Community Health Innovators

Transforming health through frontline innovators


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Start from the point of view of your patient

Someone posted a slideshare presentation on a facebook page the other day with the wonderful title, “what would Steve do?” (Steve being Steve Jobs).

It made me think about focus. When we are trying to make a change or innovate perhaps the best question is not “what do we want to do?”, but rather “what does our customer/client/patient want?”

When setting out to change things, do we really put ourselves in the shoes of those who will be affected by the change? Doing so makes a huge difference.

If you are selling a project or an idea to a commissioner, it’s far better to start with a phrase like, “patients want good signage that helps them find their way round our health centre” than “I have invented a large font signage system which I want to implement”.

Usually a story also helps.

I used to work for a charity for the deaf and blind and the changes they had made to their offices were all in order to make access better for their clients, so better signage for the deaf and voice controls for the blind. They talked to me about the way people enter a building, something I had not really considered before.  For a deaf person an intercom system on entry is unbelievably frustrating, whilst for a blind person a lot of glass is dangerous.

Perhaps as a result of learning this, I wanted to implement a better system in my healthcare building that would make more sense to people using it who are elderly and may have visual and hearing challenges. Starting from their perspective and what will help them will make far more sense to the people who have to pay for a new system. Collecting information on how many people get lost, how many end up tired and frustrated even before they have seen their healthcare practitioner may also help make my case.

Telling a story of Allan who is 81 and deaf and cannot hear when his name is called and gets increasingly upset and anxious waiting to be called to see the doctor makes far more sense than walking into a meeting with commissioners or managers and saying we need an electronic screen in the surgery.

If you have a great idea which will change services and make a difference, try to consider it from the point of view of your patient or consider the challenges facing commissioners and managers before you make a pitch for funds. Thinking something is a great idea, when it comes from a provider’s standpoint and involves an injection of cash is not the same as a great idea which is backed by patients and comes from their views of services and answers a problem which commissioners face.

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I saw a goat.

This is a guest post from Stuart Hayward was on the first cohort of Nurse First.

The other day, driving to work, there were two sets of roadworks which to a cynical mind would have appeared to have been contrived to inflict maximum mayhem and misery. One set was on a main hub into Bristol, the other was at a mini-roundabout serving commuters seeking to avoid the first set. The lack of alternative routes lead to my being stuck in traffic for an hour on a leg of my journey that can take only six minutes.

I sat there letting Radio 4 ramble in one ear and out the other, watching the growing frustration in those around me. Cars were being slewed around in aggressive three-point turns, arms were being thrown up in frustration and bonnets were dipping violently as drivers braked sharply at the last second, after having crawled forward another twenty feet.

Two things then happened to me.

Firstly, I thought to myself ‘I have a glove box full of CDs I either haven’t listed to at all recently, or are my wife’s choice.’ The one I grabbed was Adele. It was something new, out of the ordinary (for me) and took me one step away from the scene around me and the pressures of the world being described on the radio.

Secondly, as I stop-started along a bridge across the motorway I saw the allotments to my left. I often notice the allotments, holding one myself. What was different on this occasion, however, was the paddock between the allotments and the motorway.

‘Ponies!’ I thought to myself.

I then saw a solitary goat. I don’t know what type/breed/make/model or whatever, I’ve never been a goat aficionado. It had big curly horns and was white-ish and shaggy. And chewing grass.

A bit like this:

It didn’t seem to pay me as much attention as I did it. Maybe their eyesight isn’t great.

What did strike me was the fact that in all this frustration, chaos and anger, I noticed it. And I noticed that I’d noticed it. And it was good.

Natural history programmes show great herds of wildebeest migrating across the plains. There’s always an individual stood still for several seconds while the others blur past it.

Hollywood has the thoughtful protagonist standing still while all the others flow past him.

In this near-stationary traffic jam, that was me.

Crisis and woe all around, but I didn’t care. I took time out for me. I noticed the world. I was safe, warm and not going anywhere. Why worry?

The impact of this event was huge. I now have that picture as my desktop background, and now have a method to mentally put the brakes on when events threaten to careen away from me.

More importantly perhaps, my colleagues now understand why, when the work is threatening to pop, I can refocus us all with four words.

“I saw a goat.”

-Stuart Hayward, recently awarded QN, is linking nursing and military experience in his job as a Specialist Veterans Practitioner. He’s married with two energetic young sons, two quirky chickens and a neglected allotment! He occasionally tweets to @stunursefirst and is trying to improve life in his village through www.facebook.com/lockingtothefuture


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What difference could YOU make in healthcare?

Innovation in healthcare can seem really tough right now with all the ‘negativity soup’ we are swimming around in. So what type of projects are being considered and being moved forward?

  1. A project to improve the nutrition in the elderly in care homes, using ‘real foods’ instead of sip feeds…saving money, using local sources of food and creating a ‘real food’ culture ( this Nurse First project already has funding and is underway)
  2. Avoiding hospital admissions in respiratory care – again saving money but also improving the lives of the patients by treating them at home
  3. Reducing the stigma in children’s mental health – thus making sure the people who need care and treatment receive great care when they need it
  4. Preventing falls in the elderly – a huge cost to the NHS in orthopaedic surgery and long-term care
  5. Working with individuals with learning difficulties improving their sexual health, support, reducing social isolation, and improving the quality of life – with special clinics, a ‘befriending bus’ and more
  6. Creating nurse-led phone or skype follow-up for patients – reducing costs for the service and the patients – why do we have so many clinics?
  7. Creating an online system in sexual health so people can access their results much quicker, as well as getting advice, a forum and online access to healthcare professionals
  8. Reducing STI’s in young people with a ‘pub quiz’ style game to engage them and entertain them at the same time as teaching
  9. Creating videos instead of worksheets for teaching speech and language therapy to kids
  10. Working with young people in the criminal justice system who have learning difficulties

How can you implement new ideas?

What ideas do YOU have for changing the service you provide?

Can you fund any of these projects?

Join our programmes for training, input, support, ideas and more?

-Claire


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Finding success in failure

Everybody recognizes that failure plays an important role in innovation but there is a lack of structured advice about how to encourage and use failure in a practical way. Below are some thoughts about how failure can be used in a practical way:1) Remove the stigma from the word “failure” Failure has a lot of negative connotations.  Many people are uncomfortable using the word. In a recent interview, I asked applicants “what was your greatest failure?” and many replied that they did not like the word and did not associate anything they did with failure.
If I had asked “when have you ever tried anything new?”, none of them would reply “I have never tried anything new in my life”. And yet this is precisely what they are saying by saying they never failed. Nothing is ever achieved successfully on its first attempt, so any attempt to try or learn anything new will involve some failure. We need to reclaim the word and recognize its importance as a developmental step.2) Share failure stories and lessons learned By encouraging people to to share their stories of failure, the group or organization as a whole can learn much faster. If mistakes are being repeated in isolation, the learning process is much more difficult and slow. Sharing failure needs to be seen as an important contribution to the success of the group and the success of the organisation.3) Fail often and fail small Very large failures can result in the destruction of an organization (e.g. Barings Bank, NHS University, etc). Even when the organisation survives, a catastrophic failure can seriously damage an organization’s reputation (e.g. BP, Nasa, etc). By encouraging experimentation and innovation at a small scale, any failures happen quickly and at a small level so lessons can be learned before significant resources are invested.

4) Make failure survivable for the person and the organisation Linked to the previous point, the board and management team of an organisation need to make sure that failures do not destroy the organization and so this needs to be managed in a way that encourages failure but at a small enough scale so that learning can happen. Equally individuals who fail must be protected and possibly praised for their innovation. If a culture emerges that failure is met with punishment, then people will quickly learn to avoid doing anything new or innovative and this can be far more damaging to the organization as a whole.

If we can learn to reduce the stigma around failure, openly share our failure stories and learn how to fail fast and often, then we will be well on the road to creating truly innovative organizations and teams.

-Dave


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NHS – A New Charity Is Launched

This is a guest post by Sean Ledington, RNLD, currently on the Nurse First course.

I was listening to Roy Lilley at a recent Nurse First course block in Manchester and was intrigued. It got me thinking about what the NHS could look like if I had the power to change things.

The NHS is a bit like Woolworth’s in that everyone has a rose-coloured image of what they think it is but if you had been to Woolworth’s just before it closed you could see that it was not suitable for today’s type of retailing; it had failed to move with the times.  I think the same can be said of some parts the NHS: it is not suitable for the changing needs of modern Britain.

The last time I felt any real pride in anything British lately has been the Olympic Games. What made the Games great were the volunteers. It got me deliberating about what would happen if the NHS became a charity supported by a nation of volunteers.

Replace some reception staff who often can’t be bothered to even make eye contact. Replace them with volunteers who want to be there, maybe ex patients who want to put something back. What about instead of asking potential nurses to be HCAs for a year we set up a nursing volunteer scheme? It would allow potential students to get a feel for their new profession and also a chance for the NHS to assess the suitability of the person as a future nurse in a way that benefits the patient. It does not add large financial implications like the new Government HCA scheme would. Volunteers could work around their current work/study commitments like any other volunteer.

Patients being left to struggle with eating and drinking because nurses are too busy could be supported by a bank of volunteers who could give the time to support and chat with patients and make sure nutritional and hydration levels are maintained.  The 6 C’s of the Chief Nursing Officer would be instilled and the current rant about nurses needing more skills on the floor addressed (can I have my consultancy fee now, Mr Jeremy Hunt?)

There are lots of different roles both senior and at ground levels that could be undertaken by volunteers. The police now encourage all potential new recruits to spend time as a volunteer ‘Special’ why not ask potential nurses/doctors to show their commitment by spending a year as a volunteer health assistant? This would increase numbers on the ward dramatically and as an added bonus probably reduce financially expensive drop-out rates during nurse training as they would already know if they were suitable for the profession.

So that is my idea of a future NHS, a new charity with a bank of volunteers at all levels.

What do you think?

– Sean Ledington (RNLD) is currently working in the voluntary sector; a proud Nurse First student and project admin of learningdisabilitynurse.com. Find him on Facebook, connect with him on LinkedIn, or follow him on Twitter @LDNurse1.


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Why I still love being a nurse

This week Nursing has had loads of bad press, in response to the Francis Report. Despite there being 290 recommendations in his report there seems to be an unhealthy focus on how awful nurses are.

Holly’s blog explained why she did not want to be a nurse, but even after 25 years I still enjoy it – here’s why….

I work in a busy unit caring for babies and children from 3 days old to 16 years old. The sheer variety of work is great – I cannot imagine doing a job where I was in an office doing the same thing day in and day out.

I enjoy using my expertise in helping to diagnose and treat the patients, teach the parents and other staff, respond rapidly in a crisis and make sure the kids get the care they deserve.

Kids a2nd babies are good fun – they bounce back quickly, like to play, dance, laugh, listen to music and live in the moment – these are all good things to remember when life is getting us down.

The job is physical, and I like to be moving around, busy in a fast-moving environment.

It is incredibly rewarding to see a child who was sick or injured get better and be discharged. The parents are always deeply grateful for our care – and we get lots of thank you cards, chocolates (even wine!) to show their gratitude.

The job is a good match for my skills and values – every day I get to care, laugh, learn, teach and make a difference.

I like being in a team. Recently we have had some very busy shifts with lots of junior nurses on duty, and a rapidly changing workload – we all muck in and help each other out, which feels great to be a part of.

It still feels like a privilege to work with families in some of their most difficult times – sharing the journey with them, and helping them along the way.

Nursing is not all fab however, but in light of all the negative press the role is getting, it is important to highlight that many many nurses all across the UK still like their jobs, work hard and are doing the best for their patients.

Before you criticise ask yourself – would I be a nurse?


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Why I don’t want to be a nurse

Yesterday morning I heard on the radio that the government’s taking up a recommendation from the Francis Report that nurses should have to be health care assistants for a year before they can qualify as nurses.  This is supposed to teach them “compassion.”

I got myself through university working nights at a care home for people with brain injuries, and I spent two and a half years as a nursing assistant on an NHS hospital ward.  And I’ve got to say, there’s nothing magic about the job of health care assistant that can give compassion to a person who lacks it. Most people have plenty of compassion, a few don’t, and what jobs you give them doesn’t really affect that.

Anyway, compassion can be sucked out of even the most saintly person.  If you’re having a bad day, if you’re stressed, tired, too busy, distracted, or a host of other things, compassion can fly out the window.  Even if you’re not feeling like you’re being cold or heartless, your actions may be perceived that way by your patients or clients.  You may think you’re just worried about the next thing you have to do, but from their perspective, you’re not listening to them properly or caring for their needs.

I know the government want to be seen to be “doing something” in the wake of the Francis Report. They’re concerned about looking like they’ve made an effort to change things.  But I found that the least compassion was shown on short-staffed wards, and I wish they’d done more to address that, maybe encourage more people to be nurses — or health care assistants, for that matter — and more programs to keep people out of hospital in the first place by being able to treat them in the community.

It’s also important to remember, as our own Claire pointed out on BBC Radio Gloucestershire yesterday morning, that it’s already the case that no one can become a nurse without having done health care assistant work first.  Student nurses do basic tasks like washing and feeding in the placements that are a necessary part of their training.  Students work really hard — they can spend a long day on a ward, go home and write an essay, and work a part-time job just to have enough money to get by.  They aren’t just ensconced in academia for three years and then set loose in hospitals.

One reason I’m not a nurse was that I just didn’t think I was up to that huge investment of my emotions, energy and time to get through a nursing qualification.  I have a huge amount of respect for anyone who can do it.  And I don’t think we need to make that any harder by giving them an extra hoop to jump through.

-Holly