“Going that extra mile” by Sharon Shaw

Patient Centred Care

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

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

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

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

“IT WAS HIS LIFE LINE”.

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

“Hello John, my name is Sharon”

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

As my father always said…

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

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

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

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

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

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

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

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

Thanks for taking time to read this.

Sharon Shaw is Clinical Educator for NHS Dumfries and Galloway

 

 

 

In Memory of Kate by @kendonaldson

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

Inspirational by Eddie Docherty

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

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

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

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

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

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

Eddie Docherty is Director of Nursing at NHS Dumfries and Galloway

 

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.”

Time to do the right thing? by Barbara Tamburrini

During my current secondment to the Emergency Department in DGRI, I recently had the pleasure of reviewing a patient who I will call Jane and who required admission for an acute health issue. Jane was very apprehensive and reluctant to be admitted which is quite understandable. However, on exploring this further to reassure her, I discovered that much of Jane’s apprehension surrounded her experiences during a previous admission to hospital. Jane had been a patient in a very busy general ward and she had required frequent assistance but English was not her first language. Jane was very conscious that her communication and understanding had caused her some challenges and she stated she felt “slow” because of this language barrier.

Jane described in some detail, that she had felt very uncomfortable pressing her buzzer when she required assistance and she explained that she thought the staff on the ward were wonderful and caring but they appeared, in Jane’s words:

“too much, too busy busy, too small time.”

 

Jane’s perception was that by requiring assistance, she was contributing to what she considered to be an already unachievable workload for busy staff. Jane was clear that staff had been efficient and had never expressed displeasure when she requested help but the speed at which staff interacted with her and assisted her, coupled with her self-awareness regarding her language had all made Jane feel “a nuisance”.

 

After spending some time reassuring Jane, I came away from this consultation having been touched considerably by it.

Why?

Because, all too often, I have been one of those nurses on a busy ward, rushing around to get my work done and trying to juggle many different ‘plates’ in the air. It’s so easy to get into this mind set in a healthcare environment which demands so much from staff to deliver optimal services with the limited resources we currently have and a potentially depleted morale.

BUT, and this point is crucial…

Who do we forget about when this work culture is put under the spotlight?

Where does our most important element, our patient, feature in this busy work schedule?

Of course, looking after our patient’s effectively is the reason we are all so busy but is that thinking doing our patients’ an injustice? If we had the chance to ask those who utilise our services and who we interact with during our hectic shift, how they view the busy environmental culture within our wards and departments and what they think and feel about our workload, what would they say? Ask yourself honestly how many of your patients’ or clients have said to you they “don’t want to bother you”? When I think of this, I am certainly left wondering whether I have given my patients the perception that I was too busy for them. Have the patient’s I’ve interacted with during a busy shift been left feeling as though they didn’t want to ‘bother me’ or worse, they didn’t want to be a bother to me? Like most people in the NHS, I came into this profession to care for people in the best way I can but are we achieving this if this is how our patients could be feeling?

A significant quote comes to mind when I consider this…

How have you made someone feel today?

Its certainly a juggling act between making our patients feel listened to and valued and managing the hectic workload. Arguably, that juggling act has been no more challenging than it is in our clinical areas and departments today in the face of financial pressures, tight staffing numbers and a seemingly increasing need for our services.

SO, how on earth do we begin to address this? Ask yourself some very simple questions…

1. The problem is we are too busy but we need to make time for our patient.
2. The solution is to free up time from our current schedule – what do we do consistently and regularly which we could look at?
3. We perform many handovers during a busy shift, what would happen if we made these more efficient?
4. How do we give this a try?

How do we give this a try? When we come up against a question like this but our heads are full of everything else going on in our busy working day, we need a strategy to give us some direction. Think of this strategy as being our ‘work-place problem-solving’ SatNav!

The destination in our ‘SatNav’ is symbolised by the question mark in this diagram and it brings us back to the question in our problem-solving steps – How do we achieve more efficient Handovers?

This diagram leads us to the outcome by asking key questions:

• WHY do we want to achieve more efficient handovers? – To release time to care for our patients.
• WHERE do our handovers occur? – In our care area and in other departments.
• WHEN do these handovers occur? – When we transfer patients and when we change shifts.
• HOW do these handovers occur? – Are they structured, formal enough and does everyone use the same approach?
• WHAT is handed over? – Do we communicate accurate clinical details in the right way to ensure the receivers clearly understand what we want them to?
• WHO are essential participants for our handover to occur? – Which staff groups do we need at which handovers?

The key questions asked in our problem-solving approach provide the foundation for NHSDG’s current Handover Strategy;

WHO?, WHAT?, WHEN?, WHERE? & HOW?

By choosing just one handover process, which occurs at any point in your departmental working day, and answering these simple but crucial questions, you can begin to develop the structure for your departmental handover protocol. A simple protocol document is available either in electronic or paper form, which you can adapt to suit your specific area and handover needs. What’s more, you don’t need to do this alone, assistance is available from myself or Jean Robson as NHSDG handover leads or from members of the Patient Safety & Improvement Team or the NHSDG Handover Group to support and guide you through every stage.

Some tips which will help you to achieve success are:

• Start small and plan well
• Engage all your colleagues in the process
• Build up gradually & extend what you learn
• Expect challenges & address these as they arise
• Use continual evaluation to continually develop & improve
• Never think you’ve finished – its always evolving!

By making this frequently occurring element of our workload much more efficient, we will release considerable time in our day to give back to our patients, relatives and colleagues.

The added ‘Brucey Bonus!’ (and here’s a blast from the past!!) is that a more structured handover will improve the accuracy and safety of clinical communication, which will enhance cohesive, collaborative and consistent multi-disciplinary team working.

The handover group are planning information sessions on 24^th November 2015 to share existing developments from departments working on their handover processes, to learn new ideas relating to improving your handovers and give support in promoting optimal handover practice which is essential, valuable and time-saving.

So, to return to our original thought, look once again at the title of this blog:

‘Time to do the right thing?’

Do you see the question “Is it time to do the right thing?

Or do you see the question “Do we have time to do the right thing?”

The focus of this blog has been the latter. Are we giving time? Are we allowing time in our day to ensure that we do the right thing by our service users and their relatives as well as our peers and colleagues?

I leave you with one final point:

Think of your last work interaction with a patient, relative, colleague or client. During this, did you give them time and have you left them with the perception that you had time for them? If not, what do you need to improve?

Did you make time to read this?

Further information is available from Barbara (btamburrini@nhs.net) Jean Robson (jean.robson@nhs.net) or Amy Sellors, Patient Safety & Improvement Team (asellors@nhs.net).

Barbara Tamburrini, ANP & NHSDG Lead Nurse for Handover at NHS D&G

01387 246246 Ext 32983

 

“Dear Ward 7” by Jackie Shrimpton

Dear Ward 7,

I would like to take the opportunity, afforded to me by this blog, to thank all of you on ward 7 for the care I received during my 14 day stay in June of this year. I have worked for 40 years in the NHS and all of them spent in DGRI so the thought of being an inpatient was not a terribly nice one. However there was something so special about the way I was cared for, the personal touches, the kindness, that I felt I had to put my gratitude into writing.

I became ill some years ago although at this time I did not know the severity of my illness. I had a painful right shoulder which nothing seemed to help. This got progressively worse and then about a year ago I had a brief stay in hospital with a DVT. Subsequent investigations revealed that I had breast cancer and that it had spread to my lungs and shoulder. I was devastated. Treatment commenced with radiotherapy and medications but I knew this was all ‘Palliative’. Earlier this year I became increasingly dizzy and sick and eventually had a brain scan which revealed the cancer had spread to my brain. It was now that I was admitted to ward 7.

From the moment I was admitted to ward 7 I realised I was somewhere special. The nursing staff seemed to go out of their way to make me feel comfortable, even when they were clearly busy. I have heard it said before but it can’t be said enough: at times like this it is the small things that really matter. Combing my hair to make me look nice for my family, knowing the right thing to say to cheer me up when I was down, a simple wee word here and there made all the difference. To feel that someone genuinely wants to help, to see joy in their faces when they know they have helped, means so much. One nurse said that helping me to the shower and making me feel better in myself helped her because she was not coming to me to inject something or do something to me.

I am particularly indebted to Dr Finlay. She was obviously busy and had many patients to care for but never made me feel this way. I was made to feel important and all decisions that had to be made were made with me, not for me. She went above and beyond and I viewed her as a person rather than a doctor. I didn’t feel silly when I struggled to understand, especially when my head was in a fug due to steroids. This was such a huge thing to me at the time. Thank you Dr Finlay.

It is sometimes easy to forget how being an inpatient with an illness like mine can affect your family. My two children and other family were clearly concerned but all said that seeing me in ward 7, speaking to the nurses looking after me, filled them with confidence and made the situation easier for them. My daughter said that she was overwhelmed with gratitude as she wasn’t spending time at work worrying that I wasn’t being cared for. This meant a lot to them and a lot to me.

To all the nurses, auxiliaries, therapists, domestics, doctors, porters, pharmacists, everyone on ward 7……Thank You. I am very proud to know you and have worked in the same hospital as you.

Yours,

Jackie

What are you so scared of? by David Christie (@bagheera79)

“Now, what I want you to do is focus on your breathing. Slow big deep breaths, in and out. You’ll think nothing’s happening at first, then you’ll feel the world become a warm, fuzzy place. Maybe imagine yourself somewhere like a hot sunny beach, waves on the shore, warm sun… big deep breaths, in and out…”

I usually say something along these lines as I’m drifting you off to sleep for your operation. The wording and phrasing obviously varies, and to be honest it’s the tone of my voice that’s important. The aim is to create an atmosphere of calm and reassurance. Something to focus on instead of the beeping of the monitor and the plastic smell of the mask, and the thought of what happens next. It sounds daft, but it’s important. People can be terrified, when they come into theatre, truly terrified. 

Some of the reasons for this are obvious – perhaps the reason that you’re having surgery, such as cancer. Or the surgery itself carries risk – such as surgery to major blood vessels, the brain, the heart. But some of the reasons are a little less obvious, I think, and easily forgotten. Imagine you’re coming to theatre. Just getting to that point involves the co-ordinated effort of many, many different teams. Patients need to be referred, seen in clinic and booked for surgery. There’s a need to have pre-operative assessment done for all the medical, nursing, physiotherapy and social needs. A raft of co-ordinated investigations such as blood tests, ECG and more are ordered to make sure that we know enough about you to be able to do it safely. The booking teams need to create lists that need to match with the availability of the surgeon, the waiting time, the urgency of the surgery and the availability of the patient – and possibly that of your carers or relatives. The theatre team needs to know what particular bits of kit are needed and to have it ready for you on the day. Extra members of staff from different departments may also be needed – such as additional surgeons or radiography – the list goes on and on. The whole process is so enormously complicated and intricate that it astonishes me that it works at all. And it needs to have this level of complexity – we humans are not car parts, stamped out in a factory. There are so many different individual problems that need to be overcome, the system needs to be able to cope with them all. And, by and large, we do.

The downside of being able to cope with all of this with a high degree of safety is that the process has become streamlined, smoothed, tick-boxed and protocol-driven. The most widely publicised example of this is the WHO checklist. With a few simple questions this checklist manages two things that seem obvious but used to be done very badly. The first is that it requires all members of the operating team to meet, introduce themselves to each other, and discuss the day’s work ahead before anything happens. In one neat moment, suddenly everyone knows who everyone else is, what the plan for the particular patients that day is, and what problems are anticipated. The second is that, for every patient – before they’re sent off to sleep, is involved in a discussion that is designed to ensure we have the right patient for the right operation, and various safety aspects taken care of – antibiotics, crossmatched blood, prophylaxis against life-threatening blood clots… It’s simple, effective, and has saved many lives all over the world. Unfortunately, all of this can be hugely depersonalising, and worse, unsettling. Having a group of strangers discuss how much blood you’re possibly going to lose just before you fall off to sleep isn’t necessarily reassuring. The whole process of coming in early on the day of surgery – hungry and anxious – to be told to get undressed and meet a sometimes bewildering range of people, including a surgeon that might be different from the one you expected. To be repeatedly asked about yourself, and then to be discussed while you anxiously wait – no wonder people are scared!

So, what can we do? We only have a few minutes with each patient in the morning rush – but that’s enough. To engage with people on a human level, to let them know that we care, to stop them being quite so terrified is not as difficult as it sounds. Simply saying hello and telling people your name goes a long way – it says you care about them enough to let them know who you are! Tell them what’s going to happen and why, what to expect so that they don’t get a fright. Remember that the nonagenarian in front of you may have had an extraordinary life and seen more than you can ever imagine, don’t be patronising.

All of which brings me back to my little spiel at the top, there. Recently I was anaesthetising a man in his eighties for a straightforward urological procedure. He’d been telling us about his life, time in the mountains, his high-flying daughter, an severe accident he’d had racing motorcycles over fifty years ago. I started to inject the medicines to send him off to sleep, and talking about sunshine, warm weather – and he interrupted to say, “Nah, son. I’m gaunnae dream about scoring a penalty fir Liverpool, right in front of the Kop.” I loved that, it made me smile. It made everyone in the room smile, in fact. It reminded me anew, yet again, that our patients are people, with hopes and dreams and complicated lives, and to not lose sight of it. And it reminded me also, that no matter how old we get, boys never grow up.

David Christie is a Consultant Anaesthetist for Dumfries and Galloway Health Board

‘Walk a mile in someone else’s shoes…’ by @Rosgray

I remember reading a paper a few years ago now that said (something along the lines of) when thinking about the strategic direction of your organisation, you can focus on customer needs and experience, or you can focus on staff needs and experience. It doesn’t matter which, as long as you focus on one, as the quality of the service you deliver will improve. You just need to focus!

As a staff member I get the point, and as someone who works for the public sector it also feels right to put our focus on the needs of our customers.

So there is a lot of conversation in health and social care just now about the concept of asking patients and others “What matters to you?”. It is generally agreed that it can help us understand their needs and maybe understanding of the position they find themselves in under our care. In some cases it has fundamentally redefined the way the service is delivered and often in ways that health care teams might never have dreamed possible.

The newest Scottish hospital has integrated a systematic approach to delivering ‘what matters to me’ for every patient…

 

But all this got me to thinking – if I was a patient today, what would I put on that board?

I have a small family, a daughter’s wedding imminent, I am an only child so no major significant others to accommodate, so I guess they would need to be on there.

But what else would I say?

Reflecting on a fairly recent hospital admission, I had great confidence in the clinicians (a given…) I wasn’t so confident about hand hygiene; I wasn’t eating much so I was really interested in getting hot soup…

So would my WMTM board say – that your hands are clean (and show me how); I like my soup hot; and ask me about my mother of the bride outfit?

Probably…

But the important thing is that it would give us the opportunity to explore what was underneath those words and begin to consider the differences between asking ‘What’s the matter’ and ‘What matters’ and to understand the patients concerns and goals for clinical outcomes and managing life limiting, long term or indeed any conditions.

Some say you absolutely cannot walk in someone else’s shoes. Our history makes us who we are; our perspectives, our successes and failures, our experiences. We cannot put ourselves in someone else’s position in exactly the same way, at best, we can be open, to listen and truly hear, to get more information and be better placed to understand and be prepared to do things in a different way.

And that can be tough.

It can be tough on us as professionals trying hard to deliver a service in increasingly challenging times.

But I suggest it might also be rewarding, bring back the reason we went into this kind of work in the first place, and make that work more enjoyable, knowing that we are engineering a different approach to care delivery that is focused on what matters to our patients. Delivering the care to them as we would the ones we love.

So let me leave you with time to reflect…

What would be on your ‘What Matters to Me’ board?

How will you develop ways to ask your patients about what matters to them?

And how will you use that information to deliver the service differently for them and others in the future?

Because that could be you and yours…

While I accept we cant walk exactly in someone else’s shoes, some of our healthcare colleagues in the USA have attempted to open our eyes a little with this short video.

‘Could a greater miracle take place than to look through each others eyes for an instant?’ Henry David Thoreau

https://www.youtube.com/watch?v=cDDWvj_q-o8

Ros Gray is Head of the Early Years Collaborative for the Scottish Government

Kate Granger by @kendonaldson

Last week on dghealth Kate Granger told the story behind her #hellomynameis campaign and on Tuesday 23^rd 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.

 

#hellomynameis….Kate by @GrangerKate

Hello my name is Kate. I trained at Edinburgh University and in our later clinical years we spent time in the surrounding district general hospitals. For me this meant making the journey over to Dumfries to complete my Medicine for Older People attachment. I was obviously inspired by this placement as once qualified I subsequently chose to train in that specialty.

Everything was going perfectly with my career and indeed my life. I was happily married to my husband Chris, we had a lovely home in Yorkshire and had a fantastic network of supportive family and friends. However, in summer 2011 our lives were to take an unexpected turn and change forever.

I became acutely unwell while on holiday in California. Initial investigations in hospital showed I had acute kidney injury secondary to an obstructive uropathy. The reason for the obstruction was numerous tumours throughout my abdomen and pelvis. Incurable cancer. Out of blue. Age 29.

I’ve been through a great deal of healthcare since then and as a doctor have been a keen observer of my experiences on the other side. It has made me reflect long and hard about my own clinical practice and really think about what constitutes good care. I have come to the conclusion that those factors are really very simple; quality communication; remembering the little acts of kindness can have the biggest impact; person centred healthcare with true shared decision making and always trying to see the person behind the disease or condition.

I have written, blogged, spoken about and tweeted most of my healthcare experience to date. This led almost two years ago to #hellomynameis. It was summer 2013 and I found myself unexpectedly in hospital with post-operative sepsis after a routine stent exchange. During that admission there were a fair few problems with my care, but it was the absence of something so simple, so routine that distressed me the most. An introduction.

No matter which discipline of healthcare you train in, I’m sure that introductions are covered as an important part of interacting with patients. In Medicine we even assign marks in exams for introducing yourself properly. But somewhere along the line in some places this simple courtesy has been lost.

As an avid exponent for both healthcare improvement and social media I decided that it was just not enough to simply complain. My complaint would be politely acknowledged but nothing would change. Therefore, after an inspiring conversation with my husband, in which I was plainly told to “stop whinging and do something”, we set off on the #hellomynameis journey.

On the 31st August 2013 I tweeted:

“Going to start a ‘Hello my name is…’ campaign. Have sent Chris home to design the logo.”

Who could have guessed that would lead me on a path to being awarded an MBE for services to the NHS and improving care? The concept is incredibly simple; use the immense reach of social media to remind, encourage and inspire healthcare professionals about the importance of introductions and their place in the delivery of person-centred care.

Since that first tweet we have been working incredibly hard spreading this message as far and wide as possible. I have lost count of all the conferences I have spoken at and all the tweets I’ve sent. The #hellomynameis hashtag has made over 200 million impressions on Twitter. It has spread all over the world. Our latest enterprise is the #hellomynameis tour where in the space of one week in June we are planning to visit 15 healthcare organisations to talk to staff about our story and how the campaign was born. I’m happy and excited to say that Dumfries hospital will be a part of the tour.

I dedicate a huge amount of time and energy to raising the profile of patient experience in the healthcare agenda. I feel it is something that is sometimes not given the prominence it deserves. But that is changing and the patient voice is becoming louder and more powerful. Patients need to know who is delivering their healthcare, to build relationships with and be able to trust those people. #hellomynameis simply reminds us all of that.

Dr Kate Granger MBE is an Elderly Care Consultant in Yorkshire. She will visit NHS Dumfries and Galloway on June 23rd 2015