Monday, December 23, 2013

Another Take on "Making Every Contact Count"

To those non-NHS types, forgive me for another "care-orientated" post.  Much of the last two years have been massively dominated by my nursing role and my proud membership of the National Health Service - and hence my blog does tend to represent my current passions.  I do still maintain my theological/spiritual interests and have a few subjects brewing - but this one is a post that could not wait!

"Making Every Contact Count" is a very important initiative in the NHS at the moment - we are realising that as health professionals we have a unique position of serious responsibility and privilidge with the patients under our care and their families.  Mistakes in the NHS have been made in the past where care has been delivered but not in the right way.  One of my NHS heroes - Chief Executive Officer Sarah-Jane Marsh said (in a CEO briefing at her Children's Hospital in Birmingham);

"It is not just what we do that matters, but the WAY we do it".

Consider nervous parents accompanying their young child to have their tonsils removed - a relatively minor procedure in context.  Imagine if the surgeon did his job and removed the necessary tonsils, but their entire hospital experience was negative.  Say the surgeon was brisk, rude and dismissive and the nursing staff pre-and post operatively did their job and monitored the child but gave the parents and child no compassionate care and support.  The objective may be achieved - removal of tonsils - but the family and child could and would be scared by such a negative experience.

THIS is why it is not enough to simply have competent NHS staff treating the patient.  We MUST have compassionate and caring (AND competent!) staff who support and defend the patient and family from admission to discharge ensuring the whole point of contact with the NHS is positive.  "Making Every Contact Count" is a vital initiative used in the Birmingham Children's Hospital at present;

But I did find myself wondering if many nurses, student nurses and allied health professionals like myself struggle to come to terms with what actually; "every contact" means?  Does it mean if we are simply taking our parents a cup of tea we should sit down and commence a sermon on smoking cessation?  Surely not!  So it was while thinking these matters through that a common motto came to my mind;

"When a butterfly flaps it's wings in Texas, it causes a tornado in China".

This is in other words known as "Chaos Theory".  It is technically defined as; "a minor change in circumstances can cause a large change in outcome".

I am not entirely sure if healthcare professionals are entirely aware of the enormous potential of their actions (and contact) with patients and their families - whether positive or negative.  The Mid-Staffs scandal demonstrated the hideous enormity of negative contact - and it is a nightmare the NHS should NEVER forget.  But something the Chief Nurse of NHS England - Jane Cummings - is vitally reminding the negatively-biased media is that POSITIVE experiences also have a crucial impact.  

Many nurses (and I have been guilty of this in the past) have come to work at times bringing "home life" with us.  Aches, pains, heartaches or simple headaches - have meant that we as healthcare professionals have not been "properly" operating in the "6Cs" framework we should to truly impact our patients and families for the good.  It may seem little to us - a more formal sober greeting of our families after handover and perhaps a distinct lack of smiles and easy small-talk during the shift than perhaps we may do.  This may seem like just an "off-day" to us.  But what of the impact on our patients and their families?  That "off-day" may be their ONLY contact with the NHS during their lives - and the impact they take away is our lack of smiles, care and - presumed - lack of motivation to give them the patient experience they need.

When a butterfly flaps it's wings ... a tornado happens.

When a nurse smiles at a patient and family (even though his/her heart may be breaking due to a recent family dispute) a positive tornado of change and impact happens and that family may leave the hospital or care setting with a positive experience of trust and confidence in the NHS.

When a butterfly flaps it's wings ... a tornado happens.

When a nurse sits with a devastated, bereaved family and is seen to visibly shed tears, that family may leave the hospital knowing that they were cared for (even though the outcome was not what they hoped) by a human being who was impacted by their loved one.  The loss - still and always devasting in the extreme - will be tempered by the fact that they did not suffer it alone as though on a factory production line ("when's the bed available?") but as an event that impacted the healthcare professional with them at the time.

When a butterfly flaps it's wings ... a tornado happens.

When the worried and anxious family sitting in the Accident and Emergency Department, so concerned about their loved relative suffering beside them, are brought a cup of tea by the nurse and an apology for the wait and an explanation - suddenly the nightmare fear that "they just don't care" evaporates and the slight reassurance (though the concern for their relative remains) that humans are in charge and that they are not just another number in the queue potentially breaching their "targets".  But the experience they take away is that they are told and explained that the department is horrendously busy and prioritisation of care is taking place, but their relative is not forgotten and is under observation (even though it does not seem it) - ANY deterioration in health will be responded to swiftly.

When a butterfly flaps it's wings ... a tornado happens.

The devastated parent sitting with their terminally ill child on Christmas Day looks up as yet another nurse comes in to deliver the required chemotherapy (even though the parent knows it will make the child sick) the difference cannot be expressed if the chemo nurse comes in smiling and compassionately open to what the child needs and does his/her utmost to deliver the necessary medication but with the right approach.  That effect will last with them forever, just as a rushed, brutally efficient but distracted nurse who charges in, injects the medication and rushes out without comment.

When a butterfly flaps it's wings ... a tornado happens.

A family sits in a busy Outpatients department worried sick about the appointment with the consultant.  The results are in and in a few words they will be told whether they have a positive, rosy future full of hope and promise - or further worry, dread, more appointments, "maybes", "I hope" and other subject phrases spoken by healthcare professionals.  The Outpatients department is running drastically behind schedule and the worried family know they are now 30 minutes behind their appointment time.
To be approached by an Outpatients nurse who sincerely apologises for the delay, explains the reason and asks if they need anything (an English cup of tea never goes amiss!) will create a tornado of effect, even if the news from the consultant is negative - as compared to a stressed, harressed nurse who is charging around (to the family's view - and they DO see everything) accomplishing little - who then snaps that; "Dr So-and-so will now see you.  Quickly!".

There are many, many more examples and scenarios that could be cited and may ring true with healthcare professionals across the NHS.  But I hope the few examples that have come to my mind will prove my point.  I believe fervently as current HCP in the NHS - we must, must, MUST never forget that we are in a position of ultimate privilidge, trust and opportunity.  

Every action (whether it be a smile, a story read, a hug, or a cup of tea) can have a far greater wave of impact upon our precious patients and their families than maybe we will ever know.

It is our responsibility, duty and joy to ensure that we do not just deliver "competent" care (although that is vital) but we deliver such care in a compassionate manner that thinks ahead of the actual care delivered - and anticipates and expects that our patient and their family will leave the NHS and the care with an overwhelmingly positive experience that they can remember for a long time.  Even if, tragically, the care delivered sees that precious and beloved relative not coming home - let our precious families go home knowing that their relatives were treated with the highest dignity, compassion and care possible and that they did indeed die in the "best hands possible" with their families by their side.

When a butterfly flaps it's wings ... a tornado happens.

Monday, December 09, 2013

The Human Beings Behind the Trust Boards

I am writing this short blog post inspired by a tremendous friend I have yet to have the privilidge to meet (awesome Twitter effect again!).  Rev Dave is a chaplain in Worcester and he runs an outstanding blog celebrating the good news stories within the NHS.  This is something we both feel PASSIONATELY about and have spoken of much.  Much of the media focus on the NHS at the moment is negative - and perhaps rightly so.  There have been awful cases of unforgivable poor care and we must learn, take responsibility and make every effort to ensure it never happens again - and as NHS privilidged staff we REALLY make every contact count.

Rev Dave was published recently in local media writing an article about his local Trust Board that profoundly impacted me because of it's unique slant and his passionately, positive attitude shining through.  So I want to reflect somewhat similarly on my local Trust Board at Birmingham Children's Hospital FT.  I could write about many NHS Trust Boards that I have watched through the wonderful medium of Twitter and the new transparent accountability it brings (national heroes of mine include Chief Nurse of NHS England, Jane Cummings, NHS Employers CEO Dean Royles, Patient Experience Lead for NHS England, Kath Evans and of course - never forgetting Sir David Nicholson, CEO of NHS England himself - among many others such as the wonderful CEO of South Tees FT Professor Tricia Hart).

But many of us in the NHS work locally, and it is therefore obvious that most of our contact and observation is to our local Trust Board.  I have been MASSIVELY privilidged as a mere Band 5 staff nurse to perhaps have a little more contact and observation from afar of the BCH Trust Board than others (mainly through the wonderful participation I used to have on the BCH Flufighter Team).  So like Rev Dave - I want to write personally as a frontline nurse on what I have seen of the BCH Trust Board and the people who carry responsibility for the hospital.

One word about salaries - it is, I supppose obvious, that in the popular critical culture of media coverage of the NHS, that some spotlight is put on the salaries of Trust Boards.  This is guaranteed to raise my blood pressure and incense me beyond words.  Here's why.  A quick Google search through the Financial Times reveals that CEOs or Directors in the private sector earn ridiculously more than NHS Trust Boards.  How can you compare a salary of $4.1million (salary of the CEO of Barclays) even with the current salary of the CEO of NHS England?!  One CEO of course takes responsibility for the money passes through an organisation.  But NHS CEOs and Trust Directors take responsibility for HUMAN LIVES.  And they are paid far less for that responsibility.  I have said before - and again - I never resent them a penny, who can imagine the pressure they are under for running our hospitals?

So - the Trust Board of Birmingham Children's Hospital Foundation Trust (in similar vein to Rev Dave - let me tell you some stories):

Chairman Jo Davies: (I must add BCH have been ably cared for by acting-Chairman Keith while Chairman Jo was away and I understand they are looking for/interviewing a new Chairman).  But my first real contact with the pinnacle of our Trust was breathtaking in real humanity!  Chairman Jo was eager for her #flufighter jab, and I was invited to her office a few years back to give it.  I was on full, "political correctedness" mode but she breezily popped her shoulder out for me and presented, without fear!  Further contacts amazed me with her absolute fierce passion for the BEST care for the children and families coming through the hospital.  I can only imagine the tight rule she had over Trust Board meetings and the questions she would have (somewhat like HM the Queen to encumbent Prime Ministers?) if she wasn't content the best was being done!

But this amazing, force of nature could sweep through the hospital wearing the most amazing coats of a variety of velvet, gold and all manner of materials!  Presence was the word!  But this Chairman could sit happily with the children (most important in her eyes) and talk and laugh with them.  I have no doubt her successor will have to live upto her high standard!

Chief Executive Sarah-Jane Marsh:  Ah where to start with this absolutely amazing lady.  Like the Chairman, my first contact was through promoting the Trust "Flufighter" campaign.  I was amazed at the strong support from the CEO that came through persistently and positively.  Sarah-Jane always was interested in uptake results, and still is to this current day - the amaze current campaign is here!  Through that initial contact I became progressively vastly impressed with her committment to the absolute and best patient experience (this was pre-Francis) for the patients and families who came through BCH.  I seized many, many quotes from various CEO briefings I was fortunate enough to hear that I have never forgot such as;

"It's not just what we do - it is the WAY we do it that really matters".

A couple of times I heard from parents under my care who hadn't had the best experience and were upset about it.  It was without fear, and complete trust that I recommended they contact the CEO Sarah-Jane.  I would tell them of my brief contacts with her and suggested I felt she would care, and would seek to make changes.  One father in particular excitedly told me he had written a 6-page letter to Sarah-Jane!  I did have a brief moment of complete fear and anxiety wondering if my P45 would be in the post!  I was floored to be updated now and then that Sarah-Jane and our Chief Nurse Michelle (more later) had met the father and implemented REAL change from what they had learned.

One final unforgettable encounter with this amazing woman - I had the amazing opportunity to meet Sarah-Jane just before Christmas (related again to flu I think) and she asked me genuinely how my substantive work (then as a PICU staff nurse was going).  I related to her a very tragic account of being so privilidged to care for a family who were going through the tragedy of facing the withdrawal of care on their poorly child and palliative care for them.  I was stunned to see visible tears in her eyes as she connected instantly with the pain and anguish a family was going through who she had not met.  I have never forgot that.

Chief Nurse Michelle Mcloughlin:  The CEO Sarah-Jane quite rightly refers to Chief Michelle as; "a force of nature".  Patient Experience Lead Kath Evans refers to her; "Can do - will do" attitude!  This so accurately represents a role model in the most excellent, highest standard of patient care and experience delivery - I have been privilidged to meet.

Once again, my first real contact with Chief Michelle was through the contact of the "Flufighter" campaign in 2009.  I was amazed to find that Chief Michelle had expressed her wish to become an "Immunisation Champion" and join in immunising staff.  This was highly unusual around the time - typical NHS practice was to run campaigns via Occupational Health services.  Chief Michelle was key in spreading the positive message of flu vaccination to top consultants who previously may have avoided frontline immunisation nurses.

My later contact with Chief Michelle before leaving the Trust was focused around patient experience and in particular the importance of play therapy and input for our patients.  I again was Patient Experience Application" which has won several awards - and also the "Dignity Giving Suit" - which I think is the most FANTASTIC innovation for giving dignity to young people ever!
amazed at her passionate focus on improving and exceeding everything in the Trust that could be affected and improved.  I caught that vision, loved it, and it remains with me to this day.  Like Sarah-Jane - the CEO - Chief Michelle has been one of the main hero impacts on my nursing career.  Since being away from the Trust, Chief Michelle has been influential and behind the "

Chief Medical Officer - Dr Vin Diwakar:  I have always have had something of a tremendous soft spot for expert clinicians.  This comes from, I think, my esteemed and expert uncle - Dr Andrew Long (Consultant Paediatrician at Great Ormond Street Hospital FT and head of the London School of Paediatrics as well as being on the Board of the Clinical Ethics Team).  Dr Vin has more than earned my tremendous respect and admiration again - all through the accounts of his patient experiences.

As a Paediatrician, Dr Vin Diwakar has cared for and built up a tremendous rapport with many of his patients, and I have heard that many of them have his personal phone number so they can seek support and help if they need it.  He manages to balance his Executive and clinical duties somehow (who knows how!?) and is seen frequently on ward rounds, but also of course at Board meetings promoting patient interest - and the vital role of safety in the Trust.  Just as per Chief Nurse Michelle, Vin strongly supports the Trust "Flufighter" campaign and was pictured this season with Chief Michelle being jabbed!

Chief Finance Officer - David Melbourne: - Non-clinical Directors often receive a less-than-high-profile.  They have no obvious cause to circulate among patients and are often seen to be hiding in offices.  David is not guilty on all counts!  He acted up as Chief Executive while Chief Sarah-Jane was off on maternity leave, but now is frequently seen around the Trust.  I have heard many accounts of his sheer generosity and giving attitude (in an atmosphere of austerity when the NHS should be counting every penny) if it benefits true patient experience.  Quite rightly and deservedly he won the austure "Finance Director of the Year" from HFMA in 2011.

I have no doubt he manages the finances of the Trust sensibly, carefully and accurately - but love accounts where he eagerly invests money if and when it directly benefits the patient experience at BCH.

There are of course, many other BCH Trust Board Directors who I do not have the privilidge to have encountered, but have no doubt (from reading the Trust Board minutes as I do monthly) that they daily defend the importance of nothing less but excellent patient care.  But like Rev Dave - I wanted to highlight the PEOPLE I have had the honour and privilidge of meeting who step up and take responsibility for the care of the precious and vulnerable children a
nd families who are daily cared for by BCH.  I haven't even had the time to talk about the Non-Executive Directors of BCH like Professor Jon Glaseby - who again I am positive carry out a vital role in the care of the children and families in BCH.

They are nothing less than true NHS heroes and want nothing but the best and most excellent care for the patients.  For that they should be saluted!  Of course there will be some "human" Trust Boards who do sadly fail the patients they are entrusted with (such as Mid Staffs) and they should rightly face the accountability of the Secretary of State and the Department of Health and indeed the nation if appropriate.  But until such errors are revealed and proved, Trust Boards across NHS England need our support and thanks as they seek to lead the NHS to do better - and better.  A never-ending journey for the good of our patients.

To end with Rev Dave's words;

"And OK, since you’re asking, (I can’t resist it) here would be my words: expert, professional, passionate, caring, engaging and visionary. But then my Mom always used the quote from Disney’s Bambi and tell me: “If you can’t say anything nice, don’t say anything at all!”

Tuesday, December 03, 2013

Obamacare and Christians

This blog is a slight detour from my usual ponderings on the Holy Spirit, His Person, His work and His gifts.  It touches on another passion of mine - the National Health Service and the provision of free healthcare to those who need it.  Article 1 of our NHS Constitution reads;

"1. The NHS provides a comprehensive service, available to all irrespective of gender, race, disability, age, sexual orientation, religion, belief, gender reassignment, pregnancy and maternity or marital or civil partnership status".

The key principle for NHS healthcare is Article 2;

"2. Access to NHS services is based on clinical need, not an individual’s ability to pay".

Article 2 is a principle which our Chief Executive of the NHS - Sir David Nicholson (a personal hero of mine) has defended vigorously.  He said;

"The NHS was set up to provide high quality care for patients, free at the point of need".

So it is with that in mind (as my personal context) that I have followed with interest the introduction of "Obamacare" in the USA (a country very dear to my heart).  It seems incredibly similar to our NHS and is something I applaud.  The fact that individuals below the poverty line can access healthcare for themselves and their loved ones is great!  Or is it?  I have observed at times that for a reason I cannot understand - that Christians in the USA do not seem as delighted.

Here's why I wrote this blog today.  President Obama was speaking about "Obamacare" and made some points that again, from my context, I would very much agree with.  He said;

"Nobody should have to choose between putting food on their kids table or taking them to see a doctor".

It was Christian tweeter and renowned cessationist blogger Frank Turk who responded quite quickly and got my brain whirring.  Turk said;

"But they better buy their health insurance before the groceries and from the government, right?".

Other bloggers responding to President Obama made various mentions to their pro-life beliefs as well - which also confused me as to it's relevance to healthcare for those who need it.

So here is my question to American friends and in particular American Christians;

What is the deal?  What's the problem with free healthcare to those who need it?  Can healthcare be so incompatible with Christian beliefs?  After all didn't Jesus Christ heal the blind, beggars, needy - not the rich Pharisees?  So is it so incompatible that Christianity should applaud a civil healthcare system that ensures that those who cannot afford expensive care, can still receive the treatment they need?

I'm just interested - teach me!