What Matters to You: NHS at 70 by Kimberley McCole

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As part of the ‘Summer of Celebrations’, we launched our campaign around ‘What Matters to You: NHS at 70’ on June 6th.  Looking back of the past 70 years and into the future at the next 70 years how does this impact on what matters to you now?

Some thoughts we captured at a recent SPSP meeting:

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We are looking for staff to collect their own thoughts and the thoughts of our service users using ‘leaves’ that will be used to build our ‘Experience Trees’.

For further information, or to request an ‘Experience Tree’ pack to use in your department, please contact: dumf-uhb.patientsafety@nhs.net

Experience trees will be featured in our September event.

Kimberley McCole is a Project Officer with the Patient Safety and Improvement Team at NHS Dumfries and Galloway

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How do we stop people smoking at the front doors of our hospitals? by Chris Isles

Over a million smokers are treated in UK hospitals each year and a small proportion of these feel compelled to smoke when they are admitted to or visit hospitals. The image of smokers congregating at the front doors of our hospitals in wheelchairs with dripstands and catheter bags is all too familiar for those of us who walk past them as we come to work. We recognize that health risks to others are minimal because smoking in the open air is no threat to anyone’s health, but it nevertheless gives the wrong impression of a hospital as a promoter of a healthy lifestyle. We were particularly concerned that smokers would rapidly migrate to the front entrance of our new hospital in Dumfries when it opened in December last year.

A British Thoracic Society audit in 2016 of 14,750 patients across 146 hospitals in the UK found poor recording of smoking status in medical notes and little evidence that people who smoked were asked if they would like to stop smoking or were referred to a smoking cessation service. In hospitals with designated smoking areas (41% of all hospitals in the audit) smoking restriction was “completely or mostly” enforced outside these areas in only 33% cases. In hospitals with no designated smoking areas, restriction was “completely or mostly” enforced throughout the grounds in only 40% cases. This was despite a NICE guideline in 2013 recommending that hospitals should set out a clear time frame to establish or reinstate smokefree grounds and remove smoking shelters or other designated outdoor smoking areas.

As if in response, Public Health England launched a NHS Tobacco Free campaign in 2017, although the Department of Health in England has no plans to make smoking on hospital grounds illegal at present. Northern Ireland made it a criminal offence to smoke on hospital grounds in 2016. Similar legislation has been passed in Wales though here there is provision allowing the person in charge of the hospital to designate any area in the grounds as being an area in which smoking is to be permitted. In 2016, the Scottish Parliament passed an amendment to the Health (Tobacco, Nicotine etc. and Care) (Scotland) Act 2005 which made it an offence to smoke within a designated perimeter around NHS hospital buildings. The proposed perimeter is 15 metres. Smoking within this perimeter will lead to a £50 statutory fine which can rise to up to £1,000 if taken to court. When this latest legislation is implemented in Summer 2018, environmental health officers employed by the local authority, rather than NHS staff, will hand out the £50 statutory fines. As it stands there are no exceptions, for example psychiatric hospitals or hospices. It will also be an offence to allow someone to smoke on hospital grounds with a maximum fine of £2,500.

An opposing view is that instead of criminalising smokers, we should show compassion for those who have the capacity to make an unwise decision and for whom smoking may be a comfort at a difficult time. We make allowances for drug users in hospital by prescribing methadone and we do not stop the morbidly overweight buying sugary drinks at the hospital shop, so why not allow smokers to smoke in a designated smoking shelter? The fact that Greater Glasgow Health Board failed to stop smokers from smoking at the front door of their hospitals, despite spending £473,500 on a high profile campaign in 2013, suggests to us that the money could be better spent addressing the findings of the BTS audit and by asking patients if they would like to stop smoking, referring those who do to a smoking cessation service, and by reinstating smoking shelters.

Chris I 1We could endorse the Scottish government’s proposed legislation that will attempt to eliminate smoking within a 15 metre perimeter of our hospitals or we could accept, however reluctantly, that smoking will never be completely eradicated and reinstate smoking shelters, while providing access to stop smoking services and support to help people who would like to quit. In any event it is difficult to imagine exactly how environmental health officers will impose and collect spot fines. And yes, as predicted smokers did rapidly migrate to the front entrance of our brand new hospital in Dumfries when it opened in December (see photo above).

Chris Isles is a Consultant Physician at NHS Dumfries and Galloway.

This blog was originally published in the BMJ online here

Food is about so much more than just nutrition… by Claire Angus

Are you someone who craves the crunch of crisps? Enjoys a chicken and rice soup? A chocolate sundae where you delve through layers of whipped cream, ice-cream, chocolate brownie, chocolate pieces, and chocolate sauce?!

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We could describe the foods above as containing lots of textures, or as having different consistencies… runny, crunchy, crispy, flaky, smooth, chewy, soft, thick, thin.

The consistency of your dinner is unlikely to be a high priority.. unless you’re a food critic or a chef! Most of us decide on food choices based on what sort of flavours we fancy, how ‘filling’ or for some folk ‘light’ a meal is. When we order in a restaurant, we often peruse the menu before picking a firm favourite dish, or maybe we pick something we know we could never make as well at home, or something expensive – if someone else is paying!!

For some people with ‘dysphagia’ (swallowing problems), choices about what to eat, and what they can safely eat, are more restricted.

The adult Speech and Language Therapy team work closely with many adults who have acquired ‘dysphagia’ as a result of a health condition i.e. stroke, brain injury. Our main roles are in assessment of an individual’s swallow (how strong is it? How quick is it?), giving handy hints and tips about how to make swallowing easier depending on the particular difficulty (sitting upright whilst eating, tucking chin to chest), and advising on how food and drinks can be modified so that they’re easier to manage (and prevent unpleasant coughing/choking, and pesky chest infections!!)

So that you look less like Theresa May coughing on water at this conference…

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And more like this happy lady.. happy whilst eating her chips from the canteen…

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We used to use ‘stages’ to describe the consistency of drinks, and ‘textures’ to describe the consistency of foods. As is often the case with healthcare which develops and evolves, there is to be change! This change comes in the form of introducing a new way to talk about food and drink consistencies. The plan is for these to be used internationally, as pretty colourful triangles and numbers can be understood in any language. Here’s a diagram of the new International Dysphagia Diet Standardisation Initiative (IDDSI) triangles.

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Essentially, starting from the very bottom at level 0 is the ‘thinnest’ liquid available – think plain old water. As you work your way up the levels, the consistency gradually thickens – think of yoghurt drinks and smoothies. At level 3, there is an overlap where the consistency can be provided as a moderately thick drink, or a liquidised food (e.g. McDonald’s chocolate milkshake/custard) and as you work your way up to level 7, the food becomes more challenging – requiring more mouth control in biting, chewing with your teeth, mashing with your tongue, co-ordinating a mix of different textures (think of that chicken and rice soup/chocolate sundae I mentioned right at the start!) and controlling a strong timely swallow.

Our adult Speech and Language Therapy team embraced a food challenge to try and understand the new descriptor ‘levels’ and to experience what it might be like to be recommended a specific consistency ‘level’ and to prepare meals accordingly. It was much harder than we anticipated!

Here are some of our reflections:

Level 3 – Liquidised Food

Laura’s first stumbling block was when she realised she doesn’t own a blender! She therefore changed the task to see if she could buy a day’s worth of convenient food and drinks at level 3 consistency.

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Whilst it’s maybe not as healthy as making a meal from scratch, and probably more expensive, she felt it was more realistic for people like her who prefer meals that are more easily prepared. She was required to think ‘out of the box’ – buying fruit and veg puree from the baby aisle, although she highlighted that this might feel slightly demeaning to an older adult. She reflected on the challenge, saying “If I had to have my food and drinks modified to this level on a long term basis then I don’t think I would manage with the hunger! I would probably ask for the support of a registered dietitian to offer suggestions on improving oral intake and maintaining nutrition and hydration.”

Level 4 – Pureed food

Becky cooked a mushroom risotto, before putting it through the food processor!

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Becky reflected on the experience, saying that she would feel frustrated if she was having to prepare food to level 4 consistency out of necessity, as she struggled to ensure that the consistency was correct. Claire who also prepared food to level 4 consistency felt that it took longer than usual to prepare dinner as she was having to blend and sieve everything. This can be a real pain if you only have one of each and are required to keep washing everything as you go! Jan who also completed the challenge felt that she would miss the different textures of foods if she was required to prepare all meals to level 4 consistency.

 

Level 5 – Minced & moist food

Amy cooked bhurjee, an Indian take on scrambled egg.

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She felt that the challenge helped her think about how complicated it can be for patients/family/carers of people with dysphagia to prepare food to the correct consistency level. Whilst Helen was completing the challenge, she reflected on the fact that food is about so much more than nutrition.  It is often used for social occasions, and gifts, and she thinks that she would struggle going out to eat in cafes/restaurants with friends and family if she was only able to eat food which was minced and moist. Another valuable insight offered by Helen was the added layer of difficulty there may be whilst preparing food of modified consistencies, if an individual’s cause of dysphagia is post-stroke, and they are required to do food preparation (i.e. small chopping, dicing, blending, sieving) with their non-dominant hand.

 

Level 6 – Soft & bite-sized food

Kirsty cooked a Balmoral chicken with peppercorn sauce, level 6 style!

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She felt uncomfortable as an adult having her dinner presented cut up into 1.5cm bite-sized pieces almost as if for a child, but still managed to present it beautifully!! Helen prepared macaroni cheese, assuming that this would be an easy way round a level 6 meal. Turns out that pasta which measures up as 1.5cm when dry, expands to 2cm when cooked, and therefore each and every piece of pasta had to be trimmed by 0.5cm to meet the IDDSI descriptor of 1.5cm!! Talk about time consuming! IDDSI’s 1.5cm thumb nail sized pieces have been proposed as this is smaller than the adult trachea (wind-pipe), and therefore minimises the potential of a choking risk. Helen felt as though the challenge made IDDSI’s strict descriptors more practical, and personal, and removed them from just being on paper. 

 

Completion of this challenge highlighted for many of the team just how important food is.. for socialising, for comfort, for enjoyment! Most of us will celebrate good news by popping open a bottle of bubbly, or heading out for dinner in a favourite restaurant! Whilst these new descriptors have rigid descriptions – they have been created and tested so that everyone can enjoy food and drink as safely as possible!  

 

Claire Angus is a Speech & Language Therapist for NHS Dumfries and Galloway

  

(The International Dysphagia Diet Standardisation Initiative (IDDSI) is being implemented throughout Dumfries & Galloway over 2018 in all hospital, care and home settings. From 21st May, the fluid thickener Nutilis Clear changes to follow the new levels of drink, and anyone using Nutilis Clear will need to mix their drinks slightly differently.)

 

  • For more information on IDDSI, look for links on the Beacon flash adverts or visit:

http://iddsi.org/Documents/IDDSIFramework-CompleteFramework.pdf

  • Follow the adult SLT team on social media using:

@SLT_DG on twitter

@SpeechandLanguageTherapyadultService:NHSD&G on facebook.

Realistic Medicine—is it achieveable? by Heather Currie

A few months ago I was fortunate enough to be able to attend the Realistic Medicine conference held at Easterbrook hall. Hearing personal stories was, as always, moving and thought provoking. Little did I know that I would be having my own Realistic Medicine experience within a week.

My dad was a legend. Cantankerous, stubborn, opinionated, yet determined, resourceful, creative, inventive and mischievous! He has had many encounters with the NHS over recent years, mostly good but not all, from which I have learnt much. His outpatient journey, which I described in a previous blog, inspired me to look into how our outpatients run in the hope that we could do better.

He was always a farmer and continued to be involved, always knowing best (!)  until he was no longer physically able. At the age of 89, despite cardiac failure, chronic kidney disease, gout, peripheral vascular disease and osteoarthritis he managed to stay at home in the country, looking out onto hills and fields of sheep and cows, with help from family and carers until June 2017. Then, with decreasing mobility and some cognitive decline, he agreed to move into a care home. A care home on a working farm with a room looking out onto a field of cows was perfect. The staff were wonderful and he settled well, enjoying the company, feeling safe and good cooking! But he was inevitably becoming frailer.

One Sunday morning in October when I was visiting, he was quite drowsy. On discussing with the staff they mentioned that he had had blood tests showing worsening renal function and this was being monitored. My response was that perhaps blood tests were not needed and that most important was that he was comfortable. 

The following night around 11.00pm I was phoned from the care home to let me know that he was going into hospital and that the ambulance was about to leave.  Further blood tests had been taken. The results had been seen by an out of hours doctor somewhere in the north of England, who recommended hospital admission and ordered the ambulance. When I asked “What are we hoping to achieve?” the response was that while the care home staff and paramedics agreed that keeping him comfortable was the correct path for him, they could not go against the recommendation of the out of hours doctor.  I knew that he would not want to be taken to a hospital many miles away, for what? Phone calls to family members confirmed that they felt the same. Dying in the ambulance or on a hospital trolley was a distinct possibility, instead of comfortably with family with him, in the room looking onto a field of cows.

Several phone calls later enabled me to speak to the out of hours doctor. After explaining dad’s history, he agreed to cancel the ambulance and send a colleague out so that the care home had whatever was needed to keep him comfortable.  Having only blood results to go on, he could not make the fully informed recommendation. But why were blood tests taken in the first place? 

Dad died the following evening. Several family members had been able to visit during the day, he showed no signs of distress and at the end my daughter and I were with him, in the room looking onto a field of cows.

 If a death can be good, this was one, but could so easily have been very different. As my nephew later said, “Heather, none of us could have had that conversation. To move him would have been a disaster.” But why, when the family, the care home staff and the paramedics all believed that the right course of action was for him to stay, were all of us initially over ruled by a doctor who had never met my dad and had limited access to his medical history, albeit he was acting in good faith? 

So we achieved a realistic outcome this time, but is Realistic Medicine universally achievable? 

Possibly, but a major change in mind set from ourselves and from the public is desperately needed.

First and foremost we need to be kind,

But we also need to be brave

And we need to be realistic!

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Heather Currie is an Obstetrician and Gynaecologist and Associate Medical Director for Women’s, Children’s and Sexual Health and NHS Dumfries and Galloway

Let’s eat dirt by Euan Mcleod

image1Do you remember growing up and playing in the mud, jumping in puddles, playing in the middens, wellies and the ring of no confidence (for more on this see Billy Connolly et al) 

Nowadays there is growing evidence that the desire to prevent our kids from being exposed to all kinds of bugs and germs is having a negative effect on them being able to develop resilience later in life, that the overriding desire to protect them from anything that may cause them harm is in fact causing them harm

 

image2This has burgeoned into an array of various chemicals cleaners and devices some of which kill 99.9% of all known germs and keep you safe, (never mind the ones we don’t yet know about),  but not all bugs are bad and similarly not all feelings and emotions are bad for us as well or something we need protected from. 

We have as a society in the pursuit of risk free safe living, developed health and safety into a burdensome machine, aimed at reducing and mitigating against the litigation potential and the costs as well as the reputational damage that can bring. The quite laudable idea that we should try and prevent things hurting us has become an exercise in producing paper trails and avoiding blame and guilt and less about “real” discussion about harm and risk

 

image3Witness the industry and thinking that has led us to losing some of our critical thinking ability and one might say common sense in how we respond to telling people about potential dangers just in case they sue us because we didn’t tell them. Where has personal accountability gone? 

Did we not learn as children for example that water in a kettle may be hot, or that snow and ice may be slippy, that knives may be sharp.

In mental health care we are often confronted by people experiencing acute levels of distress and our natural desire as humans and members of the caring profession is to try and take that away from them. To make things better and keep them free from harm 

 

image4We place people under restrictions, observe them with a view to preventing them taking a course of action which may be detrimental , we act in their best interest, but we are in a complex area of managing risk for the organisation versus risk for the individual , whose rights and responsibilities are arguably foremost in the provision of our service.

 

image5I recently completed training in the risk assessment tool which is used across services in Dumfries and Galloway, The training helped us to see that we all view risk differently and that having a tool does not make it a simple one size fits all approach but allows us to gather information about a complex subject that is ultimately about the individual and how we help them by managing risk.

 

image6Managing risk is not about just making sure the organisation and the staff are protected but ultimately about ensuring that the individual receives care and treatment that helps them towards recovery 

 

image7.jpegManaging risk makes all of this sound like something technical process driven THING, something outside of us but its value is in helping us to see risk as something which is part of us, part of life and in living life we sometimes take risks because it’s worth it in the end. that’s where the risk assessment process can helps us to have those difficult conversations, to be able to be brave and honest, not foolhardy, succinct in our thinking, with our rationale laid bare to be observed and clear to all  and to place the person in need front and centre of those risk plans.

 

image8The Scottish Patient Safety Programme is designed and focussed on prevention of harm in healthcare settings, could this translate into a focus on preventing harm at all costs and thus creating circumstances and situations which create longer term harm

Are there times when we potentially cause more harm by not allowing people to be exposed to the very things that will strengthen them and make them more able to cope with the stress and strain of life, mental ill health and help build resilience-which involves a willingness to turn negative emotions involved in disruptive life events into something strengthening and empowering. In this sense the negative emotions like the dirt we were exposed to as children rather than being removed or cleaned away or sterilised has a value in being allowed to remain and be used to build up resilience and thus recovery

The Scottish recovery network define recovery as “being able to live a meaningful and satisfying life, as defined by each person, in the presence or absence of symptoms

 

 

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Resilience is becoming a key issue in our approach to mental health care and treatment, for example in England and Wales the government have allocated circa £15bn of resource to tackle the problem. that might mean we are seeing an acknowledgment that our modern lives are damaging our mental health and that an over reliance on medication and getting therapy hasn’t worked and has simply led to over use of mental health resource and a failure to rely on  ourselves as healers                                                                    

I am not suggesting we somehow stop caring, or throw caution to the wind and do not take seriously the very real dangers/risks of helping people “on the edge” but perhaps we are in the business of a more nuanced approach to risk, resilience and helping people lead mentally healthier lives, and eating some therapeutic dirt might be worth the risk to support people towards hope and recovery

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Ewan McLeod is a Mental Health Staff Nurse at Mid Park Hospital Dumfries

Imagine a world………… by Laura Lennox

 

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Elaine has dysarthria (motor speech disorder):

 “I hate using the phone simply because I am so self-conscious of my speech.  And if they say “Pardon?” to me, it makes me more flustered because I automatically assume it’s my speech that’s the issue.  I would never think it could be that a noise distracted them at their end.  And the more flustered I get when trying to talk, the worse my speech becomes”.

 

“I love that some companies now have the ‘chat online’ service.  I will use that instead of the phone even though it takes longer”.

 

“The other day I saw some valuable looking equipment seemingly dumped under a bridge.  When I got home I went on to the Police Facebook page to message them, but they didn’t have messaging as an option.  I googled a contact email for them but to no avail. In the end I was forced to phone but it really is a last option for me”.

 

“I hate phoning for appointments, taxi’s, takeaways- all the things other people do without thinking about it – it’s a big issue for me and I often work myself up in to a state.  I try to remember the sound advice from my speech and language therapist to speak slowly and clearly but the minute I hear “Pardon?” I break out in a cold sweat

Last year I decided to get back into studying and registered for a three-year MSc in Advancing Healthcare Practice through the Open University.  I was asked to look at a small-scale innovation in a healthcare setting that could lead to a significant impact.  Straight away I knew what I was going to look at.  Listening to people’s stories time and time over – THE DREADED TELEPHONE!!

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William and Bob both had throat cancer.

 

William:

“Speaking for myself, contact through email is the only way for me to go. I cannot carry a conversation by telephone due to the amount of Mucous and or phlegm talking generates.  I can listen on the phone to any conversation but can only give a limited response to any questions”. 

 

Bob:

“I do not answer the phone as usually the valve needs cleaned for me to speak clearly.  If I need to make a phone call I need to clean the valve first and tend to just phone immediate family due to other people possibly not understanding me.  It’s embarrassing answering the phone and not being able to speak.  An email is so much easier to correspond with. No embarrassment.”

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Typically, the main or only method for contacting any public service is by telephone.  In the 21st century we have so many more ways of communicating:

 

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A Scottish Executive report published on communication support needs (Law et al, 2007) estimates there are between 1% and 2% of the population in Scotland who have complex communication needs.  Complex meaning to the degree that they cannot communicate effectively using speech, whether temporarily or permanently.  This is likely an underestimate given that the study is based only on people who were accessing speech and language therapy services.

 

If we consider the findings of this Scottish Executive report, having telephone contact as the only method of access within an organisation may be perceived as an inequality.

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(International Communication Project, 2016)

The Scottish Government (2011) recognises the requirement for public organisations to become more inclusive of people with communication support needs and has set guidance for public authorities on Principles of Inclusive Communication.  The legislative driver for this stemming from the Equality Act (2010) and the United Nations Convention on the Rights of Disabled People (2009), Articles 9 and 21, which set out a person’s right to have access to information and communication in different forms.

 

Individuals and the wider community benefit from all people being more independent and participating in public life.

Lorraine has Aphonia (loss of voice):

 “I have difficulty with communication as my voice is a whisper and everyday there is a hurdle I have to try and jump.  One of these is appointments with NHS either hospital appointments or Dr Surgery appointments. I have lost appointments at the hospital as I can’t phone to cancel and rearrange. Also, when they send you a letter saying to phone up to arrange an appointment, I have to rely on other people to do this for me which is very hard as they work during the hours you have to phone, or they forget it’s also not very private. If you wanted to keep it private I can’t even have a phone consultation. I find it upsetting and frustrating that I have lost a lot of my independence having to rely on other people to make phone calls and appointments for me. There is a simple way to help people like me to give us part of our independence back and the answer is email. Most of us use it these days and I would have my privacy too. All they need to do is have on my records responds by email only, how hard is that? I don’t like to be one of those statistics that don’t turn up for appointments or when you don’t phone to make your appointment and think you do not need one. And that is just a small part of what I have to go through on a daily basis”.

 

Putting knowledge into action is what counts.  We could all work towards becoming more inclusive to people with complex communication needs by adding alternative options for contacting our services and departments.  It could be as simple as adding an email address to start with.

 

Now imagine if every service and department within health and social care did this then it would indeed be a giant leap towards a more inclusive communication world.

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If you have an interest in Inclusive Communication and want more information or to become involved in any future projects, please contact:

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Laura Lennox is a Speech and Language Therapist & Allied Health Professional for NHS Dumfries and Galloway

Culture Club by Wendy Copeland

How do you describe workplace culture to an alien… I hoped ‘google’ would have an answer, they didn’t.

I then thought of 80s pop culture and two bands jumped into my head ‘Fun Boy Three and Banarama’ when they covered a 1939 jazz standard – “It Ain’t What You Do (It’s The Way That You Do It)” (1982)

I then thought of Culture Club, and the pop culture that they helped form, which still influences popular culture today.

The Blitz Kids were a group of young people who frequented the weekly Blitz club-night in Covent GardenLondon in 1979-80, and are credited with launching the New Romantic cultural movement.

They had a common set of values, beliefs and behaviours, as well as a unique style. All part of the new romantic  culture.

(watch David Bowie’s Ashes to Ashes video – an early culture adopter filmed with extras from The Blitz).

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Come on Wendy back into the room, what does this all mean to all of us that work in Health and Social Care and the culture we help create and work within.

Here’s a more appropriate definition

An organisation’s culture consists of the values, beliefs, attitudes, and behaviours that employees share and use on a daily basis in their work.

The culture determines how our workforce describes where they work, how they understand the system, and how they see themselves as part of the organisation. Culture is also a driver of decisions, actions, and ultimately the overall performance of the organisation.

Our Board invested in measuring our cultural norms a few months ago, you may have contributed to the survey. We are in the process of rolling out a further cohort of individual feedback reports, that helps the person get to know them self, and identifies their own beliefs, values behaviours and assumptions, and measures how others experience them.

We used a tool called Life Style Inventory (LSI), we choose this tool as it looks at strengths as well as self -defeating behaviours, in the hope that the person will further improve what is good and work to change what they could be better at.

The tool measures 12 styles  in which we choose to think about our self and how others see us operate whilst at work.

Think about it like a big 12 slice pizza, some are tasty some are not.

We all love the blue slices!     We could do with less green ones……… and let’s keep reducing the red

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For people who would like more detail https://www.humansynergistics.com/change-solutions/change-solutions-for-individuals/assessments-for-individuals/life-styles-inventory

In the spirit of transparency here’s some of the learning that we, as accredited LSI practitioners have learnt about our self.

Caroline Sharp, Workforce Director NHS. Asking for feedback is a pretty scary thing to do when, like me, you’re as green as the Grinch in your thinking styles. In my head, quite a lot of green stuff churns around, especially the ‘approval’ slice of the pizza, and so of course I was anxious for ‘approval’ from others in how they experience me as a leader in our organisation. To my relief, and curiosity, my feedback from others shows me that whilst I may be ‘thinking  Grinch green’, I am ‘behaving blue’, and in particular, my ‘humanistic encouraging’ behaviour, which is about supporting others to develop and be the best that they can be, is my Constructive, people focused primary style . I also noticed in my results that there is still some white at the top of each blue ‘slice’ – so lots of opportunity to be even more blue than I am currently felt to be by others. So, I am currently wondering, and exploring how to let go of some of my passive aggressive Grinch thinking, and fully embrace the blueness that others see in me – and that feels really good in the moment, not scary at all!

Wendy Copeland: I thought I knew myself pretty well, I was confident that I would have lots of ‘blue’ and that’s what others would see when I was interacting with them.

However I was kinda gutted to see that my primary style was a pesky green. I had the approval slice of pizza! So what did that mean for me? It means I had have a tendency to agree with everyone, I like to be accepted and get upset if I am not, and I can be generous to a fault.

My second slice is Affliliative, I like to cooperate, include others and am I am friendly.

So what… what have I learnt about myself? Through reflection and coaching, I have learnt that I am a people pleaser; however I have not accepted that I always need to be like this. I am working on learning to think and act for myself, and accept that not everything I do will be met with ‘jazz hand’ approval. I am practising facing confrontation and recently handled a challenging situation as a mindful adult rather than the petulant child. I am a work in progress however already I am feeling less stressed and a belief that my view matters.

Oh and I am pleased to report that others see lots of Constructive Blue behaviours.

Wendy Copeland is Service Manager for Nithsdale in Partnership