March HPMA newsletter
It's Monday 7am, following a much needed week's holiday, and I'm on the tube checking my diary for the week and beyond, planning priorities and clearing the numerous emails that have cumulated. I'm also thinking about my team, eager to know how they are, especially given some current issues they are managing and knowing that some were attending meetings for me. This included a first attendance at Trust Board for Natalie, my Associate Director of OD, which whilst being good development can be nerve racking at first! I was pleased to read an email from an executive colleague giving her feedback and saying well done. These little things matter and are appreciated.
The delays on the Central line were an irritant and reminder that I was back to work so it was probably good that I couldn't see the grey sky to contrast with the azure blue skies and sunny climes of my last week. On a positive note the delays gave me more time to reply and put actions in place for all those emails!
The reason for the delays, I discovered, "a person on the line". How many times have we heard those words? It occurred to me that we just hear words. Have we become immune to what is involved here? Do we stop in our busy days to consider not only the person who has reached the point of taking their own life but, also the the staff at London Transport and the emergency services who respond to the call for help and deal with the incident? What support do they get? Do they have a debrief? And if so is this just an unpacking of the incident, who did what, did the staff do the right thing? etc etc.... And what about the people on the platform who witnessed such a traumatic event? Do we unpack the human dimension and offer emotional support for those involved? Or do we just expect people to be resilient? After all "it’s all in a day's work."
So arriving slightly late for the Executive Team diary meeting held in the hospital cafe I listened to colleagues sharing their week ahead. The number of meetings, both internal and external with partners, regulators and other organisations; the variety of visits, projects and areas of work we collectively cover is always astonishing. It's always heartening to hear amongst all of this there are people focused activities: one to ones with team members, induction meetings, team huddles and briefings. After all it's our people that provide the quality care to our patients and our managers that are responsible for delivering our services. If we don’t show respect for people, communicate effectively and involve and support them they can’t do their jobs to their best ability…i.e. do the best for our patients.
At that time I had not anticipated that I would have tears welling in my eyes later that day. You see I was scheduled to attend a Schwartz Centre Round meeting that afternoon. Despite lots of pressing work I decided to go as I had been attempting to get time in the diary for several months and having given my commitment to attend, along with other Board colleagues, I didn't want to renege on this. I am so glad I went.
For those of you less familiar with Schwartz Centre Rounds they are monthly facilitated forums for staff from all levels of the organisation to come together to explore, reflect and discuss the emotional impact of the work we do. They originated in the USA as the legacy of a young lawyer called Kenneth Schwartz who died of lung cancer and realised as he was cared for by many professionals that it is the small things that caregivers do that make the unbearable bearable. He recognised the importance of human connections, and the same time the toll that caregiving with compassion can take on staff. His family set up the Schwartz Center to provide training and support for staff. They were imported to the UK in 2009 and there are now over 130 Trusts and other healthcare organisations facilitating them. There is more information on our intranet and direct from The Point of Care Foundation at https://www.pointofcarefoundation.org.uk/our-work/schwartz-rounds/
We gathered to listen carefully to three nurses, of different roles and levels, talk about the ‘death of a patient in the night’ on their ward. They recounted the care they had given and what they knew of the patient, what they experienced after the sad event and the impact it had on them emotionally. We heard of the acts of care and kindness given to the patient the night before her death, care that will have brought comfort to her and, in the knowledge of this, her loved ones and to those caring for her. When they had finished telling their stories, which some of them had to fight through the tears to tell, the room fell silent. If like me, others were moved, not just by the sad story but the palpable impact it had emotionally on those involved, it was difficult to know what to say. Although, many thoughts were running through my head including…..do we just expect people to get on with this? Is this “all in a day’s work”?
The silence was finally broken by the nurse manager for the area expressing her thanks and care for the staff. The matron respectfully thanked her for her support. A simple exchange but it was authentic and human. I learnt later there was more to this which had provided the teams with the support they should expect from their manager. It was clear it had made a big difference to how they handled the situation despite it still being very emotional for them to speak about.
During the stories I heard the words “we are a team”, “I couldn’t have got through this without the support of my colleagues”, “They asked how I was”, “They cared, they listened”. Isn’t this what we would all expect after something traumatic or sad happens? A terrific ticket was awarded. Isn’t this normal – acknowledgement, compassion, empathy that we share with our colleagues and friends? Isn’t this what one expects of their direct line manager? And yet I heard other things I was saddened by. I heard people say that in the early stages after the death of the patient they were “scared they would get into trouble”, “I would be blamed” and “I didn’t tell anyone how upset I was”.
Our first response should be a human one asking, “How are you?” and offering support. A debrief, not just a clinical one but also supporting the emotional impact. Thankfully this happened on this occasion but is this the norm? Do our line managers do this automatically? I would like to think so. Are we inclusive? Do we also understand the diversity of our people and that they may react differently and need different ways of being supported? However, how often do we launch into declaring a serious incident, starting the process of investigation, asking questions, looking for reasons? Let me be clear, I am not for one moment saying this shouldn’t happen, we must investigate and be sure about what happened, what we can learn and how we can improve care if needed. What I am saying is that we must consider the human dimension first, the emotional wellbeing of our patients and of our staff. We are the people caring for people.
To enable our people to provide compassionate care to our patients we need to practice compassionate management and leadership. We are all human and have emotions and we must bring ourselves to work. People are trained to handle these situations and will be professional and put the patient first, and yet, however well they deal with the situation at the time there is still an impact on emotional well-being.
"It’s all in a day’s work” ... so if we want our people to give the best compassionate care we have to create an environment where they can do this. An environment where they know they will be listened to and where they will receive the support they need. The people they should expect this from is their direct line manager and leader. If we ask the question “How are you?”, we must listen carefully and mindfully to the answer. We must give time to the human dimension.
We are a people business… people caring for people. It’s all in a day’s work.