Being Wrong by Jeff Ace

Being wrong is interesting isn’t it? When you get a call right, your view of the world is unchanged and things are happening much as you expect them to; all very unexciting. But when you’re wrong, there’s something off with your perspective, or lacking in your knowledge; very interesting indeed.

Luckily, I’m wrong particularly often and accumulate large numbers of these excellent opportunities for learning. I’ve been wrong on some big life stuff and on too many professional and work related decisions to keep track of. I was even wrong in recent attempts to help my daughter with her physics homework, leading to her claim that many of the elements hadn’t been discovered when I was in school.

There’s something in this unfunny and (mostly) untrue teenage sarcasm that I think explains one of the common causes of ‘wrongness’ in that people look to the past to explain the present and predict the future. This might be fine but most of us, including my daughter, have an absolutely lousy sense of historical perspective. Smart Alec history teachers will use any number of examples to highlight how poor this perspective can be. A couple of my favourites in this list of things that just don’t seem right are that Cleopatra lived closer in time to ‘Carry on Cleo’ than to the building of the Great Pyramid at Giza, or that Tyrannosaurus Rex was more a contemporary of Marc Bolan than it was to the Stegosaurus. Similarly, England’s 1966 world cup win is as close to the outbreak of WW1 as it is to the present day, despite it being mentioned every four flipping minutes over the summer.

Broad contemporaries: T-Rex and T-Rex

These examples show that people tend to distort historical perspective by magnifying the recent past and diminishing periods further back. So, to me, my schooldays of the 70s and 80s are useful reference points in understanding how the world works and will continue to work, whilst to my daughter it was when we learned to alloy copper and tin to make our swords. This phenomenon has big implications for how we get things wrong (or how we can avoid making mistakes).

Take climate change, for example. The scientific consensus is that we’re now heading for more than a 2 degree temperature rise on pre-industrial levels and likely implications include 3 metre plus increases in sea level rises. By all rational measures, this information should be dominating the political and economic agendas, with urgent risk management and mitigation measures everywhere we look. But 3 metres… that can’t happen, can it? That would swamp St Helen’s cricket ground in Swansea where Sir Garfield Sobers became the first human to hit six sixes in an over, where all great Welsh cricketers have strutted their stuff over the years (well yes I have played there, actually. Don’t like to go on about it. It’s not like there’s a framed picture in my house of me on the pitch or anything like that *). The scale of this change, that would flood Miami and make the Mumbles Road end at St Helen’s appear only at low tide, is way outside our historical reference points, our ability to visualise the world; so we sort of file it somewhere in our brains and get on with more everyday routine problems.  

St Helen’s Swansea – spiritual home of Welsh cricket

So I worry about how our tendency to rely too much on a poor and distorted understanding of the past can make us wrong and complacent over big changes. And I worry about it a lot in the context of health and social care provision. 

Our historical perspective here is dominated by the post war model of service provision. This model is an historic anomaly, of course, radically different from that which existed through the rest of human history, but is nonetheless now seen as an unchanging piece of how our bit of the world works. The difficulty is that if you start projecting the next 20 years of demographic change, workforce availability, technology driven cost increase and the amount of funding that an economy can generate for health and care… it’s really, really hard to see how it all holds together to provide the sort of health and care service that people of my age will by then be expecting. I think there’s a tendency to dismiss these forecasts because, well the Health Service has always been short of money hasn’t it, and winters are always a bit tight, but we always get through it in the end…. and basically because our perspective doesn’t help us to imagine a radically different future. 

This I think would be terribly complacent and would open up our largely wonderful but already creaking system to existential risk. But whilst I’m a bit of a worrier, I’m also a mostly optimistic type of bloke. There is now a lot of work ongoing on the sorts of disruptive changes that could help to address the apparent perfect storm of pressures building on health and care. Organisations like The Kings Fund have been busy in this field lately (https://www.kingsfund.org.uk/publications/eight-technologies-will-change-health-and-care and https://www.kingsfund.org.uk/publications/digital-change-priceless are good examples) and show how we can move perspective from a future of tweaking our models of care to one where they are genuinely transformed. 

I’m wrong about loads of things but I’m pretty confident in predicting that, in order for us to continue to deliver the service our population deserves, we’re going to have to increase the pace of change to models radically different from those established. In D&G we have an outstanding track record of managing major change and this is one aspect of the past that I think is going to be extremely useful in preparing us for the future…

 (* ok there is)

Jeff Ace is Chief Executive Officer at NHS Dumfries and Galloway

Always look on the bright side of life by Ken Donaldson

I published this post on my own blogsite two years ago and, even though it is a little silly and dated, I thought I would share it with you again. Sadly things haven’t changed that much in the past two years.

“I don’t need to remind everyone that 2016 has been a particularly bad year. Who would have thought, 12 months ago, that we’d be leaving Europe, a complete Muppet (and that is an insult to Muppets to be honest) would’ve  been elected to the White House and far right, fascist, borderline Nazi rhetoric would suddenly become acceptable. Not me, that’s for sure, but here we are.

On top of all that we have daily news clips showing unimaginable suffering in Syria and other parts of the world whilst we sit watching helpless. And then there is all the celebrity deaths. It is as if the likes of Bowie, Rickman and Wogan knew it was all coming and thought “Stuff this, I’m out of here”.

So it is for that reason that I thought I would tell a wee story that may lift your spirits. Not much perhaps but hopefully, like me, you may have a smile on your face by the end of it.

A few weeks ago I had a bit of a crazy day trip down to London. Up at 4.30 to catch a train from Lockerbie to Euston, full day finishing at 9.30 (well, when I say ‘finishing’ that was the work bit, I then caught up with friends over some red wine until 1am…I never learn). I had to get up again at 4.30 to catch a return train to Glasgow. Forgive me a slight digression but the contrast between my two ‘walks to the station’ was quite stark. In Lockerbie it was a glorious, still, freezing morning with thousands of stars filling the jet black sky. In London it was slightly warmer walking down Tottenham Court road but there were no stars, just a plethora of homeless people shivering under blankets and, at one horrific moment, being investigated by the biggest rat I have ever seen. In fact the only rat I have ever seen outside of captivity. There was a somewhat Dickensian feel to it.

But back to my story. So I got on the 5.30 from Euston and promptly fell asleep. The next few hours were a bit of a blur but as we approached Preston the guard made his usual announcement – take care leaving the train and remember all your bags etc – but then he added “Ladies and Gentlemen I would like to take this opportunity to remind you that it is 36 days 15 hours and 43 minutes till Christmas. And with that happy thought here is a song” I must confess I was expecting a Christmas hit or carol but instead he played ‘Always look on the bright side of life’ by the Monty Python boys. I started to smile, I really had no choice, and as I looked up and down the carriage at my fellow passengers, folks who had spent the past 2 hours quietly reading the paper or tapping on their laptops and ignoring each other, I noticed that they were all smiling too. And some were staring to chat, probably about the song but who knows. The guard interjected a few times with “I want to hear you singing now” and before the chorus “Altogether now” which just added to the fun. And as the train slowed down and approached the platform the music stopped and he said “Ladies and Gentlemen, Preston” and that was that.

It made me realise the power of a small gesture, a simple thing which raised the spirits of a few hundred tired travellers. It also made me think that, sometimes, ‘Life is a piece of sh*t, when you look at it’ but Eric Idle was right, it helps to look on the bright side.”

“Cheer up, Brian. You know what they say.
Some things in life are bad,
They can really make you mad.
Other things just make you swear and curse.
When you’re chewing on life’s gristle,
Don’t grumble, give a whistle!
And this’ll help things turn out for the best
And
Always look on the bright side of life!
Always look on the bright side of life
If life seems jolly rotten,
There’s something you’ve forgotten!
And that’s to laugh and smile and dance and sing,
When you’re feeling in the dumps,
Don’t be silly chumps,
Just purse your lips and whistle — that’s the thing!
And always look on the bright side of life
Come on!
Always look on the bright side of life
For life is quite absurd,
And death’s the final word.
You must always face the curtain with a bow!
Forget about your sin — give the audience a grin,
Enjoy it, it’s the last chance anyhow!
So always look on the bright side of death!
Just before you draw your terminal breath.
Life’s a piece of sh*t,
When you look at it.
Life’s a laugh and death’s a joke, it’s true,
You’ll see it’s all a show,
Keep ’em laughing as you go.
Just remember that the last laugh is on you!
And always look on the bright side of life

Always look on the bright side of life

Come on guys, cheer up

Always look on the bright side of life

Always look on the bright side of life

Worse things happen at sea you know

Always look on the bright side of life

I mean, what have you got to lose?
you know, you come from nothing
you’re going back to nothing
what have you lost? Nothing!

Always look on the bright side of life”

Lyrics copied from this site

Bully For You!! by Anonymous

I recently had the dubious honour of being at the receiving end of a bit of bullying behaviour at work.

It was not in my usual place of work, I hasten to add, and not by someone I normally work with. The details aren’t important, the issue was resolved as much as it could be but the after effects lingered.

It has caused me to reflect on the whole concept of what bullying is, who does it and how it affects not only the individual but the organisation as a whole.

Bullying behaviour does no one any favours. It demeans all those concerned and does nothing to resolve the issue.

My experience left me feeling initially shocked, then humiliated and embarrassed in front of my peers. As days went by I began to question my ability to do my job well. In the space of a few minutes I had gone from a fairly confident person to a bit of a wreck. So why do some people behave this way and what can we do about it?  I’m not sure to be totally honest, it’s a complex issue.

Within the NHS it is paramount that we work in a professional manner with patient safety at the heart of all we do, therefore constructive criticism is crucial. If something is not being done in the correct way then this should be challenged. This can be done without conflict in a non emergency situation. In an emergency however situation however, when the adrenaline kicks in for all involved, there may not be time to worry if someone has taken offence. There will be time for reflection later, when the event can be discussed in a calm manner, with all those involved, looking at what went well and what could have been done better. Any issues anyone has should be freely discussed, or if this is not possible then a one to one with the line manager may be helpful.

Abuse is not acceptable in any situation however, and we all have a duty of care towards each other to ensure this doesn’t happen. 

Bullying behaviour occurs for many reasons, often due to stress or fear, emotions are heightened and the definition of what unacceptable behaviour is can vary from person to person. That is why it is of such concern. There are guidelines in place highlighting what constitutes bullying and continued bullying needs to be reported and measures taken to resolve it as soon as possible.

Bullying takes many forms, not always overt, sidelining a person, rolling of eyes behind their backs, not giving a person equal opportunities with their peers to progress. We may have had this happen or even done it to others. Sometimes it’s so subtle that the person being bullied isn’t initially aware that they are the victim of ridicule. This is particularly cruel.

The cost to the NHS from stress related absence is enormous; there are recruitment issues in all areas, so let’s try to ensure that we are part of a welcoming, inclusive organisation that shows zero tolerance to bullying behaviour.

Now, don’t get me wrong, I’m not exactly a paragon of perfect behaviour myself and I’ve been sharper with folk than I should have been. You always know when you have done this…..it leaves a bad taste.  It’s certainly made me rethink my own behaviour, much to my husband’s delight!! 

With that in mind, I encourage everyone to think of someone in your own place of work that you don’t interact with much, they might even get right on your nerves, ask them about themselves, take a bit of time to find out who they are and listen. You might be surprised! One thing I can guarantee is that not only will they feel good, so will you.

For further information , I found the document on Bullying and Harassment in the Workplace at the Acas website very helpful. You can find it here.

If you feel you are being bullied or maybe complicit in bullying behaviour, now is the time to do something about it.

Kindness cost nothing.

Memories…of the way we were… by Elaine Ross

Readers of certain age will remember the Barbara Streisand song in the 1970’s with the line  ‘Could it be it was so simple then…’

The way we were

The NHS 70^th anniversary is a reminder of the major progress made over the last 70 years.  The reduction in the spread of communicable diseases such as measles or whooping cough, which lead to significant numbers of deaths and long term incapacity in years gone by, is just one of them.

My own Uncle spent years in a mental health facility following encephalitis leading to learning disabilities having contracted whooping cough from my mother as a baby.

Hand hygiene and vaccinations are, in my opinion, the two most effective ways of preventing infections.  Yet we are now seeing measles outbreaks and increase in whooping cough across the UK due to a lack of uptake of the vaccine.

Whilst the essential elements of infection prevention and control have remained the same; preventing spread of microorganisms, advances in health care have led to increasingly complex procedures and equipment used on, often, more vulnerable patients.

Antibiotics were just available in 1948 but since then there has been an exponential rise in the number of antibiotics and the frequency with which they have been used, culminating now in a drive to reduce the number of antibiotics prescribed in a move to combat antimicrobial resistance, which is recognised as a global threat.

The first infection control nurse E.M Cottrell was appointed in 1959 in response to an increase in methicillin sensitive Staphylococcus aureus (MSSA) in Torbay hospital. It commonly causes skin infections and may lead to sepsis through blood stream infections (bacteraemia). The methicillin resistant version (MRSA) was first reported in 1961.  It wasn’t until the 1980’s that Infection Prevention and Control nurses began to be appointed more widely as part of the plan to tackle the expected AIDs epidemic. In reality MRSA probably killed more people in the UK than AIDs in the late eighties and reached a peak in the early 2000’s where 40%of all bacteraemia were caused by MRSA. 

Effective hand hygiene and ‘universal precautions’ as they were then known, helped to combat MRSA however screening has had the largest impact and nowadays it is rare to have an MRSA bacteraemia. This year in NHS D&G there has been only one. 

The advance of technology

There have been many advances in technology which changed the face of frontline infection prevention and control. The development of liquid soap improved compliance with hand hygiene and reduced occupational dermatitis that had been scourge of many a nurse in the days of carbolic soap.

The advent of alcohol hand rub in the late 1980s has reduced the spread of infection as it is so quick to apply; new formulas are actually kinder on the hands and more effective against the majority of organisms than soap.

Laboratory techniques have moved from manual to automatic systems utilising, in some cases, molecular microbiology. Test results are available rapidly, sometimes within in minutes and allow the swift isolation and treatment of patients. In the early days of the NHS tests would have taken several days and longer for organisms such as tuberculosis. Some tests would have used animals. There is no need for an animal house in any laboratory in the NHS these days!

In fact technological advances have affected everything from cleaning to patient records e.g. Clinical portal and TOPAS and IC net connecting lab results and patient journeys.

Sterilisation using high-pressure steam may not be an option for example with highly expensive and sensitive equipment such as endoscopes. Neither can we soak them in toxic chemicals such as Cidex as we did in my days in ENT! 

As healthcare has developed so has complexity of equipment and systems to support it. It is vital that infection prevention control is involved in the specification and purchase of equipment used in healthcare.

More recently, to further reduce the risk from an environment that may have been contaminated by a drug resistant organism, sophisticated machinery has been developed utilising hydrogen peroxide vapour or ultraviolet light which can enhance the level of disinfection achieved within a room. This is a far cry from the Dolly Mop and bucket that would have been in use at the dawn of the NHS though microfiber mops and bleach still have their place. 

The advent of automatic washing machines revolutionised hospital laundry. 

The move to predominately disposable gloves and aprons negated the need for regular washing of these items  and no nurse will be found in the sluice scrubbing ‘Macintoshes’ or draw sheets as they were known when I started. 

The need for adequate ventilation and supposed benefits of fresh air were recognised in the early days of sanatoriums. These days ventilation remains important in preventing the spread of infection but the engineering around this has become ever more complex.

Airborne  isolation rooms are a far cry from placing your patient in their bed on the veranda.

Lochmaben Hospital

What next?

We have reached a stage where there are organisms that are highly resistant to antibiotics and may find ourselves in a world where people are dying from common infections because the antibiotics we have won’t work. Prevention is better than cure, doing simple things like drinking more fluid to reduce urinary infections. 

In healthcare it’s what YOU can do to prevent infection that will make a difference to patients and as at the dawn of the NHS in 1948, the fundamental elements and messages remain the same, clean hands, clean rooms, clean equipment.

Keep up the great work.

Elaine Ross is Infection Control Manager at NHS Dumfries and Galloway

I can be high and I can be low by Anonymous

I can be high and I can be low.  I can be flaky and little miss chatterbox too.

I can be nice and then snap on you making wonder what went wrong.

I used to think all of these qualities were embarrassing, shameful, inconvenient, then

When I was given my diagnosis I was still shameful never feeling relief that giving a

name or a reason to my behaviour was supposed to give.

How can I learn to love so many characteristics of myself whilst hating them at the

same time.

How can I feel happy that everyone thinks I am so unique, so funny but still be so sad

that they have no idea I’m just broken with a smile on my face.

I’m just laughing to keep from breaking.  That sometimes the energy and excitement

pouring out of me is my best quality and sometimes it is my worst.

What makes me unique is I can’t make it go away.  I can’t just calm down or perk up

when I am depressed.

Mental illness is not just being what you think or a state of mind you can control even

when I try my best.  For me that means it debilitates me until I can no longer work. Or

when I want to socialise with family or friends sometimes even getting out of bed.

I have had a great year or two in exchange for several months that are so dark I can

forget what the light looks like. Then at other times I can appear to live “normally”

having had a bad a couple of days here and that is easy for me to hide.

Given the alternatives I consider myself lucky.

In my head I am constantly going over the negatives the parts of a mental illness that

make me weak but other times I am fun.

I have heard from friends, colleagues you are hilarious and we always have a laugh.

That’s a quality I think Bipolar gives me because during a hypomania I can feel on

top of the world.  Yet not so “crazy” its obvious.

 

Anon

 

 

 

 

 

 

 

 

Summer of Celebrations: Part 2 by the SPSP Team

Over the last few months we have seen a variety of blogs, newsletters and tea parties showcasing all the fantastic work that is going on around the region.  The Volunteer’s hosted their own Celebration Party, DGRI had its official Royal opening, we launched our ‘NHS at 70: what matters to you’ campaign and we had the very great pleasure of selecting the winners of our poster competition from an amazing selection of improvement projects.

This week’s blog features staff comments on SPSP at 10, our poster competition winners and how you can get involved by hosting your own tea party!

But first, it is time for us to start sharing the details of our big event in September…

 

 

 

 

 

What Matters to You: NHS at 70 by Kimberley McCole

As part of the ‘Summer of Celebrations’, we launched our campaign around ‘What Matters to You: NHS at 70’ on June 6^th.  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:

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