My Imperfect Blog - How to be a good enough Patient Director

This is not a perfect blog. In fact, this blog is about not being perfect. And if I can get it out in half an hour, then I will make a virtue of its imperfection.

With a year almost gone in my role as Patient Director, I have come to see a few of my faults close up. Or, should we not call a spade a spade, and label them ‘challenges’? Maybe that’s more charitable.

1. Too much to do - overwhelm

I feel overwhelmed by the amount of work on my plate. Given that I have to cover four territories – patient and public engagement, patient experience work, patient communication and information, self-management support – it can feel too much.

I do not have a dedicated team, so rely on building trusting informal influential relationships. This is going well, and with the help of Jo Howe (on complaints and some of the experience work), Marina Asaad (on information) and now Chloe Stewart (the new self-management lead), things will get easier. But I still feel the need to have to do it all. Now is the timeto build the gang - and include the informal amazing helpers, such as the clinical leads and patient care advisers (those talking to patients and arranging appointments, etc).

Knowing what to prioritise and what to let go of is an old habitual weakness. I want to be superman, and this stems from childhood (and led to my nervous breakdown). How to manage my energy and prioritise my work into small chunks is the next step. With help from those around me, this is going to get better.

2. The work is too complicated – I don’t understand

I am decent at the patient and public engagement stuff. I am excited about ensuring there is meaningful engagement in our developing CQUIN work (that is, targeted improvement work that is aligned with dosh from the CCG). We are focusing on improving pain services, through in-depth systems redesign, improving shared-decision making (at first for patients facing choices about treatment for hip and knee osteo-arthritis) and improving outcomes for patients (initially with spine problems), drawing upon a new measurement of outcomes, called the MSK-HQ.

In all these, I am working with clinicians and other staff to ensure patients are partners in co-design. This is relatively familiar territory, but for higher stakes – and is testing my navigational and relationship skills to the utmost.

But the engagement work is easier than the patient experience work.

With the latter, though I have written reports on how to best use patient experience data, the technical and logistical problems sometimes get me down. We have fixed some problems with the questionnaire itself (patients getting multiple copies as they get discharged from different ‘pathways’ so get one for each of them; wording on covering letters, etc).

Now the main task is making sure that reports we get from the survey provider allow (a) clinical leads to get the intelligence they need to take to others and how to ensure that this leads to conversations that will change things (b) the corporate team to know we are doing OK, and what to do if not. This is not an area of strength, and is leading to a few sleepless nights. I am drawing on other people’s expertise (outside the organisation as well, such as the amazing Anne Laverty at Northumbria Care Trust).

But the need to trust my intelligence in an unknown area takes me back to the days when I never felt good enough. Learning to trust and let things emerge is not easy for a ‘J’ (in Myers Briggs terms). Dealing with uncertainty is not easy for a control freak. I say it’ll be OK, but believing it in my heart is more difficult.

3. I just want to be loved - Dealing with potential conflict

I want to be loved. Doesn’t everyone? One of my skills is facilitation and with this job I know I can’t please everyone. Navigation and compromise seem to be at the heart of a job that also involves keeping the rudder square on to the needs of patients and bringing them into conversations at every opportunity. But I also need to steer between the needs of clinical and operational requirements. Sometimes this feels like swinging across choppy seas rather than a smooth steerage.

This is the essence of patient leadership in my eyes – how to build and model a ‘trialogue’ between clinical-managerial-patient purposes. Stepping up with authority means though I have to make quicker decisions, and not let a need for involvement get in the way of a clear vision for what I, and hopefully patients, want to see.

And I need to keep gently challenging assumptions. I went along with a key corporate decision last week and later regretted it. I have gone back and said so. I was pleased with that.

4. Good enough?

All the above need me to be ‘good enough’ and not perfect. I don’t need to do it all now. I don’t even need to do it all. One of the tricky things in this job is that I have made three significant transitions. Firstly, from being an outsider to an insider. Secondly moving ‘up’ into a position of authority (I have never been a Director before). Thirdly, this is a new role.

Moreover, this is is a new role within a new organisation. Finally, it is in a new organisation that is trying to change things at speed and at huge scale. Everyone says I shouldn’t expect things to happen fast. But I do. And that may be both a blessing and a curse. I need to slow down, breathe, and be good enough. All things I have been pretty hopeless at when younger.

And that is my half hour blog. Now, back to some Sunday morning poetry – because we need to give ourselves a little bit of loving time. And that is my way. Be gentle with yourselves.