Getting the relationship right – reflections on the Transforming Patient and Staff Experience conference
27 November 2014
Rebecca Myers, Director of Integrated Care at Basildon and Thurrock University Hospitals, reflects on her own life and career and how listening to multiple voices helps to ensure a richer understanding of patient and staff experience.
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Having always been interested in the relationship between the social and natural sciences and their influence on us as individuals and as a society, I knew the “Transforming Patient and Staff Experience” conference would be well worth attending.
The event prompted me to think about my experiences as a former nurse, carer and now Director of Integrated Care at an acute hospital.
Thinking back to my nurse training, three areas of study greatly influenced my approach to work: my role as an advocate for patients who were unable to advocate for themselves; the work of Isabel Menzies[i] on the way staff develop social defenses to protect themselves from the emotional labour of care; and Ivan Illich[ii]’s work on the iatrogenic nature of harm in healthcare (ie. the extent to which harm is the consequence of medical treatment).
As I waited for Professor Trisha Greenhalgh, an expert in the use of stories and evidence in healthcare, to speak I found myself reflecting on a Board meeting several years ago. The Director of Nursing, one of our Medical Directors and I presented the results of the patients and staff surveys – together. Not done previously, this approach illuminated something not considered by the Board before – the importance of ‘the relationship’.
Using both narrative and numbers, we invited members to reflect on their ‘story’ and what we needed to do to not only transform the experience of patients and staff but the relationship between them. This led us to, amongst other things, the commitment to pilot Schwartz Rounds. Schwartz Rounds gave staff both a temporal and metaphorical space to reflect on the impact of the work of caring, directly and indirectly, for patients. From the first Round it struck a chord and as the Round meetings continued and non-clinical staff and Board members attended, it facilitated different types of conversations and deeper levels of understanding of both the pleasure and challenges in delivering compassionate care in a highly pressurised environment.
Narrative through stories and numbers
Trisha illustrated the power of narrative through stories and numbers using the current Ebola situation as an example. Trisha emphasised the completeness and incompleteness of stories, where we pick up subjective fragments of situations and how they continue to be retold and edited so that they evolve, building new meaning and connections as they get repeated.
She spoke of the different forms of ‘data’ and challenged the belief that just because information is presented as a number, doesn’t mean it is true.
What gets heard?
Over the years I have often found myself struggling to convince various medical colleagues of the value of stories and qualitative data – a position which is reflected in wider society where the ‘objective’ gets privileged over the ‘subjective’ and the simple over the complex as we try to produce certainty.
Too often, in my view, the qualitative data is rejected or the story dismissed as an “isolated incident.” The phrase “lack of robust evidence” – translated as not a randomised controlled trial – can be used as a barrier to trying something different.
In an environment that values one form of ‘knowing’ to the exclusion of another so much is missed and, as Robert Francis reminded us at the conference, warning bells don’t get heard.
What I have learnt over the years is that within healthcare there is a large body of clinicians who do value qualitative evidence – often the educationalists – and it is to these people that I often go to look for support in identifying opportunities for improving services when the numbers are lacking. Afterall, it is learning or relearning that is at the core of change.
Who gets heard?
As I listened to conference speakers I thought of my own experience as a carer for my mum. The numbers on the CCG’s budget statement and continuing care assessment were at odds with our view as the family. We believed that mum, in the terminal stages of Alzheimer’s, desperately needed NHS-funded care. I was struck by how often we hit the target (in this case, the financial and CCA targets) but miss the point (the need to provide family and patient centred care). And again, whilst difficult, we need to look at the numbers and listen to the stories to really “get it” and understand how we are doing.
The importance of ‘and’
As an NHS manager I am very well aware of the importance of numbers. I regularly look at public health data on local trends in long terms conditions, referral rates by local practices and breakdowns of expenditure across the health and social care budgets. I look at national trends to see how we compare and evidence of national and international best practice. I study staffing levels, turnover and skill mix both within the hospital and across primary, community and social care and, at the same time, I am interested in what sits behind the data. What is the local community telling us about their experience of care and what they value? What is staff’s experience of trying to provide care in the current climate? How do we support them in connecting with the joy of their work as well as protect them from burnout and disengagement?
Wittgenstein said that, “knowledge is based on acknowledgment” and thus for me in order to ‘know’ I believe we need to acknowledge there are different, yet equally valuable, forms of data.
By drawing on these different data sources we will stand a better chance of achieving a high quality patient andstaff experience – something to be kept at the forefront of our minds because, just like the use of numbers and narrative, it’s important to get the relationships right.
How does your organisation explore and support the relationship between staff and patient experience? Please let us know your thoughts in the comments section below.
The conference, “Transforming the experience of patients and staff: the power of stories, case histories and numbers” was held on 5th November, 2014 and was hosted jointly by The Point of Care Foundation and The King’s Fund.
[i] Menzies-Lith, Isabel, 1960. “Social Systems as a defense against anxiety: an empirical study of the nursing service of a general hospital,” Human Relations, 13:95-121.
[ii] Illich, Ivan, 1975. Medical Nemesis: the Expropriation of Health.