17 February 2015

Preventing small problems from becoming big problems in health and care

I recently attended the 26th conference of the US Institute of Health Improvement, and had the privilege of hearing Don Berwick and Atul Gawande amongst many others sharing their reflections on the changing landscape of health and care. I was struck by the strong focus on looking for new ways to reduce staff burnout and to invest more in the human aspects of care. Having strong and resilient relationships at work was seen as key to providing sustainable care. Kindness and compassion were just as important to good care as technical skills and knowledge. Addressing these aspects of care, both for service users, patients and for professionals, was given great emphasis. Gerald Hickson spoke about the "power of an honest conversation" as an important part of this process.

Our work on professionalism reflects this pursuit of greater awareness and understanding of the interpersonal aspects of care. I am very pleased that our latest research in this area continues this exploration, and reflects the mood and direction of thinking in a wider arena. Preventing small problems becoming big problems in health and care explores the reasons behind incremental disengagement, where challenging circumstances appear to lead to concerns about practise, and eventually to a complaint. Patients and service users in the study recognised the pressures and challenges of delivering high quality care, and the need to ensure professionals were supported to do their jobs well.  They said they wanted to be seen by professionals who were compassionate, communicative, and consistent in the care they provided.

Feedback from professionals in the study highlight the links between poor supervisory structures, lack of peer support, professional isolation and disengagement from practise. Disengagement was characterised as a symptom of underlying, often longstanding issues in the workplace which could be addressed and might be resolved before complaints arose. Not rocket science to anyone working in health and care services, but nevertheless important to the debate about what needs to change.

I was struck by words from Atul Gawande who spoke about ways in which services and professionals must evolve in response to the changing needs and expectations of society. A strong advocate for team based care, and the need to break down hierarchies amongst professionals.

Gawande suggested that "The relationship between clinicians and institutions has been like a tenant and landlord relationship. Clinicians expected to be left alone by their landlords to do what they did. But now, it has changed. Thinking about what happens in hospitals and clinics, and allowing others in, has become crucial."

This notion of "allowing others in" is enormously complex. At one end of the spectrum, this means allowing reflection and self awareness to generate those honest conversations with trusted colleagues at an early stage, as a means of addressing problems early on. At the other end of the spectrum, it can mean investigation by a regulator. Between the two ends lie conversations and interventions by managers, educators, and professional associations. My hope is that our work with Zubin Austin, Carole Chistensen-Moore and Joan Walsh will help to generate more activities at the reflective end of the spectrum, and reduce the activities at the regulatory end. It is in everyone's interest to prevent harm, to reduce complaints, and to see more emphasis on support, kindness and compassion in health and care.

Anna van der Gaag

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