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Making healthcare more human: Creating enabling conditions for staff

Aggie Rice 16 April 2018

Reflecting on last month’s ‘Making healthcare more human’ conference, Aggie Rice looks back on how the day’s contributors addressed the need to create conditions for healthcare workers to thrive.


How do we create the conditions for staff to thrive in the workplace, to feel engaged, and to be able to provide compassionate, human care? In the final section of our ‘Making healthcare more human’ conference, speakers and delegates were invited to consider these questions and come up with solutions and priorities.

Otherness

As part of an expert panel representing a range of healthcare staff describing ‘when I am at my best’, Heather Caudle (Director of Nursing for Improvement, NHS England) cited the notion of ‘otherness’ within the system as being a key impediment to her thriving in the workplace. Amy Stabler (Northumbria University) highlighted hierarchy, and Tracy Boylin (independent HR expert) attributed toxic language such as ‘human resources’ as an impediment to a compassionate and human culture.

Feelings of otherness, isolation and hierarchy were reported by many delegates as obstacles inhibiting the provision of human healthcare. These divisions exist across the system in many forms: ‘practitioner-patient’, ‘clinical-non clinical’, ‘frontline-manager’, ‘nurse-doctor, ‘clinical-support staff’.

Circle of care

We know that staff wellbeing is the antecedent to patient wellbeing, and indeed this underpins the rationale for organisations to run Schwartz Rounds for staff. However, this conception of the relationship between staff and patients as one directional, may foster this feeling of otherness that staff and patients find problematic, and equally perpetuate hierarchy, isolation and fragmentation. Further, it serves to isolate patient care as within the confines of the consultation room, failing to acknowledge the care given by support staff, who often feel undervalued.

Performing Medicine, who also contributed to the morning’s programme, have developed an animation depicting care as not “something that flows in one direction, from professional to patient, [but in] a circle in which care flows in all directions – between staff at all levels, patients, their relatives and carers and friends and where healthcare professionals also care for themselves.” The video also illustrates strategies, represented as spokes in a wheel, that individuals, teams and organisations can use to enable care to flow freely and for staff to be able to deliver the quality of care they want to. These include such things as self-care, teamwork, spatial and situational awareness, and appreciation of the person. They also include leadership, which was described at the conference as ‘not a role, but an activity’ and, crucially, as not restricted only to those in managerial roles.

Visualising the relationships within healthcare systems amongst staff, patients, families and carers as circular rather than one-directional may help to remove these obstacles to human care of otherness, hierarchy, isolation and fragmentation articulated by Heather and her fellow panellists.

Medical knowledge as the other

One strategy to reduce hierarchy and otherness in the clinical setting appears in the book In Shock by Dr Rana Awdish who describes how, since her time as a patient – and the insight into the lived experience it afforded her – she now conceives of her medical knowledge as the ‘other’ rather than the patient. She and her patient can exist in any exchange as people, without their relationship being defined by the fact of one party holding the knowledge and passing on information to the other who does not possess the knowledge.

Following the panel discussion, delegates brainstormed practices and strategies that could be used or embedded to create a culture that enables staff to feel valued, engaged and able to care in the way they would like. Randomised Coffee Trials, the reintegration of social spaces and time for ‘liming’, mindful acts of kindness and positive feedback, self-care and Schwartz Rounds were all noted as ways in which organisations can foster a culture of compassion and humanity. On top of more simple interventions to support staff such as car parking, 24 hour canteens and clearer financial processes.

Final thoughts

Professor Jill Maben in her keynote address closed the day with a reminder that ‘yellow hats are not just for builders’. Hard hats are fundamental to the health and safety of builders, who work in a recognisably dangerous physical environment. Healthcare workers, though their environment may not be so visibly dangerous, should also benefit from protective strategies to support their physical and psychological health. It is through such support that we can create the conditions for staff to thrive, and thus improve patient care.