What I learnt this week: The power of personal stories #WILTW

This is the third in the series of #WILTW 

I seem to have discovered this viral video extremely late:

It tells an uncomfortable story of Social Media use which is a little cheesy in places and clearly ironic in its success. It is however a powerful film. I have been a convert to the importance of story telling through my involvement in NHS Change Day. Previously dismissiveness of those who celebrated individual case studies as a means of getting their message across I am now a firm believer in the importance of personal narrative. I highly recommend this short Petcha Kutcha style presentation if you are unsure.

This week I attended the second day of the Children and Young Peoples Outcomes Forum annual summit where we spent some time discussing the difficulties of data sharing. My views on this are very strong (see this blog for the background) and I am wary of letting my frustrations stop productive conversation. It struck me though that my most useful contribution to the debate was not any technical argument or counter assertion about risks/benefits but the simple personal story of why data sharing is important to me. Essentially a child may have come to harm because simple information was not able to be flagged up to me through a universal database (as intended by contact point). It was a story that others could relate to and provided a common ground for all.

I may well be preaching to the converted but my learning this week is to not be afraid to use personal narrative as a means of engagement. It may well be the best argument you have.

 

What did you learn this week? #WILTW

(thanks to my wife, Katie, for pointing out the Looking up video!)

#WILTW – the importance of ‘shared’ gut feeling

This is the second in the series of “What I Learned This Week #WILTW

It was an unnerving experience to be completely let down by my own gut feeling this week. A particular case caught me by suprise and it was only through following protocol that the right decsions were made. Essentially my gut feeling told me it was unlikely extra tests would be needed for a patient, but I did them because our guidelines said so, and lo-and-behold the guidelines were right! Although initially I was a little taken a back, on reflection I’ve decided that in fact gut feeling did win the day on this occassion. Not my gut feeling – but everybody else’s…

Flock of sheep, New Zealand, Pacific

In hospital Clinical Practice Guidelines, or Standard Operating Protocols, are used to condense knowledge and experience to help healthcare professionals make decisions about patients. Ideally guidelines are based on the best evidence but often clear research is not available to determine what to do in any given situation. In these cases Guidelines are often based on the consensus of experts. This happens at a local level (consultants coming together to determine department policy) or a national level (the National Institute of Health and  Care  Excellence [NICE] bringing together expert Guideline Development Groups).

Guidelines often get a bad name as being part of the ‘tick box’ culture that often pervades health care. Perhaps it is worth thinking of them as a shared gut feeling. One that will sometimes get you out of a sticky hole.

 

What did you learn this week? #WILTW

 

What I learnt this week #WILTW

The full list of #WILTW 

A few weeks ago I posted a blog with some thoughts on becoming a new consultant. I’d postulated that having insight into learning being a  life-long journey was an essential element to being a good healthcare professional. I’ve now been in post a couple of weeks: finding my feet, performing induction rituals and thinking about the goals I would like to achieve in my next year.

online-learning

What has hit me like a bomb has been my first clinical experiences on the shop floor. It’s been an amazing learning curve, far greater than I expected actually. The pure clinical component is not really an issue. I have been acting, in some respects, in a consultant capacity for the last three years as I performed locum shifts as part of my PhD. Making clinical decisions, practical skills and running a busy emergency department are almost second nature. What struck me was how little thought I’d previously put not into ‘what‘ I was doing but ‘how‘. I am now a consultant. Clearly I don’t want to create false hierarchies, I recognise I am part of a senior team of doctors and nurses and that the title does not make me lord of the manor. However I also recognise that I have  a responsibility to role model the best possible professional and clinical behaviours. In all situations the demeanor with which I speak to colleagues, the way I approach children, young people and their families and how I interact with staff sets a tone. It’s not until now that the importance of this has become crystal clear.

I thought I knew a bit about leadership. It transpires I have a great deal to learn. Reflecting on my approach to particular challenges (mainly difficult conversations about referrals or picking up staff on sub-optimal behaviours) has demonstrated how difficult being a consistent and strong ‘leader’ is. It is very easy to take a second-best option; that in order to avoid confrontation a compromise is reached which may not be your preferred choice. But when do you draw the line? Obviously always ensuring your way is the best way is no better than always accepting the other person’s point of view. However it’s all too easy to avoid the conversation about the tone that a junior has taken (potentially accidentally) with a parent or other member of staff, for example; but it’s these conversations I need to start having.

Tough Decisions Ahead Road Sign

(via http://www.advisoranalyst.com)

So what I have I learnt this week? Well, I’ve learnt that potentially I’m not as strong as I thought I was. That some of the things I thought I would be able to do in role will take a little more embedding. I am also sure that with the guidance of colleagues and passing of time I will get better. As I said previously – the learning has only just begun again….

So what have you learnt this week? #WILTW

13 years of training and tomorrow it all begins again…

The art of medicine was to be properly learned only from its practice and its exercise.
Thomas Sydenham 

So after managing to prolong my training to its maximal extent, with two separate years in Perth, Australia and a PhD, tomorrow my medical ‘training’ in one sense comes to its end as I start work as a consultant. I’ve had a chance to reflect on what I have actually learnt since starting on the wards as a wet-behind-the-ears junior doctor back in 2001. Its funny, I don’t feel I am in any way, shape or form an expert now, even though I have probably done my obligatory 10000 hours. I certainly don’t feel as wise as the paediatric consultants I remember when I was a house officer. This might reflect an element of an impostor syndrome – or perhaps I have actually become unconsciously competent.

I’m not really sure how this all happened. I struggle to remember more than a handful of occasions when I specifically learnt anything from anyone, although there are some notable exceptions.

Don’t listen for the murmur, listen for the absence of noise

This brilliant advice has always stuck with me, especially as someone who has always struggled with the complexity of paediatric cardiology.

I remember being shown during my first neonatal attachment that babies often open their eyes when put over their mother’s shoulder (which makes identifying the red reflex much quicker).

One of my most powerful experiences occurred in Australia as I watched an Emergency Department Consultant at the resuscitation of an infant from an out-of-hospital cardiac arrest. After several of rounds of CPR it was clear the outcome was going to be devastating. I saw the mother realise this; she was inconsolable. And then the consultant handed leadership of the resuscitation to someone else and went over to her, putting his arm around her and bringing her to her child’s side. He spoke to her about loss and how no more could be done. I don’t remember exact words but I vividly emember him crying with her as we all took a step back. It was one of the most incredible things I have seen a consultant do.

Clearly I was taught things – lectures, seminars, ward rounds must have had an impact – but nothing tangible remains and many of the times I know I learnt the most were situations when I was on my own, sometimes inappropriately so.

I have no idea how I learnt to cannulate the septic ex-prem with tiny hands already scarred, little knowledge of when I gained the confidence to lead a group of people I have never met to deliver emergency care to an injured child, and certainly not a clue when I began to appreciate the subtle difference in the reaction of a parent who has not deliberately injured their child compared to one who has when asked how that bruise happened.

But what is more incredible is what I still have to learn. I am a mere ’13 years old’ – health permitting, I may be practicing medicine for double that time yet. It is inconceivable that I will not learn exponentially in that time. And it will be an exciting time, I think. I hope I continue to reflect on those learning experiences, painful or not, in this next phase of my life.

My training begins again  – it’s just that now I have a different title.

Networking: Twitter doesn’t build communities, stories do…

This blog posting is based on my talk to the #HSJRisingStars. It’s good to have the opportunity to expand on my thoughts as it’s clear from feedback that this didn’t quite touch the nerve I was expecting. Raising concerns about twitter, within twitter, is an interesting experience…

In the run up to NHS Change Day 2014 a number of constructive criticisms had been voiced on the type of pledges made. How can it be that health care professionals are pledging to “deliver safe care”, “create caring cultures”? Aren’t these pledges just paying lip service to the broader purpose? Are people just jumping on a bandwagon?

I wrote a blog in response to these concerns. It centred around my acknowledgement that on a busy shift I had forgotten to introduce myself to the parents/child I had just seen. I had essentially failed Kate Granger

I am not a prolific blog writer, I’m probably not even a good one, but Kate tweeted the blog post and in the space of 3 hours it had received 1300 views. This was dissemination on a pretty impressive scale and in fact far more powerful than any previous networking opportunity I had been engaged in. It made me really think about reach and how I had communicated in and out of networks.

Change Day has taught us a lot about the NHS. There seems to be a unmet need to publicly discuss and celebrate core values; reports by Francis and Berwick have removed the taboo of some of these issues. It has taught me personally a great deal about my role in change and the roles of other networks. The story of Change Day began with a discussion about junior doctors and at the very first Change Day meeting I told a story inspired by Helen Bevan, describing how it is the new generation who are most likely to bring about radical change. Interestingly, though, one of the groups least involved in Change Day (in terms of raw numbers) were junior doctors (probably second only to GPs).

How did that happen? Did my networks fail to understand to the message? Was I wrong in my belief that Change Day can – and will – be a powerful instrument for cultural change? I think the reasons are subtle but well worth exploring.

Change Day was in essence about individual people. The real narrative was the reasons behind the individual pledges; the event itself was more like a big scrap book recording and highlighting more than half a million stories. My biggest transformation of thought in the last couple of years has been about the power of narrative. It’s personal narrative which drives us. The networks you are part of, represent, lead or create, contain people who share parts of that narrative. But I wonder how often your (or your network’s) narrative is shared by others. Just because I know ‘x’ doesn’t necessarily mean that an e-mail to their “network” will spread to a wider “network” and will be effective at spreading the message.

I’m sure I am as guilty as anyone at pushing the ‘send all’ button. Similarly asking friends  “can you send to your networks?” is something I have realised may not really add value. In fact the use of networks in this way may, in fact, create silos due to the lack of proper dialogue between them. “Nobody talks anymore” is oft quoted but there is some danger that it really is a little too easy not talk. By all means use technology – Hangout, FaceTime and Skype have enabled conversations to take place that weren’t possible previously. They are conversations with animation of expression and vocal nuance. But the real essence of good narrative goes beyond the physical conversation to the nature of what is being spoken. My story of failing at #hellomynameis is much more powerful than telling people how important Change Day is. Similarly describing my personal pledge is a much better vehicle to create interest than a newsletter about the day itself.

None of us wish to create silos as I’m sure we share the same the values. The translation of those values into a vision is probably different between our networks though. So in this time of social media and electronic interfaces, maybe we all need to be a bit more personal. We need to reconnect with each other with personal stories and communications that unite networks – not just transfer information between them.

“In this age of omniconnectedness, words like ‘network,’ ‘community’ and even ‘friends’ no longer mean what they used to. Networks don’t exist on LinkedIn. A community is not something that happens on a blog or on Twitter. And a friend is more than someone whose online status you check.” – Simon Sinek

This (admittedly controversial) quote was really brought home to me when I attended #SMACCGold, a social media and critical care conference. I thoroughly recommend watching the talks when realeased as they are all very much personal stories. Undoubtedly it was twitter, google and blogs that brought people in the #FOAMed community together but the real benefit for me was meeting the people there and engaging directly with them. As I said after the #HSJRisingStars event:

 

(Thanks to Natalie May for pre-publication proof-reading and editing)

#SMACCGOLD – It hurts..

Too often we enjoy the comfort of opinion without the discomfort of thought

The 2nd SMACC (social media and critical care conference) has just finished. A packed 4 days (including pre-conference) with over 1000 delegates developed by a few brilliant individuals who have envisioned a different way of learning and collaborating.

This is no ordinary conference, with fantastic topics discussed and innovative events. See Salim Rezaie’s great blog for the detail. There are few conferences where professionally executed simulation debriefings occur in front of an entire auditorium, speakers’ cry in a context that feels appropriate and delegates give standing ovations in some of the break out sessions.

I sit writing this approaching Doha on the second stage of my journey home. I am a SMACC virgin, utterly humbled by the invitation to speak in Brisbane. I have met and listened to some extraordinary people but my over-riding emotion at the moment is one of sadness. I am truly sad it has finished. Don’t get me wrong, my youngest developed chicken pox during my journey away, I do want to go home. I am sad though that I know I will be attending other conferences (unfortunately SMACC Chicago is over a year away!) where I will sit and listen, I may learn some additional clinical information, I may meet a future research collaborator, if I am really lucky something may inspire me to change practice.

What is unlikely to happen is that there will be a tangible excitement when the first speaker takes to the stage, that over coffee break all the delegates will be smiling, that I will witness carefully constructed slide sets that support (not deliver) the stories the speakers are telling.

The attention to detail in the narratives delivered at SMACC was brilliant. It’s likely those reading this who weren’t at SMACC will probably be a little sceptical of this hyperbole. Please, please, watch the video casts when they are released. Watch how Cliff Reid and Iain Beardsell bring their emotional talks together full circle. Natalie May delivers to a packed crowd on “paediatric tips you won’t find in a book” using slides with no text and Tamara Hills received a standing ovation for her PK presentation.  Listen to Victoria Brazil deliver a 20 minute presentation in exactly 20 minutes with no timing aids (ok – I admit this is only probably considered really cool by geeks like me).

The hierarchical nature of academic events is not present at SMACC. It was brilliant to see a mix of professionals, grades, and specialities mucking in. Medical students and junior doctors delivering lectures and being part of the panel discussions. And so I could go on….

If there was one thing that encapsulated SMACC it was the patient centered approach to challenging dogma. I am struck that although the patient should be at the heart of everything we do – I often don’t see that at conferences. I hear people ‘talk’ about it but during lectures on new treatments or methods it’s about stats and facts. It’s about why the speaker thinks something is wrong. What SMACC did was deliver lectures where the speakers understood the challenges of normal practice. That patients are humans, that the things we do in critical and emergency care have an impact on them. That if we do what we always did, we will get where we are going – and is some cases that is simply not acceptable. Challenging Dogmalyis, championed by Prof. Simon Carley is uncomfortable. It hurts sometimes to be challenged.

SMACC hurt.

But until SMACC Chicago this type of hurt is so much better than the pain of any other conference you will go to….

Post Blog note:

Have already started getting messages saying but what about…..? Will start adding 🙂

How I let @GrangerKate down and what you can do about it..

It was not a particularly busy shift. The patients were not any more sick than other evenings I have worked. I may have been a little more tired than normal, I don’t think I was anymore distracted, but as I walked out of the consulting room I realised I hadn’t #hellomynameis.

I’m pretty thorough by nature. I have always felt my communication skills were at least ok and I certainly think I’ve introduced myself to patients/parents since being a junior doctor. I actually felt everyone else did as well. It wasn’t until Kate Granger‘s #hellomynameis campaign really took off that I realised this might not actually be common practice. It’s interesting what is perceived as common practice or ‘assumed’ to be normal. You would think most people or systems would deliver at the minimum a style of care that at least doesn’t harm people but we know from some tragic events this is not always the case. We know for a fact that there must be pretty huge differences in the way things are done from variation in many healthcare outcomes (atlas of variation in care in children being one example).

It always upset me, and the term upset is correct, when I was a trainee representative for the RCPCH and AoMRC and senior medical leader or educator made a pronouncement on what trainees must be able to do. “It’s ridiculous trainees can’t get their WPBA signed off by consultants. At my hospital there is always a consultant available” Yes – at your hospital perhaps. Your world and training environment is very different from others.

And so I raised a wry smile at this tweet this evening

I’ve never met Partha but he sounds like a pretty awesome bloke. Cruelly overlooked in the HSJ Rising Stars awards he clearly has a great vision and passion for health care. He also seems to insist on calling NHS Change Day – pledge day but I’ll let him off that. It’s worth following the chain this tweet produced. I make no secret of my support for NHS Change Day and I’m happy to accept and defend criticism about it (Partha – I know your weren’t criticising but your tweet was perfect for this blog!). “What’s the point?” is a common question. “You had 3500 people pledge to smile last year. Don’t they do that anyway?” is another. For the answer to the latter reflect on when was the last time you spent an entire shift in public view and at no point looked like you weren’t upset, annoyed, bored or frustrated. How do you think your patients felt when they saw you looking like that?

Yes someone has pledged they want to keep patients safe. And yes this is a fundamental part of a healthcare professional’s role. But, unfortunately, sometimes the healthcare service doesn’t always keep patients safe. Yes – its fairly obvious that you should introduce yourself at the beginning of every consultation. But, unfortunately, even someone who has been supporting #hellomynameis passionately can fall short.

In some ways it is a shame it is ‘change’ and it is ‘day’ because it’s not always about ‘change’ and hopefully its not about one ‘day’. But if you can find a better mechanism that brings the NHS together and say look – lets just think about this – then please let me know. Because until I find one I will continue to support people pledging what they feel is important to them however obvious that might seem to you.

Post Blog Note (23.2.14)

A subsequent comment from @parthaskar following this post deserves mention as it is something I strongly support and given I gave the poor chap no notice about using his original tweet think it is only fair I utilise his wise words!

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