Take Two Bottles Into The Shower? Not me, I’m a Clinical Health Psychologist by Ross Warwick

image1Because you’re worth it

Bang! And the dirt is gone!

Eat fresh

I’ve been thinking a lot about advertising these past few weeks as September is a significant time for my team in Clinical Health Psychology. This month we will be making a concerted effort to promote our service, raise our profile and increase our contact with the people we aim to help.

As part of this, Ken has kindly allowed us to take over the blog for a few weeks. I’m kicking things off with an account of what the service does and I thought I would take inspiration from psychological tricks used in the world of advertising to help draw you in and get the message out there.

image2I’ll start, then, with a summary of the service that follows the advice of a Professor of Experimental Consumer Psychology at the University of Wales, Jane Raymond. Prof Raymond advises that rather than bombard the audience with information I should break it into chunks to allow the brain time to process each component:

  • Chunk 1: The Clinical Health Psychology service helps people who have a psychological problem that is caused and maintained by a physical illness.
  • Chunk 2: These problems usually involve unpleasant feelings and unhelpful thoughts about the illness that keep someone from doing things that matter to them.
  • Chunk 3: This can cause distress, affecting overall well-being, medical treatment, self-management and health outcomes

An article in a social psychology journal showed that a wide range of people respond well and are persuaded by stories (Thompson and Haddock, 2012). So to illustrate chunks 1-3 here’s a fictionalised case based on real events:

Jane is a young teacher who has type 1 diabetes. Her condition and the things she must do to keep on top of it are often accompanied by feelings of shame, anger and loneliness. She has frequent thoughts that her condition means she is abnormal and that it must be hidden from others. Because of these unhelpful thoughts and feelings she avoids testing her blood, guesses her insulin levels, is inconsistent with her diet and keeps problems to herself.

She has been absent from work and in and out of the DGRI several times within the past twelve months. Because of this she believes friends, family and colleagues are annoyed with her for not taking proper care of herself and landing them with more responsibility. As a result, she avoids seeing people and has become more and more isolated.”

The next steps for Jane are chunked below:

  • Chunk 4: In therapy we would work with Jane to live well with her condition by addressing her unhelpful thoughts, feelings and avoidant behaviour
  • Chunk 5: As therapy is all about collaboration, Jane’s most likely to have a good outcome if she’s motivated to participate and make changes to her life
  • Chunk 6: Jane can be referred to Clinical Health Psychology by anyone who is involved in her care, be it her GP, Practice Nurse, Dietician, Diabetes Specialist Nurse or Consultant.

In Jane’s story, she’s in and out of DGRI because thoughts and feelings stop her from acting in a way that would help keep her well. So psychological therapy would add value by reducing her distress and unplanned contact with services (and by highlighting that sentence your attention has been focused on a key message about how psychology makes a difference to both the person and the hospital; Pieters and Wedel, 2004).

But would you believe that individual therapy expertly delivered by members of our experienced, compassionate, and, yes, attractive, team is but one feature of our service? In Clinical Health Psychology we also provide training, teaching, supervision and consultation because you don’t need to be a psychologist to provide psychological care (worth mentioning because (a) it’s completely true and (b) according to Goodman and Irmak, 2013, audiences are likely to prefer multi-featured products).

Already the Diabetes and Cardiac Teams are benefitting from increasing their psychological knowledge and skill through participating in Emotion Matters training, and a group of local GPs have recently completed training to introduce CBT techniques into their routine consultations. Recruitment of a second cohort will be underway soon.

Time for pictures of the product:

headshotsBy now thanks to my evidence-based and scientifically informed techniques of persuasion, you will no doubt want to know how you can benefit from working with our wonderful service.

You can contact us by email or by calling us at the psychology department to talk about matters psychological, be it complex cases, potential referrals, or training your department. Find out more about making referrals by consulting our service leaflets which are available absolutely FREE through Beacon by searching for ‘Clinical Psychology’ or looking under ‘Documents’ after following the link below. And as the Patient Information Leaflet can also be found there, you enjoy a 2 for 1 bonus!

http://hippo.citrix.dghealth.scot.nhs.uk/sorce/beacon/?pageid=Sitesearch&searchCriteria=clinical%20health%20psychology

Keep your eyes open for opportunities to attend training events we’re delivering this month and enjoy the blog posts written by the Clinical Health Psychology team over the next few weeks. Finally, to eke this advertising ruse out just a little further, comment below to be part of a Clinical Health Psychology virtual focus group.

Just do it.

Ross Warwick is a Consultant Clinical Health Psychologist and Lead for Clinical Health Psychology at NHS Dumfries and Galloway

How to make a good death by Justine McCuaig

My Mum died on June 6th 2017 at 11 45pm at home asleep beside my Father while he held her tight.

My overwhelming and lasting memory is of going up to offer Dad yet another cup of tea, (my family home by this time had become like a scene from Eastenders with endless tea becoming a cure all for our woes) and finding them both asleep in front of the telly, holding hands, as if it were any other night in their lives together. By this point, knowing mum was soon to leave us, I chose a whisky over tea while my sister drank Mum’s Tia Maria and we laughed at our naughtiness downstairs.

We had been caring for Mum for 4 months at home. She had been diagnosed with idiopathic pulmonary fibrosis a few years before and her lungs progressively stiffened up despite her objections and indignation at the condition. Everything else was in perfect working order!

Mum was very pragmatic about her diagnosis and we often talked about its progression together with and without my Father. I asked her when her condition worsened if she thought my Dad had “got it” and understood that she had terminal disease and was not going to recover. The next day I visited and she said “yes he’s got it….I sat him down and told him that I wanted buried in the garden and listed who I didn’t bloody want coming to the funeral  so you don’t need to worry about that anymore!”

Although as a family we liked our privacy from the outside world, we were not particularly shy or private people at home and regularly discussed all manner of things and shared experiences. No topics were ever out of bounds for us and I had the privilege of being raised by tolerant humanitarians with a good sense of humour and a love of dialogue, music and life. We have always been able to talk about the big things with ease, disease, mental illness, romantic woes, religion and politics but struggled with the smaller things and general displays of affection. We loved truly and where truly loved but it was unspoken generally and wrapped up with rather woolly “oh you knows”

Cuddling was not a regular thing either (for no good reason other than we didn’t really do it much) This physical distance completely disappeared when I began to nurse my Mum and provide her with regular personal care. I was more unsure about how I would feel about this than how she would feel about it even though as a nurse I was simply using the tools of my trade.  To my delight caring for Mum (and Dad) was one of the most wonderful experiences I have ever had.  The physical closeness and honesty was liberating for us both. We had so many laughs (normally about things we really shouldn’t laugh about!) Gift giving changed and although a commode wasn’t everyone’s idea of a great birthday present, my Mum loved it, especially with the balloon attached.

To be able to wash my Mum, do her hair, paint her nails all the time chatting about this and that with up to 5 grandchildren lying alongside her at “Granddads side “ was a unique shared experience which we all enjoyed up to the last week of her life. Grandchildren came and went as it suited them without obligation and new routines developed for us all which were played out wholly to our tune. Nail painting changed to pressure care and symptom control but there were no restrictions on visiting, no alien environment or hospital smells, no distance to travel, no reduction in privacy or dignity.

Just home – where the heart is, and where sitting on the bed is actively encouraged!

Of course we couldn’t do this without support. It was great that I was able to use my nurse’s tool box to be my family’s advocate, to explain things lost in translation and to explore mums options. However it was the cohesiveness of our systems, the excellent communication between teams and professionals actively hearing what the patient aspired to and facilitating those aspirations that really worked for my family and resulted in such a good death for my Mother

NHS Dumfries and Galloway has the most outstanding staff members across all disciplines. With thier input we can successfully choose our own package of care and be fully supported in that choice. Anticipatory care planning and social care integration have the potential to really transform the patient journey and is not something to be afraid of but rather to embrace.

 However all of these services need to be heavily invested in to meet the expected demand from   an aging population. Without continued investment and service development, NHS Dumfries and Galloway will not be able to fulfil this ambition and enjoy the success that my family had.

Mum was admitted to DGRI 3 months before she died as an emergency admission and was discharged from ward 7 with a complete package of palliative care and specialist community respiratory support within 32 hours.  All of her drugs and letters were ready at our agreed   discharge time, the domiciliary oxygen was arranged and delivered and referrals completed for the McMillan, Marie Curie Nursing services and Community Respiratory Specialist Care.  Her DNR was signed and she waved it under the nose of anyone who was even vaguely interested in reading it. It remained pride of place on the bedside dresser as it was very important to her that her intentions were known. Everything my Mum did was delivered with humour and even this got a comedy slant!

The Kirkcudbright District Nurses introduced themselves and ensured that their door was kept fully open for when we needed their help and support. They responded promptly to any requests and where always available at the end of the phone to discuss Mums needs as they arose. Our Specialist Respiratory Nurse visited regularly.  When Mum developed a chest infection he promptly liaised with the consultant from our dining room relaying Mums reluctance to be admitted but advocating   the need for her to receive appropriate treatment which could prevent her condition worsening. Although her condition was terminal   there were still things that could be done to minimise her symptoms and prolong the length of her wellbeing. Mum agreed that if things got rapidly worse she would potentially consider IV therapy in hospital but would initially hedge her bets with tablets, lots of tea and nebulisers. She started her antibiotics orally that afternoon and recovered and remained well   long enough to see her beloved swallows   return   from Africa to nest in the garage, enjoy the spring flowers from the garden and support the children through their exams.

The Occupational Therapist ensured Mum had all of the equipment she needed when she needed it. If a piece of kit was ordered it was generally   installed within 24 hours. The Equipment Delivery Staff ensured that we knew exactly how to use it after they had installed it and answered all questions fully and in a voice loud enough for my deaf Dad to hear! They ensured he knew who to contact in the event of any problems. Mum had everything she needed, a bath chair, a stair lift, a stand aid, a pressure bed.  Visiting relatives from the Deep South stood with mouths wide open in disbelief at the care and support my family were receiving and began to seriously consider relocation. After Mums death the equipment was collected promptly but respectfully and was almost symbolic of starting life without her.

We did need the District Nurse’s help more regularly in the days running up to her death and because they had developed a slow growing respectful relationship with my family they were welcomed in like old friends.  They encouraged me to be Justine the daughter rather than Justine the nurse which was invaluable advice. They looked after us all, and talked us through every stage or change in Mum’s condition. Most importantly Mum thought they were great and that is, of course because, they were.  She was so interested in people and life and living that she became just as invested in how they were doing as they were in her. This was especially true of the student who approached and completed her finals during mums care. She told Mum when she   successfully passed as she knew it was important to her to know despite Mums condition rendering her uncommunicative at that point.

However we all knew she was dead chuffed!

Mum received reflexology   and head and hand massage in her bedroom as part of her palliative care package which was a new experience for her and one she really appreciated. What she enjoyed as much as   the treatment was her was that she had another person to communicate with and to learn from. She loved engaging with people more than anything. It gave us all something to talk about too. Even then life remained interesting with new experiences to share.

When Mums condition deteriorated to the point of suffering the District Nurses and GP promptly began her syringe driver to minimise her symptoms. I had discussed this often and in detail when Mum asked about “what next” and she fully understood that when her symptoms were controlled this way, she would be less awake and aware. She made a very informed choice when the GP prescribed it and her consent made me feel content with that course of action. She had had enough. Any other GP may have been phased when she asked if he was “putting her down,” especially when after administering an injection she said “No, no I’ve changed my mind” with a wicked twinkle in her eye!” However Mums GP knew her well and knew that with her humour she was trying to make a difficult job easier for him.

The Marie Curie nurses would phone regularly to see if we needed help over night which was very comforting. In the end the nurses attended the family home twice. Once to administer breakthrough medication in the wee small hours on the day the syringe driver was started (all the way from Dumfries – a round trip of 60 miles) and the following night at 10pm for their inaugural sleep over. Mum died shortly before midnight that night and Dad then made the long walk to the spare bedroom to ask our guest to confirm that she had gone.  Having her there at that time was invaluable and over the next few hours we all chatted and laughed and cried while we waited for a registered nurse to certify Mums death.  The care and support we all received that night was beyond excellent . Mum stayed the night, there was no rush for her to go anywhere and we all spent time with her before she left us mid morning. Downstairs my sister and I repeatedly heard my Dad’s footsteps as he came and went into their bedroom to check that she was really gone.

And she had gone,  Mrs T had left the building. Although we were (and are) devastated we have all reflected our relief that she had suffered so little in the end and that she died where she wanted surrounded by the people she loved . Knowing this has filled our sad hearts with a warm feeling knowing we did right by her and in time this will be a great comfort to us.

Janice M 1

Justine’s Mum and Dad on Crosby Beach 

Justine McCuaig is a Health protection Nurse Specialist at NHS Dumfries and Galloway

An Occasional Visitor to Dumfries & My ‘Scottish Heritage’ by Tarik Elhadd

(This article was written in Dumfries in August 2015)

I have always been fascinated by the Trust Weekly Blog and stemming out from my connection with Dumfries, I thought of posting this reflection, hopefully it will be deemed suitable for publication.

I first came to Dumfries in spring of 2011 several months after departure from my home country, Sudan. My re-traffic to Sudan in 2009, trying to re-uproot, make a living and help my own people, was very much dashed by several factors. Making a living there was second to impossible. Back in 2007/2008 I had an offer to join a thriving health service in the area beyond the far western Canadian prairies, in British Columbia, which encompassed both academic and service domains. Coming to Dumfries was the perfect choice as the job was still vacant. I went to British Columbia a few months earlier in a fact finding mission. Part of the Canadian recruitment process entails inviting prospective candidates and their families to come and see themselves, and then make an ‘informed decision’. Following a week in ‘Prince George’ in fall 2010 we got satisfied and decided to go for it, despite that it is in the ‘end of the world’, being 13 hours flight from UK. But for us, the Sudanese, it was ‘Safe Haven’. The prospect of working and living in the ‘New World’ proved exciting. I had just turned fifty by then, and the career prospect was still rife. I began the process of joining Prince George University Hospital of North British Columbia, but to fill the 9 month gap whilst this took place I came to Dumfries to take up a locum in Diabetes and Endocrinology. One place, one hospital and then off you go to Canada. That was the dream which proved to be elusive.

At Dumfries life was very smooth. I was embraced by everybody, from within the department and from without, as one of the team. I never felt, nor was given, the feeling of being the ‘bloody locum’, who is here to do little for ‘too much money’ and then vanishing away. I was always treated with dignity and respect and always given the feeling of being ‘one of the team’. Everyone expressed love and showed gratitude to the job I was doing. This culture you won’t see or feel in other places as a locum. At Dumfries your expertise and hard work would be appreciated and valued and, despite that I was well paid for the hours I was doing, I was never eyed as a locum and stranger by anyone save one or two people.  Weeks and months and the path to relocate to British Columbia became fraught with obstacle after obstacle. It proved to be a ‘bumpy road’, and my stay at Dumfries continued, not only for nine months but it went to one and half a years.

I left Dumfries in August 2012 pursuing the elusive Canadian dream only to come back again in December 2013 when change of heart and change of fortunes forced yet a move into the opposite direction, this time eastward. The Canadian dream been burned on the altar of destiny. I was heading towards the Arabian Gulf, another safe haven for us, the beleaguered Sudanese. I was again embraced by Dumfries with the same old love, dignity and respect. Despite that my second ‘tenure’ at Dumfries was in Acute Medicine but it was equally enjoyable and blissful. Again I was never been given the feeling of the ‘other’, or the ‘stranger’. Not only that, after over ten months, I left to Qatar with an open mandate to come back at any time if ‘things did not suit me!!! Is that not wonderful and special to be given the feeling of ‘being wanted’ and in demand? Needless to say I was even approached to consider a permanent position and a substantive post.

Back to UK after spending a full working year in Qatar, and having the demand of keeping my license and my GMC registration alive and staying close to my grownups, who were staying in Cheshire, who had all re-trafficked back to UK after completing their University education in Sudan. I was welcomed back to Dumfries. It was the same old fantastic feeling. As a trainee back in the mid and late 1990s, I began my training in diabetes in Edinburgh at the old Royal Infirmary near Edinburgh Castle & the Royal Mile, and returned to Scotland again as an MRC Research Fellow at Ninewells Hospital in Dundee. Not to miss out the two years spell I had in Ayrshire when the educational needs of my youngest son made a re-traffic to UK in 2007 a necessity. So out of over 20 years of my career I spend in UK, one third was in Scotland. I am proud to call it my ‘Scottish Heritage’. One third of this heritage belongs to Dumfries-shire.

Dr Tarik Elhadd is a Consultant in Diabetes and Endocrinology

The Pneumonia in Bed 5 by Sian Finlay

Although it is sometimes easy to forget it amongst the busyness of front line clinical duties, I am a person.  I suspect many of you are too.  Occasionally I am unwell, but I consistently find that I still remain a person during this period – I have never yet become a disease!  So why is it that when patients come into our care, we so often default to calling them by their diagnosis instead of their name?  Go onto any ward and I guarantee it will not be long before you hear someone described as ‘The Chest Pain’ or ‘The Pneumonia’.  Many handovers will include phrases such as ‘He’s a UTI’.

No, he isn’t! He’s a PERSON who has a UTI!

A common (and potentially even worse) variant of this is the ‘bed number’ name, exemplified by ‘Bed 3 needs the commode!’  Sometimes attempts are made to justify this practice with the excuse that it protects confidentiality, but let’s be honest here.  The truth is that it simply demands more mental effort to remember the patient’s name and we are taking a short cut.  All very understandable in a busy environment, and I really don’t blame anyone.  You might think it is just semantics anyway – what does it matter if we call someone ‘The GI bleeder’?  Well I argue that it does matter.   More than you think.  These patients are people, no less complex and emotional and fragile than you or me.  By depersonalising them, we are subtly starting down a path which allows us to forget this; which allows us to view them as tasks in our day rather than the individuals they are.  If you are unconvinced, try this little exercise; read these 2 sentences and see if they elicit the same emotional response in you:

Bed 5 is agitated.

Tommy is agitated.

Would you agree that the second sentence immediately makes us feel more empathy and compassion towards its subject?

Many people will be aware of the late Kate Granger, the inspirational doctor who responded to her diagnosis of terminal cancer by establishing the ‘Hello, my name is..’ campaign.  Sadly Kate died last year, but her campaign lives on and has touched many of us in the healthcare profession.  But Kate’s work didn’t begin and end with wearing a smiley badge with our name on it; it is in essence about remembering the humanity of our patients and treating them as fellow human beings.  And I can only imagine Kate’s fiery reaction if she ever overheard herself being referred to as ‘Bed 5’!!

But we are all under pressure.  What if we genuinely can’t remember the patient’s name and are just trying to communicate information quickly?  Surely that doesn’t make us uncaring?  Of course it doesn’t, but in times of acute amnesia, we could at least say ‘the man with pneumonia’ rather than ‘the pneumonia’.  And that should only be a holding measure until we can remember his actual name – surely essential for safe communication anyway!

I hope I have convinced you that words do matter.  The phrases we use set the whole tone for the level of kindness and empathy we expect in our clinical areas.  So if any of this resonates with you, I hope you will lead by example.  Look at your patients and remember they have hopes and fears and histories and personalities…and almost always names!!

Sian Finlay (aka ‘The Migraine on ward 7’) Acute Physician and Clinical Director for Medicine at NHS Dumfries and Galloway

 

 

Surviving and Thriving in a Time of Change by Dawn Allan

I have always been fascinated by human beings and why we are the way we are.

Does our cultural and family background influence us?

Why do some people believe in God and some don’t?

Why are some people able to talk about death and dying so easily?

Why do people focus on their weaknesses, what about their strengths?

How self aware are we?

Who are we when nobody is looking?

Having emigrated from Ayrshire to South Africa where I spent my childhood and early adult years, I discovered the down side of the school playground because I sounded different.  There were only so many times a 6 year old with an Ayrshire accent wanted to mandatory repeat the word ‘potato’ at the class bullies insistence, and then suffer his disparaging comments,

“…doesn’t she sound weird…say it [potato] again…oh, ja, you’re from ’SCOT-LAND’ hey…”!?!

I remember stifling back tears, wishing I sounded like my peers so he would leave me alone.  When I reflect on this childhood bullying memory, it is mainly laughable now and I quickly adapted by adopting a local accent to blend in.  Life nurtured resilience and I learned when it might be safe to confront a bully wisely, when to ignore them and when to ask for help.

This year I relocated from Shetland to live and work in a place, “Often described as “Scotland in Miniature,” South West Scotland’s Dumfries & Galloway region is characterised by its rich cultural heritage, stunning scenery, sweeping seascapes, towering cliffs, rolling agricultural land, and its wide, wild landscapes”.  Who wouldn’t want to live here?!?  So, what about the people?  I am pleased to say they too are fascinating, warm and welcoming.

The 2017 focus for NHS Dumfries & Galloway is the move for many staff from the current DGRI to the new hospital.  From what I am gathering, this process of change is daunting for some.  If communication is key to all that we offer and provide as health care professionals, part of the way we manage our expectations in preparing to move is to be aware of how we communicate with or about each other as individuals, departments and teams.  Having a person-centred approach should be our modus operandi – our behaviour and communication does not go un-noticed by patients and visitors.  Being a ‘relational person’, I believe our hospitality is as valuable as our clinical / social care, our administration skills or our financial targets.

If a holistic approach cares for the whole person, this includes acknowledging someone’s pain, providing them with pain relief and offering them a cup of tea – all spiritual ‘acts’.  We all deliver spiritual care, what I aim to define is that we as staff do not, ‘go Greek’ i.e. compartmentalise and separate a person into ‘bits’, i.e. age, gender, status, patient, service-user, client, spiritual, religious, physical, mental, psychological, emotional…When in physical pain, the whole of our being is affected.  Judeo-Christian views that –

  • every person is born with worth and dignity
  • every person has the ability to choose between doing good and doing wrong
  • every person has the responsibility to help others in need and the community

Whether the person we are caring for or working alongside has a belief / faith or not, they will have a ‘value system’.  I hope having a VBRP – Values Based Reflective Practice – approach will help all of us as we reflect and hopefully learn from the past in the present, to know how to continue or change best practice, including our communication.  Our motives are based on values we apply every day which will help or harm the people we care for, including ourselves.

To be a hopeful presence is how I sometimes describe my encounters with people.   When we are at our most fragile and vulnerable, we need others we can trust, who will listen with their eyes and ears, who can make us laugh, encourage us when we feel stressed, sick or lonely and offer compassion.  My confidential support includes staff – we are all at different stages in our professional roles and our personal lives.  Before anyone ever declares whether they have a belief / faith or not, it is what we have in common as human beings that is paramount.  Difference is a given, but negative overemphasis on difference marginalises people – companionship and inclusion build bridges.  Sometimes, ‘life happens’ and it is the sudden, unexpected occurrences that affect our health and relationships most.

One of my favourite authors C S Lewis reminds me that a man of such academic, creative gravitas was honestly transparent, he said, “I pray because I can’t help myself.  I pray because I’m helpless.  I pray because the need flows out of me all the time – waking and sleeping.  It doesn’t change God – it changes me.”

Rabbi Harold Kushner’s description speaks into my role, “When you cannot fix what is broken, you can help very profoundly by sitting down and helping someone cry.  A person who is suffering does not want explanation: the person wants consolation.  Not reasons, but reassurance.”

If we as individuals think we do not need each other, we are deluding ourselves.  My faith informs my professional practice, without imposing it on anyone.  If the Son of God relied on twelve disciples, who am I to say I can survive without the support and wise counsel of colleagues?  We are only human and we need each other to ensure NHS Dumfries & Galloway not only survives but thrives today and tomorrow.

Dawn Allan is Spiritual Care Lead Chaplain at NHS Dumfries and Galloway

Can I make a difference? by Paul Gray

It’s a big question – can I make a difference?  How does it feel to ask yourself that?  For some of us, the answer will be different on different days.  My experience suggests that your answer depends much less on what you do, than it does on how you feel.  In this blog, I’d like to offer some thoughts on making a difference.

However, some context first.  I fully recognise the challenges we face.  Health budgets are going up – but pressures on recruitment, and the demands of an aging population, are also very real.  There is also still much to do in tackling inequalities, and improving the health of the population, which NHS Scotland can’t do on its own.  And we do know that people have the best outcomes when they are treated and cared for at home, or in a homely setting.  So our current models of care are transforming to meet these demands, and to provide the most appropriate care and treatment for people, when they need it, and change brings its own challenges.

So my first suggestion is to turn the question, “Can I make a difference?” into a statement – I can make a difference.  If you start from that standpoint, you’re much more likely to succeed.  It’s easy to become pre-occupied with the things we can’t change, and the barriers and problems – I know that I fall into that trap from time to time.  But wherever I go, I see people throughout the NHS, and in our partner organisations, making a difference every day.  So ask yourself, what is the one thing I can do today that would make a difference?  And then do it!

paul-1Now, give yourself some credit – think of an example where you did something that was appreciated.  Write it down and remember it.  If you’re having a team meeting, take time to share examples of things that the team did, that were appreciated by others.  Sharing these examples will give you a bank of ideas about simple things that matter to other people.  And it also gives you something to fall back on, if times are tough.

Next – think of an example when someone did something for you, which you appreciated.  Find a way to share these examples too – if it worked for you, it might work for someone else as well.  Ask yourself when you last thanked someone for something they did well, or something you appreciated.  It’s easier to go on making a difference if others notice what you’re doing!

If you’re leading or managing a team, ask yourself how much time the team spends discussing what went well.  It’s essential to be open and transparent about problems and adverse events, but if that’s the whole focus of team discussions, we overlook a huge pool of learning, resources and ideas from all the positive actions and outcomes.  And we risk an atmosphere where making a difference is only about fixing problems, rather than about improvement.  So, as yourself and your team, what proportion of time should be spent on what went well?

Remember to ask “What Matters to You?”.  I know that the focus of this question is on patients, and that’s right because they are our priority, but it’s a good question to ask our colleagues and our teams as well.  Just asking the question makes a difference – it gives you access to someone else’s thoughts and perspectives, and is likely to lead to better outcomes.

paul-2Will any of this change the world?  Not on its own, of course.  But you could change one person’s world, by a simple act of kindness, or listening, or a word of thanks.  You can make difference!

Paul Gray is the Chief Executive Officer for NHS Scotland and the Director General for Health and Social Care at the Scottish Government

Honest Reflections by Barbara Tamburrini

As this is now the third blog I have written for DGHealth, either there is a shortage of ‘willing volunteers’ or others have found better ways to say “maybe, possibly, perhaps soon” to Ken Donaldson when his charming request drops in the email ‘in-box’. Whatever the reason, I find myself agreeing to contribute and construct another brief moment of interest in our increasingly busy days. Having written previously about handover processes and the importance of good communication, I thought I would flip this on its head for this blog and consider the ‘inward’ communication reaching our ears from eager and sometimes over-active media sources and outlets.

A scan of headlines published over recent times don’t make happy reading for hard-working and dedicated NHS employees trying their best to simply ‘stay afloat and fight the fire’. Over the last 4 days, a number of reports sum up the general gist of current NHS news:

  • 9th Feb 17 – “Worst A&E waits ever, leak suggests” – BBC News
  • 8th Feb 17 – “The NHS and its crisis: Myths and realities” – Sky News
  • 7th Feb 17 – “Scotland’s A&E departments miss key waiting time targets over festive period” – Daily Record
  • 7th Feb 17 – “Maternity services in Scotland ‘beginning to buckle’” – BBC News
  • 7th Feb 17 – “Ageing UK midwife workforce on ‘cliff edge’, warns RCM” – Nursing Times
  • 7th Feb 17 – “NHS [Scotland] cancels 7740 operations due to lack of resources” – STV News
  • 5th Feb 17 – “Scotland patients waited more than a year for hospital discharge” – Sky News
  • 5th Feb 17 – “Revealed: The hidden waiting list scandal for Scotland’s NHS” – Sunday Post
  • 5th Feb 17 – “Growing waiting times threat to NHS” – BBC News

The recent coverage by the BBC assessing the state of the NHS across the UK in their NHS Health Check Week raised issues including a perception of desperate times inside A&E departments, analysis of patient flow reducing to a halt and “clogging up” hospital wards and frontline services being radically changed in attempts to overhaul health provision in the wake of the publication of NHS England’s five-year plan for the NHS in 2014. Indeed, as recently as 15th January 2017, chair of the BMA, Dr Peter Bennie was quoted as stating the Scottish NHS was “stretched to pretty much breaking point” and “heading for a breakdown” unless the government acknowledge the disparity between the current comprehensive service provision and existing funding levels.

So what does all this mean for humble workers ‘at the coal face’ and patients who so desperately rely on the NHS and our contribution within it? Dr Bennie wisely points out that honesty is required when assessing all elements of our much loved but potentially deeply troubled NHS. Honest reflection on our actions and behaviours as NHS staff is required to ensure we are all maintaining a focus firmly centred on our patients and clients. In a profession which is becoming more and more challenging with morale which seems to be ebbing lower and lower, can I really state with certainty that my focus is always upon my patients?

If I am looking at my last shift on duty, as part of the DGRI capacity team, I know that the greatest majority of my time was spent considering patient care but, the complexities of the work involved in capacity management mean a constant ‘juggle struggle’ between complicated discharges, patients keenly attending for their long-awaited surgery and fast and furious emergency admission rates with significant staff shortages thrown in to make life really interesting. This is a really difficult environment to function effectively, positively and proactively.

Its exceptionally difficult to have to say “I’m really sorry but I don’t have anyone who can give you a hand at the moment” to hard-working and struggling colleagues whom you respect and want to help. This inevitably influences work-focus and morale, sometimes away from patients and onto less fruitful, less important areas – we’re only human after all! I’m sure many of you reading this blog can identify with this and acknowledge that there can be times when we recognise that our concentration has slipped away from the real reason we are all here. This honest reflection is being actively encouraged in nursing through the revalidation process which will positively impact the profession in the future with a similar process in place for medical staff.

Honesty is also required from patients and clients using NHS services with individual ownership of health and the impact of lifestyle choices upon this of fundamental importance. The vast majority of NHS patients freely and actively claim this responsibility but this is not always the case in some crucial clinical areas like Emergency Departments. For the headlines to stop, the public also need to do their part. In a recent article in Glasgow’s ‘Evening Times’ (9th January 2017), it was stated that around 1 in 6 Scottish ED attendances may be unnecessary at a potential cost of £33 million and whilst ministers have provided responses aimed at removing any punitive element and reassuring the public that they are right to be concerned about their health, this concern needs to be correctly channelled for current pressures on health services to be eased. Patients with 3-month history of injuries, minor ailments which could be assessed elsewhere and those telling us they didn’t bother trying their GP as “they wouldn’t get an appointment anyway” are all too frequent presentations in busy ED’s. In my ‘other role’ as an ANP in ED, every time a patient told me this, I called the surgery myself and was given an appointment that day for their patient so, as well as accepting ownership of their own health, patients and service-users also need to be well-informed, confident and comfortable about the health services they access and when they utilise these valuable resources.

My feeling is that an organisational honesty also exits within current healthcare with ‘the powers that be’ having a responsibility to consistently and carefully examine the healthcare delivered with rectitude and reliability. We are somewhat fortunate in that we have an organisation who actively engages with staff through measures such as #ontheground, weekly core briefings, active and lively facebook and twitter accounts and the informative and interesting DG Change website (http://www.dg-change.org.uk). Indeed, this weekly blog also serves as a useful interactive communication with reflections and comments on posts actively encouraged. But is this enough? I would argue that even though these proactive measures exist in NHSDG along with many other approaches, staff morale remains low in some clinical areas and sickness absence rates are running well above optimum levels in some departments. So, are the current measures of engagement between the organisation and its employees inaccessible, uninteresting or unimportant to some staff, not effective enough, not addressing the correct issues or simply not delivering the desired impact? Although impossible to answer within this blog, the significance of this question and the consequences associated with it, must remain high on the agenda if staff empowerment, engagement, motivation and morale are to be maximised as we hurtle head-long towards a new hospital and evolving chapter in our healthcare provision.

Every ward I go in to during my capacity shift has AHP’s, nursing and medical staff who look tired, strained and burdened by an ever-increasing workload with constant financial and resource pressures making the job all the more difficult. But, and this is crucial, staff continue to come to work to do the best job they can given these constraints. They continue to change rota’s to cover absences, work through breaks and past finishing times to help their colleagues and patients and they continue to ‘fight the fire’ with dedication, sometimes in the face of adversity. Healthcare staff MUST care about the service they provide, to deliver care which remains meaningful, appropriate, safe, effective and patient-centred.

Whilst we as staff have a responsibility to continually reflect on our own practice, this must be fully supported, actively encouraged and consistently underpinned by honest reflection at a strategic level on the current ‘state-of-affairs’ and how this can be promoted and enhanced within the existing inflexibility of financial austerity.

Therefore, returning to our news headlines, what does the future hold for the NHS locally and nationally? Locally, despite considerable challenges, there are exciting times ahead as we look to fully embed health and social care integration and also move our main hospital services into our new build. Nationally, the picture is less clear with ever-increasing financial pressures being placed on continually growing workloads in a society with greater demands in terms of health due to conditions such as obesity, diabetes, heart and respiratory diseases. This is compounded by an ageing population sometimes presenting with chronic conditions which one simply did not survive from a decade or two ago.

hould we as NHS employees, the general public, healthcare service providers and users be concerned about the growing tide of negative headlines? Perhaps. Maybe these give an insight into the ‘health of our NHS’ – gosh, that’s a worrying thought. Or maybe, we now live in an environment feeding off news negativity and scandal in which we have all become de-sensitised to minor challenges therefore pushing media providers to ‘raise-the-bar’ in their reactionary reporting of our beloved NHS which would have, until relatively recently, been ‘off-limits’ to the eager reporter looking for a scoop however vague, misleading or sensational.

Lets return to our honesty theme. Within this blog, I have suggested that some honesty is required in our NHS and this should also extend to the reporting of challenges and issues to a certain extent. The antonym to sensationalism, where bad, critical or damming NHS news is forbidden with offenders punished by a stint taking minutes for certain western hemisphere parliamentary press conferences, is also not good for contemporary healthcare since this stifles and prevents honest reflection from which, lessons can be learned and development thrives.

There is every likelihood that the headlines wont go away and they may even increase in frequency or adversity. Perhaps though, if we all contribute in our own way, positive, honest and transparent analysis at individual, peer, organisational and national level will drive, develop and sustain an NHS we are all proud of and which we want to protect, however difficult or complex the discussions and decisions.

Barbara Tamburrini is an Advanced Nurse Practitioner at NHS Dumfries and Galloway