Our CORE Values by Jim Lemon

I am probably not alone in my ‘dghealth blog thing’ reading habits. I usually take a very quick look at the blog on my phone while walking down the corridor and sometimes I can read a bit more in a gap in a clinic. Occasionally a multi-disciplinary clinic has finished ahead of time, the sessions have gone well, all my admin is up- to-date, and I get to read the full blog at a leisurely pace and discuss some of the issues raised with colleagues over a cup of coffee. That last one has never actually happened, but I live in hope.

Jim 1To accommodate varying time constraints, this blog is available in four sizes; one sentence, short (basic facts), medium (takes a bit longer to read, but puts it into more of a context), and big. Perhaps think of it like the ripples moving outward from where a stone hits the water. Feel free to read some or all of it.

 

The One sentence version:

Listen to your Values and Do what matters.

The Short Version:

NHS D&G have developed a list of shared values. That is, principles we agree are a central part of our organisation and should guide our behaviour. They are both ‘core’, as in essential, and ‘CORE’ as an acronym. These were developed during 2013 through a partnership process and agreed and adopted by the Board in May 2014.

Our CORE values are;

  • Compassion
  • Openness
  • Respect
  • Excellence

Jim 2So what would these values look like in the real world? The good news is that there are already lots of examples of ongoing work which is consistent with CORE values (What Matters to Me?; VOICES; Values Based Reflective Practice; Emotional touch Points, Appreciative Enquiry etc to name but a few). Several of these have featured in previous blogs. At a recent meeting we started to chart what was already being done and it became clear that there are many ways move towards these values.

The next stage is about ‘spreading the word’, so that everyone is aware of the CORE values (if you are reading this, congratulations, you are aware!) and then trying to ensure that they become part of everyday practise. Discussions are ongoing as to how CORE can become part of our everyday work through various possible ways ranging from conversations, PDP’s, Staff Inductions to posters and letterheads.

So far, so good. No doubt we will all become much more aware of ‘Our CORE Values’. People with far more artistic flair than me (thankfully!) will hopefully develop some sort of logo that would be recognisable and remind us of Our CORE values.…

Jim 3The thing is, knowing our CORE Values is one thing, acting on them is something very different indeed. 

 

The Medium-Sized Version:

You may be wondering why it is now felt necessary to state our ‘CORE Values’? Isn’t that what we already do? Is this just the latest ‘top-down’ noise/nonsense/way to keep people with not enough to do busy/busy people busier etc? You may have noticed that NHS organisations across the UK over the past year are also busy promoting their own, strikingly similar, versions of the ‘CORE Values’. How comes?

Does this stuff matter? Really?

Jim 4The Francis Enquiry (2013) took place into the causes of the failings of care which occurred within the Mid Staffordshire NHS Foundation Trust between 2005 and 2009. The report outlined ‘widespread unethical behaviour …. toxic work environments where bullying and intimidation are not uncommon’. In short, it warns that if we do not want repeated scandals due to poor, neglectful or abusive care, inadequate governance, interdisciplinary conflict and poor staff morale, then we need to do something different. This year, Robert Francis said: ‘A repeat of the Stafford Hospital scandal is still possible and it is “dangerous” for NHS staff to think otherwise’.

As tempting as it is to think that a few ‘rotten apples’ are to blame, research from social psychology illustrates that the way we behave could best be understood as part of a much wider social framework, (for example, how and why ‘good’ people do ‘bad’ things and how some groups are devalued in societies). There is also the impact of ‘power-relations’ and authority. Some people in some situations are more powerful than others.

So yes, it would appear that it does matter.

Francis made 290 recommendations, including openness, transparency and candour throughout the healthcare system, together with calls for improved support for compassionate caring, committed caregiving and stronger leadership in healthcare. The key issues here are all interconnected – patient safety, leadership, governance and staff well-being. Diagnosis of a problem and prescription may sometimes be relatively easy, but delivering effective solutions in complex healthcare systems is very hard to achieve.

‘Our CORE Values’ is one way to try to find solutions to these issues. The words that make up CORE need to become consistent patterns of behaviour. We need to first understand what these words actually mean and then what they would like in practise. This is no small task. But if we really agree with CORE, then worth it. 

Oh yeah, the ‘big version’ of this blog? My hope is that ‘the big version’ will be the conversations about Our CORE Values and whether we are acting on them.

Jim Lemon is a Consultant Clinical Psychologist working in Medical Paediatrics for NHS Dumfries and Galloway

The Value of Values by Julie Booth

Julie B 1Fred Lee’s book “If Disney ran your hospital 9 ½ things you would differently” argues that nobody has ‘moved the cheese’ when it comes to things that matter most to the patient or what motivates and keeps good employees. Whilst healthcare can’t be compared to Disney there is no denying that as an organisation it is amongst the top in providing excellent service to its guests

With that statement in mind let my first blog begin.

Julie B 2Its hard to imagine a more magical place than Walt Disney World, yet its secret is not magic pixie dust. It is its well trained, enthusiastic and motivated workforce.

 As Walt Disney himself realized

 “you can dream, create and design the most wonderful place in the world, but it takes people to make the dream a reality”.

Julie B 3

Whilst there is no doubt that the patient is at the centre of healthcare, I had the notion that as we prepare to “create and design the most the wonderful place “ in the form the new Dumfries and Galloway Royal Infirmary, it would be an opportunity to reflect on our own values and behaviours.

Within NHS Dumfries and Galloway there is no disputing that we have an excellent workforce that, combined, have thousands of years of service. Yet time marches on (even though in my head I still think I am in my twenties) and this workforce is diminishing through retirements. So how do we ensure that the future workforce that we are recruiting continues this legacy? 

The high profile case of care failure at Mid Staffordshire Foundation Trust and the subsequent Francis Report that followed, focused on the quality of care. Within the Francis Report the importance of  values ismentioned no fewer than 49 times. Although it contained a raft of recommendations one key area commented on was that staff recruited into the NHS should have their values and behaviours tested.

Driven by the need to ensure quality care and person centred outcomes there has been a huge increase in the concept of values based recruitment. 

Values based recruitment (VBR) is defined as an approach which attracts and selects employees on the basis that their individual values and behaviours align with the values of the NHS constitution. VBR is about using a range of tools and techniques to help employee recruit staff who have the right attitudes and values for the job.

Julie B 4

NHS VALUES

Julie B 5Now where does Disney fit into this? At Disney they audition prospective staff. This starts with a pre interview process which clearly outlines Disney’s expectations of its future employees (or cast members as they are known) which align with its core values. It is at this stage some prospective candidates withdraw from the face to face interview process.

So how did I get so absorbed with values and standards. Over a year ago as part of a development project which linked to various initiatives such as the 15 Steps Campaign and Leading Excellence in Care as a team we developed our ward based values and standards

The starting point was asking three simple questions:

What did the ward look like?

What did the ward feel like?

What did the ward sound like?

Julie B 6The responses from everyone were then framed around the Healthcare Quality Strategy for NHS Scotland  

The purpose of these values and standards is to enable us as a team to have a framework for behaviour within our ward which will empower staff to take action and challenge poor behaviours. It has been interesting whilst researching the initial project and for this blog that various NHS and healthcare organisations are moving to developing their own set of values and behaviours.

Given that 50% of complaints received in the NHS involve issues with attitude and behaviour is it time that we reflect on our own attitudes and behaviours!

I will end this blog on the following quotes

“Much of what needs to be done does not require additional financial resources, but changes in attitudes, culture, values and behaviour”. (Francis, 2013)

Julie B 7

 Julie B 8

 Julie Booth is the Senior Charge Nurse on Ward 3 Dumfries and Galloway Royal Infirmary

 

 

 

 

Have a nice day! by @carolinesharpe50

(or…..My New Year’s resolution to support better staff experiences in 2014)

Caroline 1Its a New Year, and a chance to reflect on what could make 2014 a better year than the one that has just gone. That’s not to say that 2013 was a bad year per se, but ever the optimist, I believe in looking forward (with the odd backward glance to make sure I remember where I have just come from), dreaming about how things could be different and better, and then working out what I need to do differently to make it happen.

 Two recent events have helped me to think about my 2014 resolution for better staff experiences for us all here in NHS Dumfries and Galloway. The first was that I had the chance in December to celebrate a significant birthday (very personal, so please don’t ask Caroline 2for the details) with a trip to New York. It was in all aspects perfect – snow, blue sky and sunshine, Christmas decorations everywhere, and above all, a community of New Yorkers with a common goal and a strong culture who obviously pull together to make a city that is welcoming, vibrant, safe and exciting – and a place to be proud of.

 The second was a hugely successful joint Area Partnership Forum and Area Clinical Forum conference in the Autumn when we worked together to consider the Francis report, and the issues arising from it relating to culture, values and behaviours of staff within the NHS. The conference was, in places, powerfully personal, and many staff members shared experiences, good and bad, that demonstrated the intrinsic link between staff experience and the experience of our patients when in our care. This was further reinforced at the most recent Scottish Person Centred Care Learning set which was the subject of a blog in December, and really got me thinking (again) and excited (all over again) about, staff experience, and what makes the difference between a great day and one best left behind at the end of the shift.

 Both of these experiences have in their background and context some difficult stuff; New York will never forget the date 9-11, and NHS England (and probably Scotland too) will take years to recover fully the confidence of patients following the tragic events reported in the Francis report into Mid Staffordshire Foundation Trust. But both of these situations also show how communities can grow and be stronger as a result, by having both the skill and the will to learn from what has happened, and getting to the heart of the values, beliefs and behaviours that will ensure it is different for the future.

Caroline 4 And so to my New Years resolution; as they say in New York, I want staff to ‘Have a nice day!’ and I’m going to get really focused on how best I can help to make that happen over the next 12 months. In the wake of Francis, 2014 is definitely the year for improving staff experience alongside patient experience – let’s not settle for one only when, with a little imagination and care we can achieve both, and in so doing enhance the health and wellbeing of ourselves (staff) as well as our patients and clients, and build a more resilient and stronger working community that is ready to take on the challenges of 2014 and beyond.

 And my starting point in looking forward? A little reflection of course! In 2007, the APF and ACF worked collaboratively for perhaps the first time to produce RESPECT – Our Code of Positive Behaviour. Its simple. It just asks each of us, every day in every interaction to;

 *Recognise our Responsibilities – in our role and to each other; and acknowledge that each of us contribute to shaping the culture, values and behaviours (good or poor) we all experience every day, and pass on to our patients and clients in each interaction with them

 *Value Equality and diversity – we are all different and we all have something valuable to contribute

 *Be Supportive and understanding – using our talents to support and develop others and our challenges and mistakes to learn and improve ourselves

 *Give, and receive Positive feedback – valuing those around us in a positive and dignified way, and making sure they know we value them

 *Develop and work in Effective teams – always striving to improve trust, relationships and performance for the benefit of those we care for

 *Strengthen our Communication – open, honest, clear and timely, with listening as a key skill to learn and practice every day

 *And finally, build a culture of zero Tolerance – none of us should tolerate poor or inappropriate behaviour and we should all feel confident to challenge it and support colleagues and the organisation to improve whenever and wherever we come across it.

 And when you add it all up?

 ‘Have a nice day’ = RESPECT – a code of positive behaviour

Respect pinned on noticeboard

 Its simple – I agree. However, this code still feels as relevant to me in 2014 as it did when it was first developed in 2007. And the ambition and focus for improvement in staff experience feels much more real, and more connected to our ambitions around patient experience now than it has ever felt before, and so I am feeling optimistic that 2014 will be a good year for us in our NHS staff community to really pull together, to make experiences for patients and staff that that are welcoming, safe and person centred – an experience that we will be proud of.

 Best wishes for 2014, good luck with your own New Year’s resolution and I look forward to working with all of you to help me ‘Have a nice day’!

 Caroline Sharp is the Workforce Director at NHS Dumfries and Galloway

 carolinesharp@nhs.net

Be kinder than necessary by @kendonaldson

“Be kinder than necessary, for everyone you meet is fighting some kind of battle”
                                                                                                            T.H. Watson

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Not long after joining the renal team in Dumfries and Galloway I met Audrey, a peritoneal dialysis patient in Stranraer. She was quite a character, “larger than life”, and whenever she came to clinic she brought her Husband, Paul. They were inseparable, soul mates, and made most decisions together.

 
Sadly, a few years ago, Audrey’s health declined and despite all our efforts it became clear she was approaching the end of her life. The conversations we had around stopping dialysis were difficult but more so for Paul who couldn’t bear to let her go. As is often the case Audrey had come to terms with things some months before and was clear about her decision to stop dialysis.

 
She was transferred from Dumfries to Stranraer where she passed away peacefully two weeks later. I heard the news on a Monday morning and was saddened at her passing but glad that it had been peaceful. She was 51.

 
The next day I was doing my ward round when I did a double take. Paul was sitting in a four bedded bay looking a little lost. I approached him and asked why he was here. It transpired that he had had a small heart attack three days before Audrey died. The team in Stranraer had kept him there until she passed away but then, on that day, he had been transferred for Cardiology review. He was now sitting in a bed that was directly opposite the room his wife had occupied just a few weeks before.

 
This man was in torment. He said to me “Ken, I’ve been told I need an angiogram. I just need to get it over and done with. I need to sort out Audrey’s funeral and a number of things.”

 
I approached the team looking after him. He had been seen by two junior doctors. I asked what the plan was and told that he would have a treadmill test and echocardiogram and then see the Consultant on Thursdays round. I asked if they were aware of his current circumstances and was astonished to find that they were not aware that his wife had died the day before. There had been no mention at the morning huddle and the consultation had left no opening for Paul to bring this up.

 
In the end I spoke to the Cardiology Consultant and he had an angiogram the next day and got home. Paul was able to arrange the funeral, organise the family and say goodbye to his wife.

 
So why am I telling this story? It’s not to offer any criticism of the teams involved but to raise the concept of empathy. When times are tough and we are all busy it’s often the first thing to go. Not because we can’t empathise but because we are so busy we never get the chance to ask simple questions like “What matters to you?”

 
The Francis Report into the failings at Mid-Staffordshire is a lengthy tome with several hundred recommendations but it has been said that, at its heart, there was a failure of empathy.

 
I recently saw a short video on you tube that was made by the Cleveland Clinic in America that highlights this subject beautifully. It’s just over 4 minutes and you can watch it here. I am aware it is a little ‘American’ but I firmly believe anybody working in healthcare today should be able to identify with the message.

 
On September 6th we shall be running our second Enhanced Patient Experience event. Throughout the day we will discuss patient stories like the one above, exploring values and asking ourselves what we need to do to enhance the patient experience. The pilot in November last year worked well and I would encourage you to consider coming along to the second outing. For more information about how the day runs you can click here to see a poster with a little more detail. If you are interested then please discuss with your line manager about putting a team together, the more ‘multi-disciplinary’ the better. You can also discuss with Peter Bryden, Risk, Feedback and Improvement Facilitator Tel: 01387 241739 (ext 33739)

 
Let’s try and take some steps in our patients’ shoes, see life from their side, ask the question “What matters to you?” After all this is not a new concept…

It is more important to know what sort of person has a disease than to know what sort of disease a person has.”
                                                                                                                            Hippocrates

 hippocrates1

(The names of the patients have been changed)

Ken Donaldson is a Consultant Physician at Dumfries and Galloway Royal Infirmary

Next weeks blog will be by Sam Johnston (@YeWeeStoater) from the Patients Support and Advice Service

London 2013- International Forum on Quality & Safety in Healthcare by The Patient Safety Team

littlebook

A quartet of quality and safety enthusiasts from NHS Dumfries & Galloway were fortunate to attend the BMJ/IHI International Forum on Quality and Safety in Healthcare last month.

We valiantly and proudly represented our Board and flew the flag for team Scotland with Poster displays on three of our improvement programmes:

  • Safer Clinical Systems Approach to reducing Prescribing Errors in our MAU
  • CAUTI (Catheter Associated Urinary Tract Infection) prevention bundle
  • Active Patient Care – an approach to actively prescribe and deliver personalised nursing care.

We networked and met improvers from across the globe with whom we traded improvement stories, our aspirations for healthcare and put our collective minds to solving contemporary healthcare challenges.

 We were inspired, we were motivated we were awed by what has been achieved around the globe and wanted to share some of our stories with you.

team

Highlights from the Developing World

The  highlight had to be Dr Ernest Madu talking about the efficiencies and improvements to health made in the Caribbean and Africa though the use of telehealth.  The barriers overcome have been huge, barriers we still don’t seem to be able to overcome with patients and clinicians alike.  Faced with having no service though I do see how the introduction of telehealth to create a service may be easier to ‘sell’ to the population that where we are as we could be seen to be offering a lesser service. 

Ernest, a cardiologist trained in the UK returned to his native Jamaica to set up Cardiac Services. He firmly believes that all people have the right to world class healthcare regardless of their ability to pay. He founded ‘The Heart Institute of Caribbean’ and set about building world class care. A centre of excellence was built in Kingston, Jamaica with patients paying what they are able or not at all. He described himself as the Robin Hood of heart care, using the wealth of those able to pay to fund care for all. Satellite centres have been built across the Caribbean with telehealth facilities to link local communities and technicians to the advice from a network of consultants across the globe. Patients requiring surgical intervention are airlifted from their local community to Kingston for surgery that day.

Ernest has gone on to set up a virtual Doctors On Call Service in both the Caribbean and Nigeria using mobile phone technology to link remote communities to medical advice, care and treatment. He has championed innovative solutions to replace glucose monitoring strips which were too expensive and impractical for use in sub Saharan Africa – a truly inspirational man with a can do attitude!

The Aravind Eye Care System in India has been described as the McDonald’s of healthcare, designed with mass customisation in mind they have employed lean thinking to develop an eye care system for very remote and poor communities. Their mission is simple – ‘to reduce needless blindness’. They have worked with communities to train locals to perform sight tests, to prescribe and make glasses in local communities. Mass screening camps are set up and IT enabled vision centres have been established in local communities. Those requiring surgery are bussed to regional eye clinics where their surgery is performed and they are returned home the next day. The volume of patients having surgery each day is phenomenal with theatres designed to enable a constant flow of patients.

Do we have something to learn in terms of flow?

How do you work with opposing clinicians/ practitioners?:

  • Let them set the standards they want to work to and then ask them to work with finance, exec team, management to work through how that can be best achieved at no additional cost (or lesser cost)
  • Allow training opportunities and networks to develop , discussing how service can be delivered  and thus giving opportunity for career and professional development/ progression
  • YOU WILL NEVER ERADICATE OPPOSITION – YOU MUST HAVE BRAVE PEOPLE INVOLVED WILLING TO PUT THEIR HEAD ABOVE THE PARAPET. 

Voice of the Customer – Are we listening?

 “[The customer] may be dependent on us. We are also dependent on him. He is not an interruption of our work. He is the purpose of it. He is not an outsider to our business. He is part of it. We are not doing him a favour by serving him. He is doing us a favour by giving us the opportunity to do so.” Gandhi, M.

 A quote for all staff room/ changing room doors?

 15 STEPS CHALLENGE – Alice Williams

  ‘ I can tell what kind of care my daughter is going to get within 15 steps of walking onto a ward’ 

 Ask patients and carers what their first impressions were and see how staff can enhance this ensuring that we are inspiring confidence and trust even at first impression.

  Robert Francis QC

The highlight of the conference for me was Robert Francis speaking about his report into the Mid-Staffordshire Enquiry.  He spoke with such passion and care, it felt like he really meant what he was talking about. 

 “Is the patients voice heard? Don’t let complaints become just a statistic”

 He spoke about how we need to learn from what happened in Mid-staff and make the NHS a safe place to be cared for in.  I suppose for me, because there was issues with HAI highlighted in Mid-Staff, and it was clear what had gone wrong, I could think about what aims we have in our own infection control team and make sure they mirror those practices that are deliverable and safe, and not those that have no clear/standardised process.

 He talked about failures in the healthcare system, saying that all NHS Trusts and NHS Health Boards need to learn from the report.  We need to be proactive in assessing what it is we need to be able to deliver safe and effective care.  And not all of this costs money…we can start off by having that one person make a change which may impact on organisational culture.  Having data available and reports like the Francis report can drive cultural change by identifying the best from the worst performers and learning from the best. 

I think the strongest message I took away from it was that everybody has the same common goal – to provide the best possible care for our patients – we just need the right processes in place to be able to do this.

 

Patient Engagement  – The New Blockbuster Drug?

One of the BMJ streams focused on patient engagement, and this made me realise that actually the majority of our systems are designed around us, the staff, instead of our patients.  Our homework from this session is to change our questioning from “What is the matter with you today?” to “What matters to you?”  Maureen Bisognano, CEO and president of IHI highlighted this with two poignant patient experience examples. Upon entering the ward A there was no member of staff available to check if it was Ok to visit, later the family overhead the clerk asking “who let them in?”  Upon entering ward B, the family were assured by staff that they could visit whenever they liked and they should check their relatives daily goals on the whiteboard above their bed.  This whiteboard contained the key daily goals that the patient identified from the earlier discussion with the ward round team when they were asked “what matters to you today?”

Which ward would you rather be in?

Social Media – Get Tweeting

I was very glad of the promotion of Twitter by Ken Donaldson, otherwise I would have missed out on several significant opportunities at this conference. Firstly, every session had its own twitter feed which was used to capture learning, comments and questions.  This was great for keeping up to speed with sessions which you were unable to attend and spreading learning to others beyond the conference-10,000,000 impressions estimated from the conference.  I also find it much faster to search publications such as the BMJ and Health Foundation instead of navigating the websites.

 twitter

It also provided an invaluable networking opportunity.  I resonated with a lot the tweets that one particular person was posting and I asked to meet them at the NHS Scotland stand.  This person turned out to be a nurse from Grampian who has been involved in the SPSP medicine reconciliation work so we had lots to share; the power of twitter!

 

Are you on the bus?

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This weeks blog was by Maureen Stevenson, Patient Safety and Improvement Manager, Laura Graham, Clinical Pharmacist, Mhairi Hastings, Nurse manager – Hospitals PCCD West  and Natalie Oakes, Senior Infection Control Nurse

Next week our blog will be by the Chief Executive Officer Jeff Ace and will be on “The Weight of History”