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Billy Boland: The importance of challenging the status quo

11 Mar, 14 | by BMJ

billy_bolandI had 10 minutes to steel myself as I marched down the Embankment in Leeds for the second residential of the Bevan Programme at the NHS Leadership Academy. Preparing to be the odd man out, I was going to gate crash a different cohort for this next three day stretch. I’d missed out on my group meeting the week before, so I was playing catch up. Thankfully, the introductions were a breeze this time round, even though I knew no one there.  Already I’d found some security in the institution and its routines. I basked in the congenial collegiate glow.
Where the first residential was all about reflecting on ourselves, residential two involved looking outwards. A lot of attention on the course is drawn to how staff in the NHS are charged with quality improvement, and emphasis is placed on the latitude we have to make things better. Most of us are guilty of falling into ways of working because it’s “how things are done around here.” Challenging the status quo can be hard. We were encouraged to think big.

The NHS is part of a rapidly changing world. It’s sometimes difficult to imagine what it will look like next year, never mind in 10, or even 50 years time. But we played around with ideas of a vision for the future.

How will social media further shape how we communicate? We were told about the tumblr site “Selfies at funerals.” As shamefully arresting as watching a car crash, it made me think about how concepts of privacy and dignity are changing, and how this might effect people’s expectations of health services.

And what about robots caring for people with Alzheimer’s disease? Can they provide the compassion and kindness patients may not get elsewhere? As a psychiatrist, the potential of technology doesn’t often feature in my thinking, but my mind opened and head was spinning.

Looking outwards can be surprisingly familiar too. We discussed the highly publicised death of a patient at the Dana-Faber Institute in Boston, MA and how the organisation responded by becoming a world leader in patient safety. Though the event occurred in the eighties, issues of patient handover, communication, training, organisational structure and culture, as well as individual behaviour all played their part in the event. Debate was fierce as we dug through the facts, doing a rapid root cause analysis en masse.

The process was a reminder of how silo mentality needs to be avoided at all costs when thinking about caring for patients. None of us in the group held all the answers to addressing the problem, and as we worked on the issues from the perspectives of nurses, patients, doctors, or the hospital board, we came up with different priorities and solutions. The high profile problems at Mid-Staffordshire NHS Foundation Trust haunted our discussions. We asked ourselves, “Could this happen in our trust?” and “what are we doing to prevent it?”

When it was all over I bade farewell to my cohort hosts, and thought about the coming months. There would be assignments to complete, and evidence to gather for a portfolio. Things were getting serious.

I declare that that I have read and understood the BMJ Group policy on declaration of interests and I have no relevant interests to declare.

Billy Boland is a consultant psychiatrist and lead doctor in safeguarding adults at Hertfordshire Partnership University NHS Foundation Trust.

Read earlier blogs in this series at http://blogs.bmj.com/bmj/category/billy-boland/

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