Will this year really be different? by @fionacmcqueen

Being the best we can be, and best feet forwards for a successful (and different) New Year.

Decisions, decisions, decisions………. to put on Mary Poppins (and sing along to Sister Suffragette), turn up the fire, and gorge myself on the children’s Christmas chocolate (and if they notice tell them they shouldn’t leave it around where the dog can get it…didn’t they know it was poisonous for dogs?) or to pound the pavements powerwalking and get my daily quota of moderate to vigorous exercise a la CMO guidelines?

Well, since it was Christmas I treated myself and did both. Slothfulness vs exercise? Are things in society always as mutually exclusive as we like to paint them?

Doing Vs being

Exercise Vs resting

Gandhi Vs Mead

Individual Vs society

Leadership Vs management

………………………discuss.

20:20 vision or Narnia?

The above may seem an unusual collection of reflections but it’s helpful in moving forwards my understanding of how we’ll achieve the 20:20 vision of everyone living a longer healthier life at home and having world class healthcare delivery.

How are we going to reach this quite different world?  For me the difference between where we are just now, and where we want to be, particularly with co-production, is similar to the situation of the children in the Lion the Witch and the Wardrobe.  The stark difference between the echoing empty wardrobe room, and the wonderland of Narnia that was indeed unbelievable by those who hadn’t been through the wardrobe, is where we in health are today.

• How many of us really believe that all babies will be breastfed?
• That no child will be left behind at school?
• That obesity will be a disease like scurvy; with very few health professionals ever having seen an obese patient?

Einstein’s definition of insanity echoes in my head when I look around the Scottish Healthcare System.  Doing the same things (but harder, faster, and destroying individuals in our wake) and expecting different results.  Why are we surprised when we’re constantly on the cusp of achieving targets, never quite getting there in a sustained and meaningful way; breastfeeding in deprived communities almost dying out as a cultural behaviour; alcohol and drugs being constants when we look at child protection issues, and in our A&E department; and the cost of obesity across the generations growing and growing.

So what’s the answer?  More targets? Pounding our hamster wheels faster and faster?

Well, in parts yes.

Remember when we counted porters’ overtime but hadn’t a clue how long people were waiting for treatment (and when we looked it could be two years for outpatient appointment then a further two for an operation).  So clearly targets have a part to play – but are they ambitious enough and are they the right ones?

And more importantly:

How are we going to use them as a compass in improving health and healthcare?

Ghandi Vs Mead

Gandhi argued that only when we changed ourselves, would the world then change, although he strongly believed that personal and social transformation went together.

Mead on the other had argued that the only way things changed was to have individuals making that change first; change in society was impossible without it.  Whichever view you take; you get the picture; we all need to change.  But more importantly for me, by us changing we will actually have the strength to bring about real improvements.

So who are we?  Is it in our professional work related behaviour only that we need to change? 

The next time you’re in a meeting or care delivery setting, look around.  How many of us are doing what we argue is essential for the rest of society to do so that we can reach our 20:20 vision?

In particular, how many senior decision makers and leaders are doing what we are asking the rest of society to do to reach our 20:20 vision?  (Lest we forget; volunteering, healthy weight, tobacco, routine and regular vigorous exercise, and of course alcohol).

Leadership

We need leadership like we’ve never needed leadership before in the NHS if we are really to improve people’s lives.

Understanding and explaining the power of personal leadership is probably easier than practising it; it requires deep human qualities beyond the conventional notion of authority.  Kashtan argues that skills essential for working in partnership  have been stunted by centuries of focussing on competition and individualism (look no farther than health Vs local authority, or doctors Vs nurses). 

Without an awareness of and practice in engaging with our interdependence, we are more likely to advocate for our own needs rather than take on the complex act of balancing our needs with those of others.

I believe we need to  change radically how we go about our business so that we can reach our 20:20 vision; we need to go in to uncharted territories.  How does that sit with our governance and control systems, never mind our belief systems?

World Class Health Service

Ann Sullivan, who taught Helen Keller to communicate, said that we must keep on beginning and failing.  Each time we fail we must start all over again.  Are we brave enough to take steps knowing that the destination may well be a healthier life for Scotland’s population, but not confident in how we’ll get there other than by having the courage to make mistakes?  How does that fit with the behaviour of today’s politicians and public?

So, if we’re to be there for people and provide world class healthcare, or if we’re to be there for communities who desperately want to shake the scourge of drugs from their community, we need to do things differently; but more importantly we actually need to be different.

Being the change we expect in others

Which takes me back to Mary Poppins, a toasty fire and chocolate…..or exercise?  Unless we as individuals change our behaviour that will give us longer healthier lives, how can we expect others to do the same?

@fionacmcqueen is Executive Nurse Director in NHS Ayrshire & Arran (@nhsaaa) and Chair of the Scottish Executive Nurse Directors Group.

Next week @gargatuan (Director of Primary Care and Mental Health Services in NHS Ayrshire & Arran) in his hogmany musings writes his first blog for Ayrshirehealth on robotics in healthcare.