Day 72: Managing Emotions

Difficult day emotionally yesterday and I chose not to write about it until today having reflected.  Several things collectively got on top of me.  I managed my emotions whilst talking with others and explained to my partner that she’d not done anything wrong, I was just in a strange mood.

It’s important to talk about emotions, but what about ‘managing’ them?  As a man I feel huge pressure to supress my emotions, but how much of that is self-imposed and internal rather than external? What would happen if I cried at work? If it happens, I’ll let you all know!

Day 71: Compassionate Discomfort

Sometimes difficult decisions need to be made.  They can make us feel uncomfortable.  When we make others feel uncomfortable, it is likely they will remember what the challenge was and behave differently in future.

If we are compassionate in how we make decisions, and empathetic in situations when we know others will be uncomfortable, we can live with this discomfort and still be effective in what we are doing.

Don’t leave inappropriate behaviour unchallenged, just because it’s uncomfortable for you and/or others.  This will be remembered; do it with compassion and empathy and this will be for the right reasons!

Day 70: Service Visits

Having started working at Turning Point during a global pandemic has led to minor limitations to my induction experience.  Wherever possible ways around this have been found for me.  I have written before about some of the ‘virtual’ service visits that I have been part of, which were helpful.

I am getting excited at the prospect of being able to physically visit some of our services, to talk with staff and the people we support.  I want to be able to use all my senses to understand the challenges that our services face and the achievements they are proud of.

Day 69: Trauma Informed Care

I was listening to the CQC Podcast today on the Out of Sight Progress Report.  It was a great listen; particularly having a parent of, and an autistic person around whose experiences it centred.

It was difficult listening to their experiences, especially those of illegal segregation and isolation.  What really landed with me was the autistic person, Amanda, herself requesting that all care be ‘Trauma-informed’.

Amanda said that even if people haven’t suffered historic or recent abuse, it is traumatic having Autism in a world that is designed by and for people without autism.  More training needed in this area.

Day 68: Pace of Change

How fast you make changes/improvements should be determined by the urgency with which change is needed.  It’s important those directly involved in and affected by change are involved in agreeing the change timetable.

It’s also important any change has the right measures so that it can quickly be determined whether it is working.  If it is not, fail fast and move on to the next thing.  I like the use of a PDSAR cycle for this:

  - Plan,

  - Do,

  - Study,

  - Act,

  - Rest.

 

This last stage is valuable as change fatigue can be debilitating to improvement activities.

Day 67: What Matters To You?

All too often targets and measures of outcomes are set centrally without any engagement, consultation nor anything resembling co-production with the people that the outcomes affect.

It is critical e ask, “what matters to you?” before we make any assumptions about what we think, as professionals, is important.

It’s also important to treat patient stories and qualitative information as ‘data’.  This should not be dismissed as unscientific but should be given the value it deserves and used to drive improvement.

Central support for consistency of measurement, but locally derived standards that are meaningful to the people they affect is essential.

Day 66: Performance Vs Outcomes

Organisations use many metrics to judge how well they are operating.  I get frustrated when performance, quality and outcome measures are seen as different things.  As far as I am concerned, if something you’re measuring is not for the purpose of improving outcomes, why are you measuring it?

Efficiency and productivity measures are important, as they can help with improvement leading to release of resources and/or reduction of costs to achieve outcomes.  Outcome measures are the ultimate demonstration of quality.  However, these outcomes need to be set with the person they are the outcomes for and must matter to them!

Day 65: Predicting The Need For Support

Today I spent time working on a project;

Improving how we provide support is the object.

We aim to use information, intelligence, and data,

To predict when a service will need help sooner or later.

 

It’s important we provide help when it is needed;

If we’re too late, people’s health and wellbeing may be impeded.

To foresee services before they struggle is not an easy ask,

Our teams will develop tools up to the task.

 

This will be a new approach we will do with the help of AI;

Success will depend on human intelligence of the team and I.

 

(Today’s post is written in recognition of World Poetry Day!)

Day 64: Basic Human Needs for Engagement

We all need connection, there’s a lot of evidence that loneliness has a significant negative impact on life expectancy and has been cited to be as bad as smoking for your long-term health!

Our human need for engagement includes building relationships so that we have trust.  This causes us to feel a belonging with others, to have hope and to be able to share that hope with those we trust and who trust us.

This also leads to a sense of worth and enables us to feel competent, which in turn leads to us feeling valued and needed by others.

Day 63: Risk of Burnout

The risk of burnout is not due just to stress.  It is the accumulation of stress without adequate capacity and capability to deal with it.  Stress is not a bad thing, but if this builds up without an outlet then it can be bad for you.

I am very lucky that I enjoy physical activity and being outdoors, both of which bring great stress relief to me.  One of the challenges of isolating due to Covid is that along with being unwell I have not been able to get outside and exercise as much as I would have liked to.

Day 62: Managing Complexity

We provide care for people with needs that are extremely complex to meet.  It is important that we don’t describe these individuals as complex just because we, as a provider, may have some challenges in how we meet their needs.

This includes people with multiple diagnoses of mental illness, learning disability and/or difficulties arising from substance use.  The complexity of meeting needs is, in part, driven by how the health and social care system is set-up, with some finding coming from the NHS and some from Local Authorities.  This arises from the distinction between a ‘health’ and a ‘care’ need

Day 61: If they don’t know, how do we tell them?

This article by The Health Foundation makes for a fascinating read about the differences between public perception and belief about health inequalities versus reality. 

What I found particularly interesting, but unsurprising, is how much the public’s view of what affects their health and the power they have personally to change it differs so much from what the evidence says influences this.

To be effective in informing the public, we need to make our narrative personal and relatable to them.  We need to accommodate the range of educational, cultural, and generational differences that exist.  Much more work needs to be done.

Day 60: Testing Times

I tested positive for Covid on my Tuesday pre-work LFD Test.  I feel a terrible guilt for being ill; is this the nurse in me, middle-child syndrome, knowing there are many much worse off, or parental ‘inner voice’ telling me to just get on with it?!

I assure you I cannot just get on with it and if I tried; I would be doing a disservice to my employer and colleagues.  I also know the macrophages fighting the infection in my body send out cytokines. These cytokines can affect the parts of your brain that deal with emotions and reasoning.

Day 59: National No Smoking Day

It’s not easy quitting smoking!  It can take between eight and 30 attempts before the average smoker gives up.  We have a responsibility working in health and social care to take every opportunity to support people who smoke to quit. 

I am the Executive Sponsor of ‘Smokefree at TP’, our internal campaign to help the people we support and those who work for us to lead healthier lives through reducing and/or stopping smoking.  This is a co-ordinated set of actions aimed at providing the tools to our people to help others.

What can you do to help us be Smokefree?

Day 58: International Women’s Day #BreakTheBias

#BreakTheBias isn’t anti-men, it’s pro-women, just like #BlackLivesMatter isn’t anti-white.  With male privilege comes the responsibility to actively advocate for women.

I count myself extremely lucky to have had so many wonderful women make such an impact on my life.  These include my inspirational mother, sister, and fiancée.  

Professionally in my entire career I have only had a male line manager two years (both of whom were also good influences if you’re reading this Matt and Colin!).  I have learnt hugely from the compassion, calmness, direction, and way in which my female role models have shaped me as a person

Day 57: Responding to Feedback

Whether the feedback is about you personally, or a service you’re responsible for, it can prompt an emotional response.  Health and social care organisations have well established complaints and feedback processes to try to be objective about what may have gone wrong and what needs to be done to resolve it.

However, in doing so, it is important to remember that although organisations can minimise the emotion in an investigation and response, this remains for the complainant.  It’s important to acknowledge the feelings of the person who has taken time to provide feedback and understand this in how your respond.

Day 56: Improving Access to Psychological Therapies

We provide Talking Therapies Services called IAPT in two parts of England.  One service is a fully integrated ‘wellbeing’ service, catering for mental and physical health and wellbeing.

I learnt more today about how we provide these services, seek to improve them and the impact that pandemic has had.  This has caused people to have a greater need for support, to engage with services at a later stage and has increased the difficulty in recruiting staff.

I am still in awe every day of the wonderful jobs my colleagues are doing to serve the people we support, despite these challenges!

Day 55: Standardisation

To ensure consistent approaches to the safety of the people we support, services need to apply consistent policy and procedures in a standardised way.  This is a challenge with such a geographically spread organisation and personalising to meet local needs.

Evidence-based repeatable processes that are used consistently in a common way can still allow the provision of personalised services and care.  This allows for the use of checklists, audit, and other quality tools to be able to monitor concordance with processes and identify areas for improvement.  Standardisation of process is not the enemy of personalisation; it can be its friend.

Day 54: Grow Your Own

In discussion today about how we meet the challenges of recruiting to some of our harder to fill posts.  These include clinical roles that support the front-line delivery of our services.  With an organisation outside of the NHS it is difficult to access funding to support the training, development and backfill costs of trainees.

If we seek to ‘grow our own’ talent, then we must make a compelling offer to them as both a learner and what the employment prospective is post-qualification.  This applies to nursing, psychology, medical specialties, and other roles too.  This will help with recruitment and retention.

Day 53: Ambition

I have an ambition for Turning Point regarding Quality Improvement.  Developing a new approach to Quality Improvement is a Mountain that takes years to climb, not a hill ascended in a day.  We are in the mere foothills now, but everyone have spoken within the organisation is supportive of the journey we need to take.

Our strategic direction is to continuously improve what we do leading to better outcomes and experiences for the people we support whilst reducing health inequalities and improving wellbeing.  This is not easy; if it were everyone would be doing it and we wouldn’t be needed!