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.
It 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.
I 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.

Thank you to Ward 18 and DGRI by Kevin Irving

Dear Mr Ace,

I am writing to you to express my sincere gratitude and thanks to the staff in Ward 18 (Elderly Care) of the Dumfries and Galloway Royal Infirmary. Whilst I was visiting the UK my Mother took critically ill and was admitted to the hospital where she received excellent care from the doctors and staff on this particular ward. I spent nearly 4 to 5 hours a day in the hospital for over 15 days attending my mother’s bedside and could observe the highest quality of care. Having worked in health and safety in my career as a mining engineer, at the most senior executive level, for over 35 years I can honestly comment that the leadership and team work on Ward 18 was some of the best I have seen and is a credit to the staff.

The doctors on the ward, from the lead consultant caring for my mother to the rest of the team, showed enormous care and compassion to my mother’s needs and requests. My mother made what I think we all would agree was a remarkable recovery. During the difficult time of when my mother was very ill the doctors ensured that both my sister and I were well informed and we were able to have very open and honest discussions regarding my mother’s care. They also showed compassion towards my sister and my own feelings through what was a very stressful period.

I would like to give special thanks to Snr Charge Nurse Janice Cluckie who demonstrates incredible leadership to her staff and also discussed my mother’s needs with empathy and thoughtfulness. It was clear to see that she took time to see that all patients on her ward were well cared for. Janice is certainly a role model that your organisation should be proud of.

I have nothing but praise for the ward staff who showed consideration and care for all the patients. From a visitors point of view I saw total dedication to their duty for the well-being of their patients with humbleness and sincere kind heartedness.

Whilst spending time in the area I had the opportunity to look around the premises and surf the internet about the hospital. I see from your Board papers and Inspectors reports that you have some areas for improvement. I can only say from my observations that you certainly appear to be on a positive trend. I noted in your most recent Board papers that complaints about the hospital service are on the increase. I would recommend making a KPI of some of the positive comments you may be receiving, such as this letter, as they may show another side of the story or use information from the website www.patientopinion.org.uk or NHS Choices website.

As an aside I used the dining room daily at lunch times and the food served was of good healthy quality, a good price and presented by excellent welcoming staff. I feel the NHS food is sometimes often viewed negatively. I can only say that Dumfries and Galloway seem to be improving this aspect of patient and staff care.

I would be very grateful if you could ensure that the leadership team of Dumfries and Galloway Royal Infirmary give some recognition and positive feedback on my behalf to the doctors and staff on Ward 18.

With many thanks, yours sincerely

Kevin Irving

Kevin, who lives in Australia, added a handwritten post script which read “Wishing you all a Merry Christmas and a Happy New Year from the sunny side of Down Under.”

Team work – Ward 12 style by @jacalinanicnac

I have been nursing for 33 years this November and over those years I have experienced a variety of good and not so good team working. Those experiences have influenced me greatly to form the nurse and team leader I am today.

My job as Senior Charge Nurse in Ward 12 is to provide a high standard of effective care in an environment that patients feel safe in and by a team that feel confident and supported to do so , and everything else that falls within the patient / relative experience. Working in a team can be challenging but also fulfilling when the job is done well. We couldn’t do what we do every day without good team work .

WHAT IS A TEAM?

A group of people that share a common purpose, are committed and empowered to set goals and problem solve. Without these traits they are not a team but a group of people who work together, a work group.

A patient sent us this thank-you card ,

“Together Everyone Achieves More”

Together = we have a common purpose = giving excellent care.

Everyone = all who work in Ward 12= everyone has a voice.

Achieves = how we deliver our care = evidence based, safe and effective.

My role as team leader is to make clear the team goals, identify the issues that stop the team from achieving their goals and solve those issues with the help of the team .We would do this by doing tests of change , getting feedback and auditing improvement . My job is to create an environment where team members are supported and valued in the work place .By keeping the team motivated, developing and maintaining skills, being aware of individual strengths and weaknesses and attitudes and behaviours I can enhance the staff experience. I was encouraged and guided by work done by Julie Booth, Senior Charge Nurse in Ward 3. Julie and her team developed Values and Standards for the ward. All our staff had input in developing the ward standards and all staff agree to work by them. The basis for the Values and Standards is respect, being non judgemental, and being respectfully open and honest in giving and receiving feedback.

As well as the patient wellbeing, the wellbeing of my staff has equal standing. I believe you can’t enhance or improve the patients experience unless you value and enhance your staff experience. I have encouraged staff to attend the National Person Centred Health and Care Programme, and our local Patient experience events. The staff come back to the ward enthused with ideas for change, they share them with colleagues and then as a team we plan how best to introduce those changes to the benefit of patients and staff.

One such idea was after a local Patient Experience event. Team members returned to the ward and wanted to introduce reflection for staff. The team felt that after a busy shift there was no opportunity for them to say how that shift was for them. Staff felt they took their thoughts home and returned on their next shift with heavy minds and frustrations from the previous shift.

We have a definition of reflection, an aim and a process for reflection. The purpose of the reflection session was to be able to speak freely about their experience of that shift , any challenges and to discuss what could have worked better, or to say what was good about that shift and how that could be embedded. It is time limited to 10 minutes at a convenient time, it involves all nurses on the shift, there is a lead person for the session (not necessarily the Senior Charge Nurse, or person in charge), and ground rules were established = confidential- no notes taken – what was said in the room stayed in the room, discussions are relaxed and non confrontational, open and honest. Any “bigger” issues arising would be discussed with the staff member and myself out with the reflection session. The sessions were greeted with apprehension by some staff who found it difficult to speak about their experiences, but after a few sessions everyone soon got into the swing of it. These sessions were soon generating ideas for improvement and themes of frustrations in the work place. We added 2 boxes , one where staff could write down their good ideas =Golden Nuggets box, and one where they could write what was annoying on their shift = The Bug box.( replacing what you had used and tidying up were the top 2 ). We then discuss what is in the boxes each week and plan how to improve or change our practice. We have a questionnaire for staff for feedback and we use the safety cross check chart per month to record our consistency. We saw very quickly that staff felt they had the chance to reflect on the challenges and the successes of their shift and by giving everyone the chance to talk about it freely the staff felt they no longer left work feeling burdened by “work stuff”. This has improved our communication within the team and improved staff morale .It takes commitment by all staff to maintain these sessions, when we are extremely busy some sessions do not happen and the staff comment that they miss them. It is my job to raise the focus again and encourage the staff to keep it going.

Dale Stewart and Wendy Langan who facilitated the reflection development.

Another idea introduced by the Health Care Support Workers in the ward was to have a welcome and information leaflet for all staff coming to help in the ward. It starts with thank you for coming to help in the ward today, you will be working with….. , the ward routine is…. , your break is… . We have feedback sheets which we review monthly and encourage suggestions to improve staff’s short term experience whilst in ward12. We have had a lot of positive feedback from staff helping in the ward and they look forward to coming again.

By encouraging staff to develop their ideas and improve the team performance they take ownership of change and enthuse others to do the same. This makes my job easier it enhances the patient care and journey which we measure with our patient questionnaires; What did we do well? What could we have done better?

Being part of a good team gives you a sense of pride in achievement and celebrating success, and camaraderie in supporting the team. In Ward 12 a wicked sense of humour and a liking for sarcasm will also enhance your experience!

 

Celebrating success , Susan ,Drew and Mary.

I would like to dedicate this blog to Charge Nurse Heather Renwick who retires this week after an outstanding 37 year nursing career, one of my excellent experiences in my nursing career.

Jackie Nicholson is the Senior Charge Nurse on Ward 12 at Dumfries and Galloway Royal Infirmary

“Here to Help” by David Johnstone

“Hello, how are you today? Is there anything I can help you with?”

These simple but effective words had an instant affect on me. They came from a teller as I entered a bank – of all places! – in Australia.

Whilst I didn’t need any help, it got me thinking about our channels of communication with people we serve here at NHS Dumfries and Galloway.

Only recently, hospital managers in Acute and Diagnostics took forward a pilot to make themselves more visible at the front entrance of DGRI.

What did this achieve? (I hear you say!)

Rather than waiting for you – patients, visitors and staff – to come to us, we took a proactive approach and decided to go out to you.

It goes without saying that too often all of us get caught up in the day-to-day jobs and diary commitments that it is too easy to lose sight of what we are actually here for. That is to deliver high quality, person-centred care and treatment for all who access our health services.

Over a week, we scheduled time in the diary for us as managers to stand at the front door and listen to what people have to say.

By showing a visible presence, we were met with a constant flow of real time feedback from those coming in and out of the hospital. There was positive praise for individuals and teams in the hospital which was directly fed back to staff. We also dealt with families worried about loved ones and in need of direction and support. We were able to deal with the situation there and then. Feedback gathered included:

• very positive feedback at Accident and Emergency, Ward 10 and 7. The standard of care is excellent
• A 92-year-old patient had a positive experience in Ward 16. She loved the food!
• Patient and family gave good feedback about care delivered in Ward 18. She said: “Canny fault the hospital.”
• Patient commented that Ward 16 was very busy but the care was very good.
• Person commented the wards were gleaming and were very clean and tidy.
• An elderly couple commented on the lack of parking facilities
• It was noted that some visitors were not using hand gel when going in and out of wards
• It was said the ‘staff are brilliant and you couldn’t ask for a better place to work.”

 

Mr Whitelaw went to Berlin recently to see how our European counterparts deliver health service. As he entered the German hospital, he was met with a trained nurse who was there to help. Again, the impact was extremely positive. There is no opportunity for feedback and complaints to get lost. Things are dealt with in real time, face-to-face.

We are all aware of how important patient experience is and the challenges that we must meet to deliver on targets set by the Scottish Government. Reflecting on my own experience from the pilot it has confirmed how we all, no matter what level of the organisation we are at, have a responsibility to listen and help.

It is perhaps good timing, especially as we start the ball rolling on how we want the inside of the new hospital to work. We are now developing a sustainable approach to ensure our managers are constantly visible. For my part, I am involved in recruiting new nursing posts at the moment and I very much plan to ensure that the ‘Here to Help’ approach comes as standard.

If each and every one of us – especially “the management” – ring-fenced some time to help the people we are here to care for, can you imagine the message this sends out?

David Johnstone is Lead Nurse for the Acute and Diagnostics Directorate at NHS Dumfries and Galloway

Take a deep breath by @ginaalexander

No, this isn’t the start of a blog on the effective management of labour!  But instead my recommended first step when you are about to receive a piece of feedback.

In a previous life as Personnel and Training Officer (that’s what we were called back in the days before HR Consultants) a big part of my role was supporting the organisations appraisal system.  We were highly focussed on training managers how to measure competencies, set SMART objectives, creating development and in giving constructive feedback to get the best out of human resources! 

There’s lots to read about how to give feedback.

I used to suggest this acronym to structure feedback in an appraisal context: BOOST.

 http://10minutemanager.com/boost-constructive-feedback-technique/

I am sure many of you will have your own strategies and techniques.

Human nature finds it hard to be critiqued, challenged, measured, assessed.  As the mother of a 15 year old facing “big” exams for the first time, I am keenly aware of the pressure this scrutiny brings to bear.  (Who knew I’d ever have to tussle with a quadratic equation again!)

Resistance and defensiveness is built into our DNA.   And, on the whole, when we look at health and care and what drives people to do the jobs they do, the intensity at which they work, the complexity and life-in-the-balance decisions they deal with, you see people who desperately want to do their best, be the best.      Being on the receiving end of feedback telling you, you could do better is at odds with the way most of us are wired.

I saw a tweet containing this great infographic recently.  The title could easily read “to stay “productive, sane, encouraged” and there slap bang in the middle is “Get feedback”.

http://t.co/6eYNPbA8C3

Given that a key aim of feedback is to improve, surely we’d want to embrace it?   But it’s so dependant on our motivation to receive as well as the motivator of the giver, the way it’s communicated, how we are feeling about ourselves and others and also, crucially, the prevailing culture of the organisations we are part of.   We know it’s good for us, and it is, but sometimes it feels like being fed a spoonful of castor oil! (Back to labour!?!)

We have all been on the receiving end of feedback and are, no doubt, aware of the profound impact it can have.

In our world of instant communication, feedback is available in real time!    I have seen lots and lots of feedback which would make you fit to burst with pride – hurray! 

But sometimes the giver hasn’t heard of “BOOST”, perhaps their motivation is frustration, pain, fear, worry, grief, confusion, anger.  Feedback might not follow a constructive pattern, is one sided, can be ill thought through and, to be honest, pretty brutal.   

What can we do?   Do we ignore it, dismiss it, disengage, move to self protection? 

We can manage our reaction.  We can choose to listen.  We can seek to learn. We can strive to improve. 

Do we need to develop our skills in receiving feedback?    I think so.    I speak with lots of different people across health services about receiving and responding to feedback through Patient Opinion – 50% of which, I hasten to add is positive! (see link above)  The first thing I encourage people to do is …. take a deep breath.

Then, some things to think about:

• Take your professional hat off; seriously take it off!  Remind yourself of the other roles you have in life: son, wife, father, sister, friend;
• Imagine it’s you, from or about someone you love, try standing in their shoes, empathise;
• Try to understand and connect with the feedback and the motivation;
• Control any inclination to defensiveness and stay open;
• Walk away, reflect, get someone else’s viewpoint;
• Examine your own motivation – to learn, to improve, to protect, to defend;
• Decide to respond and act, check your decision with others.

As I always say, it’s not rocket science, but neither is it easy.  We need practice and we can learn from others who do it well.

Oh, and we also operate within the phenomenon which is the NHS, and although progress is being made, we still don’t, organisationally, handle critical feedback all that well!  Another blog in the making there methinks.    Still perhaps we, as individuals, can be the change we want to see in others.

Good luck!

Gina Alexander, Director of Patient Opinion Scotland, an independent not for profit organisation who run an award winning website where people can share their experiences of care services.

gina.alexander@patientopinion.org.uk

@ginaaalexander