Posted by: ayrshirehealth | May 15, 2013

Daffodils in full bloom by @rosgray

Daffodils in full bloom

April 1987, the daffodils were in full bloom as I drove to the hospital, much further ahead than we had this year and as I write this.Daffodil 1

It’s hard to believe that it was 26 years ago about now that I walked into a busy medical ward and saw Veronica a 60-year-old woman in the last stages of her battle with with lung cancer, sitting in a chair barely conscious.

I called the nurse and asked if Veronica could be put back to bed and given some analgesia to make her comfortable.

The nurse said that wouldn’t be possible because Veronica’s chart was in the pharmacy department.

To cut a long story short, I went to the pharmacy department and retrieved the chart. The nurse, after much huffing and puffing gave Veronica her Diamorphine. She was put back to bed and I sat with her, holding her hand to comfort her until she dozed.

Did that need said?

After about an hour Veronica passed away very painlessly and with great dignity. I went to inform that nurse whose immediate response was ‘ …that’ll be the Diamorphine”.

Of course she was probably right, but did that need saying? And was this a ward that was designed to deliver safe, effective, and person centred care? Was there a culture that anticipated the needs of the patients and their families and wanted to deliver care in a way that would make both the patients and the staff feel good? Or was this a ward with systems designed to deliver the exact opposite?

SPSPI often wonder if I could only do one thing, what would I do to improve patient safety and drive quality improvement. Without doubt it would be to build a safety culture, done in a considered way so that as a matter of routine and certainly in an emergency situation when safe systems are absolutely paramount a well practised scenario unfolds, where staff are confident that everyone is doing the right thing and preventable harm to patients is avoided and a positive experienced is had by all.

We all know the safe system of care we would like to see if it was ourselves or family members on the receiving end. Wouldn’t it be great if everyone treated their patients exactly as they would want that family member’s care delivered?

Our way or the highway

One world renowned health care system in the USA reportedly has a saying which sums up their safe systems ‘it’s our way or the highway’  Our way or highwaymeaning that behaviour out with those safe systems is not tolerated.

So how do we get to that point?

Are you fortunate enough to work in a system that actively learns when things don’t absolutely go to plan? Do you know what the plan is? Are there many different plans depending on who is in charge? Would you even know if things hadn’t gone to plan? You will know from your own answers if you’re working in an organisation that has, or is developing a truly safe system that delivers optimal care to patients 24 hours a day seven days a week.

Or are you in a system where people have to work smarter and harder to remember how things are meant to happen in every eventuality?

And to do that in every situation, and especially in emergency or urgent care where self generated adrenaline can eliminate the power of rational thought?

Which system do our patients and staff deserve?

And what are we going to do to make that happen? A place where everyone knows… ‘This is how we do things around here’.

One way to grab everyone’s attention is when there is a burning platform from which everyone is keen to jump – something terrible has happened or there was a spotlight on an issue that exposes less than optimal care delivery. This is an uncomfortable and painful place but does tend to focus the mind across the board.

A nicer place is to have a compelling vision of how things could be; what if we could work in an environment where there was no avoidable harm to patients?

All care we delivered was effective and efficient and both our patients and staff had a great experience? How would we work together as a team to deliver that vision?

Looking around the world at the great work on patient safety and person centred care, perhaps we can use an improvement approach in this context to spell out exactly what it is we want to achieve, how we will know that our change is an improvement and the changes we can we make that will result in improvement for our patients and staff?

That very special time I spent with Veronica all those years ago probably influenced my career choices to try to make things better for our patients in this way.

Daffodil 2It is an immense privilege to play a part in our patients lives (and deaths) and the impact we have on them and their families when they are at their most vulnerable can be profound and last a lifetime for them. For us it may be just another day.

The words of that nurse have certainly lived with me. Veronica was my mum.

 “….And then my heart with pleasure fills, and dances with the daffodils”

        William Wordsworth

@rosgray was previous the lead for the Scottish Patient Safety Programme and now works with the Scottish Government on the Early Years Collaborative.



  1. What a beautifully written piece. Brought tears to my eyes at the end. I was in a similar situation 2 months ago when my mother was crtitcally ill. Against all the odds and with the exceptional care of ICU staff, my mum survived. My family is eternally grateful. It is unfortunate that there are so many variations in the standard of care delivered within the NHS. Sadly, it now seems to be accepted that ALL staff are delivering poor care. The quality of care my family received was first class. The care was for the family, not just for mum. I too wish that resources were available to enable NHS staff to deliver high quality care EVERY day to EVERY patient ALL of the time. By resources, I dont just mean money and time. There has to be a willingness to achieve.

  2. I’m sure this is a lack of knowledge on my part, but why did Veronica need to be transferred back to bed, and why did she require analgesia if she was ‘barely conscious’?

    • It rather seems that your comment missed the point of compassionate care that was the key message of the blog and simply focuses on technical care. Perhaps rather similar to the nurse who made a technical comment (about meds) without considering what the person really needed.

  3. Excellent brought a tear to my eye reminds me of a poem written by a dementia patient ,she was telling the nurses in the poem that she had a life was a mother a wife had a job a fasanating life etc so to see her as a person.

  4. Excellent.. brought a tear to my eye. Really makes you think. patients should all be treated the way you would want your own family to be treated

  5. […] Daffodils in full bloom by Ros Gray […]

  6. […] related blogs and this week is no different. We have a real personal blog by Ros Gray called Daffodils in full bloom , which was posted on the Ayrshire Health Blog. In this blog, Ros looks beyond the technical care of […]

  7. […] Safety Programme and now works with the Scottish Government on the Early Years Collaborative) in Daffodils in full bloom. Ros is the second of two bloggers this month that reflects on their personal experience of […]

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