Dialogue

futurefit, healthcare, shropshire, shrewsbury and telford nhs hospital trust, Sath

As FutureFit, the much-needed programme to improve the delivery of healthcare in Shropshire, continues  towards a conclusion, I think it’s time to take stock of where we have got to so far. Much of the discussion in the press and on social media has focussed on differences between points of view. At times, the debate has become rather heated and has resulted in opinions polarised around geography or party politics.  If we are going to make any progress, I think we need to take a different track. My work on the Generation Q programme looking at dialogue offers some different possiblities. In modern society we have tended towards using adversarial debate as a way to change public services. The way this works is I state my position, people who disagree with my point of view point out all the flaws in my thinking and I then explain why they are wrong. In my experience, this intensive advocacy rarely results in  anyone changing their mind or in any new ideas.

Dialogue is different to debate. The word dialogue comes from an Ancient Greek root and can be understood as “meaning through words”, in dialogue we aim to find new meaning rather than impose a point of view. The concept of dialogue has its roots in ancient civilisations when decisions were made by a group of people sitting around a fire and talking. In the twentieth century, people such as David Bohm and Bill Isaacs resurrected the concept of dialogue as an antidote to the adversarial nature of interactions in modern journalism, business and public life. Issacs describes 4 principles of dialogue:-

Respecting

Suspending

Listening

Voicing

It is only by giving attention to all these areas that we can make any progress towards a new understanding and make the difficult decisions we need to improve healthcare in Shropshire and the whole of the UK. A key feature of dialogue is to find areas when we agree and build on these, rather than our traditional and destructive focus on differences. So perhaps if we really wish to improve healthcare in Shropshire we should develop a list of things we agree on and develop them. Here are my first thoughts, let me know what you thing.

 

I propose that we agree that:-

People  in Shropshire deserve the same quality of healthcare as people in London.

We need to change the way healthcare is delivered in Shropshire.

General practice in Shropshire (and the UK)  is struggling to recruit doctors and keep up with the workload.

(So are some of our hospital services .)

People should only go to hospital if that’s is the only way to deliver the care they need.

Healthcare  in the U.K. is underfunded compared to other Western nations.

The current means of allocation of healthcare care cash favours cities over rural counties like Shropshire.

Consolidating some of our hospital services on one site will improve  quality.

We cannot afford to wait too long before we make some changes.

 

I am sure there’s more we can agree on , or maybe not! Let me know!

I hope we can use the forthcoming public consultation on FutureFit to develop this ideas further, rather than resorting to name-calling and narrow-minded parochialism.

 

 

 

 

 

 

Leading with kindness

The health system in the UK is currently running red-hot. Money is tight, there are significant pressures on the system and morale is low. Against this background, I feel that it is timely that our forthcoming annual leadership conference at Shrewsbury and Telford NHS Hospital Trust is themed around “leading with kindness”.

At first sight, leading with kindness may seem a little trite. It would easy to think about this simply on the level of being nice to people at work. I feel that this rather misses the point and that there is a much deeper level to leading with kindness.

So why is leading with kindness important?
Like many acute providers in the NHS, we struggle to recruit and retain people into some key posts. In order to provide a safe level of staffing we are often forced to use expensive agency and locus staff. Treating people well and developing a reputation for doing so across the region may help some of our recruitment issues. Michael West’s work has shown that there is a very clear relationship between levels of staff engagement in an organisation and clinical outcomes. Conversely, staff burnout is associated with poor patient experience and outcomes.  This means that treating people well in the workplace is important for business and patient safety reasons. As Richard Branson said “Train your staff well so they can leave. Treat them well so they don’t want to.”



Creating a culture of kindness.

Self Care

If we are to become a kind and caring organisation, there can be only one culture. We cannot force people to be kind, this simply wouldn’t work. To me leading with kindness starts with how we look after ourselves. Healthcare has a culture of long hours and presenteeism which is not always healthy and can lead to burnout. We somehow need to stop this by setting reasonable deadlines, not taking on too much in at one time and by committing to self-care. There are political and financial pressures with the health system in the UK at the moment, as leaders we need to try not to pass all the pressure on to others in the work place. We need to be more self-aware and develop skills our skills or emotional intelligence to monitor our impact on others. We need to ensure that we spend quality time away from the workplace to recharge and regroup. We need to keep connected to friends and family away from work.

Caring for others

If we purport to be a kind and caring organisation, there can be only one culture. We need to be kind to our staff so they can be kind to our patients. We cannot order people to be kind. We need to role model kindness. We need to recognise that burnout and compassion fatigue are real problems in the caring professions. We need to take time to truly listen to others in the workplace and at least try to see the situation from their perspective.

Better organisation of work

We need to organise the work so that is possible to be done well in the time available. Some areas in acute hospitals are particularly pressured – A&E and the assessment units in particular. We need to think how we can support staff better in these areas. Do we need to review staffing levels, shift patterns and rotas in these areas? Is it kind to expect everyone to work 12 hours shifts? As Deming said; “A bad system will always beat a good person”. I feel that we have a real opportunity to use our link with the Virginia Mason Institute to create better ways of working. I like it that one of the key principles of Lean is respect for people, which incidentally is one of our values.

2015-10-22-20-41-32

Focus on staff and patient experience

If we are going to be the kindest organisation in the NHS, we will need to shift some resources which are currently focussed on measuring and managing activity to refocus on measuring and managing staff and patient experience. Yes, you can measure kindness! Other organisations such as Northumbria Healthcare Foundation Trust and Wrightington, Wigan and Leigh NHS Foundation Trust  have shown significant improvement by listening to patients and staff. Where there are problems, we need to correct them. This includes dealing with behaviour in the workplace, it is not kind to other staff or patients to allow them to be subjected to bullying or rudeness.  Conversely, where there is good practice we should celebrate this and spread this to other areas of our system. Sometimes we at so focussed on the negatives that we fail to see that right under our eyes, hundreds of people are having great care in our hospitals everyday


Our Leadership Conference is on Friday 11th November 2016 in the Shropshire Education Centre . I will be running a workshop on “Developing Dialogue”. I hope to see some of you there.