Guest Blog – Afni Shah-Hamilton

Please welcome our guest blogger, Afni Shah-Hamilton.  Afni graduated from University College London in Podiatry BSC (Hons) and completed her master´s degree at Kings College London. She has years of experience in biomechanical problems of the lower leg, specialist knowledge on how diabetes and cancer treatments affect the feet and how to treat ulceration and has seen and treated hundreds of common problems like athlete´s foot and verrucae.  Afni has also been trained in acupuncture to help treat conditions of the lower limb such as painful plantar fasciitis. Afni previously worked for Southwark Foot Health Department in conjunction with Guy´s and King´s College Hospital. She also worked for the Society of Chiropodists and Podiatrists as a Learning fund Project Worker and was involved in organizing a numbers of courses and learning events for them as well as liaising with members of the profession and other medical professionals.

http://www.tiptoefootcare.com/

@AfniShah1

Afni has also experienced the NHS as a patient on a number of occasions; in particular in relation to the birth of her two boys.  Over the coming weeks we will be sharing her story as a serial blog related to maternity safety.  What we will be doing is sharing her story and then picking out a theme which relates to her experience of aspects patients safety in the NHS over the last five years or so.  These will be posted one by one over the coming weeks.

First a bit of context; Afni has severe allergies to wheat and gluten and this means that she is also allergic to a large number of medications. She is also from Asian heritage, as well as being naturally small boned and thin.  These will be important as the story progresses.  Also just to relieve you as a reader up front, despite her poor experience Afni has two healthy boys.

Over to Afni….

As a patient all I want to do is feel safe and cared for. But my experience, like many patients, is that lots of little things impact on this feeling.

It is rarely the one big event, it is much more insidious than that, it’s like a snowball; there are lots of things that go wrong which build and build and build so that the overarching impact is that of feeling unsafe.

The instances of unkindness or lack of caring, which for us (as patients) are safety issues, can linger on in your memory for some time and do affect your future encounters with other healthcare professionals.  There is ultimately a loss of trust.

On the positive side – as a patient you can almost instantly know when an organisation takes your safety really seriously.  You can feel it, you can see it and it makes a world of difference.

I will share with you via a series of blogs my thoughts, feelings and experiences of the different parts of the NHS who were involved in the births of my two sons.

So this is my story. 

My first pregnancy started with me being sick at around 8 weeks. However, this didn’t feel normal.  I was being sick all day not just in the morning and I was feeling permanently nauseated.  I started to feel really quite ill – I was progressively becoming dangerously dehydrated and my weight was tumbling down.

This I didn’t realise was the start of hyperemesis

Hyperemesis Gravidarum (HG) is extreme sickness – almost continual nausea and vomiting all day long, which can cause dehydration, ketosis, weight loss and low blood pressure – along with feelings of isolation and despair.

I went to my GP who I have to say was fantastic then and throughout. She really made me feel like she understood what I was going through but she also didn’t know quite what to do to make me feel better.  She provided me some medication to help with the nausea but the unceasing vomiting continued.

My first appointment with the midwife was not nearly as helpful as my GP. She did not understand the severity of my sickness and said ‘you’re having a baby so get flexible’.  I was left feeling at a loss; she didn’t take my condition seriously or understand how my allergy made the condition worse or the implications of potential drug issues such as the inability to take certain pain relief or antibiotics during labour. So despite my signs and symptoms and my obvious distress I felt like I was being dismissed as someone who was complaining too much over something that is considered to be a natural part of life.

Hyperemesis is a severe and debilitating disease  – you are unable to eat more than a few bites of food at a time, and only occasionally would they stay down.  Unfortunately, there is no known cause, and no proven cure. For many women the variety of medications only help take the edge off the worst of the symptoms — and some women with severe case are hospitalized for the entirety of their pregnancies. It takes a mental toll, but it is not a mental illness.  The saddest thing is that you feel miserable at a time when it should be one of the most joyous times of life.

With hyperemesis you can barely muster up energy to read a book let alone go out and about.  This impacts on your partner, your family and all around you. One of the worst things about it is how isolating it is. I could not go out, or talk on the phone for a long time because it made me feel sick.  However, many healthcare practitioners seem to be unfamiliar with hyperemesis and we are often classified as having a “mental condition” and told to just “get over it”.  This is simply not true — it is a physiological disease, one that must be treated aggressively and compassionately.

There is nothing more potent than being in the presence of someone who just wants to listen to you. That is, someone who is both open minded and open hearted; someone who does not get restless as you are talking (ref: David Naylor).

Conversation is a powerful thing. Done right, it can lay the foundations for future relationships and the creation of the right culture.  Sadly many patients do not feel that they are being listened to or not being heard and if heard definitely not understood. There is a great talk that sums up the key issues related to conversations by Celeste Headlee:

 

Celeste Headlee has worked as a radio host for decades, and she knows the ingredients of a great conversation: Honesty, brevity, clarity and a healthy amount of listening. In this insightful talk, she shares 10 useful rules for having better conversations. Within this Celeste says – people teach you all about how to listen, what you should do with your eyes, your body language and so on – but she says if you are really listening, then you are really listening and you don’t need to worry about what you should be doing.

See @signuptosafety and www.signuptosafety.nhs.co.uk for more ideas on having better conversations.

 

 

 

 

 

The campaign just recently attended Patient First conference where we held a Campaign Kitchen.  We had hundreds of visitors to our kitchen, enticed by cake but also enticed by the ability just to sit down and have a conversation with someone about their work, the highs and the lows and what we might be able to help in terms of just listening, or provide some ideas or advice or create connections with other people doing the same thing.  Have a look at our twitter account; @signuptosafety for comments and pictures and our amazing Campaign Kitchen Cartoon.

We were truly humbled by how many people stopped by and how willing they were to share their hopes, dreams and challenges.

I shared our work in helping people talk to each other with one or two of our kitchen guests and they asked me to write up the trio method, so here goes.

The Trio Method

The campaign team have been experimenting with holding conversations about safety.  These might focus on an incident or a programme of work or implementation of a solution or a moment of excellence.  We have written about this in other ways; here in my blog, on the campaign website and in our newsletter.  Some of our members have come to these conversations and then gone back to their organisation to do the same there – we will be sharing their stories over the coming months.

There are two suggestions that go down really well with our members:

• holding a conversation shortly after an incident
• holding a conversation between the organisation’s leadership and frontline staff

ONE; Holding a conversation shortly after an incident

This is where on the same day as an incident or a combination of incidents (there never is just the one thing is there)… all members of the team come together and sit in a round.  There is a facilitator who is someone who can bring the very best out of the conversation.  I have steered away from the word debriefing because I am told this has connotations of blame and people are immediately cautious when they think they are going to a debrief but they are much happier if they are joining a conversation.  This is not an interrogation, nor is not a substitute for an investigation if one is required.  There are two main reasons:

• to explore what happened as close as possible in time – so that there can be some quick learning and maybe even pick out some immediate actions needed

and

• to support everyone involved, to truly show people that they are cared for when things go wrong and not so that they end up by going home (perhaps even alone) distraught and unable to cope

It is quite fascinating how the key contributory factors that may have led to the incident happening are often identified at this time and that there are some consistent themes pretty much every time.  This feels so much more proactive that filling out an incident form.

TWO; Holding a conversation between the organisation’s leadership and frontline staff

People tell us that they feel there is a bit of a disconnect between the leadership of an organisation and the frontline.  This is one way you can address this.  It is applicable to a GP practice as much as it is to a provider trust or ambulance trust and so on (i.e. this can work for everyone).

Presuming there are around 12 people or less on your organisation Board or leadership team.  Divide the team into trios – one speaker, one active listener, one observer.  A topic or question is chosen: this could be …..

‘how safe do we think our organisation is and how do we know’ or ‘what kind of safety culture do you think we have in our organisation?’

The speaker is given a minute or two to think about what they want to say so that it isn’t a rush or jumble… then they answer the question based on their own story, their own thoughts and feelings.  They talk for around 10 minutes.

The active listener and observer sit respectfully and really listen to what is being said – only when the storyteller has finished can the active listener then ask clarifying questions (questions that cannot be answered with a yes or no)… this is not about them telling the story teller what they think or what the answer is but seeking more detail.  This usually takes no more than 5 minutes.

The observer notices what is being said, what questions are being asked and then notices the key themes that may be coming out of the story.  The three of them then talk together and agree on a metaphor or visual image that may summarise the story; e.g. it looks light a flock of starlings in flight, or it feels like we are all hitting our heads against different brick walls.  This again usually takes no more than 5 minutes.

So a total of 20 minutes to have a really important conversation.

At the end of this – depending upon the time you have, you could swap roles and do it all over again so that everyone gets their turn to share their story.  However many you do, even if its just one round, the facilitator of the group draws the themes and metaphors into the open so that all can benefit from the individual trio conversations.

This process can then be replicated with frontline teams – all over your organisation and even in really large events with hundreds of your staff.  Same process.  The exciting bit is when you gather the themes and metaphors you can start to look for similar themes and where they may be gaps between the teams and between the frontline and the leadership.

The final step is then to bring the two together and hold conversations between leaders and the frontline staff.  This all along has been your goal – to enable both sides to hear each other’s stories – and to truly listen to each other.

The ingredients you need?

• Great facilitation
• Time
• Venue that can enable you to position people in trios (similar to the world café events)
• Cakes !

Any questions just contact us at signuptosafety@nhsla.com