Compassion in Healthcare at Torbay Hospital

Last month Mum mentioned she’d seen a talk advertised in the library, it was being held at our local hospital and was being given by Sarah Tobin. It was on a Monday evening, a day I worked at home, Mum was curious and thought it might be of interest to me from a work perspective. So we agreed we’d go and I did a quick google to find some info and came across this. The event was the first attempt at a Health Science Cafe event being held at the hospital and most importantly they’d be free parking, a small but important manner. If you were to play a word association game with anyone who has had anything more than casual use of the health service I’m confident it wouldn’t take long before they mentioned parking – finding a space only being half the battle. Anyhow, I digress, this was an early evening event with free parking and Sarah Tobin, what was not to like.

Who is this Sarah I hear you ask? Sarah was one of the many professionals who provided support for my Dad, and all of his family, when he was first diagnosed and through his treatment for bile duct cancer. Specialist nurses are worth their wait in gold, they have intricate knowledge of what you are facing, have always made themselves readily available, always *always* return your phonecall if you have to make one, have the ability to unlock doors and generally give a sense of confidence in a quite daunting experience. I guess you could think of them as nursing sherpas who guide you through it all….we were lucky to have the support of several different ones and they all helped enormously.

Last Monday we arrived at Torbay Hospital, parked up and I checked in on Foursquare and was delighted to see I’d not been to the hospital in nearly six months. Dad died last November and until then I think I had visited at least every four months and in the latter stages of his life far more frequently, with a large number of visits as an emergency admission. The last time I’d been at the hospital was to drop Mum up to deliver thank you tins of chocolates to the staff who had cared for Dad. I still wasn’t really sure what to expect but off we went.

IMG_3612We were greeted by Helen, the Trust librarian who came up with the idea of the Health Science Cafe at Torbay. She had mentioned in the press release linked above that she felt it was important for people to have the chance to visit the hospital site for occasions other than just to meet medical need. One of my take home thoughts from the evening was how good it had been for me to return to the hospital that has played such a significant role in our lives over the last five years, with a positive reason. To drive up without the nagging doubts, the butterflies, the anxiety, the stress. To be honest it felt a little odd, after we’d parked up I had to remind myself that there was nothing to worry about!

The talk was very informal, there were about ten of us there although I think most people were previously associated with the hospital in some formal way. Sarah introduced herself, she now works 0.5 as a specialist nurse and 0.5 in teaching and education. She told us a little of her own personal experience, and indeed what fuels her interest in this area, and about her masters that focused on whether you can teach compassion and her current PhD studies in the same area.

She went on to talk about a number of key approaches adopted within SDHT (South Devon Healthcare Trust) to support work on compassion. These included:

Patient storytelling – this was introduced as a benefit to patients, where they are given the opportunity to share their experience. Their experience is tape recorded, transcribed and then shared with teams in a facilitated discussion designed to identify future improvements.

Observations in care – after a day long training session people are given 2o minutes to observe a ward/healthcare experience. Observers work in pairs, they note down what they see, hear and smell, purely as objective observations with no reasoning or judgement attached to them. They compare and contrast their notes after 20 mins and feed back to the staff members they have observed.

Schwartz rounds – this approach developed in the US at The Schwartz Centre and piloted in the UK by the Kings Fund provide a monthly, one-hour session for hospital staff to discuss difficult emotional and social issues arising from patient care.

Other approaches discussed included the development of a Leadership Programme for nurse leaders and ward managers, the introduction of the Friends and Family test, and Jeremy Hunt’s new requirement that nurses work for a year as healthcare assistants before training. The discussion was wider than just the steps taken to increase compassion, we also discussed the issue of complaints (90% focus on communication in some way), the changing shape of training over the years to include a greater focus on communication skills, the balance of positive to negative feedback (3:1), pride in nursing, how to gather feedback to get a hospital wide picture, the number of patients in hospital and their reasons for being there (80% of the surgery carried out at Torbay is now done as day surgery – this leads to changing methods of patient care, changing demographic of inpatients and so on).

Media Impact Mention was also made of the media and the negative expectations that many people have of hospital care, before experiencing it for themselves or those they care for. Initial analysis of the Friends and Family test feedback at Torbay commonly reports ‘it was loads better than I was expecting’. The local paper had been invited to advertise the Health Science Cafe and run a story on it, they had declined the opportunity. I can’t help but feel bad news sells more newspapers than good! Maybe they’ll get behind the later events, perhaps even send a reporter along to share with a wider audience.

Our discussion of the impact of the media also extended as far as two fly on the wall documentaries currently showing on TV, 24 Hours in A&E filmed at King’s College Hospital now in it’s third series, and Keeping Britain Alive: the NHS in a day filmed across the NHS on Thursday 18 October. I have a real interest in these documentaries, part morbid fascination with something new, part as an example of human behaviour and within that the compassion captured, part also as a reminder of how lucky we are to have a national health service.

While I imagine only certain people are interested in these programmes (best viewing figures for an episode of 24hours in A&E just top 3million people, Eastenders and Coronation Street routinely get double or three times that), that is still a large pool of people who do appear interested in this user generated content. One Born Every Minute, another Channel 4 documentary series now in it’s fourth series is set in an NHS Maternity Ward and clocks viewing figures of almost 5million; it’s not clear what exactly it is that people are interested in but I’d hazard a guess that it is part real-life stories that could as easily feature us and our family members as players that attracts them. Thinking about the three approaches Sarah had discussed one of the common features of them is reflected in this documentary approach, they all give a real-life focus and focus on the experience (of patients or staff) and allow for reflection on that experience as a prompt to identifying learning points, or building resilience, and also in humanising people.

This blog post was designed to share the experience a little more widely, partly because I was left with quite a few ideas and questions I’d like to think of further, so your own thoughts and experiences are very welcome. A lot of my thoughts were about how it’s possible to create a common team/organisation wide focus that focuses on an individual’s experience of compassion; how you define, or develop a shared definition of compassion; how you keep learning and reflections alive and tangible; whether there is enough focus on positive feedback as well as negative; how important and value laden compassion is – perspective being key; whether certain environmental circumstances are likely to reduce, or increase, compassion; and whether greater focus on staff members’s as individual’s could create behaviours among patients that increase their own chance of being treated compassionately (and vice versa)! What do you think?

0 comments on “Compassion in Healthcare at Torbay Hospital”

anniecoops says:

Hi there

A few comments – first of all I have always believed that hospitals, clinics and practices are part of a wider community; we seem to have lost this somewhere along the way. They should feel like they belong not just to the staff but the local community. The more I look at the community asset based approaches (thanks to my friend @smclrk ) the more I think that this is right. The librarian was brave though;10 people isn’t many really and its hard when local communities don’t feel able or want to respond. I’ve sat in many public sessions where only a couple of people arrive – how can we do this better?

Your real questions though relate to compassion and the trouble is I don’t know – I don’t know the answer to the question you pose and I’m going to explain why. Its so individual and unique that it almost defies definition.

I spent Friday on a ward where mainly elderly people are rehabilitated. I was really upset when I came away because there was a lady who I knew I couldn’t help. I sensed her pain, frustration, anger and even a level of contempt but she couldn’t tell me. I did my very best – I tried to listen (although she couldn’t speak) and tried hard to ‘tune in’ to her feelings. I’m fairly confident she saw hospital as a prison. I was tired when I came home, frustrated too. Perhaps compassion was the issue – I felt it and it was upsetting.

All of the approaches they described to you are familiar to me. I’ve been an advocate of story telling for a decade or more, feedback and observations from people are also invaluable (15 steps good example – linked to johari window concept) and I think Schwartz rounds are amazing. But I’m not honestly sure there is a silver bullet – more a genuine and sustained endeavour to listen, hear, feel, experience and so on and perhaps – like Schwartz rounds support staff in what is after all emotional work.

I’m not sure if I’ve answered your question…. But I hope my thoughts help

Anne

A couple of links for you x

http://www.theschwartzcenter.org/

http://www.institute.nhs.uk/productives/15stepschallenge/15stepschallenge.html

http://www.patientvoices.org.uk/

and finally but I think you are connected:

http://www.frameworks4change.co.uk/#!

Here is Andy’s TED talk too – worth a watch http://www.youtube.com/watch?v=eMelRxXl3-M

[sorry if you know all this already 🙂 ]

Becky Baines says:

Thanks Annie and George, your words have got me thinking on a quiet Sunday night.
Andy Bradley’s TEDxBrighton talk is simple and very effective. “We stand for compassion” is a great motto for any healthcare organisation.

Schwartz rounds seem to be increasingly used and discussed locally in Devon. St Luke’s Hospice in Plymouth are already using them and finding them helpful. There is talk at the Royal Devon and Exeter about using them in the acute trust, which I wholeheartedly support.
Using them as fora for reflection across an organisation seems like a great way of spreading the compassion fire.

I’m also a great believer in clinical supervision for healthcare professionals and have undertaken monthly personal reflection sessions with an external supervisor now since 2000. Sometimes I have stumped up the cash to pay for these vital sessions (I have vowed to myself never to work without them), but mainly they have been funded by organisations I have worked for.

There is precedence for such clinical supervision sessions in psychology, counselling, psychotherapy, mental health nursing (and doctoring). Balint groups in GP-land perform a similar function. Stopping to think about how one’s own behaviour and responses impacts on the care one is able to give is so important.

However, it’s not seen as vital in many organisations, and often is the first to go when clinical and time pressures are high. I hear “I’m too busy to go to supervision” not infrequently, and often reflect that it is this “busy-ness” that can act to reduce our ability to be compassionate. We all have many roles, jobs and tasks to do. Time is extremely pressured. Staff shortages and sickness are common. But often it is the simple things (like offering a patient a sip of water if their mouth is dry or making sure they have a drink within reach) that take such a minute fraction of time, but can be so helpful in letting people know they are truly cared for.

Good quality supervision is fantastic in getting individuals to reflect, learn and grow. However, often it’s seen as an add-on, too expensive or not important enough. It’s often confused with management oversight and the “rods” that are sometimes (I think unfortunately) in place to “improve staff performance”. It will be interesting to see if Schwartz rounds can bring the message of reflection and growth into the mainstream.

Anyway, probably enough of a ramble for now.

I wrote an article about clinical supervision for doctors about a decade ago….it never went anywhere, even after 10 drafts. Maybe the climate is now right to fish it out again and stimulate some more discussion.

It’s been lovely thinking about this with you tonight. Many thanks. Becky.

Dear George, Becky and Anne, I found George’s excellent blog just now, browsing on line having attended Sarah;s PhD transfer at Plymouth Uni yesterday ( she and I are train companions!) ( she passed and is now continuing her PhD on what is compassion in health care). I am passionately interested in the things that George and Anne describe thinking of, and I share Sarah’s interests in compassion and story telling. I am now the facilitator for Schwartz Rounds at RDE ( we are now running them there in partnership there with the mental health Trust Devon Partnership Trust) and doing this is one of the best things I have done in my whole career. It is so moving to enable people as staff to talk safely and openly ( letting down some of their defences) to share their feelings and cameraderie about the tough work we do as health professionals. Providing mutual support and ensuring that staff are well and happy is critical to our being able to work compassionately and effectively in hospitals. Like Becky, I am a great believer in clinical supervision and my profession of clinical psychology I hope has a lot to offer – but we are so small in numbers. the real psychological care is done by doctors, nurses, cleaners, porters, morticians etc and patients themselves with their families and friends. As an educator I am very keen that we do far more in training the next generation through inter-professional learning and patient and family participation in training. Lovely to find fellow spirits on line, and local! ! I am also a member of a southwest women’s Playback Theatre Company, Tarte Noir ( there’s also a mixed group, Mirror Mirror, who are wonderful) – we are all about hearing and sharing our stories to deepen our human connection. Our theme this term is – what frees us, what binds us.” google to look us up on line! Come along to a performance. Thanks , Annie Mitchell

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