Wednesday, 14 August 2013

Our greatest asset

The news that Whipps Cross has fared poorly in a recent CQC assessment triggers some consideration of how many other Trusts across the country are struggling in a similar vein. (http://www.theguardian.com/society/2013/aug/14/whipps-cross-hospital-systematic-failings)

Some friends of mine have worked at the hospital, and their stories about working there have often been notable by the amount of graft that they have to put in. It seems like a busy place to work. 'Busy' in medical speak can be something of a euphemism. It encapsulates a lot of implied truths. That the numbers of patients are high, that staffing levels can seem insufficient, that the types of patient they deal with are often very sick. There is no precise definition, but there is the suggestion that a 'busy' job is one in which it can be difficult to provide the level of care that you would like to. Working in a busy job can seem like it is a job that asks a lot of you as a person, physically, intellectually, and emotionally. It is draining. It is disheartening. It is unsustainable.

It has been a feature of our assessment of the NHS in the wake of the Francis report to be shocked at some of the stories that have come out. But how shocked are the doctors and nurses who work in the system when they read about the failings at another hospital. Nothing takes away from the disappointment of hearing that patients across the country are failing to be offered the kind of care that all patients deserve. Nothing excuses it. But how many clinical staff read the stories and wonder how different their own wards or services how. How many of them think, "There but for the grace of God go I."

We live in a world where basic human compassion should be the fundamental principle underpinning our health services, and it is on top of this absolute requirement that all other quality measures should be built. There is no reason why the care we offer patients should not be compassionate, high quality and timely.

Except there are lots of reasons why it isn't.

Chief among these, perhaps, is the failure to understand that the delivery of healthcare is entirely about people. Not just the people it serves, but also the people it employs. Compassion is delivered by people who are able to feel compassion. It cannot be rushed, it cannot be contracted out, and it cannot be put on a protocol.

Compassionate care is the inevitable result of staff who are supported to perform at their best; by managers who understand the strain they are under, who take the time to understand the strain they are under, and help them manage it. Compassionate care is given by staff who feel that they have the time to do their jobs properly, who have the training to learn how to manage the demands of their jobs, and for whom managing their own personal responses to their job becomes part of their routine.

Being expert at a job, particularly in healthcare is not just about technical excellence, it is also about learning to deal with the personal demands that the role makes of you. This does not happen by chance. With time, your experience guides you through, but before that time, it is about having the right kind of mentoring, the right kind of instruction, and the support to do it. It is about open communication, constructive feedback, and having dedicated time.

Highly functioning teams do this informally. But highly functioning teams do not occur often by chance. They need to be honed, tended and grown.

The stories about the care at Whipps Cross from the media coverage are alarming. They are disappointing, and they are sometimes shocking. But what strikes me through all of them, is that they are the result of a hospital running at full steam, and running out of drive. They are the result of staff members and teams who, under the constant and unrelenting strain to deliver, have unravelled.

There is no place for unkindness in our health system. But ask yourself whether the individuals who have been seen to be giving unacceptable care have always been like that, or whether they need always be like that.


In the urgency for quick solutions, one wonders how well the systemic issues that are affecting hospitals like Whipps Cross will be dealt with. But certainly part of that solution needs to involve a conversation with the staff not just about their responsibilities to patients, but the organisations responsibilities to them.

Ask the team leaders what they need, and how they can be helped, and slowly watch the culture shift. Support underperforming individuals to achieve more. Let people be fragile or scared or stressed, and help them manage the challenges. Then watch them blossom.

Is it fanciful to argue that the main asset the health service has is its staff, and that if we fail to look after them properly, we will be underselling how much good the NHS can do for its patients?

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