Five a day (plus one): Small ways we can all contribute to a better healthcare culture

by David Gilbert

September 17, 2015

People say it's the hardest ever time for the NHS. Staff under pressure, resources tight. And, from there of course, quality and patients’ experience of good care under threat.

I’ve been thinking a lot about what my contribution might be. And what has helped me in the past. I am no leadership guru or expert on human resources. And I don’t have a political or regulatory solution up my sleeve. What can we do in our day to day work, while others pant and pout about how bad things are? I am no shiny preacher of positivity or compassion cultist, but there are small things…

  1. Gratitude

I’ve worked in many organisations where people forget to say thank you – for getting a report in on time; for saying something useful in a meeting; for going out of their way during a busy day to buy biscuits. Don’t forget to appreciate what people are doing around you. I think forgetting to do that is the first step towards a loss that is much greater: forgetting to value people. And if you don’t value others, soon it’ll be your turn to mourn the lack. When was the last time you thanked someone (genuinely)?

  1. Praise 

There’s a difference between saying a simple thanks, and being specific about what you liked about what someone did for you. A simple ‘well done’ is OK. But, just like they say in leadership text books about feedback generally, so too for praise: Make it specific, and about people’s behaviour. I recently received an email: “I really enjoyed your presentation. I was also reading how it was landing with our professional colleagues – and you were very skilful in bringing to them the right mixture of objective data, calm authority, and passion for the cause. This is no mean feat to pull off!’ Aw, that was nice, and it made me feel good. And I bet you could think of something just as nice – and specific - to tell the person next to you right now. Do it?

  1. Acknowledgement

With healthcare staff under extreme pressure, many call for individual staff to grow a thicker skin, or develop more ‘resilience’ (another weasel word, interpreted by different people in different ways). Yes, I think we can try to respond in different ways to pressure, build a bit of a pause before we react, and sometimes change our habitual responses – that way, lies freedom as human beings.

But it’s a long and hard road. And when your workload is doubled, or you've got family problems, it’s pretty damn obvious that someone telling you to 'work smarter, ‘be positive’ or ‘change your thought patterns’ is not going to go down well. Or happen overnight. Being overwhelmed is a feeling, not necessarily a choice.

So, if you find someone at work who feels bad, then listen, don’t advise; acknowledge their difficulties and give them the space they need to cathart – you really have no idea how it is for them. And the space you give them is a small portion of the space they need more generally. ‘Yes, it is really tough, but you’re doing well to cope’ is more helpful than ‘buck up’ or (the new age way) saying ‘you can change the way you respond’.

Usually, your attempts to contain other people's anxiety are just a defence against yours. It's uncomfortable stuff to listen to. But it's the best way. And you really don't want them to thump you for saying: 'snap out of it'.

  1. Kindness

If you can, and if you notice the need, perform an unnecessary act of kindness. I don’t do this as often as I should. One small act. Did you notice someone looking stressed and worried over the photocopier (not simply because it has run out of toner, though that can be the last straw)? Ask if they want to go for a quick walk. If they haven’t got time, go get them a Mars Bar (or, if Simon Stevens objects, an apple).

On my second week in the new job, Peter Devlin, our Clinical Director, did just this (the walk offer, not the Mars Bar). It is probably the memory of the job that I will remember the longest. If you can go further, and offer support (what about giving your mobile number?), even better. Collaboration in healthcare is an easy phrase that trips off the tongue – model it, be it. In the small things

  1. Model

No, I don't mean swap the day job to be a model. As Mark Doughty says: Model the sort of high quality relationships that should be at the heart of good healthcare. I know you can’t easily change habits. But you can sometimes shift a behaviour in small ways and ‘act as if’. My recovery from many years of anxiety and depression was all about small difficult acts of will in the restricting conditions of awful mental anguish. Slowly, slowly, it lifted.

But in the workplace, I think it’s also time for people to show a bit of vulnerability. Ironically, this takes enormous confidence to do well. I am not there yet, but I am committed to being authentic, a word that is getting heavy usage in the media with Corbyn’s crowning. But it means something very particular for me.

I want to bring my full self to the work. I don’t want to pretend that I am not unsure, if I don’t know something. I will ask questions if I don’t understand. And I will let people know how I am feeling (to some extent at least!). If people don’t like that, then tough. It’s actually their problem. This is at odds with all I used to think about being a Director – you have to be tough, and, ultimately lonely, as Robert Naylor recently admitted. I don’t want to be like that. I believe, difficult though it may be, one can admit vulnerability as a leader and that this can build collaboration rather than undermine it. Maybe I’m wrong. We shall see.

  1. Improve

There is a danger that we can focus more on the individual level - the five things above - then addressing the systematic causes. Helping individuals to cope – albeit in different ways to the old-fashioned ‘resilience’ rhetoric – is no substitute for wider scale changes in the work culture and in systems. Making sure front line staff handle phone calls and interactions with humanity (while doubling their workload) is no substitute for capacity plans. And this is the toughest nut to crack in a time of decreasing resources.

I am no expert in how to solve this. But if we just try and do more and more, within less and less, and perpetually blame others (or get them to change in response), then something has to give. I only hope I can help here too. Again, we shall see.

I’m sorry (a bit) for getting preachy on this one. Much of this is tentative and uncertain exploration. And it’s much to do with how I am seeing things currently in my new job. The organisation is under huge pressure, and has vast and wonderful ambitions for changing the way healthcare is delivered. We want to make sure that we focus on people as well as the numbers.

In other places I have worked in, I have seen the stress build and people start to pass on their performance anxiety to the next person down the food chain. National Agency to Commissioner; Commissioner to provider; Provider to its staff; Staff to patients. Small tasks that were done for each other (“I’ll get that phone call for you, ‘cos you look like you need a break”) are casually omitted. Before long the culture turns painful, and bullying is not far off.

The staff experience becomes the patient experience. I saw it at close hand in the psychiatric wards. It was the staff there that needed love, as much as us patients. Their lack became ours. Punishment, sometimes literally, was handed down the line. If we forget to treat each other well, we may hit the targets and miss the point.

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