I recognise that it is a bit cheeky of me to put my name to this as I haven’t written any of it. A few months back I was scrolling through Twitter and came upon this thread that really moved me. The messages are simple yet immensely powerful. I have therefore simply taken some screenshots from Twitter and published them here. As you can see this is by a Doctor called Alastair McAlpine who is a Palliative Paediatrician in Cape Town, South Africa. Read on…..
Hello! My name is Alison! I work as a Clinical Psychologist in the Clinical Health Psychology Service; the final member of the team to blog this month as part of our service promotion! Part of my role within this job is to help individuals and their families manage psychological distress caused by or maintained by physical health problems. Of course as a psychologist I do this at a professional level, but do we always need to be a psychologist to provide psychological care to those who need it?
This is the story of a man with a tea trolley; an ordinary chap who made a big difference to me at a particular moment in my life when the chips were down. I didn’t know him and he didn’t know me. We only met once and we don’t keep in touch. He probably doesn’t even remember me. He didn’t need to do what he did; it definitely wasn’t in his job remit and he probably bent the hospital rules.
The story starts on a Saturday afternoon several years ago when my husband unfortunately had a heart attack and was admitted to our local coronary care unit. It all came as a bit of a shock as he had none of the typical risk factors. He wasn’t overweight; he didn’t have high cholesterol, and had never smoked. He drank sensibly and walked miles every week. The event itself was fairly low key; just a burning sensation from throat to stomach followed later by an aching jaw. Symptoms so low key that he still 
went off to a football match that afternoon as planned. Twelve hours later after a trip to A&E (“just to be on the safe side”) our worst fears were confirmed. I’m happy to say that after a successful angioplasty he made a great recovery, but at the time we both pretty devastated. I was beside myself with worry. My stomach churned and my thoughts raced out of control “Was he going to die?”, “Would he have another?”
“Would he be able to stay active?”, “Would he still be able to work?”
I felt overwhelmed. How would I help my husband to cope if I was struggling myself? I had no one to talk to and could not voice my fears to my husband who needed me to be strong. As a Clinical Psychologist with many years experience working with people who have experienced distressing life events, I knew that my thoughts and feelings were normal but I was at a loss as to how to help myself.
The coronary unit that my husband was admitted to was located in another region in the UK and has now closed. My husband received excellent medical care, but as a worried spouse I felt alone. Nurses and doctors were busy. Visiting hours were limited (I was not permitted to stay longer than an hour). I wanted to be near my husband and to feel that others understood that we were in this together. I wanted reassurance. I wanted information. I wanted someone to ask me if I was alright. I felt that I needed looking after too.
One afternoon with all this weighing heavily on my mind, the man with the tea trolley came into my life. I had seen him before on and off during my visits serving hot drinks and biscuits to the patients. He was always cheerful and took the time to have a chat with people. He bustled passed me as I sat in the visitor’s room. I guess he must have noticed my forlorn expression through the window, because he doubled back and came into the room. What he did next was a small act of kindness that changed my day, and helped me feel a little better.
He simply smiled, gave me a cup of tea and said, “It’s hard isn’t it? How are you doing?”
We chatted for a short while about this and that, and he listened to me as I told him what had happened. Of course he couldn’t answer my medical questions, or give me any assurances about the future. He couldn’t really do anything as such, but he was there for me at the right moment and he seemed to understand. He knew I needed a friendly ear. I never saw him again, so I didn’t get chance to thank him. So whoever you are, thank you! That cup of tea made all the difference.
Dr Alison Wren is a Clinical Psychologist for the Clinical Health Psychology Team at NHS Dumfries and Galloway
Many things in life are complicated, require great debate and despite huge resources are not guaranteed to be successful in practice. There are other things which are simple to understand, can easily be implemented and immediately make a difference to improve lives or in some cases save lives. You only have to think of the meaningful campaign to change the care of people with a diagnosis of dementia led by Tommy Whitelaw (Tommy Whitelaw @tommyNTour). It makes sense and it hits you in the heart. As a professional you cannot listen to Tommy talk about caring for his mum and withhold your support for this campaign. His mum is your mum.
Another example is Kate Grainger’s inspirational campaign (#hellomynameis). This focuses right in on the doctor/patient relationship. It goes further than just making us think more about face to face contact with patients who may feel vulnerable, distressed and in alien surroundings. It asks us to look at our practice on a basic level, to say our name aloud, on every contact. At one point this patient was Kate Grainger but the patient could be any one of us.
Last November an important, widely supported campaign for the mandatory teaching of Cardiopulminory Resuscitation (CPR) to schoolchildren was unsuccessful. This Emergency Bill was opposed despite irrefutable evidence that it saves lives. In Norway it has been compulsory for schoolchildren to be taught CPR since 1961 and survival rates are double what they are in the UK. As out-of-hospital cardiac arrest is the commonest life-threatening emergency in the UK so I thought this campaign was bound to be fully supported and unchallenged. You can imagine my disappointment.
I felt at a loss about what to do next, yet felt there had to be a ‘next’. To increase survival rates of cardiac arrest the immediate action of bystanders is crucial. Personally I have carried out CPR three times, twice in a hospital setting and once at a family event. A day of laughter and pleasure turned into tragedy. Event though, as a nurse, I’m aware that the outcome from CPR is variable for a myriad of reasons, I was left affected by this last experience. Then a doctor said to me, “If I had a cardiac arrest I would want someone to have a go.” I am glad I have been taught CPR and am able to ‘have a go’, otherwise the most I could have done that night would have been to phone an ambulance instead of giving a friend a chance of life.
What could I do now? I decided to put together a resolution to RCN Congress 2016 calling on governments to mandate the teaching of CPR to schoolchildren (the remit of the Emergency Bill had been wider, encompassing all kinds of First Aid). The resolution was accepted and I presented this in June this year.
There were wide ranging contributions to the debate. Personal stories were shared about children delivering CPR successfully. A delegate told us about a situation where his 27 year old teammate collapsed during a game of football. 23 players including the referee were there and nobody knew how to do CPR; this man died. He went on to describe a more recent experience when an instructor was brought in to teach CPR to the junior football team. Within 10 minutes they were doing it perfectly.
Some delegates expressed concern about the effect on children if they delivered CPR and it was unsuccessful. Others answered this by saying: remove the fear, teach them young. The evidence is there. Someone else highlighted again that encouraging CPR lessons in schools as an add option is not enough; teaching needs to be a requirement so that there is no national disparity. Kate Ashton made a very acute observation at Congress:
“If we can educate youngsters in schools about sex education and creating life then surely we can educate them about saving lives.”
Every year an estimated 60 000 out of hospital cardiac arrests occur in the UK (BMJ 2013;347:f4800) It could happen to any one of us. What can you do?
Write to your local MP and express your support for the campaign to mandate teaching of CPR.
Become a local First Responder.
Find out if your town/village has a defibrillator and where it is kept.
Ask your school if the teaching of CPR is on the curriculum.
Let’s insist on the possible.
Valerie Douglas is a Staff Nurse in Mental Health at Midpark Hospital, NHS Dumfries and Galloway
“The single biggest problem with communication is the illusion that it has taken place” George Bernard Shaw
What is the reading age of the most popular newspaper in Scotland, The Sun?
If you were to categorise it and place it on a shelf where would you put it? 8-10 yrs? 12-14? 14-16 yrs? The answer is 8 years old.
In terms of language level, vocabulary, grammar etc. The Sun is written at the same level as a school reading book for an eight year old child. According to The Literacy Trust the average reading age in Scotland is only 9 years old. This sort of information has massive implications for the way we communicate with our patients, carers, their friends and family. If we are producing written material or talking in a way that is too technical, medical or wordy we lose, bewilder and alienate our audience whilst thinking we have been clear. It is referred to as health literacy – the gap between what we as professionals think we have said and what our patients have actually heard or understood or are able to access. It brings to mind the confusion in the classic Two Ronnie’s sketch where a man walks into a hardware shop and asks for Fork Handles and receives 4 candles!
October is World Health Literacy Month and the aim is to raise awareness of this gap in communication. The Health Literacy Place is a website attached to The Knowledge Network and details the Making It Easy action plan to improve Health Literacy here in Scotland. It contains some frightening statistics:
The implications for patient experience, safety and access to services are clear. This is not just a welfare or financial obligation, but a legal one. The Patient Rights (Scotland) Act 2011 states that “people should be communicated with in a way that they can understand and that healthcare staff should make sure that the patient has understood the information given.” Our skill as healthcare professionals is not only to diagnose and treat but to communicate those findings in a culturally appropriate, meaningful and memorable way.
Here in D&G it has never been more timely for us to think about these issues as we plan our own Big Move, thinking about clear signage, systems for patient appointments, e-records etc in our new home. In addition our English neighbours in Cumbria are getting to grips with the Accessible Information Standards. These legal standards were introduced into NHS England on 31st July this year and go one step further in addressing communication needs. They stipulate that a person with a disability, impairment or sensory loss should be provided with information that they can easily read or understand with support. The Standards also state that these needs should be identified and recorded prior to a patient accessing a service.
The good news is that because of the introduction of these standards in England there are lots of resources to help us look at our practice here in Scotland. So where do we start? As a communication specialist, it’s a subject close to my heart.
If you are looking at a service audit or improvements, some handy hints include:
but also…….
Asking this initial interview question allows you time to tune in like a radio to the person’s wavelength. By asking this I can assess fluency, coherence, intelligibility, cognitive ability, word finding skills, language level and most importantly adjust mine accordingly .. but also assess the patient’s accuracy as a historian, their interpretation of events, what they believe the doctor said, if there’s an outstanding or unresolved issue or complaint, their mood and motivation for engaging with therapy, what is important to them, their family, goals, hobbies and start to identify any hooks that I can hang my therapy on to make it personal and meaningful and therefore increase its success. Not bad for one simple question!
Perform the SMOG!
The simplified measure of gobbledygook – yes it’s a real thing. Created in 1969, take any piece of written material your service routinely supplies and apply the formula to calculate a reading age. If it’s higher than 9, think again. http://prevention.sph.sc.edu/tools/SMOG.pdf
Access The Health Literacy Place
This NES website gives some really great tailored resources for GPs and medics, AHPs and nurses including simple techniques like Teachback, but also online courses, training and templates to re-evaluate and improve your communication personally and within your service. http://www.healthliteracyplace.org.uk/media/1360/health-literacy-month-eflyer-2.pdf
Chat to a friendly Speech & Language Therapist
But then I would say that! The Royal College has a new position paper and website to support Health Literacy or Inclusive Communication as it’s sometimes known.
…for a chortle and a lighter look at Health Literacy as seen from the perspective of the doctor we all love to hate, click or paste the link below…. If you can’t see it you may need to upgrade your version of Internet Explorer to 11. http://www.youtube.com/watch?v=zG2DVoRP86g
Happy Friday and happy Health Literacy Month!
#healthlitmonth
Helen Moores is a Specialist Speech and Language Therapist for Adult Service & The IDEAS Team (Interventions for Dementia, Education, Assessment & Support) at NHS D&G
Follow us @SLT_DG
Find us at NHS D&G SLT Adult
Health Literacy Month logo and Health Literacy Heroes illustration are reprinted with permission of Helen Osborne, founder of Health Literacy Month
#hellomynameis Kim and I am encouraging the people of Dumfries to consider self referral to a dental student at Dumfries Dental Centre for free dental treatment.
There has been a dramatic improvement in access to NHS dental care in the region over the last 6-8 years. The Dumfries Dental Centre opened January 2008 to provide an outreach / training programme for student dentists and student dental therapists, aimed at supporting the future growth of these professionals across Scotland, while continuing to provide secondary care dental services, emergency dental services and routine NHS dental services which moved from Nithbank. The plan was to provide additional access to NHS dental registration at the centre, but on opening, access to Independent Dental Contractor practices for NHS dental registration had increased. Following a review of the Health Board’s managed dental service, recognising the increased access available for patients to NHS dental registration, routine NHS dental services at Dumfries Dental Centre were withdrawn in 2015.
With the goal of improving oral health while modernising dental care, prevention has played a key role in the dental care being provided by dental professionals for some time. This means that patients who are registered and regularly seeing a dentist, dental therapist, dental hygienist or extended duty dental nurse are getting orally fit.
This combination of increased access to NHS dental registration and patients getting orally fit is great news but it does mean finding suitable patients who require routine treatment to support our dental student outreach programme is becoming more challenging each year.
Outreach programme aims
David J. Watson, Senior Clinical University Teacher at Glasgow Dental Hospital and School explains that ‘The Outreach experience is intended to enable the student who has already attained basic competence in a range of areas to grasp the concept of the provision of holistic oral health care in the primary care setting and to gain an appreciation of integrated multisectoral involvement in health care delivery. The aim of the entire experience is to aid transition from the dental school to the practice environment by replicating the primary care experience as closely as possible.’
Who makes a suitable patient?
A broad base of patients with differing needs is desirable for the Outreach programme. Patients receiving emergency dental care provision and who are unregistered with a GDP may happily return for a course of treatment. Patients who self-refer can be screened for suitability at the initial examination, as can other healthcare professional referrals.’
Please note the following;
Appointments can last 1-2 hours and sometimes a bit longer.
Patients won’t always be able to see the same dental student, as they attend Dumfries Dental Centre from Glasgow Dental Hospital and School one week at a time.
Patients should have realistic treatment expectations.
Patients who are, for example, extremely nervous of dental treatment or requiring specialist intervention should be suitably referred.
Patients with special care requirements would be assessed for their ability to cope with routine dental care.
Patients with health preclusions would not be excluded automatically unless they would impede routine treatment provision or necessitate specialist intervention.
How and where do we find patients for our students?
The answer is from You. Please spread the word about our student dental outreach programme. Come and see us for yourself if you are unsure about us and/or happy to refer people to us. The facilities at the Dumfries Dental Centre are quite something. The staff and the students are all friendly and good at what they do; believe me they get lots of praise from their patients.
Are you interested yet? I really hope you are.
Further information and self referral application form is available at: http://www.nhsdg.scot.nhs.uk/Departments_and_Services/Dental_Services/Dental_Student
In summary;
Dumfries Dental Centre has a student dental outreach programme operating August to May.
The student dental outreach programme needs dental patients requiring routine dental treatment; this could be you, your family, a friend, your neighbour or a member of the public that you come into contact with.
Student dentists are in their final fifth year of studies.
Student dentists are supervised which includes their work being checked.
If accepted to the programme, treatment is free from a student.
Kim Jakobsen is Dental Services Manager for the Public Dental Service
Over the last 2 years NHS DG have been offering a structured programme of work experience to young people in their final years at school thinking about a career in medicine. This has been very well received by the young people who attend and the success of the programme is largely down to excellent organisation and communication skills of Anne-Marie Coxon and her team in the education centre who arrange tasters in various areas of medicine including medical admissions, theatre, surgery and A&E along with some time with me in the diabetes centre
Linocut by Hugh Bryden Crichton Hall- home to the Dumfries Galloway Diabetes centre
As a clinician it has been really interesting to spend time with these young people who have yet to develop preconceived ideas about healthcare and for me to try and understand what it is that excites them about spending a lifetime in medicine and to try and remember what it was that motivated me to apply for medicine and ultimately what made me move into Diabetes and Endocrinology.
For those of you who know me you will have heard me say that it is diabetes that excites me rather than the rare and esoteric conditions that I deal with in the endocrine service but I recognise that despite my real enthusiasm and commitment to improving care in diabetes that when these young work experience students come to diabetes clinic I sometimes find myself apologising to them that I don’t have any exciting procedures to show them, or new diagnoses to make; in fact in diabetes clinic I rarely examine people and I spend my time just listening to things that seem unrelated to sugar levels and talking…..
Just Listening and Talking…
The fact that I feel the need to apologise about the nature of diabetes clinic being “just listening and talking” has made me realise how little value we as hospital healthcare professionals place on these core skills that we all use every day. We are required to do mandatory training in many important areas such managing the deteriorating patient, infection control, awareness and fairness to name a few- yet it is possible for a healthcare professional to go through their in working career without any update, assessment or post graduate training in the core communication skills that we use every day. This lack of post graduate training in clinical communication skills is particularly apparent in the acute hospital setting compared to our colleagues in general practice and psychiatry where advanced post graduate training in consultation skills is the norm. Despite the seemingly acute nature of a hospital environment many of us spend a large part of our working week in clinics working with people to try and improve their health and wellbeing but what are we doing to ensure that these interactions are effective and meet the patient’s agenda? Do we find it easier and quicker to pursue our own agendas and default into education mode rather that hearing about what is really important? Several research studies have shown that by exploring a person’s background, worries and their understanding of their condition can help to avoid unnecessary investigations or anxiety for the patient as well as reduce the strain on resources[i][ii]
The success of the late Dr Kate Granger’s “Hello my name is …” movement and the “What Matters to Me” campaign show that in acute setting healthcare teams are beginning to contemplate a change to a more patient centred rather than the traditional paternalistic, didactic approach to our interactions with patients but this change is slow and these important initiatives are only an entry level to improving our communication with the people we see in clinic and reaching a shared agenda.
Locally Jean Robson and her colleagues from psychology, human resources and other interested clinicians have recently worked hard to put together a directory of diverse courses and programmes which are delivered locally by NHS Dumfries and Galloway aimed at improving advanced communication skills including sessions on communication skills which allow individuals to film and review their performance in real life clinic setting (been there and done that -daunting but very helpful), communicating with people with existing communication difficulties, human factors training and sessions on communicating with colleagues in meetings to name a few
So, back to the title of “cutting the sugar”. The discovery of insulin almost 100 years ago is one of medicine’s most remarkable discoveries changing the outcomes for people diagnosed with type 1 immeasurably as the before and after pictures below poignantly demonstrate
December 1922
February 1923
“Child 3” before and 3 months after insulin treatment
There is of course a but; insulin is not a cure for type 1 diabetes just a treatment and Insulin treatment brings with it a huge burden for the person with type 1 diabetes- blood testing more than 4 times a day, injecting insulin at least 5 times a day, assessing the carbohydrate content of foods are all required to achieve the tight blood sugar targets required to maintain health and wellbeing. This all needs to be balanced against activity levels and avoidance of hypoglycaemia. People with diabetes can never have a day off. They become experts in managing their blood sugar levels and this brings me to the “just listening and talking bit”. Listening to what’s important to people when I’m clinic seemed more time-consuming in the beginning but by encouraging this shared understanding I have come to recognise that almost universally people with type 1 diabetes want to be healthy and that they fully understand the importance of controlling blood glucose but what I also now appreciate more clearly is that there are many other things that get in the way of achieving this goal. Some of these barriers to change seem obvious e.g. fear of hypoglycaemia, fear of injections but others may take gentle probing to identify e.g. the young woman who removed her insulin pump because she had a new boyfriend who didn’t know she had diabetes, the young mum on her own putting her own health after the needs of her family. Through training, practice and reflection I have come to learn is that each person is different and whilst a particular solution may work for one person it might not work for the next and whilst the temptation is for me to offer the solutions that I think will work by practicing the skills I have learnt at various communication skills sessions I now recognise that solutions generated by the person with diabetes are far more likely to be successful that anything that I may suggest. Of course very few consultations are perfect and like every skill we use practice, reflection and additional training can help us to improve which is why I believe that consultation and communication skills shouldn’t be seen as just “the icing on the cake” but more of the “meat on the bones” of our daily work.
Dr Fiona Green is a Consultant in Diabetes and Endocrinology at NHS Dumfries and Galloway
[i] Heisler M, Bouknight RR, Hayward RA, Smith DM, Kerr EA (April 2002). “The relative importance of physician communication, participatory decision making, and patient understanding in diabetes self-management”. J Gen Intern Med. 17 (4): 243–52. doi:10.1046/j.1525-1497.2002.
[ii] eisler M, Bouknight RR, Hayward RA, Smith DM, Kerr EA (April 2002). “The relative importance of physician communication, participatory decision making, and patient understanding in diabetes self-management”. J Gen Intern Med. 17 (4): 243–52. doi:10.1046/j.1525-1497.2002.
Dreams are made when your great idea gets out there in this social world and goes viral. The very thought that thousands of people (likeminded as you) are looking at your good idea and thinking – “That’s a great idea, I could do that”
especially in our health and social care world when it isn’t necessarily the idea that’s new (although sometimes it is) but the ability to engage others to get them to follow your lead, for the benefit of patients and families.
So when things take off in this way, is it just good luck, or is there something we can learn? How does a good idea move from being MY great idea to something that a lot of other people want to do too?
In his New Yorker article ‘Slow ideas’ Gawande started my thinking on this topic (and a million other things!) when he discussed the evolution of surgical anaesthesia compared with the uptake of antiseptics to prevent sepsis. He described how the former spread almost worldwide in 7 years, the latter taking more than 30 years (and you might argue that the inability to clean our hands consistently even today means that we still haven’t cracked it).
It’s easy to imagine the difficulty undertaking any surgical procedure on a patient not anaesthetised (not least for the patient) – having your colleagues hold down the poor patient until such time as they (hopefully) passed out with the agony of the ordeal. Then you hear of an innovation where the patient inhales a gas and goes gently to sleep, allowing the procedure to be done with ease – a no brainer in terms of its likelihood to be adopted by others… and swiftly! The action of holding down the screaming patient and wrestling to undertake the procedure was clearly very personal and real for all those present.
However, the use of antiseptics to prevent an infection that the practitioner might never even see personally, leaves a lot to the imagination and limited personal cost, with the exception more latterly of professional reputation and in some quarters accreditation.
This situation was also exacerbated by the unpleasantness of the environment, where the practice of good antisepsis in the early days meant that theatres were gassed with antiseptics, hands scrubbed raw with early chemicals – all to prevent something that the practitioner might never witness… Perhaps, then, it’s easy to see why that adoption took longer than 30 years. Or is there more to it than that?
Gawande’s article goes much further and is very thought provoking but he fundamentally sets out how, if we want our ‘thing’ to be taken up by others at scale, then “…technology and incentive programs are not enough. “Diffusion is essentially a social process through which people talking to people spread an innovation,” wrote Everett Rogers, the great scholar of how new ideas are communicated and spread.”
He goes on to say that while our new social world can get the ideas out there
as Rogers showed, “…people follow the lead of other people they know and trust when they decide whether to take it up. Every change requires effort, and the decision to make that effort is a social process.”
I think these might be key concepts for us to consider with our personal improvement efforts. How hard do we make it to do the right thing?
Looking around at some other recent great ideas gone viral that I have become aware of – I thought it might be helpful for us to take a closer look at these and consider their spread from this perspective – I thank Delivering the Future Cohort 11 for their help with my developing thinking #DTFcohort11.
And also to consider how would the business world more broadly consider this issue?
Great marketers certainly start with two concepts that absolutely relate to our world and reflect Gawande’s thinking:
Know your audience
and
Make an emotional connection.
So looking at 3 examples of great ideas that have gone viral a little closer to home, can we identify the critical success factors that made them work so that we can apply that learning to our own work?
Case 1 – What matters to me
| Who | Jennifer Rodgers @jenfrodgers Lead Nurse for Paediatrics NHS GG&C |
| What | What Matters To Me (WMTM)
WMTM is a 3 step approach 1 Asking what matters 2 Listening to what matters 3 Doing what matters |
| Why | “Clinicians, in turn, need to relinquish their role as the single, paternalistic authority and train to become more effective coaches or partners — learning, in other words, how to ask, ‘What matters to you?’ as well as ‘What is the matter?’” |
| Where | Yorkhill Children’s Hospital Glasgow – global |
| When | Last 4 years |
| How | Originally Jens’ Quality and Safety Fellowship project, building on the concept of Lauren’s list in the USA; national and international presentations, Used the Model for Improvement as the improvement method. Started by asking one child to draw what mattered to them, and staff making every effort to include and react positively to this information – now used routinely as part of the paediatric admission process. Spread includes other specialties such as the Care of Older People and those with Dementia. |
Case 2 Hello my name is…
| Who | The sadly very recently deceased Kate Granger (http://hellomynameis.org.uk @grangerkate) a young doctor battling at the time with terminal cancer, made observations about the human interactions she was struggling with at a very vulnerable time. |
| What | Kate decided to start a campaign, primarily using social media initially, to encourage and remind healthcare staff about the importance of introductions in healthcare. |
| Why | She made the stark observation that many staff looking after her did not introduce themselves before delivering her care. She felt it incredibly wrong that such a basic step in communication was missing. After ranting at her husband during one evening visiting time he encouraged her to “stop whinging and do something!” |
| Where | NHS England – Global |
| When | Last 3 years |
| How | Twitter campaign initially – #hellomynameis has made over 1 billion impressions since its inception with an average of 6 tweets an hour.
Kate has left an incredible legacy with #hellomynameis that will continue to impact positively for patients. |
Case 3 The Daily Mile
| Who | Elaine Wylie – Headteacher (recently retired) St Ninian’s Primary School, Stirling
thedailymile.co.uk |
| What | The aim of the Daily Mile is to improve the physical, emotional and social health and wellbeing of our children –regardless of age or personal circumstances. |
| Why | It is a profoundly simple but effective concept, which any primary school or nursery can implement. Its impact can be transformational- improving not only the childrens’ fitness, but also their concentration levels, mood, behaviour and general wellbeing. |
| Where | St Ninian’s Primary School, Stirling – global |
| When | Last 3 years |
| How | The Daily Mile takes place over just 15 minutes, with children averaging a mile each day.
Children run outside in the fresh air – and the weather is a benefit, not a barrier. There’s no set up, tidy up, or equipment required. Children run in their uniforms so no kit or changing time is needed. It’s social, non-competitive and fun. It’s fully inclusive; every child succeeds, whatever their circumstances, age or ability. Elaine demonstrated huge impact on eliminating obesity in her primary one class that had stated the Daily Mile in Nursery. |
In each of the cases the idea started with one individual who had a simple, sensible, not necessarily unique idea, but certainly something that was a bit different from the status quo – perhaps even challenging and making the status quo uncomfortable.
Each leader had a degree of power and autonomy in their local context, for Kate this was as an informed patient, so some might argue her ability to influence would have been limited.
Each idea was simple and easy to try in different arenas.
Each was free or relatively low cost to implement, even at scale.
The impact on patients or children was obvious or in the course of early testing clearly demonstrated.
Each leader used social platforms as a spread mechanism.
In every case, the idea clearly feels like it was the right thing to do, or scandalous that it wasn’t happening routinely, something each of us would want to happen if we were the subjects in question. Perhaps even the standard we apply every day in our professional or personal lives and assume that everyone else does too.
So clear evidence to support Rodgers view that “Diffusion is essentially a social process through which people talking to people spread an innovation,” – Perhaps the easy access to social platforms in these cases made ‘people talking to people’ helped in these cases?
Each leader knew their audience and played to that strength – but also and perhaps most importantly in each case, the emotional connection is huge, but each from a very different perspective.
Is the emotional connection the critical success factor in these cases – and something we should consider carefully if we want our work to spread?
Which emotions might you tap in to when trying to engage folk in your great idea? Emotions described in pairs of polar opposites might give you some food for thought and a place to start with your great idea:
Joy or sadness
Anticipation or surprise
Fear or anger
Disgust or trust
You will have many more thoughts than time permits here, but I leave you with a thought of mine… perhaps we all have an opportunity to use a more considered approach to the scale up and spread of good intentions by learning from those that have done that well.
If not you, who? If not now, when?
Simple checklist
How simple have I described my great idea – Have I got my 1-minute ‘elevator pitch’ worked out to easily influence others?
Does it feel the right thing to do?
Is it relatively cheap or free? If not who will fund the idea, now and then at scale?
Am I convinced that it isn’t happening to every patient/family every time, reliably? Do I have the data that proves that?
Do I have the power to influence, or if not, who do I have to get on board?
Do I have the data and story to describe how it works and how easy it is to adopt, including the impact?
What social platform for spread will I use?
Which emotions are triggered, or will I aim to tap in to, in order to engage people to want to do things differently?
Ros Gray recently retired from her post as National Lead for the Early Years Collaborative. Prior to that post she was Head of Patient Safety for Healthcare Improvement Scotland.
Over the years compassion and kindness have been common themes on this blog and nobody encompassed them more than Kate Granger.
Kate was many things; Consultant geriatrician, campaigner, wife, aunty, MBE and patient. She was born and raised in Yorkshire and after qualifying in medicine from Edinburgh University returned there to complete her training in medicine for the elderly. She married the love of her life, Chris Pointon, in 2005 and then in 2011, at the age of 29, everything changed. After falling ill whilst on holiday in California she was diagnosed with a Sarcoma and given 12 – 18 months to live. Characteristically she decided to defy the odds and do something meaningful with the short time she had left.
I think it would be fair to say that prior to her illness Kate was a compassionate, caring and person centred clinician who inspired those around her. However her illness gave her a unique insight into how we deliver healthcare, in particular the ‘small things’ which we often forget – like introducing ourselves. It was during a hospital admission in 2013 that Kate noticed that none of the healthcare professionals dealing with her told her their names. The first person to do so, and show real care and compassion, was a porter. She reflected (and raged a little) about this and from that experience the #hellomynameis campaign was born.
#hellomynameis is a great example of a very simple idea which has the power to make a difference. It started on twitter and progressed to name badges, internet memes and finally circled the globe. During the Ebola outbreak in Western Africa those caring for the afflicted could write their name on a #hellomynameis sticker and attach it to their protective suit and thus patients would at least know the name of those tending them. Many politicians and celebrities have endorsed the project and it has been adopted in many countries around the world. I for one continue to wear my badge with pride.
We were very fortunate that Kate wrote for this blog in 2014 just prior to her visit to NHS D&G. Her blog can be read here.
Since Kate died I have read many obituaries and blogs which are far more thoughtful, and certainly more eloquent, than anything I can hope to write. I would like to quote a few of them here.
Ali Cracknell, a fellow Geriatrician and friend had this to say on the British Geriatrics Society blog:
“I always thought we would work together long term, and the thing that makes me really smile is Kate is with me more than any other person at work. Every encounter with a patient “hello my name is …”, every MDT, every meeting with a new member of the team and every morning I put on my “hello my name is” badge, she is with me, she is behind every little thing I do every day, that just makes such a difference. How could one person make a difference like that? “#hello my name is”, is so much more than those 4 words, Kate knew that and felt it, and we all do, it is the person behind the words, the hierarchy that melts away, the patient:professional barrier that is lowered, the compassion and warmth of those words.”
Just Giving, the website through which Kate raised over £250,000, described 5 Lessons they learned from Kate. You can read them in depth here but the 5 lessons are:
1) We need to communicate
2) Always rebel
3) Remember romance
4) Make goals
5) It’s ok to talk about down days
A little more about number 3, Remember romance. Just giving had this to say about that…
“Kate and her husband Chris have set the bar high when it comes to romance. Throughout Kate’s journey, she never forgot to mention how important her partner is to her and how lucky she feels to have met her soulmate. After the diagnosis, the couple recreated their wedding day and renewed their vows. They even did their first ever date in Leeds all over again.
The duo did absolutely everything together, including competing in fundraising events.
Seeing Kate and Chris wine, dine and care for one another teaches us to never take our loved ones for granted, and to remember romance. The couple remained incredibly close and strong for the duration of Kate’s illness, and managed to maintain an amazing sense of humour in the darkest of
times. It reminds us all to reflect on how we treat our partners.”
The BMJ published a particularly touching obituary which can be read here.
I will end with a quote from Macleans, a Canadian weekly magazine…
“Jeremy, Jackie, Tasha, Lucy, Pam—Kate’s doctors and nurses had names in her blogs and Twitter feeds. Outliving expectations by three and a half years, she met her fundraising goal of £250,000 for Yorkshire Cancer Charity, encouraging doctors worldwide to say hello, as she herself said goodbye.
On July 23, 2016, on her 11th wedding anniversary, three days after meeting her fundraising target, Kate was lying in her hospice room, no longer able to swallow. Christopher opened a bottle of champagne and placed drops on Kate’s lips. Caretakers called in her other family members. At 3:50pm, after Adam and Christopher’s mother had arrived at her bedside, Kate stopped breathing. She was 34.”
Ken Donaldson is Deputy Medical Director (Acute Services) at NHS Dumfries and Galloway
Last week on dghealth Kate Granger told the story behind her #hellomynameis campaign and on Tuesday 23rd June NHS D&G were delighted to welcome her to the Easterbrook Hall where she spoke to over 150 healthcare professionals.
Kate, and her husband Chris Pointon, had embarked on a two week whirlwind tour of 15 healthcare organisations around the UK to promote their campaign. We are really privileged as Dumfries was their only stop in Scotland and early on in her presentation Kate explained why. As part of her clinical attachments at medical school in Edinburgh she spent four weeks in Dumfries working with Dr Ian Hay in Elderly Care medicine. She had such a good time, and was so inspired by Ian, that she chose to specialise in Elderly Care and is now a Consultant in Yorkshire.
It is difficult to find the words to describe how humbling it was to hear Kate tell her story. She is very matter of fact about her diagnosis of terminal cancer, her journey through chemotherapy and the complications that ensued…and her prognosis. The power of a clinician seeing care “from the other side” cannot be underestimated.
On one occasion, after a change of ureteric stents, Kate became unwell with a fever and had to be admitted to hospital. A nurse took her history in the emergency department, as did a young doctor and another nurse administered antibiotics. She is unable to tell us their names as they never told her. In fact the nurse who gave the antibiotics didn’t even check her name band or allergy status before plugging her into a drip and starting them running – all the time talking to another colleague.
However she did remember Brian’s name. Brian was the porter who took her from the ED to the ward. He introduced himself, asked her how she was, recognised she was in pain and ensured that he pushed her bed slowly over all the bumps as to minimise her discomfort. In short he was kind. He cared. Unfortunately there were other examples of poor introductions and she found herself ‘Emotionally Reflecting’ (or as Chris pointed out ‘Whinging’) about this and decided to do something – hence #hellomynameis.
This is about more than just an introduction. It’s about effective, skilled and compassionate communication. It’s about the little things, a smile, a hand on hers, the offer of a drink. It’s about true person centred care and seeing every patient as an individual, a person. ’See me’ as Kate puts it. If when you enter a patients room you lower yourself to their level and introduce yourself with a smile then your conversation will follow a different tack than if you stand towering over them eulogising to the entourage of nameless followers at the end of the bed.
Kate is now an MBE. She has met numerous politicians (all rather keen to jump on the bandwagon!!) and celebrities and the #hellomynameis brand is now truly global. Hospitals in many countries including the USA, Australia, Italy and Sierra Leone have embraced it. The latter example is extremely powerful as, during the Ebola outbreak when clinicians were forced to be completely sealed in protective clothing, #hellomynameis stickers could be put on the visors of helmets so that patients would know the name of the doctor or nurse caring for them.
Kate’s talk was inspirational. The courage she and her husband demonstrate in touring the country telling her story time and time again is breathtaking. I know I can speak on behalf of everyone who made it to the Easterbrook by saying how proud we all were to have met Kate and Chris. While Hazel Borland and I waited for her to arrive we both confessed to some nerves at meeting this celebrity. We told Kate this and she responded “but I’m not a celebrity, I’m just a normal Yorkshire lass” and this was what came over throughout her visit. Despite everything she has been through, and all she has achieved, she remains grounded, normal and human.
Kate’s talk was recorded on video and will be available for all to watch soon.
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