Sunday, 21 February 2016

Niceness in a time of crisis

Is it me, or is there a bit of meanness percolating around the world of healthcare?

Where has your mind taken you to with that sentence? The imposition of the new junior doctor contract, all that talk of healthcare privatisation, the state of NHS finances? All would be suitable examples, but let's think more locally.

Whether you are a user or provider of healthcare, have you noticed rushed, harassed or over-worked professionals wandering around?

I have. Everywhere I go, I see colleagues grinding away at a daily slog of providing good services, and doing their best to make sure that their patients get the care they need. Talking to them, it's not the fact that they are busy that bothers them - it's the feeling that they are swimming against the tide. The feeling that they are being asked and expected to do ever more, with ever less.


Every service I know talks of vacancies: GPs can't replace retiring colleagues; nursing vacancies are high, and junior doctors seem to be wandering off to places where people are nice to them. The remaining staff have to work longer and more often to make up the short fall, yet the message they keep hearing is that we have to do more with less. I bet they go home and wonder how long it will be until they too are broken or simply cannot find the motivation to keep grinding on. It's like a professional depression: you keep going, you keep grinding, pretending that it will get better by itself, until one day you can't get out of bed, get dressed or even stand up.

I worry all the time about my colleagues; I wonder how I can protect them and myself from this funk we're stuck in. Speaking to a management colleague I was disappointed at how unsurprised I was at what she told me: during her hospital's recent rather profound bed crisis, her boss required her to check in every hour to tell her what she had done to find more beds for patients waiting to be admitted. Sounds reasonable? Perhaps, until you learn that these hourly check-ins amounted to little more than a bit of a dressing-down for not doing more to solve the systemic crisis that was none of her doing in the first place.

It doesn't sound like her boss took much time to thank her for her efforts, or remind her how grateful the hospital was for her efforts, or even to empathise about what a difficult time they were experiencing.

And this for me is the rub: every where you look, you will find health and social care professionals working flat out for the benefit of the people they serve. They are driven by compassion and dedication to their jobs. Yet within the workforce, the message they keep hearing is that they must try harder, be better, be more efficient, that they are not doing a good enough job. It simply doesn't ring true. They are working hard, all the time. They go home knackered, they return to work still knackered, and they put in the extra hours to try to get everything sorted. But the same message keeps being repeated: more, better, faster - all the time.

In the midst of this culture, we have forgotten that the starting point for compassionate care is to show compassion to each other. The pugilistic attitude from the top pervades its way throughout the organisation, and becomes normal. We forget to be nice to each other, and succeed in only being a bit mean to each other. It's crazy.

Yet, it needn't be like this, and in lots of places it isn't. I was reminded of how good it feels to work with compassionate colleagues this week. Sometimes, the care we offer patients falls short of our own expectations, and this week, we have been dealing with one such episode.

This week was the culmination of our internal review, in which we presented our findings to our medical director and nursing director, and I was gratified at how useful the experience was. It was allowed to be useful, because we treated it as the opportunity to learn as a team what went wrong, rather than blame particular individuals. Throughout the process, I noticed colleagues being very mindful of their colleagues emotional well-being, and allowing people to learn usefully without feeling like they were exposing themselves to excess blame. As a team, we were prepared to be open, and our senior managers allowed us to be. This allowed us to be open with the family, with whom we have spent time talking things through.

In dealing with this learning process, I have experienced from colleagues sympathy, empathy and support that I didn't even know I needed. I came out of a review of our care failings feeling that I had been part of a team learning exercise that emphasised the compassion of my teams not just to our patients, but also to each other. This week, instead of wondering where the strength to continue comes from, I know that it comes from colleagues like mine.

I have no idea what is going to happen to the NHS over the next few years, and I am still worried about it. The one thing I do know, though, is that I work with the kind of people, in the kind of organisation that you want to face a time of uncertainty with.

So perhaps, individually, we all need to take a leap of faith: be nice to the person next to you, and perhaps they will pay it forward. And who knows, in time, perhaps there will be a cultural reset, and niceness will percolate in the way that meanness currently does. 

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