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The urgency of slowness

Patrick Cullen 23 September 2016

Patrick Cullen investigates why top-down transformation creates so little positive change and suggests that leaders need to slow down and trust frontline staff to improve care for patients.


A lot of our work at The Point of Care Foundation involves training individuals and small teams across many different locations and in a diverse range of settings.  Because of this, it can feel like a scattergun approach; we know our work positively affects many individuals, but does that create a knock-on effect on their organisations more broadly? Can we measure the improvements in patient care that result from our work?

The difficulty of measuring our impact stems from the fact that we do not just teach technical skills; we go deeper, showing people how to start new conversations; to ask new questions; and to work in new partnerships to create lasting change.  We want staff and patients to challenge the status quo and to take a different approach, one that is more human and compassionate.

The fundamental premise of our work is that solutions can be found within the teams and organisations we work with.  I was very struck by a blog I read recently, written by Cormac Russell, which describes Asset-Based Community Development (ABCD).  ABCD is a movement that aims to build stronger, more sustainable communities for the future by building on the skills of local residents, the power of local associations, and the supportive functions of local institutions.  I think healthcare can learn from the approach, which aims to strengthen communities by focusing on “what we do have, not what we don’t have”.

How can we meet the needs of patients?

Large-scale efforts to transform services tend to focus on making the NHS more efficient or integrated, because people perceive that there will be a knock-on benefit to patients and staff.  In reality, these efforts are often doomed to fail, because they start by asking the wrong question: ‘how can we cut out waste and save money?  The question they should be asking is ‘how can we provide care that meets the needs of patients?’

When transformation is built around the needs of patients, then the efficiency savings follow and you end up with less waste, but if you start by trying to cut waste, the patient doesn’t feel the benefits.

The difficulty of the second approach is that it requires trust and patience on behalf of organisational leaders and national bodies.  Leaders must realise that they will not achieve radical change unless they have the support of staff, and that staff will not be supportive unless they see how their patients, whom they have dedicated their lives to protect, will benefit.

We do not underestimate the scale of the challenge we face to make healthcare more human.  As Cormac Russell sums up so perfectly in four words, we believe in “the urgency of slowness”.

We’re not alone

We know that there are many more individuals and organisations who share our goals for a better way to do healthcare: the late, great Kate Granger; John’s Campaign; National Voices; The Schwartz Center for Compassionate Healthcare; Patient Opinion; the Patient and Family Centred Care Innovation Centre; Health Experiences Research Group; dedicated patient experience professionals across the UK; and many others.

I am encouraged by the number of people we train who spread their skills and knowledge and become advocates themselves, because the change we want to see depends on building a grassroots movement.   In a more human healthcare system, staff will feel comfortable working in partnership with patients; they will have the confidence to create change that benefits patients; and healthcare leaders will trust that lots of smaller changes will all add up to a big change overall!