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Compassion in Healthcare at Torbay Hospital
Last month Mum mentioned she’d seen a talk advertised in the library, it was being held at our local hospital and was being given by Sarah Tobin. It was on a Monday evening, a day I worked at home, Mum was curious and thought it might be of interest to me from a work perspective. So we agreed we’d go and I did a quick google to find some info and came across this. The event was the first attempt at a Health Science Cafe event being held at the hospital and most importantly they’d be free parking, a small but important manner. If you were to play a word association game with anyone who has had anything more than casual use of the health service I’m confident it wouldn’t take long before they mentioned parking – finding a space only being half the battle. Anyhow, I digress, this was an early evening event with free parking and Sarah Tobin, what was not to like.
Who is this Sarah I hear you ask? Sarah was one of the many professionals who provided support for my Dad, and all of his family, when he was first diagnosed and through his treatment for bile duct cancer. Specialist nurses are worth their wait in gold, they have intricate knowledge of what you are facing, have always made themselves readily available, always *always* return your phonecall if you have to make one, have the ability to unlock doors and generally give a sense of confidence in a quite daunting experience. I guess you could think of them as nursing sherpas who guide you through it all….we were lucky to have the support of several different ones and they all helped enormously.
Last Monday we arrived at Torbay Hospital, parked up and I checked in on Foursquare and was delighted to see I’d not been to the hospital in nearly six months. Dad died last November and until then I think I had visited at least every four months and in the latter stages of his life far more frequently, with a large number of visits as an emergency admission. The last time I’d been at the hospital was to drop Mum up to deliver thank you tins of chocolates to the staff who had cared for Dad. I still wasn’t really sure what to expect but off we went.
We were greeted by Helen, the Trust librarian who came up with the idea of the Health Science Cafe at Torbay. She had mentioned in the press release linked above that she felt it was important for people to have the chance to visit the hospital site for occasions other than just to meet medical need. One of my take home thoughts from the evening was how good it had been for me to return to the hospital that has played such a significant role in our lives over the last five years, with a positive reason. To drive up without the nagging doubts, the butterflies, the anxiety, the stress. To be honest it felt a little odd, after we’d parked up I had to remind myself that there was nothing to worry about!
The talk was very informal, there were about ten of us there although I think most people were previously associated with the hospital in some formal way. Sarah introduced herself, she now works 0.5 as a specialist nurse and 0.5 in teaching and education. She told us a little of her own personal experience, and indeed what fuels her interest in this area, and about her masters that focused on whether you can teach compassion and her current PhD studies in the same area.
She went on to talk about a number of key approaches adopted within SDHT (South Devon Healthcare Trust) to support work on compassion. These included:
Patient storytelling – this was introduced as a benefit to patients, where they are given the opportunity to share their experience. Their experience is tape recorded, transcribed and then shared with teams in a facilitated discussion designed to identify future improvements.
Observations in care – after a day long training session people are given 2o minutes to observe a ward/healthcare experience. Observers work in pairs, they note down what they see, hear and smell, purely as objective observations with no reasoning or judgement attached to them. They compare and contrast their notes after 20 mins and feed back to the staff members they have observed.
Schwartz rounds – this approach developed in the US at The Schwartz Centre and piloted in the UK by the Kings Fund provide a monthly, one-hour session for hospital staff to discuss difficult emotional and social issues arising from patient care.
Other approaches discussed included the development of a Leadership Programme for nurse leaders and ward managers, the introduction of the Friends and Family test, and Jeremy Hunt’s new requirement that nurses work for a year as healthcare assistants before training. The discussion was wider than just the steps taken to increase compassion, we also discussed the issue of complaints (90% focus on communication in some way), the changing shape of training over the years to include a greater focus on communication skills, the balance of positive to negative feedback (3:1), pride in nursing, how to gather feedback to get a hospital wide picture, the number of patients in hospital and their reasons for being there (80% of the surgery carried out at Torbay is now done as day surgery – this leads to changing methods of patient care, changing demographic of inpatients and so on).
Media Impact Mention was also made of the media and the negative expectations that many people have of hospital care, before experiencing it for themselves or those they care for. Initial analysis of the Friends and Family test feedback at Torbay commonly reports ‘it was loads better than I was expecting’. The local paper had been invited to advertise the Health Science Cafe and run a story on it, they had declined the opportunity. I can’t help but feel bad news sells more newspapers than good! Maybe they’ll get behind the later events, perhaps even send a reporter along to share with a wider audience.
Our discussion of the impact of the media also extended as far as two fly on the wall documentaries currently showing on TV, 24 Hours in A&E filmed at King’s College Hospital now in it’s third series, and Keeping Britain Alive: the NHS in a day filmed across the NHS on Thursday 18 October. I have a real interest in these documentaries, part morbid fascination with something new, part as an example of human behaviour and within that the compassion captured, part also as a reminder of how lucky we are to have a national health service.
While I imagine only certain people are interested in these programmes (best viewing figures for an episode of 24hours in A&E just top 3million people, Eastenders and Coronation Street routinely get double or three times that), that is still a large pool of people who do appear interested in this user generated content. One Born Every Minute, another Channel 4 documentary series now in it’s fourth series is set in an NHS Maternity Ward and clocks viewing figures of almost 5million; it’s not clear what exactly it is that people are interested in but I’d hazard a guess that it is part real-life stories that could as easily feature us and our family members as players that attracts them. Thinking about the three approaches Sarah had discussed one of the common features of them is reflected in this documentary approach, they all give a real-life focus and focus on the experience (of patients or staff) and allow for reflection on that experience as a prompt to identifying learning points, or building resilience, and also in humanising people.
This blog post was designed to share the experience a little more widely, partly because I was left with quite a few ideas and questions I’d like to think of further, so your own thoughts and experiences are very welcome. A lot of my thoughts were about how it’s possible to create a common team/organisation wide focus that focuses on an individual’s experience of compassion; how you define, or develop a shared definition of compassion; how you keep learning and reflections alive and tangible; whether there is enough focus on positive feedback as well as negative; how important and value laden compassion is – perspective being key; whether certain environmental circumstances are likely to reduce, or increase, compassion; and whether greater focus on staff members’s as individual’s could create behaviours among patients that increase their own chance of being treated compassionately (and vice versa)! What do you think?
GMC Consultation – Good Medical Practice 2012
This weekend I did my good turn for humanity by responding to the General Medical Council Consultation on Good Medical Practice. This draft guidance encourages debate about what good medical practice should look like in the future. This post isn’t likely to be of interest to many of you, but if you are interested (and can make your way through the appalling formatting – apologies) then please feel free to see my responses that I submitted – and better still discuss/debate/disagree with me – I do love a good online debate! Thanks.
Section 1: Continuity of Care
Q: How important is continuity of care? (Options: Very — quite — fairly — slightly — not)
A: The single most influencing factor in my experience of the NHS has been continuity of care – I reference this as influencing because it has had significant positive and negative impact. When continuity of care is well established, professionals talk to (and respect) each other, work well in collaboration and are able to easily pass information between those involved with providing care – this makes for a top notch customer/patient experience.
Q: Do you agree that doctors should take action whenever they see poor care?
A: I think all staff, and patients, should take responsibility for taking action when they notice poor care.
Section 2: advising patients on their lifestyle
Q: Do you agree doctors should give patients advice about their lifestyle choices?
A: If we expect doctors to treat patients holistically, and if as a patient I complain when a doctor does not consider me as an individual, then I’d fully expect a doctor to advise me on my lifestyle choices.
Q: Would you be happy for your doctor to advise you in this way?
A: Yes
Section 3: Supporting and encouraging research
Q: Should doctors encourage patients to take part in a research study that is relevant to their condition?
A: I think doctors should provide information, inform patients of the benefits or risks of taking part, and support patients to make their own decision.
Section 4: Doctors’ personal beliefs
Q: Doctors must tell patients of their right to see another doctor if they object to providing treatment themselves. Do you think that’s fair?
A: Yes
Section 5: Openness
Q: Doctors must be open and honest with patients if things go wrong. Doctors have a duty to: 1) put things right if they can 2) offer an apology and 3) explain what has happened and its effects on the patient’s health. We say doctors must do this when patients have suffered harm or distress. Should doctors always follow this guidance when something goes wrong?
A: Doctors invariably know more than their patients, they usually hold the power (and responsibility) in the doctor-patient relationship and therefore it would seem essential that they follow this guidance. I would also expect that patients would follow it to and would be comfortable with a doctor-patient agreement that both signed up to.
Section 6: Doctors treating themselves and those close to them
Q: Do you agree that doctors should, wherever possible, avoid treating themselves?
A: Yes
Q: Do you agree that doctors should, wherever possible, avoid treating their close family members or others close to them?
A: Yes
Q: Do you agree that doctors should be registered with a GP who is not a member of their family?
A: Yes
Section 7: Vulnerable Adults
Q: Do you think that doctors should tell the police or social services, even if the patient doesn’t want them to?
Section 8: Maintaining trust
Q: Patients must be able to trust their doctors. So we think that doctors should not do things that could undermine a patient’s trust in them as a doctor, or society’s trust in the medical profession, even in their lives outside their medical practice.
A: I completely agree, however I think this is quite a value laden judgement. I suspect I have a very different view to my parents, for example, about what would undermine my trust, and about what I consider to be professionalism.
Section 9: General
Q: Anything else you want to say….
A: I’m sure that it would be considered implicit in the other sections but as a patient, not a professional, I’d like to see something explicit about communication and an acknowledgement of the patient’s role within the doctor-patient relationship.
So what do you think?
#Dilnot Commission – funding care and support
Almost a year ago the Government set up the Dilnot Commission to look at the future funding of care and support in England. Chaired by Andrew Dilnot, with the support of two commissioners Jo Williams and Norman Warner, the Commission is charged with making recommendations on how to achieve an affordable and sustainable funding system/s for care and support for all adults in England, at home and in other settings. Andrew explains it in the 60 second video below:
What is care and support?
Care and support is usually referred to as social care. It is enabling support, it helps people to be independent, active and healthy throughout their lives. It is the support required to enable people to do day-to-day things such as live at home, work, cook, shop, care for their family, engage with their friends, family and community, and essentially lead a fulfilling and independent life for as long as possible.
This support is provided by a range of services, including support to live independently, benefits for disabled people, practical support such as meals on wheels, day centres and care homes, home adaptations and adjustments and other housing support. Services are also available to provide support for carers.
Who needs care and support, who provides it and who funds it currently?
All of us, at some stage in our lives, are likely to require care and support. Most people who currently use care and support services are people who are disabled, who have a long term health condition or illness, people who have had an accident or injury, and older people.
Care and support is provided by local authorities who pay for (commission) or provide support services, funded by general and local taxes. These services are means and needs tested. People who are not eligible for support from local authorities, pay and provide for support themselves or with the help of their families. Voluntary and community organisations provide some support, as do private companies. Support is also provided by family and friends, there are 5.2million carers in England and Wales, you can read a post about one of them here.
Care and support is funded in three ways: people pay for some or all the charges for the support they receive; families provide support or pay towards its cost; you and I, everyone in society, pays through local and general taxes.
So what are the commission doing and why?
The Commission are looking at future options for funding care and support. They are using five criteria to assess options: sustainability and resilience; fairness; choice; value for money; and ease of use and understanding.
They need to do this because the current system is not sustainable. We are living longer than before and we are living healthier lives – this means that we need more care and support than we have done in the past. This is a good news story and it requires a positive response. The other reason is that our expectations have changed, people expect and want more choice and control, and care and support needs to change to meet this expectation.
What do we know so far?
The Commission launched a call for evidence at the end of last year to gather ideas about what future options could look like. You can read the summary of the 250 responses they received in the summary document on their website here. They also commissioned TNS-BRMB to carry out qualitative research to gather the views of the general public, a summary of their results can be found here. The final report and recommendations will be published on 4 July.
What we absolutely do know is that change needs to happen. I also think we can safely assume that this is going to get swallowed up into a political issue, see the report in today’s Observer, and @rich_w‘s blog post commentary “Our politicians have a moral imperative to ensure the future of social care funding is known, sustainable and fair“.
I agree wholeheartedly with Rich, at least I think our politicians *should* have a moral imperative, that said I’m not sure they do, and I think that is the bigger problem here. I believe that social care has an identity crisis, and if not an identity crisis certainly an image problem, consequently it is not high enough on the agenda of the general public or their politicians. The vast majority of people don’t recognise themselves as health or social care users, they are just people, who need some support. Until social care gets itself to a point where it can define clearly what it is, how it helps, and openly discuss its limitations (whether financial or otherwise) we’re in trouble.
I am looking forward to reading Dilnot’s report, and I’ve enjoyed the twitter discussions so far. I feel though that we need to continue to widen this conversation to ensure we really make a long term difference…and force our politicians to face up to their responsibilities.
