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

Reflections on Imperfections (In memory of Dr Johan Leuvennink, my friend) by Fanus Dreyer

While writing I am listening to Dozi, a troubadour who sings in Afrikaans and Zulu.

On Monday I attended the memorial service for my close friend, Johan Leuvennink, consultant psychiatrist, who died so suddenly. For the last two weeks I have been thinking about the paths we’re on and why these are so imperfect…

In December 2012 I had a knee replacement, necessary due to damage from playing rugby, jumping from aeroplanes and boulder hopping in canyons and on the Cape coast. It was 14 weeks before I could go back to work and where else would a knee recover more quickly than in the heat and dust of Africa. So we went to Zambia for teaching critical care and then to South Africa to visit family. As David Ball and Pete Armstrong returned from Lusaka to Dumfries I went south, with a stopover in Johannesburg. At O.R.Tambo’s Ocean Basket I ate Cape kingklip and calamari, with a glass of Durbanville chardonnay. My waiter was Pioneer, who recognised me from a visit the previous year, when about 10 of us descended on them for a meal. He asked me in detail what I did and so on, and then said “You have the greatest job. Not only are you able to save people’s lives, but you actually teach others to do the same“. I was humbled by Pioneer’s insight and very thankful for his words at a time when I didn’t feel like going back to work.

Pioneer’s words led to some serious thinking. Why then was I dreading to go back to my NHS job after only 3 months off? Well, I always feel that way after experiencing something of the heart and soul of Africa, but this time it was worse. Some things happened around the three weeks we spent in Zambia and South Africa. I received emails about critical incidents in patient care that I could not have influenced, but I was still asked to comment. On the first day back home I was phoned about students who had complained and I was asked to respond, even though I had not met these students. Somehow there is this perception that, if we just complain enough and change systems constantly, we will one day reach perfection. NO, it ain’t gonna happen!

In Tanzania in 2009 our guide, Cyprian, described the caricatures of all the different nations that he had taken on safari. We laughed at how he described Afrikaners, Germans, French and Japanese clients. He said that the British were those who would say “thank you very much, it was the most amazing trip of my life”, but on the feedback form they will always write one thing that should be better or different. Make no mistake, I always take complaints or concerns of those who “suffer under surgeons” very seriously, but simple moaning leaves me cold. I have just bought a car and, although it is great to have a new toy, it is not perfect for my requirements. My job is not perfect, nor is anything else in my life. So what! I’m happily cruising along through this life and can only stand and stare at the miracles it brings every day, again and again. We meet people who have suffered unimaginable losses and with severe disability and sorrow, and they continue to inspire me. I think Africa accepts life’s imperfections more easily. That is why Rwanda could move on and why South Africa had a peaceful transition. You also see that in the total lack of self-consciousness in the girl with a long scar on her face, in the man wearing a woman’s blouse and in the patient with the large goitre or fungating cancer. So my job is not perfect but Pioneer is not far off, it has perfect opportunity, and for that I am forever grateful.

…I had known Johan since he was my student in Tygerberg Hospital. He stood out because he asked challenging questions. And then we met again in Dumfries and shared some good times together, usually in serious discussion. We walked a difficult road together. I still cannot believe that he is gone and the question that remains in my head is “What price do we pay for the work we do?” I know that surgeons have a high rate of untimely deaths, and am sure the same goes for psychiatrists.

fanus-1This took me back to thinking about the National Geographic picture of Dr Zbigniew Religa and his patient, taken after he did the first heart transplant in Poland in 1987, which took 23 hours. In the picture Dr Religa sits and observes his patient’s vital signs, absolutely drained but still alert for anything that could go wrong, while an exhausted assistant sleeps in the corner. Twenty five years later the patient, Tadeusz Zytkiewicz, holds the same iconic photograph of “giving everything”, but Dr Religa, his surgeon, had died in 2007. The patient had outlived the surgeon.fanus-2

…Three years ago I asked Johan if he could teach me to play the piano. I have no talent and no ear for music but wanted to learn to play one song. He took on this challenge with his usual enthusiasm. After months of patience from him and practice by me I was able to play the right hand of this one special song, and this is still all I can play…

I see trees of green, red roses too
I see them bloom for me and you
And I think to myself what a wonderful world

I see skies of blue and clouds of white
The bright blessed day, the dark sacred night
And I think to myself what a wonderful world

The colors of the rainbow so pretty in the sky
Are also on the faces of people going by
I see friends shaking hands saying how do you do
They’re really saying I love you…

I think that at the end there is only one question to answer and that is “Did you love enough?” I have no doubt that Johan could say “Yes, I did”….

Maybe perfection really lies in what we give, not in what we achieve.

 

Fanus Dreyer 

Consultant Surgeon

NHS Dumfries & Galloway. 

There is no truth, only Perception by Emma Murphy

I recently started as the new Patient Feedback Manager for NHS Dumfries and Galloway. Just as I was settling in to my new role, life popped a little bump in the road and I found myself rushing through the doors of A&E one Friday morning with my poorly toddler. After a number of tests and assessments we found ourselves on Ward 15 for the weekend. I’m usually a reasonably laid back parent and when the kids get unwell, I generally believe in ‘keeping it til it gets better’, but watching my baby girl lie listless in my arms stirred up something almost primal in me. I needed to protect her and I needed to do whatever I could to get her better. Of course, this was paired with the realisation that I alone couldn’t fix this and that we were almost entirely reliant on the doctors and nurses. So there I was, anxious, frustrated, frightened and feeling more than a little helpless. Feelings I am sure many of you have experienced in similar situations.
Later that weekend, as things began to calm, I took some time to reflect. Whilst the treatment we were receiving was of course important, the key thing that was making our experience so positive was the kindness; the gentle tones, the sweet smiles directed at my daughter, the hand placed on my shoulder when I was particularly worried and most of all, the fact that those looking after us genuinely cared. I thought about how I had felt when I first arrived at A&E and how determined I was to ensure that my daughter received urgent help. I imagined how I would have felt if the care had been different. What if the kindness hadn’t been there? What if I was dismissed as an over anxious mother? What if somehow they missed something or didn’t give us the right treatment?
I can see how any one of those scenarios could occur and after many years working in the public sector I can also understand how sometimes, there are justifiable reasons for such. As patients and family members we often don’t know what the doctors and nurses are facing. It’s difficult to fully comprehend the overwhelming task they face each and every day with limited resources, conflicting demands and huge, often unpredictable, pressures. We must remember too that they are juggling all of this alongside their own lives, challenges and all. Whilst sitting here on the other side of this experience it is easy for me to apply that logic and understanding, it would however have been very different had any of those things happened when I was actually in that moment, dealing with those big emotions.
image2-2It can be thoroughly unpleasant when someone complains about you. Even more so if you feel that it is unfair or unjustified. We must appreciate however that it is often about perception. The view from every angle is slightly different. We must too remember that nothing occurs in isolation. Just as a complainant may not know what you are facing that day, you may not know their story. Someone once told me that people shout because they feel they are not being listened to. The anger we sometimes see from complainants often stems from fear or frustration. The same emotions that can make us defensive or even dismissive, when we are on the receiving end of that anger. If we approach complaints from a position of empathy and with a genuine desire to learn and improve, we will go a long way towards reaching more positive resolutions.
Until recently, different parts of the public sector had different approaches to dealing with complaints. This meant that patients, service users and customers were facing challenges negotiating the different procedures which, on top of an existing complaint, often escalated their frustration. Staff were also unclear about how to deal with complaints which led to a further variety of approaches. This issue was identified by the Scottish Government a number of years ago and as a result they have been working towards a standardised approach to complaints handling across the public sector in Scotland. The Scottish Public Services Ombudsman (SPSO) has led on this work, already delivering a model Complaints Handling Procedure to local authorities which they implemented in 2013. They are now working with the NHS to help us to implement a very similar procedure from 1 April 2017 and it is a key part of my role to support NHS Dumfries and Galloway with that task.
image3.pngI know my NHS colleagues care deeply about their patients and the experience they have during their time with us. It is however a little more challenging to try to ignite that same passion about legislation, process and statutory timescales. We all know they are crucially important, but colleagues generally just want to get on with the job they are here to do, which is caring for people. It’s my job to help them understand that these changes will make everyone’s lives a little easier. It will ensure we have a clear procedure and a consistent approach to dealing with complaints. It will also ensure that we are offering the best support we can to those that wish to provide us with their feedback. This will help them to tell us their story and will better assist us in our quest to deliver the best possible care to those in need. Something we are all committed to.

You can learn more about the national changes to complaints handling here – http://www.valuingcomplaints.org.uk
To tell us your story about the care you have received, please contact Patient Services by phone on 01387 272 733 by email at dumf-uhb.PatientServices@nhs.net or by visiting the national Patient Opinion website at http://www.patientopinion.org.uk/

Emma Murphy is the Patient Feedback Manager at NHS Dumfries and Galloway.

“Going that extra mile” by Sharon Shaw

Patient Centred Care

Being caring and compassionate is an unique talent and sometimes sadly often gets forgotten about and falls by the wayside. We are all human beings and sometimes we all need to take a step back and grasp how valuable our lives are and that of loved ones.

I want to share my story. This is the first time I have written a blog, so please be “patient” with me.

sharon-1

In November 2015 I started my new job in clinical education. I was excited and yet in a way I wanted to prove to myself and others how valuable education is in this forever changing healthcare environment.

Approximately 3 weeks into my new role, the Respiratory Team contacted me concerning a patient with a complex condition. It was a 59 year old male who had severe emphysema and required an Under Water Sealed Drain (UWSD) to try and reinflate his left lung. The damage was so severe it became evident that the UWSD could not be removed or his lung would continually, spontaneously collapse.

“IT WAS HIS LIFE LINE”.

I walked into the side room in Ward 12 to introduce myself. With hos blue eyes he gazed up at me looking slightly anxious. Giving him a good firm handshake, I smiled and said

“Hello John, my name is Sharon”

I’m a great believer in “non-verbals” as it delivers communication and initially builds upon a trusting relationship. And indeed it did as from then on it had a huge impact.

As my father always said…

“Sharon a good solid handshake goes a long way”.

John was palliative. He had not long retired and to get devastating news about his diagnosis and outcome was so sad. His ultimate wish was to get back home to spend the rest of his short life left with his beloved family.

sharon-2I made a point of seeing John everyday in Dumfries and Galloway Royal Infirmary. It was essential to build up that relationship. During the 2 weeks I delivered education on how to care for a patient with an UWSD. Approximately 30 nurses received education, Kirkcudbright Hospital Staff, District Nurses and Rapid Response Team. As you can imagine there was a lot of anxiety, fear and uncertainty amongst the nurses. This was actually the first patient to get discharged to Kirkcudbright Hospital with a UWSD. John was fully aware of my role and was updated.

The time had come, John was ready for discharge. Understandably so, he was very anxious. I took the decision to actually go in the back of the ambulance with him to Kirkcudbright Hospital. Holding his hand and bantering away we both arrived to our destination. We were pleasantly greeted by the nursing staff. They knew John as he was a local from the town and had received care from them in the past.

His family were so supportive especially his daughter Michelle, whom I have now made a lifelong friend.

John managed to continue life for 7 months in Kirkcudbright Hospital. Unfortunately he did not get his wish to go home but in all fairness the care he received from the hospital staff made his last few months comfortable and to have that precious time with his family. He managed to celebrate his 60th birthday with his family. It was an emotional, uplifting day.

I guess what I’m trying to say folks….

“Going that extra mile” was so successful and beneficial. I would certainly do it all again.

Thanks for taking time to read this.

Sharon Shaw is Clinical Educator for NHS Dumfries and Galloway

 

 

 

“Ae Fond Adieu” by Alwayn Leacock

Recently the NHS Trust of Dumfries and Galloway saw the departure of its greatest ambassador ever.

When I first arrived in Dumfries in August 2000 I thought I was going to the end of the earth. I had driven through fields of greenery and seen more sheep, cows and land than my native country.   I was briefed on arrival by Colin Rodin and Fiona Patterson to report to Mrs Mcvittie the residences officer. Having lived in several NHS residences in England I was already in fear of the staunch matriarchal and regimented residences officers who were very territorial   and authoritarian and had very little conversation with anyone.  I shuddered once more at the thought that I was going to be housed in a military barrack and be greeted by yet another person of the same making who gave me the impression that they were merely facilitating my refuge in this country and that I ought to be on my best behavior and conform to UK norms and standards.

The Tobago keys a UN declared Marine Park just south of Mustique in the Archipelago state of St.Vincent and the Grenadines

The Tobago keys a UN declared Marine Park just south of Mustique in the Archipelago state of St.Vincent and the Grenadines

When I met Mrs Mcvittie for the first time that fear and reservation vanished immediately. Behind the desk sat a lady with a most welcoming smile. She greeted me in a most alluring and delightful way and informed me that she had already met my  country fellow Dr Camille Nicholls  who was another “cold tatty” like myself. Camille had to be provided with extra blankets to survive her winters. Her first concern then was whether I was managing in the cold. I could not be compared with Camille Nicholls, because apart from being an excellent physician, she was a   stunning five foot eight   beauty who made heads turn when she walked into a room.  All the men held their breath to the point of collapse not wishing to exhibit their customary abdominal protuberance.   She enquired about Camille’s’ well being.  From her conversation I could sense that she had a very good rapport with Camille as she appeared well versed about the geography of    Saint Vincent and the Grenadines, its  pristine  volcanic  black sand beaches,  the turquoise  blue Caribbean waters ideal for sailing and the splendid  golden sands   on which  Kiera Knightly was marooned with Johnny Depp on the Tobago keys in that ever so famous scene form  pirates of the Caribbean.

Mrs.  Mcvittie possesses a radiant personality which placed one immediately at ease and made a very cold September very warm. After I moved into the house at C3 Mayfield terrace there were several calls to find out if I was comfortable enough and if the accommodations had fallen short of anything I wished.   I had no complaints the residences despite not being plush and ultramodern were very clean and some of the best kept and habitable ones that I had lived in thus far in the UK.    I had very little need for further embellishments. The psychological and the emotional support and welcoming embrace made one forget about any adversity if there was any.  As a non EU resident as MTAS and the EWTD took effect   I went from being employable to non employable. Locum trainee to non trainee and therefore was set adrift. One day I was working in Dumfries doing a locum replacement for Heather Currie and the next day I had no job and could not be given a job. Over the subsequent years my sojourn took me to many hospitals and regions of the UK looking for work.   Strange but true despite having an excellent command of English and having worked in the system for your years I was no longer required. I almost fell victim to the massive Exodus of trained non European doctors who had to leave the NHS and the UK. I did eventually leave for a brief period and then was given employment in England when the job advertised for on several occasions was not taken up by a European. That short respite allowed me to gain indefinite leave to remain in the UK. My next step was to wind my way back to Dumfries and guess who was there to greet me as a prodigal son or sheep that had been lost?  The delightful Mrs. Mcvittie.

I was welcomed like a long lost friend who had returned home once more and the feeling was reciprocal  amongst the affable Scots. Mrs. Mcvittie is the “hands on” type of boss who looked after everyone and made sure they were well. If you infringed the residency rules you received a little note placed under the door asking you in a rather polite and diplomatic way to conform and be considerate to others. When you looked through the windows in the early morning you could see her approaching and before going to her office she would set about doing little errands around the compound. She was never afraid to muck in and get her hands dirty.  She was an ambassador extra ordinaire I am yet to meet anyone in her capacity that can fit in to her shoes. She it was that gave the trust in Dumfries a face and a persona that foreign doctors like me could hold on to as being welcomed and appreciated. I was delighted to nominate her for the excellence award a few years ago and was rather disappointed that her work and that of her staff were not recognised as being equally important to the function of the NHS as a heart bypass surgeon. I was devastated that she did not get that  award and even more so that someone revealed to her that I had nominated her and so my secret was blown and I embarrassingly and to admit to her rather coyly  that she was doing a herculean job that few could manage equally as well.

So it was that with much sadness and personal grief that I attended her small farewell gathering at the Margaret Barty room. I thought many more would have been there to give her the fond farewell she deserved.  I sincerely hope we can use her as an occasional resource person in teaching hands on human relations for which she has a natural knack.  I wish her well in her retirement and hope that she will be around for many years to come. She is a truly remarkable daughter of the soil of Dumfries.

 

Dr Alwayn Leacock is a Specialty Doctor Obstetrics and Gynaecology at NHS Dumfries and Galloway

 

 

 

‘How I survived change’ by Kirsty Bell

I read a quote recently that inspired me to write this blog

“It is not the strongest of the species that survives, nor the most intelligent. It is the one that is most adaptable to change”.

That is evolution, and I suppose in my opinion and to be black and white about it, when it does comes to evolution, those who adapt survive and those that don’t – may feel it’s forced, become extinct.

So how do we respond to change? Whatever form that change presents – it changes your life in some way or another.

Change is inevitable throughout our lives. I have gone through various events in the last 5 years which changed my life forever, so here’s some insight into how it effected me but most importantly, how I survived.

I married my first husband Colin in September 2011, a very happy day and one that lives with me every day. Six week later, on my birthday, I had a knock on the door where two policemen presented. Seconds later, they told me my husband had suffered a heart attack and had tragically died; he was only 36, my life changed forever.

And goodness, did my life change. I felt utter fear of what was ahead of me… how will I cope? I don’t want anything to alter or be different, I just want it to stay the same, I need him back, I am just married, it’s a mistake, someone please change it back to how it was, nobody understands…. This isn’t my normal!! This was just to name a few…….

Actually, I think I went into autopilot and wasn’t really aware of how I was behaving as I was more focussed on surviving. So are we working on autopilot when it comes to change and do we recognise how we come across to others?

So to answer my first question; how do we respond to change? – Well obviously we are all different and it varies, some people don’t like change – they like things just the way they are, where others can adapt to change well. We all respond differently and there is no right or wrong in the ways how we react, everyone is an individual.

I also ask myself the question do we respond differently when it’s forced or voluntary change. For me, the death of Colin was forced, however, I had to learn to adapt to the change by relying on support from friends, family and colleagues to ensure that I wasn’t making any major decisions as a reaction to the change (well I tell you that was some task for them), also asking for help and most importantly me accepting it.

Through time I found the strength to actually accept the change and knew who I was again, sorry actually who I had become without Colin. You know, Colin was so full and happiness and positivity, and if you know me, that is certainly the legacy he left with me when he died.

To put into context, I have talked about how I adapted to enforced change but since then I have very much embraced change and moved on. I met my now husband, Ewan in 2014 and at that point, I just knew that is was right and felt so happy, I actually couldn’t believe that I could feel like that again. I embraced my changes I re-married and moved away from my home town. I suppose what I am really trying to say is the changes that I had previously experienced, however hard, really helped me to recognise and adapt to change which made me into a much happier and stronger person.

So following on from this I do believe that we master the art of change over our lifetime of experiences which provides us with a great advantage and more importantly we learn about ourselves and how we respond to change.

I have learnt in some pretty hard lessons in life, and no matter how much we want our lives to stay the same – it just isn’t going to happen, we need to embrace it, become part of it, and make the changes inspire you.

My final word really, if you do feel yourself confused and lost in the process of change. Share any concerns, confusion and talk about it. Remembering it’s an individual’s desire to change that drives them — and that’s how I survived.

Kirsty Bell is the Clinical Change Programme Project Manager for NHS Dumfries and Galloway

“This is doing my head in!” by Harriet Oxley

Harriet 1I wonder how often you’ve heard someone say these words. Every day perhaps? Depending on our circumstances the things that provoke each of us are different. As we become more stressed and pressurized it becomes harder to see the way forward clearly. If we go unsupported and problems start to pile up they can start to bring us down.

Staff listening offers one-to-one support that is confidential and non-judgmental. Each person is supported to talk about issues of concern, deepen his or her understanding and rediscover hope. As a result they are enabled to tap into personal strengths and find a way forward if that’s what they need to do. Staff listening is a service offered by the NHS Dumfries and Galloway’s Spiritual Care team.

I recognise that some people are not sure what spiritual care is or what we do. I notice that some people hear the word ‘spiritual’ and imagine everything from ‘religious nut’ to ‘bible basher’. Others wonder why we need spiritual care in the NHS nowadays.

I wonder if it would help to make the distinction between religious and spiritual care. Religious care is given in the context of the shared beliefs, values and rituals of faith communities. Spiritual care, on the other hand, makes no assumption about personal beliefs or lifestyle. In other words, spiritual care is not necessarily religious and many people with no religious beliefs recognise their own need for spiritual care.

Spiritual care recognises that everyone needs to have meaning and purpose in their lives and fostering this promotes resilience and wellbeing. Spiritual care enables people, whether they’re patients, carers, volunteers or staff, to cope with life transitions, such as illness, loss or bereavement, as well as ethical dilemmas and major life decisions.

The Spiritual Care team consists of self-aware and sensitive listeners who have time to be with each individual in their need. Staff listening promotes spiritual wellbeing by offering a safe space for people to explore their concerns and draw strength from their own inner resources and those of supportive people around them. It is available to any member of staff, volunteer or carer within Dumfries and Galloway Health and Social Care. Equality and diversity is important to us and we welcome everyone irrespective of personal beliefs or life circumstances.

Harriet 2So perhaps you’re wondering what happens in staff listening. Firstly I’d like to point out that our role is not to fix problems or give advice. Instead we listen as each person tells his or her story, ask the right questions and offer support and encouragement. For many people telling their story is all they need to do. To have someone listen to the issues they are struggling with is enough to leave them feeling heard and able to carry on.

Sometimes, in talking about the situation, the person hears themselves say what they need to hear and gains insight just from having put their story into words. At other times the person’s story may be very complex, with many different strands. In such situations our role is to help them disentangle some of these strands, to look at them in turn and perhaps identify what some of their options are.

‘I have just realised what I need to do – I have never thought about that before.’

‘I have just heard the answer to my problem in what I have said.’

‘Saying that made me hear and see my own story differently.’

Space to reflect and talk through issues with colleagues has become rare, yet it is often the very thing that makes a difference in how we cope. If something is troubling you or you’re struggling with a particularly difficult situation, maybe it would help to talk in confidence with someone outside your situation. If so, please drop us an email to: dg.stafflistening@nhs.net

Harriet Oxley

Spiritual Care team