Posted by: ayrshirehealth | October 8, 2014

Who’s Needs are Being Met by @maidenturret

Truly learning from patients and families

Person centred thinkingI have been reflecting on last week’s excellent blog by @murrayawallace, which raised a number of questions for me.

How do we support clinicians to be consistently person centred?

How can we ensure that we receive and respond to feedback in the spirit of resolution and learning?

The Context of Healthcare Delivery

There are so many variables that impact on the ability of a clinician and a service to be consistently person centred. It is only in the last 10-15 years that policy, professional and patient expectations have driven a cultural shift towards person centeredness. PCHC

There is growing traction in service to engage with patients and families in a more person centred way and while paternalism persists (and is entirely appropriate at times), clinicians are responding positively to changing public/patient expectations.

The increasing demand for healthcare services, current models of service delivery, changing demographics, patient acuity and a endless number of ‘quality improvement’ initiatives imposed centrally makes it incredibly challenging to be a person centred clinician.

Many of the current processes in the health service (often one size fits all) are unable to flex to meet individual patient need and I believe an unintended consequence of the patient safety agenda is a drive for standardisation at the expense of person centeredness (and I am not knocking the huge benefits of the Scottish Patient Safety Programme). Plane under constructionIt is important that we listen to patients and clinicians as we redesign services to be more person centred and sustainable (many compare this to rebuilding a plane while it’s flying!!).

Emotional impact of care

For me the fundamental variable that can facilitate or inhibit person centred care is clinicians coping with the emotional impact of caring. What must it feel like to tell someone their dying; be ‘present’ for a patient with a list of questions in a consultation when you know there are ten patients in the waiting area; explain treatment choices with someone who is experiencing psychosis; take blood from a confused patient who is trying to hit you because their scared.

HumaniseIt is a huge privilege to be alongside patients at some of the most vulnerable and intimate times of their lives. To be truly person centred and compassionate is not without its consequences for clinicians. The evidence suggests that clinicians (human beings not deities) only have a certain capacity to empathise.

Without an adequate coping strategy there is a danger of disengagement, depersonalisation, stress and burnout all of which negatively impact on the ability of the clinician to be person centred.

ReflectionI believe that ‘reflection’ is a powerful tool that can be used as a positive emotional coping strategy for clinicians, offering time and space to re-charge the empathy batteries.

Reflection can take place using a range of informal or formal approaches and within NHS Ayrshire and Arran we are offering organisational support to encourage reflective practice with clinicians and teams.

Patients tend to place greater priority on how their experiences of healthcare made them feel (which you always remember). Individual clinicians, functional teams and managers need to constantly revisit the question ‘whose needs are being met?’ (We hugely underestimate the cognitive bias we bring to clinical and non clinical decision making) and also remind ourselves of that old Fun Boy Three Song ‘it ain’t what you do it’s the way that you do it’.

Responding to Feedback

A system that is wholly dependent on humans will make mistakes. You cannot underestimate the emotional impact of a poor experience on patients and families (this is particularly true of end of life care – where you only have one chance to get care right). Catastrophising Maintaining public confidence in a service they will have to use again is crucial. It is therefore essential that there is a compassionate response to negative feedback that offers answers to questions, an authentic apology and action that demonstrates lessons have been learned.

We can no longer add insult to injury by handling negative feedback poorly.

ImpactIt is only human nature to take negative feedback personally (this demonstrates that you care). Reflection is key to processing feedback in order to get to the point of acceptance and an opportunity for learning. I am always concerned concerned when clinicians are unable to move beyond the point of shock, anger or denial.

A person centred approach to listening

Within NHS Ayrshire and Arran we have been encouraging a more person centred response to negative feedback through early engagement with those providing negative feedback in an attempt to secure local resolution.

NHSaaaLetter writing gives no one involved any satisfaction. We need to build on this approach further, making the process less bureaucratic, more transparent, with far greater clinical (medical in particular) engagement.

I am confident that we can deliver a more person centred approach to listening and responding to feedback.

To support greater understanding we are running workshops in partnership with @murrayawallace on the 28th/29th/30th October. There are still a few places available to NHS Ayrshire and Arran staff.

Please contact andrew.moore@aapct.scot.nhs.uk or Laura.Harvey@aaaht.scot.nhs.uk for more information.

This week’s blog was by @maidenturret (Andrew Moore), Assistant Nurse Director – Person Centred Care, NHS Ayrshire & Arran

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Responses

  1. This is a good follow on from last week’s blog and a timely reminder that people who work in the NHS carry the burden of their caring responsibility seriously and sometimes heavily and need tike and a place to reflect….I am less grateful, however, for the ear worm of Fun Boy Three now rattling around in my head!

  2. Well said Andrew. I agree entirely. As the Patient Opinioin Coordinator for NHS Ayrshire and Arran, I see many situations where patients and carers have hit a brick wall and they feel there is no way forward. The feedback on the PO website has helped many of them, although not as many as we have the potential to. We still seem to have an intertia against change, which in many cases can be ‘minor changes’ but with big implications for patients. There is no doubt that if we use the feedback to develop and grow as both individuals and the organisation, we will all benefit. the real bonus will be when we can all use negative feedback in a way that does not damage staff but supports both the staff and the change. This will take some time but must surely be the ultimate aim as the benefit to pateint centred care is boundless for all.

  3. This is a very thought provoking Blog Andrew – a buffet of thoughts and reflectons on person centred care… how we can do it better and also celebrating our fabulous nurses, doctors and all our clinicians who do it very well.

    “rebuilding a plane while it’s flying” is a great way of describing the challenges with Service redesign, however a plane can refuel in the air, so a bit of building as well can be added into the mix!, Let’s keep going! 🙂

    Thank you Andrew.

  4. their dying?


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