{"id":19202,"date":"2012-08-03T11:20:58","date_gmt":"2012-08-03T10:20:58","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=19202"},"modified":"2013-02-13T11:46:54","modified_gmt":"2013-02-13T10:46:54","slug":"penny-campling-thoughts-on-a-healthcare-culture-part-2","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2012\/08\/03\/penny-campling-thoughts-on-a-healthcare-culture-part-2\/","title":{"rendered":"Penny Campling: Thoughts on a healthcare culture\u2014part 2"},"content":{"rendered":"<p><a href=\"https:\/\/blogs.bmj.com\/bmj\/2012\/07\/27\/penny-campling-thoughts-on-healthcare-culture\/penny_campling\/\" rel=\"attachment wp-att-19011\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-full wp-image-19011\" alt=\"\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2012\/07\/penny_campling.jpg\" width=\"160\" height=\"150\" \/><\/a>I recently attended a symposium at the Tavistock Clinic entitled <em>Cultures of Care: Cruelty and Kindness<\/em>. As the Tavistock is a psychoanalytic institution, there was a lot of focus on <em>understanding<\/em> the problem and the discussion was complex and challenging with the shameful examples of Mid-Staffordshire, Winterbourne View and the Care Quality Commission\u2019s report on the elderly to keep us grounded in reality.<!--more--><\/p>\n<p>A presentation on the work of the Commission on Improving Dignity in Care for Older People made it very clear that high quality care is about valuing front-line staff who will then go the extra mile for patients. Common sense, you might think, but why so difficult to enshrine in practice?\u00a0 The presentation was sensible and humane but there was some frustration that it didn\u2019t really get to grips with what goes wrong.\u00a0 After all, there are countless documents that advise about good practice; the real challenge is to understand why such very sensible \u2018lists\u2019 don\u2019t translate into more compassionate care?<\/p>\n<p>One response to this is to think about how, and how adequately, we process anxiety in the system.\u00a0 Healthcare workers are constantly in touch with existential anxieties that trigger our most primitive feelings \u2013 including rage and fear linked to madness, decay and death. If this is not worked through adequately, not only do the individual staff members suffer, but the whole system becomes dysfunctional.\u00a0 This in turn causes more anxiety for individuals which feeds a vicious circle.\u00a0 Healthcare organisations then become driven by a frantic attempt to distance anxiety and deny reality.\u00a0 We see this in the compulsive re-organisations and reactive policy initiatives that overwhelm the system, but also the failures, for example, to address the needs of an aging population and engage more sensitively with the reality of death.<\/p>\n<p>We then heard from Dympna Cunnane, who combines being a Jungian analyst with being a consultant to organisations and programme director at the London Business School.\u00a0 Dympna was able to make comparisons between the Health Service and work she\u2019d done for the Oil and Aircraft industries\u2014especially in terms of how they address risk and manage internal relationships.\u00a0 It was fascinating to realise how many of the major problems that undermine our culture in the NHS are live issues for these industries as well. Talking for example about &#8220;Disasters&#8221; in the various organisations she has worked, she explained how the problems are <em>always<\/em> known prior to the disaster, but, because &#8220;failure&#8221; is not allowed, such knowledge cannot be shared and reviewed and small signal events are ignored.\u00a0 She talked about cost cutting and conflicting priorities, about remote, often narcissistic leadership, about responsibility being pushed down the system and a culture of fear where people daren\u2019t speak out.<\/p>\n<p>Sadly, these issues all resonated strongly with my experience working over recent years in the NHS.\u00a0 Whilst the comparison between these industries and an increasingly industrialised NHS didn\u2019t surprise me, the link with &#8220;disasters&#8221; and the idea that these issues are seen as just as much a problem to the smooth running of the Oil and Aircraft industries is interesting. It confirms the truth that attending to the culture of an organisation is not a soft woolly peripheral concern, but directly impacts on the primary task. And if this is so for heavy industry, how can we dare to continue to ignore this fact in our health and social care organisations where a thoughtful caring culture is so obviously fundamental?<\/p>\n<p><em><strong>Penny Campling<\/strong> is a psychiatrist and psychotherapist and was a clinical director for many years. She has recently co-written a book entitled &#8220;Intelligent Kindness: reforming the culture of healthcare.&#8221;<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>I recently attended a symposium at the Tavistock Clinic entitled Cultures of Care: Cruelty and Kindness. As the Tavistock is a psychoanalytic institution, there was a lot of focus on [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2012\/08\/03\/penny-campling-thoughts-on-a-healthcare-culture-part-2\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[223,236,5685],"tags":[],"class_list":["post-19202","post","type-post","status-publish","format-standard","hentry","category-guest-bloggers","category-nhs","category-penny-campling"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Penny Campling: Thoughts on a healthcare culture\u2014part 2 - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2012\/08\/03\/penny-campling-thoughts-on-a-healthcare-culture-part-2\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Penny Campling: Thoughts on a healthcare culture\u2014part 2 - The BMJ\" \/>\n<meta property=\"og:description\" content=\"I recently attended a symposium at the Tavistock Clinic entitled Cultures of Care: Cruelty and Kindness. 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