Contrast two scenes. The first is a restaurant – where the food is carefully prepared and warmly served in an atmosphere which seeks to delight its customers. The second is a hospital. Parking the car is nearly impossible – the long impersonal corridors where people avoid eye contact. The noisy ward – the short temered administrator; the disinterested receptionist; the doctor talking over the patient who feels ignored. There is no space or time or sensitivity. If we were treated like in a restaurant we would complain and ensure that we warned friends against any contact with that place.
We are proud of the NHS and its values. It is deeply rooted in a philosophy of care for all – it aspires to mend and heal; to prevent and support. It inspires great public service from energetic practitioners who want the best for those they serve. We have all benefited from the developments and investments in health.
However, there is a crisis deep within our culture. It is a crisis of care – the way we treat people; how we engage and listen to our service users. If we believed that patients paid our salaries then we simply would not go on failing them. Managers have a responsibility to oversee the shape of the culture within which health targets are delivered. We are shapers of both systems and structures. Are they fit for ‘care’ purpose? How radical is our commitment to the patient and their experience in all its complexity? How responsive and people-centred are our transport access, reception areas, our wards or consulting rooms? Would an ordinary older woman be empowered to respond to her doctor with gratitude for his time and compassion? Are hospitals places of understanding? Is the PCT Board meeting a place where feedback from the patients is as important as the financial results or the latest set of targets? If we want to develop and grow, then managers should take a lead in asking: ‘Don’t tell me what is going well here – let’s look at what is wrong!’ I do not doubt the intentions of those who work in the service – but there are preciously few people who are angry at not getting it right enough for people. We exploit their fear and dependence at very vulnerable moments of life by failing to enlarge humanity through the sharing of power and control.
Dismiss this plea at your peril. There can be no improvement of quality without attention to creating communities of compassion where the person is the beating heart of our work. We must make the jump from seeing things from others’ perspectives. Here are some actions that might help you explore the added value of putting care firmly on your organisational agenda.
1. Find time and places where you can observe your organisation at work. Take note of those things that would be unacceptable to anyone about whom you care.
2. Invest in listening to the patient experience. Respond to complaints as opportunities to deepen care.
3. Ask others how they would describe your place of work with one adjective. Be energised by the gaps between how we describe our aspirations and what the actual practice is! Let us do away with the minimalist functionality of much of the space where we deliver care. What about the imaginative use of colour, light and texture?
4. How much power and control do we give to the patient? Are they partners in decision making? Let them decide what is appropriate – we do not always know what is best! In Birmingham, our Palliative Care Network has launched a compaign to ensure that choice is given back to people at the end of their life. What shape would your campaign take?
5. Discover what makes your staff tired and de-motivated. Invest in programmes of staff support so that we can be energised by service. Too often our staff makes the experience of going into hospital like going to a foreign country – an alien land where no-one tries to understand your language let alone engage with your vulnerability. Our staff need to be supported to deliver care differently.