Last week I went to see my daughter’s school carol service. A small church in our town hosted pupils singing carols in-between reading the nativity. I was particularly inspired by a nine-year old girl commencing the proceedings with a solo version of “Once in Royal David’s City” but also by the general quality of the readings.  My daughter, barely 4 when she started this year I suspect was not as interested, but over the next few years I hope she will take on board this sign of a very positive culture at the school.

This has been a year of emphasising culture and compassion in healthcare. Francis and Berwick laying down a gauntlet that the status quo is simply an unacceptable path to follow. The mechanisms by which this can occur are still not clear though. This has been clearly illuminated to me as I spend my last few months in medical training. Having recently been appointed as a consultant, to start in spring 2014, I reflect on the current thinking about the need for cultural shifts in the future. My practical skills, clinical reasoning and communication with other health care professionals have been developed during my training to avoid the need to ‘step up’ once in post. However developing and enhancing a culture of quality and compassion in my department will require me to speak up about others practices and be exemplary in my own. As a junior medical professional it is easy, although not necessarily right, to turn a blind eye to others’ terse tones with patients, unnecessary delays providing treatments or passive aggressive overtones in communicating with colleagues. I am not talking about clear breaches of professionalism or causing patient harm but those things which unchecked can lead to the development of ‘acceptability’ of poor practice.

This will be a hard for me.  I am also very aware it really easy to talk about these things on a podium at a conference (or in a blog) but a completely different thing to act on in the clinical work place. I have much to learn from other colleagues but I hope I can be a credible and consistent champion for excellent practice in my trust. On a national level much time has been spent developing medical ‘leaders and managers’. I am still not clear of the definition of these words but I am increasingly aware that management skills and techniques can be learnt and developed but ‘leaders’ are not so easily bred. “Leadership” though is something that any health care professional can display. Demonstrating compassion, empathy and quality of practice, consistently, even if not challenging others sets a tone for a strong culture. Anyone can do this, you just need to remember that you are always potentially being watched. The cynics who challenged the Change Day 2013 “Smile” pledge missed the point:

Yes, it seems like such an obvious thing to do, but do you always do it?

This is a time of year of reflection. For some reason a particular christmas song will remind you of past events and states of mind. The constant repetition of these songs forces an often frank summation of where you have been and where you are going. New Years Resolutions one mechanism of acting these subtle challenges.

I hope in 2014 I can set a similar example to colleagues and patients the pupils of Farndon Fields school showed to their fellow pupils.

Have a great holiday period and New Year…….

Post Blog note:

If you want an mechanism for acting on any healthcare related resolution please do pledge at changeday.nhs.uk and join a social movement of individuals, teams and organisations delivering on what is important to them. Look out for the #100daysofchange listing some of the achievements so far..!