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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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


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Learning from the users of the service…what needs to be done?

I interviewed my Mum, who is 75 and a user of her local GP services, about her thoughts re the NHS and the media frenzy and negativity that is happening right now

She is not frightened by the media reports of Staffs and the NHS generally (although she reads the Daily Mail!!) just about her local hospital…which is Stepping Hill, Stockport, which has also had tons of negative media. She worries about going into hospital and coming out dead…although the case against the specific nurse was never proven and it all seems a mystery…

When she had her hip replacement her notes went missing. She had moved house after my Dad’s death and some departments had the new address, but not all – why not?! Some appointments were therefore sent to her old address, so although the mail can be forwarded, it can take weeks.

She had a fabulous experience of the care around her hip replacement – the nurses and surgeons were fabulous, and gave her a round of applause when she left the ward to go home. The nurses were generally very good, although ‘one was stroppy’ (Mum’s words). She felt the most important characteristic of nurses is that she wanted to feel ‘special and cared for’. She felt the most important thing for her surgeon was to be technically good, with sympathy and empathy. Her surgeon treated her like a ‘person, not a number’.

She thought the environment was filthy – and impractical. The shower had nowhere head height to put shower gel etc. Hip replacement patients cannot bend…seems obvious! Behind the door in the bathroom was dirt and hair, but it was generally clean.

Her friend had a hip replacement recently and received different advice, care and follow-up.

Parking is ‘impossible’ and causes a lot of stress when she has to go for appointments.

At an audiology appointment, she was introduced to someone that she felt was a student. Mum had to prompt her what to do as she was doing it wrong.

Tips from my Mum:
1. No mixed wards – she was on a female ward and was shocked that a mixed ward was a possibility
2. Treat patients as people with families, a history, needs, values and personalities (my words)
3. Take into account the needs of the individual – like shelves in showers at the right height for a hip replacement patient, lockers on the right side for stroke patients, i.e. no citrus fruits should be offered for meals for those with arthritis as it’s contraindicated…
4. Give your patients a round of applause!
5. Have professionals who are properly trained to do the job
6. Know what is ‘best practise’ (my words) so everyone gets the same effective care and follow-up.

-Claire


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Angels, or uncaring brutes? The image of modern nursing.

It has not been a good year so far for press coverage on nursing.

The Francis report published in February highlighted scandalous stories of poor nursing care. A few celebrities have put in their two penneth and MPs like Ann Clwyd have started movements to bring back compassion to nursing.

Nursing is under pressure as never before. The changes to the health service –restructuring, cost cutting and changes in nursing itself — have often been forced upon the profession, rather than worked through and agreed with nurses themselves.

A public who admire and support you is something many of us nurses have taken for granted, but there has been a shift in some of that opinion. The number of criticisms levelled at the nursing profession has grown.

So what has been the response of the profession?

Dr Peter Carter of the RCN has said that poor care cannot be tolerated and everything should be done to ensure it doesn’t happen again. He has said that the RCN needs to learn lessons about how it supported members in Mid Staffs and has called for the regulation of Health Care Workers.

The Chief Nurse said in her bulletin in February

The report made extremely uncomfortable reading and I remain appalled that members of our profession could betray the trust placed in them by patients and their families. Compassion is a word that keeps coming up in the Francis report and it is clear we must now restore this value to its rightful place in our day-to-day work.

Jane Cummings has launched the 6 C’s

  • Care
  • Compassion
  • Competence
  • Communication
  • Courage
  • Commitment

in order to support compassion in practice. Jane Cummings does go on to say that lack of compassion and empathy is rare but for those nurses who do not have it there is no place in the NHS.

Interestingly, Unison has used the Francis report to talk about staffing levels, skill mix and sisters being on wards not in offices dealing with administration. It has also focussed on a change in culture towards openness, transparency and supporting whistleblowers.

Nursing is a profession with proud past and it is apparent that whilst there have been mavericks such as Beverley Allitt, the public remains supportive of most nurses.

To keep that trust means being open about our faults and not closing ranks, but at the same time ensuring that we do not become scapegoats when the system needs changing. Nurses tend to hate being called “angels,” get cross when nurses are always portrayed in uniform, and dislike stereotypes. But some of these have protected us from a reality which of late has become all too focussed on poor care rather than good. We need to get our image right and concentrate on what we do well rather than letting the bad outweigh so much that is good about nursing.

What do you think about the image of nursing? Is it realistic of the profession or the job that you do?

-Ali


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Rules, rules, rules.

Talking to colleagues in nurse education about the little things that make a difference was very interesting. We thought up many changes that could be made, costing little or nothing to implement, that would improve the experience of being a patient or relative.

One of these was something which has been implemented in a hospital near Manchester where patients are given a ball to hold which vibrates when they are needed. This means that they don’t have to worry about missing things they can’t hear or see. Outlining this innovation to a nurse who worked in outpatients, the first thing she said was, “Oh that couldn’t work because of infection control.

Just as business uses “health and safety” as an excuse for avoiding change and keeping things the same old way, healthcare is now using “infection control.”

Of course patient safety is the most important thing to get right, and of course no one wants to break rules and regulations if doing so risks patient safety. But that is not the same as using infection control as an excuse for not putting things right.

As a manager, I was often told to wash my hands when going into clinical areas, even when I did nothing more than go to an office and talk to a nurse. I asked why I had to wash my hands if I did not go near a patient and was going to an office to talk to someone. No one ever gave me a satisfactory answer. Infection Control rules was one answer and the other was that if I didn’t use the hand wash on the wall others would copy me.

When a consultant told Nick Clegg and David Cameron off a few years ago for not being bare below the elbows and for not following infection control practice on the ward, I understood. They were going and talking to patients. Whilst he was a little rude and shouted at them, it was a reasonable request. Their status and the TV crew present were irrelevant.

Sometimes blanket rules are unnecessary. They prevent staff from doing something sensible or from ensuring patients are comfortable and cared for.

This was brought home to me when a nurse refused to allow a very tall man to have the long bed on admission from the admission unit because the rule was that it was their bed and had to go back downstairs. Unfortunately, this meant that for three hours until another bed was found this man had to have his feet held by his son to stop them from dangling over the edge of the bed. The man was terminally ill and frankly it was an awful and uncomfortable thing to happen.

Many times it is common sense to break a rul, but we should make sure we know why we are doing it and ensure that it benefits patient care.

Are there any rules you think should be broken? Do rules and regulations help or hinder you in your role as a healthcare professional?

– Ali