As health and social care professionals we are in an especially privileged position often spending time with people at some of the most momentous or traumatic times in their lives. A new life entering the world; facing up to serious illness; recovering from an injury or perhaps the loss of a cherished parent? These are the most memorable, meaningful and often challenging times in people’s lives and in our daily work we have the opportunity to support people, to encourage them and walk alongside them.
Yet all too often in the hustle and bustle of a busy day we forget about this unique privilege – the honour of being a visitor in someone’s life story. Not taking the time to find out what really matters to them; a hasty response or a word spoken a little more harshly than it should have been. These lapses pass quickly form our memory in the bustle of the day, but what about the person? Do they forget so readily? The daughter seeking information about her Mum at a time of crisis? The young Dad (or Dad to be) that just wants to be as close as he can to the most precious things in his life? Do they forget so readily? A careless response by us becomes an experience, even a trauma, carried by that person for the rest of their life.
The spirit is willing but the flesh is weak
So, how do we make sure that we stay connected to the deeper meaning and purpose in our work? How do we make sure that we always have to the opportunity to focus on what really matters to the person in front of us? How do we create processes and systems that recognise the value human connection and provide reliable opportunities to and reminders to help us in this endeavour? How do we improve?
Often we set out with good intentions: “I promise to….” I will always…” But what do these good intentions look like in action? Even with the best will in the world, do they always happen? I think if we reflect on our own experience we realise that despite our best intentions we are at best patchy – the spirit is willing, but the flesh is weak!
Transforming good intentions into actions and making these behaviours part of our daily routine is probably the single biggest challenge. The reality for most of us is that the scale, pace and technicality of the modern world, and especially the health and care system, means that we can’t take it for granted that we will always remember to do the right thing, to say the right thing and treat people as they should be treated. We need prompts and reminders to help us. We need to design a more person-centred system to support the growth of a truly person-centred culture.
Purpose, Measures, Method
To turn our good intentions into reality we need to start by focusing on purpose. Once we are clear about our purpose or aim at work we can then start to think about the question: “have I achieved the aim that I set out to achieve?” To get answer to this question we need to measure something – DON’T stop reading just because I said measures!!
By starting with purpose measurement is made much easier and much more meaningful. In this context measurement can be as simple as observing (or reflecting on) whether the thing you wanted to do actually occured? Keep a tally or watch what goes on around you for 5 minutes. For example: “did I always ask every person about the things that are really important to them at this time?” Yes or No? If not, why not? And what could I do to remind myself to do it?
Your chances of success are much increased if alongside purpose and measures you have an improvement method. There are lots of methods out there – pick one and stick with it! We have widely used the Model for Improvement (MfI) in Scotland and I think it is probably one of the simplest and most adaptable methods out there. It starts with three simple questions:
- What’s the thing you want to improve? (your aim: how good do you want to be? and by when?)
- How will I know I’ve improved? (what are you going to measure?)
- What’s the first step towards making this happen? (your ideas about things you could try to make this improvement happen)
Once you’ve answered these three questions the second part of the MfI is to move to action – using a simple framework called the Plan. Do, Study, Act (PDSA) cycle. This structure can help you test your idea in a very small way to see if it works. Try it with one person on one day. Tweak it and try it again. Try it with two people, and so on. Once you’ve run a few tests you’ll be amazed at what you learn AND most importantly – your good intentions are turning into actions!
So, let’s maintain that strong sense of purpose, but don’t stop there. Think about what your good intention would look like in practice and then measure whether it actually happens. Being fallible human beings we inevitably realise we’re not quite as good as we’d like to think we are – there’s always room for improvement!
Then move to the final step and think about the thing you can do to make yourself more reliable – focusing on what matters for every person, every time. A prompt in the notes, a personal “what matters to you?” board above every bed in a hospital, a reliable framework, such as Talking Points, to help you understand what matters most to the person in front of you.
Take good care of yourself!
This isn’t just about you changing the world. There are all sorts of other things that need to change in the wider system around us, but these things are outside the sphere of influence for most of us. In light of this reality we need to maintain good self-care and set our sights on the long view as we work on our small wins each day. Sometimes we will have set-backs and this type of work can feel difficult and challenging in the prevailing climate and culture. But don’t lose heart! The overall momentum is in the right direction. Maintain your strong sense of purpose, think about how you will measure your progress and then move to action.
It’s also important to find some like-minded folks so you can support and encourage one another. Start small and begin by designing some prompts and processes into your daily routine that will support you to turn the desires of your heart into your daily reality.
~ Shaun Maher, Strategic Advisor for Person Centred Care and Improvement, Scottish Government