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Is it good enough for my mum?

19 July 2019

From Jönköping to Ikea and Fart tablets!

My wife won’t be happy! I recently wrote a blog post where I was cleaning the floors of a ward and in this blog post I’m going to talk about making patient beds.

I thought we had a new modern Ikea coat hanger at home - turns out it’s a Dyson vacuum underneath my coats. Who knew!

I really do enjoy spending time on our hospital wards and I recently visited a medical ward where I had a positive time.

It wasn’t all great though. I need to mention that the physical environment, although clean, just never felt like a modern work or patient environment.

I do wonder who actually gets involved when designing hospital facilities. I should say that the building I was in was very old and expectations and standards have changed a lot (thankfully) in the decades that have passed since it was built.

The “Esther” concept - a model of care designed to improve care for elderly patients with complex needs which originated in Jönköping in Sweden - is well known now. This model asks the question: “Is this good enough for Esther?”

Esther was the name of a healthcare leader’s mother in Jönköping. Would the care I witnessed be good enough for my mum, Jane? Yes, is absolutely was. 

Apparently, I had to re learn how to make a bed (insert your own sarcastic comment from my wife here!) especially something called a “nurses’ corner”.

The process reminded me of being a kid and my older brother, when home on leave from the army, showing me how to ‘square a bed’.

I want to acknowledge the student nurses on the ward in this blog. There were two of them and while I was there they had two patients they were caring for.

The best way I could describe it would be to say they were both shouted at by the two patients. I could see that both patients were highly frustrated and emotional but the student nurses took the time to talk to them compassionately and tenderly and the situations de-escalated.

During this time, I noticed a female patient who had become quite distressed so after making a brew for one of the other patients, I took my drink and sat and talked with her.

I’m going to call her ‘Mary’ for this blog post. Mary explained to me that she’d lost most of her eyesight. She was in her 90s and had come into hospital a day or so earlier. She told me she didn’t know why she was in hospital and it was clear that she was confused.

I asked a nurse to explain again to Mary why she was in hospital.  The nurse sat with us and once again explained to Mary about her fall at home and her other ailments.

I felt really sad for Mary. She reminded me of my step-mum when dementia had started to confuse her mind.

As soon as the nurse had finished explaining, we were back to confusion and Mary once again telling me she didn’t know why she was in hospital.

I stayed for about an hour with Mary having a chat about how she felt, the vulnerability and the loneliness.

We thanked each other for the talk and I went off for a cry where Mary couldn’t see me.

I came back the following Saturday morning. “You’re back again,” shouted Joe, one of the patients on the ward. I’d met him the day before and he had spent time talking to me about the food and his “fart” tablets!

We had a good laugh I found Mary and gave her some Malteesers I’d bought for her. It was lovely to see her again and she was smiling. Mary told me that she was worried that nobody knew where she was and she didn’t know why she was in hospital.

One of the nurses again took the time to sit with Mary and talk her through what had happened. Mary then seemed more relaxed and had an understanding of why she was there.

I’m not a clinician so I don’t know if Mary had dementia or not. She was certainly a bit clearer on the second day. Regardless of that, every time her situation was explained to her I could see that it brought some relief.

I’ve been thinking about Mary and what she’s lived through in the last 90 years or so. It’s an almost endless list. I have a bizarre hobby of collecting antique cameras -largely broken one - and I’ve often thought of writing a story about the things the cameras may have seen in their lifetime.

My experiences with Mary and Joe have started me thinking about writing it again.

After a brief spell on Google, I came up with an incredible list of things that Mary has witnessed happen in her lifetime, not least Liverpool FC winning Six European Cup finals:

  • Hitler Becomes German Chancellor (1933)
  • King Edward VIII Abdicates (1936)
  • Hindenburg Airship Crash (1937)
  • Germany Invades Poland (1939)
  • Evacuation of Dunkirk (1940)
  • D-Day Landings (1944)
  • Germans Surrender to Montgomery (1945)
  • Roger Bannister Breaks the 4 Minute Mile (1954)
  • Martin Luther King Delivers His "I have a dream" speech (1963)
  • Armstrong Sets Foot on the Moon (1969)
  • Chernoybl Nuclear Disaster (1986)
  • Nelson Mandela Released from Prison (1990)

What did I learn and observe from my short time on this ward?

  • The future is bright, based on the two student nurses I observed
  • The calmness and positive atmosphere on the ward which I felt was due to the composure and approach of the Ward Manager leading by example
  • That I can’t make a bed very well
  • A few moments (however small it might feel) can make a huge difference to some of our patients
  • Non-clinical staff could make a huge difference to our ward staff and patient wellbeing by getting more involved.

I was away on an NHS Leadership course for the week after my visit and I’ve thought about Joe and Mary all week. I think I’ve missed them!

I also met some new colleagues on the ward who have joined the Trust this year they were both from other countries. I felt quite proud that they’d chosen to come to work with us in Morecambe Bay. Both from different countries but each leaving families and friends behind to travel half way around the world to join us!

How must that feel? I thought moving from Carlisle to Garstang a few years back had been a big move for me! I chatted with one of them and we discussed some differences; food, etc and, of course, our favourite topic in England, the weather. You’d think we’d be used to it by now?

A huge thank you from me, as these new members of the team must have felt quite lonely and even frightened at times leaving everything behind and coming to join us. Quite remarkable, I feel.

I want to do a few things differently after my recent shadowing experiences:

  • I’m now leading a project to review how it looks and feels when you first come into contact with one of our hospitals and I want to expand the Jönköping ‘Esther’ principle to UHMBT a family and a number of staff members as a local planning principle
  • Look at how we could introduce a “helping hands” scheme for our non-clinical staff to volunteer and support our patients.
  • Explore an ‘adopt a colleague’ scheme where new colleagues to the area or country are buddied up with a staff member to help introduce them to the area and local life.

So, in summary, a positive experience and, as always, I’ve come away with great admiration for my clinical colleagues. Just a shame the premises don’t always match.

I do understand the financial constraints and decisions made a decade or more ago on investments that are having consequences today. I know my Director colleagues have this in their sights and they are working as hard as the next person to find a solution.

Was the care good enough for Jane, my mum? Yes.

Was the environment good enough for Jane? It wasn’t bad, it just wasn’t great.

I understand the constraints but I believe strongly in the environment playing a part in the care of patients. It is one thing to have a building looking nice but surely such environments should assist in providing a stimulating and compassionate space that aids care and recovery.

I imagine there is a whole raft of evidence out there to support this so please share it with me if you have any.

I’d imagine, it must be a delicate balance between creating a hotel-like image to actually demonstrating it making a difference through design to a carefully thought out environment  that helps to attract and retain the very best talent.

Healthcare, for me, has never been about buildings. It’s always been about people.

“If we look after the people, the rest will follow.” People can move mountains and do some amazing things if you treat them well, is my philosophy.

I really don’t always get this bit right, sorry.

But even ‘modern’ hotels get it wrong. I was in one last week and the shower head fell off the wall while I was in it and cut the top of my head.

After reporting it, it took two days to fix. No apology or moving me to a room with a working shower, or an appearance from the manager. It’s ok, you can laugh. It is a little funny! 

If this had been in a NHS building we would make the local press. We aren’t hotels. Thankfully, we are more than that, much more we are people trying our best.

Someone said to me other day I won’t say anything bad in my blogs. This is really not true. I’ve just not come across anything bad yet.

Are people acting differently when I’m around? Possibly but I’m no ‘mug’ and I’m not fresh out of school. This is my 20th year in the NHS and I can tell the difference. I also have a knack of blending in.

What concerns do I hear about in our wards and departments?

  • Ward staff can be vocal about the lack of work life balance. The mantra leaders like me spout about the importance of looking after yourself “and when do you think we have time to do that?” They’ve asked me, which is one of the reasons I feel the environment is key
  • The pressure of being cost effective without reducing standards of care
  • “Do you Directors even understand how busy we are?”
  • Rudeness they sometimes experience from other colleagues. Sadly, stress can bring out the worst in all of us.

However, by and large, I witness and experience dedicated and hard-working people who are proud to work in the NHS but desperate for some recognition and understanding, especially from the media and politicians.  

I’m only alive today because of the care the NHS gave me in 2016 after falling quite ill.

Ok, so I’m a little critical of the environment, but our facilities and estates teams have shown what is possible with new investments such as the South Lakes Birth Centre in Barrow and the Therapies Department at Medical Unit 2 in Lancaster.

Both create the right atmosphere and foster environments that can support staff to flourish. They rival any private facility I’ve ever visited.

Clichéd NHS Manager word time now: in my own ‘journey’ as a leader I’m trying harder each day to ask myself, “what difference am I making to my colleagues and patients?”

If I’m not making it better for them, then what am I doing? And why? Fair to say I’m at a career crossroads. Advice welcomed!

Phil Woodford

@phil_woodford, Phil.woodford@mbht.nhs.uk