Dr Sharryn Gardner is a paediatric emergency consultant and practicing paediatrician. She has a special interest in psychological aspects of wellness and illness and started the first solution focused paediatric clinic nationally.
Sharryn Gardner recently published her report “Compassionate Conversations” in BMJ Quality Improvement Reports. Compassionate Conversations are a ground-level initiative focused primarily on supporting and motivating individual staff as the primary focus. They are led by a Psychologist and Consultant in a coaching supportive atmosphere in an open or selected group. Here she talks about her inspirations for quality improvement and thoughts on customer service for quality.
Once I’d finished professional exams I certainly never expected to become a bookworm again. While as a trainee books were for specific purposes, after several years as a consultant they’re now for real professional development. However, I’ve found that as a consultant it has been possible to develop some new ways of getting things done. It started by embracing solution focused practice in my clinical work, which has inevitably led to me considering new ways of working and interacting with colleagues.
The scope of this reading has been wide – I’m a huge fan of Seth Godin’s blog[1] as I’m sure many readers are. Two books have been particularly influential. The first is the Disney book (more of that later), and the second is a Kindle book called “A Simpler NHS.” Its basic premise is simplicity, starting from the proposition that NHS management could be much simpler and at the same time be more effective (sample that simplicity here). It is a step back from the treadmill of measuring everything that can be measured. And unusually, our quality improvement project is the result of collaborating with like-minded individuals who met through Twitter; three managers and three consultants (including myself).
Bringing Disney to healthcare
While Disney may conjure up visions of severe consultants as Captain Hook or senior sisters as fairy godmothers, it might actually be a profound change in thinking. Fred Lee’s book “If Disney Ran Your Hospital – 9 1/2 Things You’d Do Differently” (read a sample here) helped make many of the practices my colleagues and I had already introduced into something more concrete. It turns out that Disney’s relentless focus on the customer experience is what ultimately keeps them at the top of their industry. That same constant focus on “customer experience” can be equally effective in almost any industry, including healthcare.
If I’m honest, I found this book to be life-changing, even if some of the core messages were seemingly obvious. What’s all that got to do with Healthcare? Fred Lee was a hospital manager. He learned from Disney’s values and fabric as much as their processes. More importantly he took them back to where they led directly to big improvements in healthcare. The NHS hasn’t previously had hospitals in direct competition for patients (and income), though that situation is evolving. Lee suggests that even without this competition, embracing the customer experience culture should lead to happier, more productive staff and a much more collegiate approach to running organisations in any sphere.
As a fellow BMJ Quality blogger notes, staff like us have an innate desire to do well, to do better, and to be appreciated, and this is not confined to the so-called “caring” professions. Financial and other material rewards are apparently surprisingly poor motivators; genuine appreciation is much more effective.
Reading back through previous blog entries here on BMJ Quality, they almost universally highlight the fundamental need to not just involve frontline staff and open the process to engage everyone, using everyone’s skills and ideas to move forward as a team.[2] “Freeing up The Frontline” and “Customers, Simplicity and the Frontline” from A Simpler NHS[3] describe how much more effective devolving power to the frontline is, and how we “live or die” by our customer service. That might make us sound like a business, but that’s exactly the point. Patients compare our levels of service with them rather than other hospitals.
Perhaps we’re not yet shouting that message loudly enough, or at least not in the right ears.
Handy’s Curve and scepticism
The simplicity chapter also describes Handy’s Curve. This is a well-known phenomenon in general management where any new initiative takes a short period to amass expertise or resources to get going and then has steady upwards growth. The sting in the tail is that by not planning the next steps or spread of the idea, death of the initiative is virtually guaranteed. The new ideas or changes need to be in place from the mid-point of the upwards curve – point A on the diagram. The NHS, as much of business, repeatedly fails to plan for the next steps early enough. Little wonder that staff get more and more sceptical about any shiny new initiatives delivering real sustainable change.
Quality improvement project
Our project started from a grassroots implementation of the solution focused practice principles in the workplace. Our local psychology department had already embraced this as their primary model. Staff were individually given personal feedback from colleagues who attended sessions as groups. Some staff groups had separate sessions leading to spotlighting and showcasing of their people and achievements.
In the future, the same principles will be used in more and more diverse areas, and the sessions at the core are being further spread locally and within teams.
Compassionate Conversations was shortlisted for the following national awards:
- BMJ Clinical Leadership
- HSJ Patient Safety Award for Changing Culture
- HSJ Value in Healthcare Award for communication.
References
1. Seth Godin’s blog www.sethgodin.com
2. Amar Shah. Embedding continuous improvement to achieve transformational change, BMJ Quality blog. https://blogs.bmj.com/quality/2014/08/06/embedding-continuous-improvement-to-achieve-transformational-change/
3. Cantley P, Finegan M, Nisbet A, O’Regan D, Gardner S, Gay T, Oldham J. Freeing up The Frontline from “Customers, Simplicity and the Frontline” from A Simpler NHS. A Simpler NHS: A fresh look at management in the NHS (Simplicity Book 1).