Utilising the improvement from healthcare social movement #MedX

I am pretty sure it is impossible to change the world alone. You may be innovative, provocative, and inspirational. But even our greatest leaders will cite key influencers to their success

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Hello – My name is Damian. I am a paediatrician. I am also a father and when my second daughter was 8 weeks old she was admitted to hospital with suspected meningitis. I saw the best that healthcare has to offer patients and their families during that worrying time. Compassion, dedication and great skill. To the colleague who expertly performed procedures on Bella’s delicate veins I will always be grateful.

But I also saw the worst of healthcare. A failure of senior staff to introduce themselves, the neglect of staff not washing their hands and the public display of hierarchy for the benefit of an individual needing to assert their authority.

There are many things I wish I could change about Bella’s stay in hospital. What would you change in healthcare? If you are a patient what frustrates you most? As a health care professional, how would you like your service to be run? Sadly change can become somewhat of a dirty word.

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Max Davie, a paediatrician, once said to me, “we are fed up of change, but not of improvement

There are many things we can improve with robust research and the scientific method. The dose of chemotherapy, the type of surgery or the treatment of infections with new generation of antibiotics. But what of personal change, system change, cultural change? For these we need movements.

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Social Movements are collective actions by large, but sometimes informal, groups of individuals or organisations to carry out, resist, or undo a social change. When we think about resources for change we tend to think about economic resources (budgets, technology, individuals etc). These resources are limited and finite whereas social movements can release resources in the form of social capital which is vital in environments where monetary intervention is not possible.

Within healthcare there are many shared values, both for patients and professionals, so achieving common goals through a movement has an obvious appeal. For example, the Institute for Health Care Improvement’s (IHI) “5 million lives” campaign aimed to reduce medical harm in American hospitals. The movement generated considerable publicity and the IHI claimed they surpassed their target.

Social Movements are not a new idea. They have been occurring for centuries. However in the last decade there has been a seismic change though the accessibility and reach of social media.

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Social media is increasingly seen as credible and accepted medium by which to disseminate information, decrease the knowledge translation gap and allow professional and patient engagement in a meaningful way. It has hugely increased the momentum and motivation behind social movements. I’d like to discuss some social media derived movements I have been involved in, or aware of, and share some learning.

NHS Change Day was about harnessing the power of collective action. It was a grass roots frontline movement for improvement in health and care and 98% of the activity was undertaken by volunteers. It asked for a simple action. To pledge to perform a healthcare intervention on a single day (March 13th 2013). It became single biggest day of collective action for improvement in the history of the NHS with 189000 pledges made. Change Day has been replicated across the world and is now in its 4th year.

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Change day started with a tweet that enable a first conversation between junior doctors and an improvement leader. From that first conversation a timeline can be drawn that resulted in a national event that impacted on the lives of patients.

Change day taught me about the power of stories. My pledge in the first year to try some of the medications that I prescribe to children. One, an antibiotic, was absolutely vile. It was truly disgusting. It made me realise that this wasn’t something you could give to parents and expect them to religiously give to their child. I realised you need to provide clear guidance on how to hide the taste and encourage adherence.

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Importantly the process created a story of my experiences. The staff in my department know about my pledge. They have seen the video of the odd contortions my face made when I tried to swallow it. The narrative a powerful back drop in promoting change in others.

This year Kate Granger, a doctor, passed away having been diagnosed with a rare form of cancer. She was responsible for #hellomynameis. A social movement that clearly begins with her encapsulation of how frustrating it is when health care staff don’t introduce themselves. Her campaign started on twitter and with now 1300 million impressions continues to spread throughout the world. A powerful personal narrative with meaning for others.

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Free Open Access Medical Education (FOAM) is an international movement that has brought together people from many backgrounds and specialties. It describes the production of educational materials in a variety of forms that are openly accessible. The concept of FOAM started in a pub (much like all great innovations!). Mike Cadogan coining the term during an international emergency medicine conference. It has come to represent a focus point for critical care and emergency medicine communities in particular. The term encompassing not just the materials produced but the bringing together of enthusiasts who design and digest them. It has developed into a true digital community of practice as demonstrated by examination of the hashtag #FOAMed. FOAM, along with patient derived digital communities such as #chroniclife, are social movements almost entirely derived within social media yet have all the attributes of a community of practice with the potential benefits they confer on professional and patient outcomes.

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We are now at the beginning of a new approach to social movements. One in which anyone: pubic, patient or professional can contribute to the challenge that is change.

A very public social movement can inspire others to feel passionate about what they are doing. To do this we must:

  • Learn to tell and share stories, always keeping in mind the event(s) that prompted the initial story
  • Let these stories build communities

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I am sure it is impossible to change the world alone. But with others we can achieve great things. The 21st century social media enhanced social movement will continue to teach us about connectivity and community. I for one am very glad to be part of it.

Huge thanks to Helen Bevan, Jackie Lynton, Daniel Cabrera, Jesse Spur, Chris Nickson, Mike Cadogan and many others who have impacted on my thinking in some way. 

This is a shortened version of my presentation at #MedX 2016

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