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geriatrics

Life and how to live it

So my page broke this week.  When I say broke more bits fell off but ever the stoical page that it is it’s kept going.  Over the years it has experienced many unexplained falls, there’s been several episodes of acute confusion as it struggled to tell me extension numbers (usually resolved by a new battery) and on occasion it just became unresponsive.  The exact cause of this has never been fully established but I strongly suspect it has an intermittent fault caused by degenerative, wonky wiring.

In short I think my page might be frail.

The assessment made I’ve made a few adjustments to it (micropore tape) and it continues to happily bleep me again.  We both know the time will come when we need to be honest about how it can continue fulfil its role but we’re not there yet. Until then I will do as much I can so my page can continue to enjoy many bleeping years to come.

Frailty is a concept I have struggled with over the years.  And yes I know as a Geriatrician that could be seen as blasphemy. I’m just being honest though.  I am frustrated that we are still to agree a formal definition that can be easily translated into operational use.  And yet I find myself in a position where I am trying to do just that.

So what is it exactly?  Well, I can tell you what it’s not so that seems as good a place as any to start.

You don’t have to be old to be frail.

My colleague Rowan Wallace gave a presentation years ago which sought to challenge the concept of frailty by showing a photo of her grandparents and asking who was the frailer of the two. Spoiler alert it wasn’t the ‘old looking one’.

It is true that in the very old (>85yrs) around a quarter will be frail but it’s worth remembering that some younger people will also be frail.

Think of it this way.  Take stroke.  It affects all ages but your risk of it increases with age.  The same is true of delirium when superimposed on dementia.  Heart failure is another example.

So I tend to think of it as a long term condition and that makes more sense. In thinking about it that way you might start to ask why is it bad? How do you screen for it?  What  do you about it?  Why should I care? And why is every man and their dog banging on about it?

I think we’re in uncharted territory at the moment and this is why no one can quite articulate why frailty is now a thing.

As I reflect on another weekend on call I am beginning to see why.  We have gotten used to good health such that when a person (especially an older one) becomes unwell it is met with surprise not just by families but by the person themselves.  I used to think it was just the concept of dying that we had lost the ability to talk about but I actually think it goes deeper than that.  People have this amazing contradictory expectation about their own health.  They expect to live for a very long time, with a good quality of life and with a NHS that will attend to their every person specific need.  Death also comes on their terms.  What I saw this weekend was a receiving unit full of broken, unwell people accompanied by their equally broken and exhausted relatives and carers.

This is frailty in action.  And this is what we need to be talking about as openly and honestly as possible.

However we continue to be surprised when these people turn up at our acute medical receiving units.  We are unprepared for them as we continue to function as a reactive service.  One that is risk adverse and offers little in the way of alternative options.

So we need to do things differently and that starts by changing up our approach.  It’s common sense really but when people are exhausted it can feel too difficult.  Of course we don’t make it easy either with increasing silo working which further reduces the ability to share information.

We need to start by how we define risk. I would argue there is a disconnect between what we mean versus what we do. Specifically we seek to manage our own risk but present it as managing the risk to the patient.

We need to be get away from this idea that if we had infinite resources we could deliver a much better service.  This is true to some extent but I predict we will see continued paternalism rather than re-enablement.  Seven day working is a fabulous concept but re-enablement shouldn’t stop just because there isn’t an OT on the ward on a Sunday morning…..

So lets begin again.  Lets agree that frailty exists.  These people will turn up at our front door so we need to be able to recognise who they are regardless of age. We need to be able to offer them some kind of intervention or model of care.  Lets call that Comprehensive Geriatric Assessment (should it even contain the word Geriatric anymore….???).  Let’s admit the very sick as that will always be the right thing to do.  For the others lets see what alternatives we can offer – it could be a community team of therapists, nurses, doctors, pharmacists and third sector.  We could deliver it in their own home or a local centre.  Why not even via Skype or FaceTime?  (crazy talk I know, it’s the stuff of Sci Fi!)

We should continue the conversation around what the person would and would not want as life progress.  We should share that information with as many relevant people as possible, most importantly with their own families.

We should talk to each other in health and social care with improved IT systems but also an actual conversation is pretty good too.

It shouldn’t be hard. This is life and it’s up to us how to live it……

Leadership

You can’t always get what you want

Church has the ability to calm, inspire and on occasion surprise me.  Today it delivered all three.

Now I’m not one for coincidence or ‘signs’ but the parallels between my current work life and the topic of the sermon was uncanny. The team from OneLife Leadership (www.onelifeleaders.com) had just delivered a conference for the church youth and Liz Bewley was sharing how it had gone.  What then followed was a leadership masterclass unlike any other I had heard before.

I hadn’t actually expected to spend the morning exploring values based leadership in church.  I’ve always associated that type of thing with work and to be honest I’ve become a little weary of them.  So I wasn’t immediately enthused when we were asked to speak to our neighbour about what we do in our lives that could be considered ‘leadership’?

I trotted out my stock answer – ‘I’m a doctor’.  I also threw in that I’m a mother but the person seemed more taken with the doctor aspect.  Apparently we doctors are considered leaders.  We lead teams of people to help the sick.

And I suppose that’s true about the clinical work.  I certainly find it the most rewarding part of my job but it’s also the easiest.  However with that comes the potential to stagnate.

It was the word ‘potential’ that resonated with me throughout the sermon.  To my mind it’s the single most positive word in the English language and one I usually associate with hope.

Of late it’s been a word that has had me feeling claustrophobic, backed into a corner and compromised.

How can ones potential be viewed as something so negative?  Well, try taking on a senior leadership position in the NHS.  My taking on Clinical Director has been met with two polarising responses – mass enthusiasm or sceptical surprise.  No middle ground it seems.

Trying to articulate the how and the why has been really difficult.  My response is not so negative as to reply ‘well someone had to do it and I’ve the skills and the expertise so it might as well be me.  Even if that is in fact true.  Equally I’m not bursting with enthusiasm either ‘I really want to make significant change and impact on the lives of older people’  But  there again that’s also true.

I have wrestled with all of this as I try to align my core values as a person with what I am as a Geriatrician and that of the organisation. It’s super hard!

I’ve tried to get clarity by speaking to some very wise and trusted friends and colleagues.  They’ve been great but it wasn’t until I heard this that it all fell into place:

‘Leadership is not about titles, positions or flow charts.  It’s about one life influencing another.’

John C Maxwell

The next 15mins were essentially a replaying of a conversation I had had just the other day.  It was bizarre!  I had spoke about how the expectation of change is naive and unrealistic in the short term.  What I hoped to do was influence.  Even just one facet or one persons way of thinking in order to guide pathways, policies etc.

The sermon went on to talk about perseverance.  Things take time and you should take that time to do things well and for eternity (possibly not directly applicable to the NHS but you get the idea).

Finally was this idea that perspective is important.  Lots and lots of them so you can digest and distill in order to do the right thing.

All of this is built on a foundation of values.  Being true to them means you will ultimately be true to yourself.

I had wanted this to be easy but then there’s no potential to learn, grow or even fail.

So as the service wrapped up with the inspiring words from Haggai 2:1-5 ‘Be strong, now get to work’

I thought of the other great orator, Mick Jagger ‘You can’t always get what you want but if you try sometimes, you just might find, you get what you need’

education

Letter from America

I went to my first American Geriatric Society Conference last week.  I’d been asked if I could speak about the delirium undergraduate education work to one of the specialist interest groups.  It also happened to be taking place in Orlando, specifically, Disney.

Not one to turn down the opportunity to visit the happiest place on earth I was also curious about how my colleagues across the pond approach Geriatric care.

Before going quite a few of my own colleagues asked ‘what exactly is it they do over there?  I mean, the US healthcare system is an ology one.  Do they just pick up people who fall through the cracks?’

I thought this was a little unfair. Even trying to define the role of a Geriatrician to some of our own UK ‘ologists’ is often met with blank looks.

Another question was why was I going ‘all that way for 4 days?  It’s not worth the hassle surely?’

I paused at that.  It’s true, it is a long way. I mean 9 hours on a plane with only movies, music and books to amuse you, no wifi (so no emails), free G&T and food.  Oh and some of the most gorgeous sunsets, sunrises and starry skies you’ll ever see.  Yes, it’s easy to see why some people would choose not to go.

All that aside the concept of travelling thousands of miles is not something I really consider a big deal anymore.  Since my elective in Medical School took me to Canada my view of the world has both simultaneously shrunk and expanded.  I mean how crazy is it that within the space of a day you could be on the other side of the world!

It’s not just travel that’s had this elastic band effect on my world view but social media.  It’s through this that I have had the pleasure of connecting and collaborating with so many amazing people.

This idea of connection and communication was what kept resonating as I attended the conference.

I’d been told American conferences were pretty big and this was no exception.  There was a constant hum of conversation as people moved from room to room.  It was exceptionally well organised – it even had an app! Everything was on it – downloads of abstracts, links to papers, a notes section which you could email yourself and you could even connect with other conference attendees.  Not knowing anyone I relied on good, old fashioned twitter to meet up with colleagues old and new.

The sessions were excellent too! One such presentation was on the healthcare needs of the older incarcerated population, in particular anticipatory care planning.  This is a topic that is rarely spoken about. The presentation demonstrated the gross misinformation and misunderstanding that surrounds this sensitive area.  A lot of it was in the language used and how education will be used to correct this.

It was probably why I then found myself at the session on the use of language (my favourite of the conference). The gist of it was how sometimes we can be quite flippant in our use of language. They spoke about how it’s absorption, both consciously and subconsciously, can lead to negative attitudes and behaviours towards older people.

You would imagine the people in the room would be vigilant to it right? Wrong! It wasn’t until some language was systematically broken down and dissected that we realised we can be guilty of perpetuating it too.  Not on purpose I might add but usually we’re either going so fast or not paying enough attention to realise.

‘Ceiling of care’ anyone?  How about treatment escalation plan as there should never be a ceiling of care…..

The AGS has many special interest groups reflecting the diverse, heterogenous speciality that is Geriatrics.  Happily education featured heavily – all interdisciplinary and all keen to share.

So what did I learn the most?  That we are all connected.  No matter how big the world is, or the conference, we can still find ways to come together to share common goals and aspirations.

Leadership

99 problems

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….

faith

Find the river

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…….

nhs, Uncategorized

Do you want to build a snowman?

What a mad few days!

It started on Tuesday with the warning that the ‘Beast From the East’ was coming.  Although it was predicted to only hit the east side of the UK I thought I’d best prepare.  Or at any rate buy some thermal tights.  To be fair we’ve had these kind of armageddon warnings before so no one was really that concerned ‘it’ll be a pussy cat by the time it gets to Scotland’.

However this was to be no fluffy kitten of a storm.

Waking up on Wednesday morning it became apparent that we were in for a rough day.  Waiting for the train in a snowy Queen Street Station my phone buzzed constantly. Our rota WhatsApp was rammed with messages from the trainees saying they’d either be late with some unable to make it at all.

Despite that I honestly didn’t think it was going to be anything more than a really rubbish day.  Then came the news a 1.30pm that a red weather warning was to come into effect at 3pm.  People were advised to leave immediately and public transport stopped running.

It became clear that this was going to be more than just a rubbish day.

A mass exodus ensued for all non essential staff.  WhatsApp, email and my page was going constantly.  In the midst of the chaos people were still turning up to my clinic despite having been phoned not to come.  Trying to manage the situation was, how they say, ‘challenging’

As with any crisis you get to see a wide spectrum of human behaviours.  Now I’m writing from the perspective of a doctor who also happens to be in charge of all things junior doctor related.  It’s not to downplay or ignore the work of all my other colleagues.  It’s just how I experienced it.

To say I was impressed with how our junior docs stepped up would be a gross understatement.  I was blown away.

As the hospital emptied they took the initiative to arrange a meeting for everyone who was left to sort out what was needed.  I was acting as support/go between (or gopher for want of another description) between the trainees and the remains of the management team.

There were many rumours circulating which made trying to manage the situation more tricky:

  •  ‘your insurance is invalid during a red weather warning’
  • ‘will I be made to work nightshift if I’ve been on days’
  • ‘the buses are running – no they’re not, yes they are’
  • ‘the canteen has run out of food and is closing at 3pm’
  • ‘THERE’S NO CHIPS LEFT!!!!’

We tried to get advice from the BMA only to be told the office had been temporarily evacuated due to the weather – much to the amusement of everyone at the meeting.

Whilst it seemed to be getting a little silly it seemed to only further fuel the trainees enthusaism.  I didn’t hear one word of complaint/moan/whinge.  That was until the news broke that the pub at the Premier Inn had shut. Deflating balloon would be an accurate description looking round the room – however hero of the hour Dr Dan Beckett went out into the blizzard to source some supplies.

I did manage to get through to the BMA. Rumours were clarified.  Patient care was sorted. It was all good.

As Wednesday morning arrived the reality of what we were dealing with became apparent.  The hospital huddle was reporting next to no staff had made it in.  It had the feeling of a war zone.

Still everyone pulled together.  It was phenomenal.  We had senior management out and about in 4x4s picking people up.  Serco doing everything they could to ensure patients and staff were fed and the place was clean.  Our nurses continued to deliver excellent care. That doesn’t even cover our other colleagues in pharmacy, the labs, rehab and countless others.

All the while I was bouncing around seeing thrombolysis referrals, doing a ward round and manning the texts and WhatsApp.  Adrenaline may’ve increased my average working speed to 1000mph but I did force myself to slow down as I spoke to worried relatives/carers.

So the day went on. As did the snow. It. Never. Stopped. All. Day.

We were all getting tired at this point.  The hero in my story was my Charge Nurse Nyree Philips.  Living across from the hospital she came in off her annual leave as well as providing me with chat, an ear and later in the night, gin!  All this despite my laughing at her when she face planted in the snow as we walked out of the hospital.

I spent time with colleagues I rarely see and got to know others better.  A thought that went through my head was ‘you just don’t know’  – you don’t know what people are dealing with or going through.

We also talk a lot about how we’ve lost that sense of team spirit and camaraderie with all the rota changes.  On reflection I disagree.  I don’t think it ever went away.  We just lost sight of it.  Now I’m not suggesting we should get snowed in on a regular basis but I do think we need to try harder to make time.

As the past few days has shown even when we were at our most stretched and busiest we were still able to make the time to ask ‘You alright?  Fancy a coffee/chat? That’s what’s going to stay with me after this experience.

However now that I’m finally home you will need to excuse me.  I’m off to build a snowman…..

snowmaggedon team photo
Team Snowmaggedon

 

nhs, Uncategorized

Here comes the sun

When I started writing this blog a couple of weeks ago there had just been the GMC ruling over Dr Bawa-Garba.  Not surprisingly it sent shockwaves through the medical profession.  One of the main issues was around rota gaps and trainees being stretched even further in order to cover them.

As I’ve mentioned before I am the Forth Valley medical rota lead.  Some refer to it as the ‘Poison Chalice’.  I roll my eyes whenever things like this are said in my presence.  Why?  Because it shouldn’t be so difficult or complicated to run a rota.

With that in mind I think it’s important to remind people that rotas are a fundamental necessity of the NHS.  A service that is about patients.  Or people.  People who are sick. People who are vulnerable. People who need people to take care of them.

This service can only operate if the doctors, or people if you will, are not over tired, stressed or lack the skills or support to do it safely.

This service of caring also requires processes to help facilitate the safe delivery of it.  Sometimes we refer to these processes as people too.  Behind every flow chart, piece of paper and email are people whose job is the smooth running of this mammoth organisation.

However in every high pressure service there can be obstructive, confusing behaviours or opportunists trying to push personal agendas.  I’m sure we’ve all experienced this at some points in our careers.

Now I can appreciate that people are apt to do to unusual things when they are under pressure.  I can also accept that some lack the insight or self awareness to recognise when they do.  What I can’t accept is when it appears to be wilful.  Blaming others for their mistakes, not taking responsibility or being accountable in any way.

So how does this change?

You need formal governance around any rota work. Without it there can be no consistent management, cohesive policies, guidance, processes or decision-rights to allow the safe running of the service.

The GMC have said there should be a ‘guardian of safe training’.  Now I would love if Chris Pratt came and fixed it all but this seems far fetched.  Well is it so far fetched to have processes and people that work for the service instead of against it?  A service that strives to care for people.  Well I don’t think it is.

This week I had several conversations with those instrumental in improving it.  They were long, they were at times difficult but we made progress.  I could not be more proud or impressed with the way people showed up.  I don’t just mean physically.  I mean actual showed up and had the uncomfortable conversation from a place of honesty and willingness to change.

It’s been a long, cold, winter and I think we could all use a little respite.  So as the sun begins to creep through, I think it’s going to be alright…..

nhs, Uncategorized

Shine bright like a diamond

Happy New Year!

We haven’t exactly got off to a flying start.  To be honest the NHS is usually hit pretty hard at this time but nothing like we’ve experienced this year.   However I don’t want to waste what precious time you have talking about the flu or the so called ‘NHS crisis’.  It’s well documented and I’m pretty sure most of you are still in the midst of it.

No, what I’d like to talk about are the conversations I’ve had.  While it’s felt like working in a pressure cooker at times, it is this pressure that can turn a black situation into a gem.  You just need to see its potential.

For example, talking about death.

As a Geriatrician it comes with the territory.  However if you ask hospital doctors or nurses, most of these conversations are had with people who we know are going to die.  What do I mean by that?  Those with a cancer or a progressive chronic disease like heart failure or COPD.  It’s expected and we’re comfortable in talking about it. What we’re not so good at is when the person doesn’t fall neatly into one of those categories.

How do you tell someone they may be dying  when they’re alert, not confused and want to know why they’re not getting better?

To look someone in the eyes and tell them ‘I may not be able to make you better’ when that’s what you’ve been trained to do is hard. However I have always taken the view that I don’t want the person (or their family) to be surprised. I certainly don’t want to deny what time they might have left by not being as honest as I can.

I think it would be fair to say that as doctors we tend to shy away from these kind of conversations.  There is a gradual shift in this however as people are becoming more comfortable with being uncomfortable.

Some time after I listened to a podcast with Dr Jil Bolte talking about her book ‘My Stroke of Insight’.  In it she spoke about how she lost the power of speech and understanding due to an intracerebral haemorrhage.  The part of her brain that dealt with perception of tone, intonation was still there.  What struck a chord was the way she spoke about people including doctors needing to ‘show up’  when they came to see her.  Don’t just go through the motions but really connect for the time you’re in the room.

This may sound an obvious thing to say but working in such a pressurised environment it’s something that’s easily forgotten.  Not on purpose I might add.  Its just we become very task orientated when the place is so busy. I totally understand how that may come across but do not confuse it with not caring or not doing a good job.  It’s just sometimes there is very little left to give.  You need energy to make a connection or have an uncomfortable conversation.

On that note she spoke of being accountable for the energy you bring to the room.  So with that in mind I try hard (not always successfully) to leave whatever baggage I am dealing with at the door.

It then becomes about compartmentalising. How do you teach that?  I’m not sure you can to be honest.  Stopping to reflect is key.  Even mid ward round.  I’ll often throw out questions with no expectation of an answer. It can generate some interesting discussion though.

It was during one such conversation I was reminded by one of the FY1’s that medicine is taught as black and white but life and people are colour.  You need to allow for that.

So that’s whats made this flu crisis so interesting in some respects.  People are being forced to behave in ways they don’t like or are used to. They’ve had to not only show up for the patients but also their colleagues.

One things for sure people are having to dig deeper to find that reserve.  Let’s see if 2018 will lead to something more sustainable for the future……

Leadership, Uncategorized

Everything is everything…

So I’ve been a bit quiet of late on the blog front.  My head has been rammed with all things work related specifically the medical rota.

I don’t think it’s any secret that things had not been going as well as we’d hoped. We had (and still do have) significant staff shortages. It was becoming a total nightmare trying to balance training, education and service delivery.

It all came to a head a couple months ago and what followed were some uncomfortable but honest conversations.

I took over the day to day running of it.  First up was trying to get clarity over what needed doing first. I set about distilling it into short, medium and long term goals.  That was the easy part however I had forgotten to factor in one thing:

It turns out some people do not want problems fixed.

Yes, it’s true!

This is not a new phenomena either – think about all the projects you’ve tried to get off the ground or change you’ve tried to implement and you’ll know it’s true.

Now of course the trainees wanted it fixed as did some other like minded folk but very few other people did.

To start with it confused me. Perhaps naively I hadn’t appreciated just how many people merely talk a good game.  You can usually recognise them by their passionate agreement with everything and anything followed by doing nothing.

Then you have the people who are downright obstructive either in their behaviour or use of bureaucratic process.  This makes me angry.

At the point where traditionally I say ‘stuff it, I’m off’ I chose to dig my heels in and work harder.

It has made me hugely unpopular at times and probably damaged a lot of my working relationships with colleagues.  However things could not continue on a downward spiral.

To that end I have taken a rather detached but objective view on things. There have been some overwhelmingly positive things to come out of the work so far. Some of which I truly believe have the all the hallmarks of culture change.

There are some who have really stepped up and are effecting this much needed change.  Having the trainees involved in the rota management has been key.  We meet every week to work thorough the issues. The process is still being refined but it is starting to become more slick.

One of our early success stories is the WhatsApp group to help share information and deal with urgent issues in real time.

I also send a weekly rota update to my Consultant colleagues and the wider trainee group.

There is even representation from the management team at our rota meetings.

I know there are those who continue to be unhappy about the perceived lack of progress.  There will also be those who use the rota to push their own agendas, blaming everything on it.  Some are simply furious for all their perceived loss of power and control.

Personally I can see a glimmer of light creeping in through the thorny trees of a dark wood. It is also now that I can allow myself some breathing space to pause and reflect on where we are and where we need to go next.

The path is becoming clearer. It is one where everyone is now much better equipped with information and support.

We just need to keep going, forging new paths before we ultimately reach our destination….

Leadership, nhs

Music

Up until this week I’d considered the concept of ‘team work’ to be within the context of sport. Organisations such as the NHS have also adopted it however I’d never really thought about it within the context of music.

My daughter has recently started learning the glockenspiel and plays in the school band.  She’s pretty good – yes I’m bias but she can play the Star Wars theme tune note perfect and with no sheet music. Come on, that’s good!

Anyhow I digress…. The kids have a completion coming up so having been rehearsing hard.  This particular morning the parents were treated to a performance of how they were getting on.  At the end the teacher explained to us some of the non technical skills they were learning in addition to the actual music.

I found it fascinating.

There were 5 main features:

  1. Focus – the kids were told to ignore any waving or shouting from the audience. By ignoring any distractions they were to walk to their positions looking professional. Focused on the music ahead.
  2. Tempo – each piece of music has a particular speed restriction.  Knowing it means everyone in the band adheres to it, neither going too fast or too slow.  The team goes along at the correct speed
  3. Leadership – keeping an eye on things is the band leader or the conductor.  The band members are advised to look to the conductor to ensure they are playing at the correct speed and at the right time.  The conductor themselves has the job of keeping everything harmonious and on time.
  4. Vision – is it what the composer wanted? Does it sound like what was envisaged for the piece.  The conductor can only do their job right if the various parts have the correct notes, in the correct section and aligned perfectly.
  5. Resilience – when it all goes bit pear shaped can you listen to what’s going on around you to pick it up again?

Point 5 I found the most interesting concept. It essentially spoke to me about the idea of silo working that I’m seeing at work.  What I liked about it in this context was while everyone has their own part/instrument to play, they are taught to listen to the other band members to guide them when they get lost or play a wrong note.  They don’t just give up and stop playing.  They get right back into the music and continue to contribute.

I think we need more of this in the NHS.  I do accept there are those out there trying to do this but they are still in the minority.  I have yet to fathom why.

While I was mulling this Kenny Dalgliesh came on Sunday Brunch.  Amongst the many questions asked of King Kenny (my husband tells me I’m legally required to refer to him by this name) he was asked what is was like to change from being a player to a manager?

In his very matter of fact way he explained that essentially he wasn’t part of that world anymore.  He noted that when he’d walk into dressing rooms the conversation would stop.  It was fine though.  He understood the change from playing with your mates to being the one who makes the tough decisions and enforces the rules.  Sure you can have the banter but at the end of the day the players look to their manager for guidance.

I see this in my work.  I am the big bad rota meister. I am also the one who constantly goes on about having structure and action plans. I am the one who walks into a room and the conversation stops.

However these days I have a choice of rooms to go into.  There are some that require the direction of a conductor.  And then there are those full of composers trying to create the vision.

At the end of the day the choice is clear for the NHS – we can collectively create beautiful music or continue to tolerate a big old noisy mess.  I am optimistic that the answer will be music to our ears…..