April 2018 – Sparklystar55

This week I was sent the ‘imatter’ questionnaire to complete. It’s badged as a ‘staff experience continuous improvement tool designed to help understand and improve staff experience’. In other words it’s a cultural snap shot.

There are many ways that organisations will try to gather data on the prevailing mood and climate. However I believe if you truly want to know what the culture of any NHS organisation is then I suggest looking at their education departments.

Education and culture have a symbiotic relationship. It’s something that the GMC believe is important too but do we really understand what it means?

Take a superficial look and yes you will be told that most healthcare workers are supportive and approachable. Yet something still feels off. Reflecting on the various trainee surveys the things that are consistently highlighted are around this idea of culture, the learning environment, communication and a feeling of inclusivity. This is mirrored in the trainers reports as well.

So there is something of an irony that as we live in a time of greater connection through social media, email etc we continue to feel isolated.

So how do we bring a sense of community back or joy at work, if you will?

I believe it begins with the culture and at its core, organisations placing a high value on education and training. It also requires organisations to recognise the multi faceted nature of the problem

Take for example educational supervision. In many organisations there is an imbalance between number of trainees per trainer. We need to look at ways to not only encourage more people to become trainers but for them to feel supported in this role. To my mind that comes from providing courses/time specific to the needs of local trainers. Currently people are forced to go elsewhere – assuming they can given the current service pressures. So it makes no sense to me why there isn’t better local Faculty Development to make it easier for people to access these courses.

Another hugely important area is to better engage with our primary care colleagues. They are renowned for delivering excellent training but again remain isolated and disconnected from secondary care. I believe that through more collaboration we could share learning on every level from how to deliver training but also in shared educational events. In my experience, these type of events lead to better understanding, more collaboration and adds to a more inclusive culture.

Our medical students also play an important yet understated role in the culture of the local workplace. They may appear on my ward rounds but I rarely see them elsewhere. This isn’t meant as a criticism but I do wonder why they aren’t made to feel more part of the team?

I also spend a lot of time listening to our trainees and they tell me that they feel our particular hospital has something of an identity crisis. It may be a District General but it has the workload of a tertiary centre without the workforce to match. Why is there not more trainee advocating going on? This may seem a trivial point but again it does have an indirect negative affect on the culture.

We have Realistic Medicine to weave into not only the content but the delivery of our education and training programs. To do that we need to be more forward facing and flexible. Part of this will come through working with colleagues in e-health. We should be more creative in the ways we deliver our traditional CPD – not just face to face but stream or record them for people to watch at a time that suits. Podcasts would provide even more flexibility.

However motivating a workforce that feels somewhat downtrodden under the weight of the service is perhaps the biggest symptom of something not being right.

So you can carry out survey after survey but if your organisation comes back with 99 problems and education ain’t one of them then you have a much bigger problem….

I love this time of year. Increasingly more so than Xmas even with all its twinkly sparkliness. Easter is definitely my new favourite. Why? Well, I think it’s the most hopeful time of year. The clocks have just sprung forward giving us lighter evenings. The birds are singing and there’s a general sense of things coming back to life. However it’s the sense of hope that Easter brings that I love the most. And it’s hope that I want to focus on.

I was at church today and as you might imagine everyone was in a jubilant mood (there were three confetti cannons!). I expected the sermon to be equally uplifting so you can imagine my surprise when the pastor opened with how terrible it all was. People were sad, they were bereft, the church was about to get much worse.

I began to wonder if I was in the right place. As he went on I thought about making a sign saying ‘Easter = happy’. Spiritual nourishment it was not. Then he quoted this by Jurgen Moltmann:

‘That is why faith, wherever it develops into hope, causes not rest but unrest, not patience but impatience’

Ok…… This was interesting.

Now I don’t want to get into the detail of the rest of the sermon – it turned out to be one of the most inspiring and uplifting ones I’ve heard in ages. I also think that some reading this won’t be particularly interested in it. So why I am mentioning it? In that moment it challenged every idea I had about hope.

I had always took hope to be this thing that you could hold onto tightly like an unshakeable solid foundation giving you security.

Hope is also something that I have thought to have both spiritual and non spiritual connotations. For example every year I hope that the Pittsburgh Steelers will win the Superbowl. My hope never gives up until its clear they are not in the Playoffs. I digress…. Everyone has something they are hopeful for whether it be a cure for cancer or merely that it won’t snow again. To suggest that it causes unrest and impatience came as a bit of a shock.

In reality this is something I’ve been struggling with recently in my day to day work. In particular the work I’m doing around education. In the main I would consider myself to be a positive person. When it comes to getting things done the hope is to get people to see the why in order to get to the how.

So I was surprised when I found myself telling an audience at a delirium conference that i was getting grumpy and a little fed up. I felt like I was always preaching to the converted. We have yet to see delirium education imbedded into induction programs. It is yet to be made a priority within our clinical governance structures. We also still talk about other quality clinical indicators but not delirium.

This frustration continued into the leadership course the following week where I was challenged to essentially get my own house in order before tackling bigger or loftier projects.

I found myself thinking about a comment from my previous workplace in which I was told ‘you can’t be a prophet in your own land’. Was history repeating itself?

I asked a colleague how they thought I was perceived by others ‘Challenging, very challenging but in a good way!’

I was beginning to loose hope. Not faith but hope that anything I did was ever going to matter or make a difference.

‘That is why faith, wherever it develops into hope, causes not rest but unrest, not patience but impatience’

Today on this beautiful spring day I have renewed hope. A sense that my deep dissatisfaction with how things are done will inspire unrest in others. I hope it will make people impatient for things to be better.

After all we’re closer now than light years to go…….