Monday, December 23, 2013

Another Take on "Making Every Contact Count"

To those non-NHS types, forgive me for another "care-orientated" post.  Much of the last two years have been massively dominated by my nursing role and my proud membership of the National Health Service - and hence my blog does tend to represent my current passions.  I do still maintain my theological/spiritual interests and have a few subjects brewing - but this one is a post that could not wait!

"Making Every Contact Count" is a very important initiative in the NHS at the moment - we are realising that as health professionals we have a unique position of serious responsibility and privilidge with the patients under our care and their families.  Mistakes in the NHS have been made in the past where care has been delivered but not in the right way.  One of my NHS heroes - Chief Executive Officer Sarah-Jane Marsh said (in a CEO briefing at her Children's Hospital in Birmingham);

"It is not just what we do that matters, but the WAY we do it".

Consider nervous parents accompanying their young child to have their tonsils removed - a relatively minor procedure in context.  Imagine if the surgeon did his job and removed the necessary tonsils, but their entire hospital experience was negative.  Say the surgeon was brisk, rude and dismissive and the nursing staff pre-and post operatively did their job and monitored the child but gave the parents and child no compassionate care and support.  The objective may be achieved - removal of tonsils - but the family and child could and would be scared by such a negative experience.

THIS is why it is not enough to simply have competent NHS staff treating the patient.  We MUST have compassionate and caring (AND competent!) staff who support and defend the patient and family from admission to discharge ensuring the whole point of contact with the NHS is positive.  "Making Every Contact Count" is a vital initiative used in the Birmingham Children's Hospital at present;

But I did find myself wondering if many nurses, student nurses and allied health professionals like myself struggle to come to terms with what actually; "every contact" means?  Does it mean if we are simply taking our parents a cup of tea we should sit down and commence a sermon on smoking cessation?  Surely not!  So it was while thinking these matters through that a common motto came to my mind;

"When a butterfly flaps it's wings in Texas, it causes a tornado in China".

This is in other words known as "Chaos Theory".  It is technically defined as; "a minor change in circumstances can cause a large change in outcome".

I am not entirely sure if healthcare professionals are entirely aware of the enormous potential of their actions (and contact) with patients and their families - whether positive or negative.  The Mid-Staffs scandal demonstrated the hideous enormity of negative contact - and it is a nightmare the NHS should NEVER forget.  But something the Chief Nurse of NHS England - Jane Cummings - is vitally reminding the negatively-biased media is that POSITIVE experiences also have a crucial impact.  

Many nurses (and I have been guilty of this in the past) have come to work at times bringing "home life" with us.  Aches, pains, heartaches or simple headaches - have meant that we as healthcare professionals have not been "properly" operating in the "6Cs" framework we should to truly impact our patients and families for the good.  It may seem little to us - a more formal sober greeting of our families after handover and perhaps a distinct lack of smiles and easy small-talk during the shift than perhaps we may do.  This may seem like just an "off-day" to us.  But what of the impact on our patients and their families?  That "off-day" may be their ONLY contact with the NHS during their lives - and the impact they take away is our lack of smiles, care and - presumed - lack of motivation to give them the patient experience they need.

When a butterfly flaps it's wings ... a tornado happens.

When a nurse smiles at a patient and family (even though his/her heart may be breaking due to a recent family dispute) a positive tornado of change and impact happens and that family may leave the hospital or care setting with a positive experience of trust and confidence in the NHS.

When a butterfly flaps it's wings ... a tornado happens.

When a nurse sits with a devastated, bereaved family and is seen to visibly shed tears, that family may leave the hospital knowing that they were cared for (even though the outcome was not what they hoped) by a human being who was impacted by their loved one.  The loss - still and always devasting in the extreme - will be tempered by the fact that they did not suffer it alone as though on a factory production line ("when's the bed available?") but as an event that impacted the healthcare professional with them at the time.

When a butterfly flaps it's wings ... a tornado happens.

When the worried and anxious family sitting in the Accident and Emergency Department, so concerned about their loved relative suffering beside them, are brought a cup of tea by the nurse and an apology for the wait and an explanation - suddenly the nightmare fear that "they just don't care" evaporates and the slight reassurance (though the concern for their relative remains) that humans are in charge and that they are not just another number in the queue potentially breaching their "targets".  But the experience they take away is that they are told and explained that the department is horrendously busy and prioritisation of care is taking place, but their relative is not forgotten and is under observation (even though it does not seem it) - ANY deterioration in health will be responded to swiftly.

When a butterfly flaps it's wings ... a tornado happens.

The devastated parent sitting with their terminally ill child on Christmas Day looks up as yet another nurse comes in to deliver the required chemotherapy (even though the parent knows it will make the child sick) the difference cannot be expressed if the chemo nurse comes in smiling and compassionately open to what the child needs and does his/her utmost to deliver the necessary medication but with the right approach.  That effect will last with them forever, just as a rushed, brutally efficient but distracted nurse who charges in, injects the medication and rushes out without comment.

When a butterfly flaps it's wings ... a tornado happens.

A family sits in a busy Outpatients department worried sick about the appointment with the consultant.  The results are in and in a few words they will be told whether they have a positive, rosy future full of hope and promise - or further worry, dread, more appointments, "maybes", "I hope" and other subject phrases spoken by healthcare professionals.  The Outpatients department is running drastically behind schedule and the worried family know they are now 30 minutes behind their appointment time.
To be approached by an Outpatients nurse who sincerely apologises for the delay, explains the reason and asks if they need anything (an English cup of tea never goes amiss!) will create a tornado of effect, even if the news from the consultant is negative - as compared to a stressed, harressed nurse who is charging around (to the family's view - and they DO see everything) accomplishing little - who then snaps that; "Dr So-and-so will now see you.  Quickly!".

There are many, many more examples and scenarios that could be cited and may ring true with healthcare professionals across the NHS.  But I hope the few examples that have come to my mind will prove my point.  I believe fervently as current HCP in the NHS - we must, must, MUST never forget that we are in a position of ultimate privilidge, trust and opportunity.  

Every action (whether it be a smile, a story read, a hug, or a cup of tea) can have a far greater wave of impact upon our precious patients and their families than maybe we will ever know.

It is our responsibility, duty and joy to ensure that we do not just deliver "competent" care (although that is vital) but we deliver such care in a compassionate manner that thinks ahead of the actual care delivered - and anticipates and expects that our patient and their family will leave the NHS and the care with an overwhelmingly positive experience that they can remember for a long time.  Even if, tragically, the care delivered sees that precious and beloved relative not coming home - let our precious families go home knowing that their relatives were treated with the highest dignity, compassion and care possible and that they did indeed die in the "best hands possible" with their families by their side.

When a butterfly flaps it's wings ... a tornado happens.

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