To see oursels as others see us?

This strangely mild January in Edinburgh I have been reflecting on when I worked in a medical practice as a nurse leader, every conference I attended had something on medico legal issues. It was guaranteed to give me at least one sleepless night that week. Here we were in many ways at the leading edge of new practice and any innovation put us at risk according to the advice. I'm surprised we achieved anything new given that- but we did. We worked hard, we looked at the evidence, we consulted with those receiving the service, we planned, we did our best. Any grumbles we learned from and genuinely tried to do better. I was proud of our work, it wasn't perfect but we cared about people and improving the service and it showed. 

So when my own father experienced a poor standard of care it absolutely distressed me. I complained because I knew it could be different and wanted it to be better for others. An unplanned discharge caused him extreme pain ( not least when he fell trying to get to the toilet with metastatic bone cancer-a hasty , uninformed discharge meaning nothing had been put in place to support him even though his mobility was by then very poor) and all the family huge distress and concern. As a family we were well placed to be able to quickly turn it around but what about those who can't? Less than two weeks later he was admitted to the hospice ward which was through double doors from his original ward and culturally was a whole world apart. We were all supported and cared for and my father died peacefully without pain. It's twenty years ago and I remember every detail. That's the impact of poor care and indeed good care. After he died I wrote not only to complain but also to praise the hospice care, employees of the same hospital after all. I never had a response to the praise and my complaint was initially met with defense so I didn't let go-we finally got an apology. At that stage I had recently finished treatment for breast cancer and was at my lowest ebb but it was the final thing I could do for my Dad and I needed to complete it.

Why is this in my mind now? Because there has been much written on the power of complaints recently, the importance of apology, the value of feedback and I found myself back there again. The experience of taking  the time to write a complaint and then having it met with defense was awful. And also my mother had to cope with the aftermath, her distress about my fathers last few weeks lived on, an apology helped her to let go. It's all we wanted, a simple we are sorry ,we should have done better. We will learn from this. The reluctance to do that reduced the power of the apology when it finally came.

I know in many organisations feedback can one of the hardest things to receive as an employee, the NHS is no different. Is it a British thing? Do we squirm in our seats before we give feedback, even if its good job? How hard it must be when the only feedback you get are complaints. Yes a box of chocolates from grateful people is nice but its not feedback. You don't know what you did right, never mind what you did wrong. And how many people like me have been trained in giving feedback as the aptly termed "shit sandwich". Yes really! When all we do then is wait for the shit, the bread long forgotten as the shit lands. How genuine and person centred is that and what is the result?

If we want to get complaints and feedback right, to learn from it, to grow personally and organisationally then it has to permeate the whole culture. No blame culture will result in mature responses to feedback. 

We do have existing mechanisms to help with this; we have the patient opinion website to feedback into the system ( remember the majority of the feedback is positive through patient opinion), we have the opportunity for people powered  healthcare to help improve and  co-produce services, we have volunteers and so called patient leaders in places,  we have complaints procedures-complex as they are. But are they enough in themselves? Only if they are embraced by the whole service in my experience. We need mature systems and leaders who are self aware and responsive, who are willing to learn, to change, to be flexible, to listen. We need a system born of compassion and collaboration , not competition and judgement-responsive to people not only focused on targets.

We aren't there yet everywhere, but I see in my work people who are truly open for this, who recognise the need for change and are actively pursuing it. That gives me real hope...the next stage is to make that the norm, working with the culture rather than in spite of it. I know it's possible and the time is right...

Reasons to be heartful

My work and life gives me the opportunity to work with really inspiring people. To see their efforts despite a grinding schedule and an ever growing need to make a difference in their world. Perhaps sorry still seems to be the hardest word but maybe we can practice getting better at it together as well as celebrating the great care delivered each and every day by carers formal and informal, paid and unpaid. Next week I'm looking forward to a celebration of carers for people with dementia, hosted by Tommy Whitelaw and colleagues from the Health and Social Care Alliance Scotland. Eddie Reader is headlining and I'm hoping as Burns night approaches she might do my favourite Burns song, her beautiful version of Ae fond kiss. It's  going to be a fabulous evening I know and I suspect as a daughter of a mother with dementia, not a little emotional. But with dementia being such a prevalent and growing condition as we age as a society, I won't be alone.

 And that is important not being alone as we all tackle the health and social care needs moving forward , support will be the key to resilience for us all.


  1. Apart from his routine and usual clinical case , a doctor will come across certain “Medico legal problems at one time or the other during the practices of his profession.


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