Inspirational by Eddie Docherty

As the new Nursing, Midwifery and Allied Health Professions Executive Director I’ve now been in post since February 1st. As I write this blog almost exactly 4 months since starting, Id like to use this opportunity to introduce myself to as many staff as possible, and share some of my initial thoughts.

Prior to starting in NHS Dumfries and Galloway I’d worked in a number of health boards. Initially working in NHS Lanarkshire, in critical care and advanced practice, I moved to NHS Ayrshire and Arran in 2007, initially as nurse consultant for the acutely unwell adult, moving on to senior nurse consultant then associate nurse director. During this period I also worked in NHS Orkney as associate nurse director for 8 months, learning about the challenges and rewards of working in a remote and rural setting. For the year prior to commencing in D&G I worked as the lead nurse for East Ayrshire Integrated Joint Board and Associate Nurse Director for Primary care and Community Nursing. I’ve been incredibly lucky in my career, supported and developed by truly inspirational staff throughout the years, and have maintained roles which have allowed for direct patient contact through most of my time in nursing. Working with patients and staff has always been a key priority for me- its why I started nursing.

This link to inspirational staff continues as I’ve moved to NHS Dumfries and Galloway. At the last Twitter conversation held by the Chief Nursing Officer, Professor Fiona McQueen, one of the questions posed was: – What are you most proud of in your current role? I didn’t hesitate in my answer. I spoke of the compassion I see and hear about everyday from the staff in NHS D&G. The value of compassion is clearly embedded throughout our teams, from the Board to the staff directly delivering care to our patients. The key attitude of compassion in our delivery of care is reflected in the shared behaviours and attitudes I’ve seen in the last 4 months and is the springboard for the excellence in care we all strive for. Of course we aren’t perfect, but on the whole, compassion is being displayed. What I would ask everyone is this- are we compassionate to each other? Are you compassionate to yourself? The organisation is in a period of unprecedented change as we join an integrated world and build a new hospital. D&G couldn’t do just one major change at a time! The financial challenge is more acute than ever as we try to do the same, or even more, with less. If we are not compassionate towards ourselves and each other we may find ourselves overwhelmed and begin to lose touch with the reasons we all came into health care? Something to think about.

We often speak of our challenges, but clearly this period brings significant opportunities. I believe that each team hold the answers to most problems within their areas. The ability to adapt and innovate, to find solutions to complex problems, lie within the gift of all of our teams. If empowerment of staff is to truly have meaning then the staff have to feel empowered to enact change. The application of quality improvement methodology and an understanding of the theories of profound knowledge are the survival tools of the 21st century health care team. I have spoken to staff around our areas about the need for innovation and commonly say “The answer is in the room” It usually is. Someone within the area has the exact answer to the problem. If all staff members can see that improvement is something they do rather than have done to them, combined with the skills and understanding of the science of improvement, we can absolutely change the landscape we all work in.

Speaking to senior nursing, midwifery and AHP staff I have been incredibly impressed with the projects and ideas being developed, and in many areas there is great work being done in one key area: patient experience and satisfaction. For many years patient experience and satisfaction have been placed in the ‘nice to do’ category of work. As we move forward it is clear that the patient experiences of our systems are key to understanding how effective we are. There are many great local examples of this, from such areas as mental health, critical care, occupational therapy and medicine, but we haven’t yet shown our ability to do this at scale and share our learning across the entire organisation. I’m confident we will, following the discussions I’ve had with various teams, but it’s not something we can do without anymore. We look at, and report on, complaints as they come in and use them to look at individual areas of improvement, however, working in Scotland, we don’t spend any time looking at compliments and positive feedback. If we can capture the learning points from the good and bad episodes of the patient experience we can gain a better understanding of the impact we have in a balanced way.

I feel honoured to be Executive Director for Nursing, Midwifery and Allied Health Professions within NHS Dumfries and Galloway. Everywhere I look I see staff members that are committed to the care and well being of their patients and who place the person at the heart of everything they do. We have challenges and opportunities ahead of us and I’m absolutely convinced we can shape the future of our services together to meet the needs of our patients and improve the health of our communities.

Eddie Docherty is Director of Nursing at NHS Dumfries and Galloway

 

Fire in your belly by Euan Macleod

What is the fire in your belly?

When it comes to what you do? Do you feel passion for it and are you excited about the possibilities that could come your way, or is it a bit like the guys with the Gaviscon have just hosed you down and your fire is quelled?

 

 

Fire in your belly-you know when you’ve got it

You feel it

Sometimes it is hard to find time to listen to our feelings in the midst of busy work schedules, the passion that you first felt when you entered a career in the NHS may have become blunted by the daily trudge-is it always going to be like that?

I recently mentioned in a blog the creation of the NHS and the welfare state.

Beveridge had a passion for that, but where did that passion come from?

Beveridge’ report might have been destined to be another dry and dusty Government document. What made it a huge public best seller was its breathtaking vision and passionate language. The fiery rhetoric largely came from Scotland after weekends spent with Jessy Mair in the spring and summer of 1942.

Jessy was Beveridge’s close confidante and companion for many years. His biographer, Jose Harris, highlights her influence on him during his visits north of the border:

“Much of his report was drafted after weekends with her in Edinburgh and it was she who urged him to imbue his proposals with a ‘Cromwellian spirit’ and messianic tone. ‘How I hope you are going to preach against all gangsters,’ she wrote. ‘who for their mutual gain support one another in upholding all the rest. For that is really what is happening still in England’. . . .”

Beveridge didn’t miss; the report sold 100,000 copies within a month. Special editions were printed for the forces.

The gangsters referred to by Jessy Mair were the deliverers of health care who profited from the sickness, squalor and disease prevalent at that time. Beveridge clarion call to a sense of community welfare based on need and not ability to pay heralded the start of the NHS.

No surprise that today many of us remain passionate about the values and aspirations of the health service, a service that many of us have experienced as employees, patients and carers of loved ones. There is still some fiery rhetoric and a will to retain and improve on the values and service which the NHS provides.

But it won’t be easy in this time of austerity.

It might need

Guts-More fight

Grit-More passion

Gumption-Being courageous

It means that you find a way to get better

It means that you’re putting in every ounce of extra effort you have

It means that you get pushed down but don’t stay there

Easy to say

Perhaps harder to achieve

But unstoppable when it starts

So what’s your passion and where is it taking you? Share the fire in your belly, it could start a bonfire

Euan McLeod is a Senior Project Officer for the National Bed Planning Toolkit

 

 

 

 

Ethos by Laura Jones

It is heartening to see how much development and reflection is happening in the central area of patient care in NHS D&G. Dr Donaldson and others are to be congratulated for bringing this area to where it belongs- at the core of what we do in our daily work.

The key word seems to be consideration, taking time to really see the patient as a person and acting on what we see. It seems to mean being person- centered before process or pathology.

Would it be feasible to extend this open mindedness laterally also?

We all work in teams in the Health Service. The NHS is the largest employer in Europe…that’s an ‘awfy lot of people’. How well do we relate to those other people who are our co-workers in this amazing endeavour that is the NHS? Could I suggest that the best measure of this is not based on a computer checklist but inside ourselves…how do we feel?

As a GP I regularly communicate by telephone with DGRI and many others in allied fields. I worked in Outpatients for a time also giving immediate contact with any of the hundreds of people working in the Hospital on a given day. More recently I have been employed as a GP locum across the region. At the risk of crudeness I can (like all of us) sense the ethos of a workplace in my gut.

Is it warm and helpful or off -putting and officious?

It is in the tone of voice before a phrase is uttered.

It is in the body language- a smile that says “I have time for you’ / ‘I see you as another person trying to do what is best for your patient- not a problem’.

It is also there in how the staff in a location interact with each other. Is it respectful and supportive or brusque and dismissive?

Across NHS D&G a huge deal of the former and much less of the latter happens. It is there from the telephonists in DGRI through medical secretaries, laboratory staff , Nurses and Health Care Assistants and so many others. In Primary Care it is in medical receptionists with their understanding of elderly patients on the phone or at a desk, the welcome of Practice Nurses and the commitment of GPs. Paramedical teams like Physiotherapy or Podiatry go the extra distance that makes all the difference.

(The picture above is of the Welcome Desk ladies at DGRI. A member of the public recently posted a lovely comment on Patient Opinion about them which can be read here)

Each small effort contributes to the building of ethos. It needs to be valued for the vital component it is. Can we learn to say thanks more often- especially those in positions of power and management? Just a moment to say ‘I appreciate your help’ or say in an e mail – ‘you are doing a good job there’ creates positive waves that flow far beyond that simple contact.

For a brief time I had the pleasure of working with medical students and junior doctors in DGRI reflecting on their experience of the hospital…not the hospital as building but the hospital as people.

I was blown away by their positive feedback. Everyone commented on how welcome they felt, how supportive everyone was and how much better an experience they had as a result. Sadly, they had felt this had not been the case in big teaching hospitals in the cities.

So we have a good ethos in D&G – but it needs to be treasured and nurtured. If we value and respect each other then doing the same for patients and their families follows naturally.

It is something that needs to be nurtured and valued and can be lost when not prioritised.

The consequence of losing sight of the value of the individual has been brought home to me as I am currently working 12,000 miles away in New Zealand. Christchurch Hospital has a huge core of Uk doctors working at all levels. It appreciates its doctors from the UK who are well trained, speak excellent English and fit into the Kiwi way of life like a hand in a glove.

On first questioning they usually say they are here for the adventure. Question a little deeper and there are other drivers that have brought them here.

These invariably include words like valued, respected and not feeling that happened in Britain. It goes along the lines of  ‘working my socks off to get into medical school, continuing to work hard and knowing that would continue in my hospital jobs but there would be the pay back of doing a good job. Instead I worked shifts that left me unable to get settled in the same ward or the same team.Seniors got frustrated and so did I. Then I wanted to progress and hit up against MTAS*. I felt like a widget made in the factory of medical school who was just to be parcelled up and sent anywhere.I had little say and there was nobody to listen- just a computer.

So I came out here and I feel like a person who is respected for my skills and potential.’

This story of expensively educated young British doctors is repeated across New Zealand and Australia.

Some will return home- where they are badly needed. More will not and we have lost a valuable asset. The root of that loss is not valuing what we have and allowing an industrial process be applied to people.

There are people in D&G in senior management and consultant level who can influence what is happening with the training of our young doctors at national level. They need to use that influence and force the decision makers to listen.

Most of us do not have that influence. However, in continuing to make D&G a good place for all of us to work we may entice back some of our former medical students and junior doctors. That can only benefit us all who work for NHS D&G and the community we serve.

*MTAS – Medical Training Application Service -the UK wide computerised system which allocates all medical training posts.

Dr Laura Jones is a GP who works between Dumfries and Galloway and New Zealand, from where she follows our blog.