From my experience of meeting patients who have submitted a complaint and from hearing patient stories at the local Patient Experience days, I have been struck by their detail of recollection on a day when to us it would have been “just another day”. While we all remember certain key days, moments, procedures, outcomes, encounters of our working days, we are unlikely to have the same vivid memories for most of our working days. Yet to our patients, that experience, provided by us, may be their only patient experience, will be with them forever, will be recounted to friends and family and will often have a lasting impact.
I don’t know why I was surprised to realise this, after all, I have been a patient myself several times. Do you remember what you were doing on Wednesday 20th January 1988? Possibly not. I remember every detail since I was a patient in Unit A, room 2, Cresswell Maternity Hospital with pre-eclampsia and a known growth-retarded baby at 37 weeks gestation. Fetal heart monitoring showed evidence that my baby was in distress and I was delivered in the evening by emergency Caesarean section under general anaesthesia of my beautiful daughter, weight 1.76kg. Of course I do not recall the events while I was anaesthetised, but all else is as clear as it was that day. My care was superb, the outcome was excellent, yet to everyone involved with my care, it was just another day.
Do you remember what you were doing 11 days later? Possibly not. I do…having been allowed home the evening before, I returned at a pre-arranged time to feed my daughter who was still in the Special Care Baby Unit (SCBU as it was known then) to be met with surprise by the staff who had not been told that I was coming in, had already fed her and asked me what did I think I was doing there. Already struggling to cope with the trauma of going home without baby, the worries of being a first time mum, especially with her being so small, this was not a good experience to be felt unwelcome, in the way and not a proper mum. Tears were shed in private and it took much determination just to go back into the unit, to spend time with MY baby. Again to the staff, just another day yet that one episode had a huge effect and still fills me with emotion.
How we act, what we say, how we say it is as important to our patients as making the diagnosis, initiating the treatment, or carrying out the complex surgery or procedure. Small simple gestures make a huge difference. Of course this does not just apply to how we speak to patients; how we speak to and work with our colleagues is crucial in building teams, learning, understanding each other, feeling safe, enjoying work, in supporting each other to provide the best patient experience possible. So often, the atmosphere on a shift can be changed in a moment by a sentence, a look, a gesture, an e-mail, a hug and how we feel can impact on the care that we provide.
There has been much talk and publication in recent times about culture and behaviour within the NHS and about the importance of clinical leadership in promoting a culture where the focus is always on providing the best patient experience possible, being curious as to how we can make it even better, being able to raise concerns when we don’t get it right and learning from mistakes.
But how do we create this culture on a day to day basis? What can we all do to make a difference?
Clinical leadership applies to many levels, not just to those in specific leadership roles and all of us can make a difference by firstly reflecting on our own behaviour, to then influence and support our colleagues to do a good job. A tool developed from the Delivering the Future leadership programme, cohort 8, can be used as a checklist and is known as VOICES. We all have a Voice and as discussed, the way that we use our voice can make the difference between night and day on the experience of our patients and colleagues and the components of the VOICES tool are key elements in developing the right culture.
C—Care and Compassion
E—Ensure focus on patient Experience, Encourage and Enable
Ask yourself every day or week the following questions, with adaptation to your own work environment, and mark yourself out of 5, 5 being really good and 1 being really bad.
V—have I been Visible, have I listened to colleagues, have I been involved, have I been visible to my patients, have I spent time with people?
O—Have I been Open and transparent, have I spoken up when things didn’t go well, have I accepted when I could have done better, have I talked to people not about them?
I—Improvement–Have I taken time to reflect, to think how this could be improved for the patient, have I supported others to think, develop or progress an improvement idea? Let’s understand that the people working on the shop floor understand their service better than anyone else and are most likely to know what needs to be improved, and how—“the answers are in the room”.
C—Have I shown that I Care, have I shown Compassion, have I asked how they are, taken time to understand, offered help?
E—Have I Ensured that our focus is always on patient Experience, whatever the other pressures of resources, waiting times, funding, asking ourselves what experience would we want for ourselves, our family, our friends and is that different from what we are providing? Have I Encouraged and Enabled my colleagues to do a great job?
S—Have I helped to provide a Safe, Supportive culture, where we have zero tolerance to bullying, where we can all feel able to politely challenge inappropriate behaviour?
How did you score? The first week that I scored myself, 1 awarded myself 17 out of 30. It was clear that I needed to improve, particularly in Visibility. Second week—22 out of 30 with a gradual improvement since then, but I know that I still can do better!
If we understand how little actions, how we use our VOICE every day can have a huge impact on our colleagues and ultimately the experience of our patients, we can all make a difference. Let tomorrow not be “just another day” make it, and every day, be the day that patients in Dumfries and Galloway can be confident that we will provide the best experience for them that we possibly can.
Dr Heather Currie is an Obstetrician and Gynaecologist and is Clinical Director of Women and Sexual Health at NHS D&G