Understanding the middle

Imagine a range which has at one end the status quo i.e. the way in which we continue to do the same thing time and time and time again (I’m talking safety wise, incident reporting, incident investigations, focus on error, harm and failure etc) and at the other end is ‘change’ or ‘innovation’ or ‘improvement’ whatever you want to call it (I’m talking QI project, doing change projects etc).  Now I am not for one minute saying we don’t need all of it – and even in the last week we have seen some astonishing innovations and improvements but…

What about the ______________________________________________ bit in the middle

Let’s imagine a world without the relentless collection of error, incident and harm data, let’s imagine the world without incident reports, investigations and QI.  Let’s imagine around about 1990.  Then let us think about what have we learnt today in 2020 that we would tell ourselves in 1990.

Create a through line – what is our shared purpose, the thread that combines us all – our through line – what is it today and everyday? Do everything we can to make that shared purpose a reality.  Our shared purpose? To provide the optimum conditions and support to the people caring for people who need health and social care in the safest possible way.

Collect data yes – but collect the right data and use that wisely, use it to support our shared purpose.  Really understand how the system functions normally and then how it it fails occasionally – feed that into the people who do that job/role/task/practice so that they can tweak or amend or strengthen.  Even today – collect data; what worked well today, what could we learn from today that we would want the next shift to know, what did we learn today that we would want everyone who works in the same area as us to know – how can we share that.  Share what works well, share the acts of kindness and thoughtfulness and joy, share it with the people who are being kind, thoughtful and joyful.  Let them know. Whenever you see someone do something that you thought was lovely, stop for a minute and highlight it.

  • Offer them the chance to gain an insight
  • Highlight a pattern that is already there within them
  • Help them recognize it, anchor it, re-create it, and refine it

That is learning

Be supportive when things do not go as planned – we are human, machines break, we don’t always have exactly what we need when we need it, there are not an infinite amount of resources and people and stuff gets in the way of doing things as we would like – as heartbreaking as it is, things don’t always go to plan and sometimes that leads to patients and staff being harmed.  This should be studied to see how we can reduce it, prioritise, take out things that are not needed, stop things that are not leading to our shared purpose and reduce the spikes so that the variation is less and less.

Understand the middle – what do we know about our work and how it usually works, how does it usually work so well and how do we continue to keep it working in the same way, this is really important for the people who are working in the same place / role / specialty and who are now working with people who are completely new to the place / role / specialty.  Share with them the normal routine, the normal day to day, have a heightened awareness of what you do usually without thinking – notice it, learn from it, share it with the people who you work with, are shadowed by and who you hand over. I always remember as a student nurse that first day, that first week – you knew so little, but gradually day by day that knowledge grew.  Observing what people did so naturally so that you could do the same, listening to their every word, tidying up the equipment room so you could find something quickly when you wanted it.  All those little things that kept you in the middle.

What would 2020 look like if we had started down that path in 1990?

What will 2021 look like if we start going down this path in 2020?