People do speak up and sometimes they are ignored. It is cultural and procedural. And it can be hard to hear those difficult messages – particularly if the listeners themselves feel overwhelmed or unable to respond.
There is a huge gap between the rhetoric and policy on freedom (indeed obligation) to speak up, and the reality of what people face who try to speak up. There are probably more examples of where it has gone badly than where it has gone well. But there are examples of where people have spoken up successfully so we know it is possible, and we can learn from those who do it well.
At the Point of Care Foundation, our key philosophy is about improving quality for patients AND professionals, and the relationship and interplay between them. This mission couldn’t be more relevant than it is today.
Patients’ and staff experiences of health and care are often regarded as two sides of the same coin: separate but inextricably linked. Sometimes this relationship is seen as a functional one: that we should improve one to improve the other (‘happy staff equal happy patients’).
But high-quality services depend on positive interactions between clinicians and patients (and indeed positive interactions between people working in the system, regardless of their roles). It is people’s experiences in the round – not just staff experience or patient experience in isolation – but also the relationships between them that catalyse positive change. Stories (dare I say it, experiences) help to heal the system. Since the start of civilisation, the stories we tell have helped us make sense of the world.
Making the measurement of experience, ‘a thing’ (a policy objective) was done with the best of intentions. But there are unintended consequences too. It makes it something to be measured, compared, tracked over time, boiled down in a pan where all the ingredients meld together. We talk about triangulation, data, and special cause variation. And those are important tools and techniques – necessary but not sufficient.
Making sense of people’s experiences (plural not singular – no one has a single experience) is about helping people to listen. But experiences and stories are treated as anecdotal, unreliable small samples to those whose training is seen as ‘scientific’. ‘Anecdotal’ is treated as a dirty word, instead of being seen as providing valuable examples that can inspire reflection, and sometimes action. A social pedagogy that itself has a long and rigorous scientific basis behind it. We can learn from these examples, while at the same time, they don’t violate the rules of the status quo. That’s what makes them so powerful.
Hearing stories mean we hear a plurality of perspectives because experiences are both similar and different. We only understand and appreciate that when we hear different voices.
So how do we at the Point of Care Foundation advance this mission. How can we stay optimistic?
The thread that links all our work is that we help people to listen better. Whether that is in our work to improve patients’ experience through co-production or our work to support staff through Schwartz Rounds. We know that people who engage meaningfully with patients to co-produce change, experience profound connection with patients, satisfaction with this work, and feel changes they make are more meaningful to people using and delivering care.
Schwartz Rounds – confidential fora in which staff share stories about the emotional and psychological impact of their work – promote connectedness and collaboration between colleagues, level hierarchies, and improve communication. These are powerful signifiers of improved culture in healthcare organisations.
I spent an afternoon with the inaugural meeting of the Darzi Fellowship last week. The Darzi Fellows also strike me as a cause for optimism. It seemed to me that the Darzi Fellowship includes the secret sauce which recognises that the process of change happens through social relationships, and at the speed of trust. Fellows emerge from this programme seeing things differently, speaking about them differently and thus behaving differently.
In Margaret Mead’s words, “Never underestimate the power of a small group of committed people to change the world. In fact, it is the only thing that ever has.”
Join us for the first Point of Care Foundation and Picker Care Experience Symposium – a conference with a difference. This event will provide space to think differently, reflect and share experiences, improve appreciation of stories and discussions on how to make the best of them to make the greatest difference to people giving and receiving care.