Can I make a difference? by Paul Gray

It’s a big question – can I make a difference?  How does it feel to ask yourself that?  For some of us, the answer will be different on different days.  My experience suggests that your answer depends much less on what you do, than it does on how you feel.  In this blog, I’d like to offer some thoughts on making a difference.

However, some context first.  I fully recognise the challenges we face.  Health budgets are going up – but pressures on recruitment, and the demands of an aging population, are also very real.  There is also still much to do in tackling inequalities, and improving the health of the population, which NHS Scotland can’t do on its own.  And we do know that people have the best outcomes when they are treated and cared for at home, or in a homely setting.  So our current models of care are transforming to meet these demands, and to provide the most appropriate care and treatment for people, when they need it, and change brings its own challenges.

So my first suggestion is to turn the question, “Can I make a difference?” into a statement – I can make a difference.  If you start from that standpoint, you’re much more likely to succeed.  It’s easy to become pre-occupied with the things we can’t change, and the barriers and problems – I know that I fall into that trap from time to time.  But wherever I go, I see people throughout the NHS, and in our partner organisations, making a difference every day.  So ask yourself, what is the one thing I can do today that would make a difference?  And then do it!

paul-1Now, give yourself some credit – think of an example where you did something that was appreciated.  Write it down and remember it.  If you’re having a team meeting, take time to share examples of things that the team did, that were appreciated by others.  Sharing these examples will give you a bank of ideas about simple things that matter to other people.  And it also gives you something to fall back on, if times are tough.

Next – think of an example when someone did something for you, which you appreciated.  Find a way to share these examples too – if it worked for you, it might work for someone else as well.  Ask yourself when you last thanked someone for something they did well, or something you appreciated.  It’s easier to go on making a difference if others notice what you’re doing!

If you’re leading or managing a team, ask yourself how much time the team spends discussing what went well.  It’s essential to be open and transparent about problems and adverse events, but if that’s the whole focus of team discussions, we overlook a huge pool of learning, resources and ideas from all the positive actions and outcomes.  And we risk an atmosphere where making a difference is only about fixing problems, rather than about improvement.  So, as yourself and your team, what proportion of time should be spent on what went well?

Remember to ask “What Matters to You?”.  I know that the focus of this question is on patients, and that’s right because they are our priority, but it’s a good question to ask our colleagues and our teams as well.  Just asking the question makes a difference – it gives you access to someone else’s thoughts and perspectives, and is likely to lead to better outcomes.

paul-2Will any of this change the world?  Not on its own, of course.  But you could change one person’s world, by a simple act of kindness, or listening, or a word of thanks.  You can make difference!

Paul Gray is the Chief Executive Officer for NHS Scotland and the Director General for Health and Social Care at the Scottish Government

Reflections on Imperfections (In memory of Dr Johan Leuvennink, my friend) by Fanus Dreyer

While writing I am listening to Dozi, a troubadour who sings in Afrikaans and Zulu.

On Monday I attended the memorial service for my close friend, Johan Leuvennink, consultant psychiatrist, who died so suddenly. For the last two weeks I have been thinking about the paths we’re on and why these are so imperfect…

In December 2012 I had a knee replacement, necessary due to damage from playing rugby, jumping from aeroplanes and boulder hopping in canyons and on the Cape coast. It was 14 weeks before I could go back to work and where else would a knee recover more quickly than in the heat and dust of Africa. So we went to Zambia for teaching critical care and then to South Africa to visit family. As David Ball and Pete Armstrong returned from Lusaka to Dumfries I went south, with a stopover in Johannesburg. At O.R.Tambo’s Ocean Basket I ate Cape kingklip and calamari, with a glass of Durbanville chardonnay. My waiter was Pioneer, who recognised me from a visit the previous year, when about 10 of us descended on them for a meal. He asked me in detail what I did and so on, and then said “You have the greatest job. Not only are you able to save people’s lives, but you actually teach others to do the same“. I was humbled by Pioneer’s insight and very thankful for his words at a time when I didn’t feel like going back to work.

Pioneer’s words led to some serious thinking. Why then was I dreading to go back to my NHS job after only 3 months off? Well, I always feel that way after experiencing something of the heart and soul of Africa, but this time it was worse. Some things happened around the three weeks we spent in Zambia and South Africa. I received emails about critical incidents in patient care that I could not have influenced, but I was still asked to comment. On the first day back home I was phoned about students who had complained and I was asked to respond, even though I had not met these students. Somehow there is this perception that, if we just complain enough and change systems constantly, we will one day reach perfection. NO, it ain’t gonna happen!

In Tanzania in 2009 our guide, Cyprian, described the caricatures of all the different nations that he had taken on safari. We laughed at how he described Afrikaners, Germans, French and Japanese clients. He said that the British were those who would say “thank you very much, it was the most amazing trip of my life”, but on the feedback form they will always write one thing that should be better or different. Make no mistake, I always take complaints or concerns of those who “suffer under surgeons” very seriously, but simple moaning leaves me cold. I have just bought a car and, although it is great to have a new toy, it is not perfect for my requirements. My job is not perfect, nor is anything else in my life. So what! I’m happily cruising along through this life and can only stand and stare at the miracles it brings every day, again and again. We meet people who have suffered unimaginable losses and with severe disability and sorrow, and they continue to inspire me. I think Africa accepts life’s imperfections more easily. That is why Rwanda could move on and why South Africa had a peaceful transition. You also see that in the total lack of self-consciousness in the girl with a long scar on her face, in the man wearing a woman’s blouse and in the patient with the large goitre or fungating cancer. So my job is not perfect but Pioneer is not far off, it has perfect opportunity, and for that I am forever grateful.

…I had known Johan since he was my student in Tygerberg Hospital. He stood out because he asked challenging questions. And then we met again in Dumfries and shared some good times together, usually in serious discussion. We walked a difficult road together. I still cannot believe that he is gone and the question that remains in my head is “What price do we pay for the work we do?” I know that surgeons have a high rate of untimely deaths, and am sure the same goes for psychiatrists.

fanus-1This took me back to thinking about the National Geographic picture of Dr Zbigniew Religa and his patient, taken after he did the first heart transplant in Poland in 1987, which took 23 hours. In the picture Dr Religa sits and observes his patient’s vital signs, absolutely drained but still alert for anything that could go wrong, while an exhausted assistant sleeps in the corner. Twenty five years later the patient, Tadeusz Zytkiewicz, holds the same iconic photograph of “giving everything”, but Dr Religa, his surgeon, had died in 2007. The patient had outlived the surgeon.fanus-2

…Three years ago I asked Johan if he could teach me to play the piano. I have no talent and no ear for music but wanted to learn to play one song. He took on this challenge with his usual enthusiasm. After months of patience from him and practice by me I was able to play the right hand of this one special song, and this is still all I can play…

I see trees of green, red roses too
I see them bloom for me and you
And I think to myself what a wonderful world

I see skies of blue and clouds of white
The bright blessed day, the dark sacred night
And I think to myself what a wonderful world

The colors of the rainbow so pretty in the sky
Are also on the faces of people going by
I see friends shaking hands saying how do you do
They’re really saying I love you…

I think that at the end there is only one question to answer and that is “Did you love enough?” I have no doubt that Johan could say “Yes, I did”….

Maybe perfection really lies in what we give, not in what we achieve.

 

Fanus Dreyer 

Consultant Surgeon

NHS Dumfries & Galloway. 

I am human by Dawn Renfrew

“I am human: I think nothing human alien to me”

dawn-1-terence-the-african

Terence the African

So wrote Terence the African, around 2000 years ago. He was a slave from Roman Africa, a dramatist, and an interpreter. He was quoted recently in the annual BBC Radio 4 Reith lectures, by Professor Kwame Anthony Appiah, professor of philosophy and law at New York University.

dawn-2-appiah-now

Appiah Now

Professor Appiah’s subject, “Mistaken Identities”, is one of the most defining issues of our age. We all have multiple identities which describe who we are. These include those suggested by our gender, age, occupation, political affiliation, nationality, race etc. The possibilities are endless when you think about it: parent, child, sibling, friend, Bake-off fan, or Queen of the South fan are just a few.

In a healthcare setting, we also have many identities, including being part of our own discipline, team, ward or service. Sometimes we are ourselves patients, and some of us are managers. Any health condition, whether physical or mental, can become part of our identity.

Appiah himself embodies many complex aspects of identity. Half-British, half-Ghanaian, he was brought up in Ghana and England, and has now adopted America as his homeland. He is the grandson of the Chancellor of the Exchequer, Sir Stafford Cripps. He is a crime novelist, and a fan of Japanese haiku. In addition, he was one of the first people to take advantage of the new gay marriage laws in New York State. He is probably ideally placed to set about unpicking assumptions which we all have about the “labels” associated with identity.

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Growing up in England

Appiah discusses 4 aspects of identity over 4 lectures: creed [religion], country [nationality], colour [race] and culture [Western identity vs non-Western]. These are delivered in 4 different locations: London, Glasgow, Accra [capital of Ghana] and New York. The lectures cover the great sweep of history, and examples from a range of countries across the globe. They argue that identities are more complex and fluid, than are commonly supposed. They are more a “narrative”, than an “essence”, and do not necessarily determine who we are. Everywhere you look, you can find exceptions in identities, which challenge our commonly-held assumptions about them.

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Growing up in Ghana

Identity is important for our survival. It helps give meaning to our lives, and helps us feel, and be, part of a community. Evolutionary psychologists would argue that it has been critical to our development as a species. All identities are constructed and evolve over time, but as soon as you construct an identity, you create potentially not only an “us” [those within the group], but also an “other” [those outside it]. When there is competition for resources, things can turn nasty, and the “others” may be persecuted or scapegoated. So it is important that we are relaxed and open about our identities, and that we recognise why that process of “othering” arises so easily within all of us. It’s a trap that is easy to fall into, and we need to resist it.

Appiah doesn’t mention healthcare in particular. But if we apply these ideas to the healthcare setting, we can see that a shared identity can help us pull together to meet our patient’s needs, in what are often increasingly challenging circumstances. Equally, there can be a process of “othering” which operates, whether it is towards our patients, our managers, our employees, or other agencies. Whilst understandable, “othering” can prevent us fully engaging with the “other” in a way that leads to the best outcome for all of us. This is relevant to our aims to provide person-centred care, and to integration with other agencies.

On the question of nationhood, Appiah isn’t against nationalism, so long as it is an “open, civic nationalism”. His favourite idea of nationhood, however, involves 2 concepts. The first is patriotism, defined as concern with the honour of your country [or countries]. This means feeling proud when your country does something good, and ashamed when it does something bad. The second concept is cosmopolitanism, which means being a citizen of the world. These can combine to form a “patriotic cosmopolitanism”. You can, and should, respect both “the local” and “the global”.

Identities connect the small scale, where we live our lives alongside our kith and kin [and healthcare colleagues], with larger movements, causes and concerns. Our lives must make sense at the largest of scales as well as at the smallest. We live in an era where our actions, both ideological and technological, have global effects. When it comes to the compass of our concern and compassion, humanity itself is not too broad a horizon. We live with 7 billion other humans, on a small, warming planet. The concept of cosmopolitanism has become a necessity.

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Appiah with Obama

Appiah argues for a tolerant, pluralistic, and diverse society. He says, failure to accept this is not just a failure to understand human identity, it is not in our collective self-interest. We do not need to abandon identities, but we don’t need to be divided by them either. Ultimately, the identity of “being human” ought to transcend all others.

As Scout, the young heroine in the novel about race and mental illness, To Kill a Mocking Bird, concludes: “I think there’s just one kind of folks. Folks”.

The Reith lectures are available to listen to on the Radio 4 website, indefinitely.

Dr Dawn Renfrew is a Consultant Child and Adolescent Psychiatrist for NHS Dumfries and Galloway