About being Kind and Adjectives


cropped-img_16971.jpgI am very lucky; people often say nice things to me when I work with them or meet them professionally.  Not all the time of course  – I feel sure I irritate some and that others actively dislike me but I do my best to be myself, to set my own standards and to be authentic.  I have previously blogged about authenticity so I feel confident they are responding to the real me these days.  I have relaxed into being me and increasingly only know this way.

What I find confusing though is the feedback I get and I can’t decide if it matters or if its just another thing I need to relax into, I mean is this enough?

When people say nice things to me I often ask ‘What do you mean? Can you tell me exactly what I did that made you feel x or y?’.

Their response is most often ‘you are kind’.

kindnessI struggle with this – I wonder why kindness is something that isn’t ordinary and deserves feedback in this way.  Am I being damned with faint praise?  I’m not being disingenuous (or looking for reinforcement) – but isn’t kindness ordinary? I honestly don’t understand the feedback.  I’m not looking for more kind (there it is that word again) words but why is the quality of being friendly, generous, and considerate (definition of kindness) seemingly of note?

So I have thought about all of the adjectives I would like to be and am thinking perhaps need to try a bit harder! Here’s the list:

  • Clever
  • Musical (I think I can sing but I fear its not musical)
  • Creative
  • Loving (I need to practice this a lot more)
  • Generous (there are some things I would struggle to give away)
  • Knowledgeable
  • Funny ( I would so love to be funny – if you don’t know what I mean look up @gussiegrips)
  • Sassy
  • Agile
  • Flexible (I can’t even touch my own toes)
  • Athletic
  • Brave (r)
  • Focussed (To say I’m butterfly like is being kind!)
  • (more) organised

Don’t even get me started on the list of things I don’t want to be!

Well that’s my list for today.  Do you have a list of adjectives you would like to be described as?

Passing on the baton


passing the batonFor any of you who know me today, you might find this hard to believe, but I was often picked for the 4×4 100m relay team at school. OK – I wasn’t the first choice, probably the fourth – but, hey, chosen I was, and I learnt how to pass the baton.

For those of you who have ever run in relay you might remember being taught how purposeful that baton passing on needs to be; a process of firmly slapping the baton into the hands of the recipient, so they know they have got it and they can confidently stretch and run to the end of their leg. As I was often the second or third to run I was both the ‘receiver’ and ‘passer’ of the baton. Being passed the baton as efficiently and effectively as possible with no margins for error is a learnt skill and although my speed might not have always been what they hoped I don’t remember having a problem with baton passing.

So here I am many years later reflecting that now is the time to start to think about my baton passing technique in earnest again but it’s a slightly different race.

I was always ambitious and serious. Even when I was a student nurse, I secretly wanted to be the nursing officer or manager because I believed that way I had more influence over what happened to patients. I was shrewd, I knew that managers wielded the power to make a positive difference. I then went on to make some less orthodox choices, still related to trying to change things, and in many ways that’s how I ended up in informatics, I believed (and still do even more so) that information and technology can help citizens and patients for good.belt and badges

But I find myself at a time in my career when I’m thinking differently about the future, having conversations with friends saying things like ‘I have one big job left in me’, talking in ways I have never spoken before, as if the end is in sight. Sounds dramatic? Feels it too and slightly scary.

Perhaps its natural progression as I gaze forwards to times when I have more time to choose what I do and where I give my time and effort to making a difference in other ways – I don’t mean not working but I do mean working in different ways.

What I know is that this means I need to brush up on baton passing on again. If I hold any knowledge and skills how can I pass them on; how can I baton pass without taking my eye off the forwards race and still keep running as fast as I can?

I have written about eldership before and my thoughts keep coming back to the same thoughts. How can I help the people picking up the race beyond me? How can I make sure we don’t stall and drop any batons?

Supporting and investing in leaders of the future is what I need to do but it’s not always easy.  Broach a conversation about succession planning and people gaze at you as if you are giving up, rolling over and lack ambition – I’m not and I don’t. What I am doing is adjusting my focus, making sure I pass my baton on. Informatics is still hard, the hardest gig I have ever had, in a profession that, in the main, still seems to kick back against it despite predictions that digital is part of the future of health. So I’m focussed on finding the nursing digital leaders who I can pass the baton on to, but it’s a long time since I’ve passed any batons so I may be a bit clumsy at first but I will improve so watch out… I could be passing the baton to you! ;)hand waiting for baton

A messy unpredictable future?


Recently I was lucky to be a member of a leadership Indaba. An Indaba is a South African word often used to describe a gathering or meeting and I was with a diverse group of leaders thinking about the system challenges we see in the health and care system and this blog is my reflections at the end of the Indaba.

anne 1983I started my nurse training on 31st January 1983. As it turns out 1983 was quite an important year for the NHS too. On 6th October of the same year the Griffiths report was published. Funnily enough it was mentioned in our training; I can remember being intrigued as to why a Director from a supermarket called Sainsbury’s should be asked to look into how the NHS was run. We didn’t have a luxurious Sainsbury’s in the North East where I lived so that made it exotic and slightly strange and I confess I might have been more impressed back then if it had been M&S! Little did I know how important that report was going to be for the NHS but also my career.

Sir Roy Griffiths was asked by Margaret Thatcher to look into and give ‘advice on the effective use and management of manpower and related resources in the National Health Service’. As the Griffiths recommendations were implemented it started the evolution of a strong management culture that had by all accounts been lacking before this. Griffiths clearly pointed out that in his opinion there was little difference between NHS management and business management and the NHS went on to be restructured into a management hierarchy not unlike a national ‘for-profit’ business.

So how did that affect me? By the time I qualified in 1986 many of these structures were in place, budgets were devolved to wards and gone had ‘nursing officers’ and we had brand new ‘unit managers’ (who often happened to be a nurse). The first additional serious studying I did was a Certificate in Management, I had already been identified as having potential so this was the first thing that was suggested, and I went on to complete a Diploma in Management. I was ambitious and had a hunger for a healthy career – studying management was the way to go!

I believe that most of the senior managers in the NHS of my generation were brought up this way. Of course we need excellent general management in the NHS, probably more so than ever before, but this type of approach and culture may not be the only thing we need in 2015. Most senior managers are of my generation and if they have a career spanning decades in the NHS they too are likely to have a background context firmly embedded in general management. OrganisationManagers work through cultures of systems and order – give them a messy problem and they will seek to resolve it in a systematic and logical way. They most often seek order and control and although they believe in delegation, power is only given with a good dose of performance management sprinkled, or is it heavily blanketed, over the top. They seek organisational structures with clear and logical relationships, the right ‘span of control’ and formal reporting mechanisms that allow them to feed their external regulators. They seek to be successful at an organisational level as that means survival of their organisation – they are organisationally centric.

I was trained and educated like this but I believe that in 2015 and beyond it will no longer work. Over the last few years I am starting to see that the complex adaptive system that is the health and care system can’t survive if we behave like this and yet I still see these old styles of thinking. We often say the right things but we don’t walk the walk. So what do I mean:

1     Giving things up

In the new world working across communities, which is what we need to do, means giving up power and sometimes resources for the greater good. If we are going to change the way we deliver care it means some organisations will have to change and give up some of their share.  It takes good managers to make this happen but it takes guts to lead it.

I have blogged about this before, and I won’t repeat it here, for me Buurtzorg remains a fantastic example of siting power in organisations back where it matters, in the staff working directly with communities.

2               Dealing with messy people

Change in the way that we need it means messiness. It means small may be beautiful, that solutions delivered in local communities may be messy unpredictable and probably don’t look like to corporate solutions managers know best. It’s taken me a while to get used to this, the idea that each local ecology may be different from its neighbour but that’s how it is – messy and complex – so get used to it!

Salford Dadz for me is a perfect example of how messy can be glorious and beautiful – you can read more about it here. I’m not saying that it’s disorganised or out of control, more that its perhaps unexpected and beautiful for it – an example of asset based community development outside of the corporate systems with a unique system of its own.

3     The role of citizens and the impact of unexpected choices

Systems think they know best for people. I hear people talking this way all the time, assuming that all the expertise is in the ‘system’ and implying that there is none beyond. I do not believe this is true. Citizens, patients if you prefer, or even service users, may also have other ideas about what is the right thing to do and choose differently.

I remember working on a rehabilitation ward a couple of years ago. At the team meeting they were discussing a lady who wanted to go home. She wanted to go home despite the fact she couldn’t get up independently during the night to go to the toilet. She chose to go home and be ‘padded up’ at night, preferring her own bed and a sort of adult nappy rather than being in a care home or institution. It really made me think about the choices I might make. We may have some way to go with personal budgets but I think they could provide a way for people to make different choices. As system leaders we will need to help to make these things a reality even if they mean breaking up what we know and throwing it away and living with unexpected choices.

4     Finding energy where it smoulders

digitalawards VB, RL, AC

Lovely Victoria Betton, wonderful Roy Lilley and me kicking off the #PDDawards15

We need to find the energy where it smoulders, in communities, in people, in hearts and let it burst into flame. As well as the Indaba I have been helping Victoria Betton (@victoriabetton) to deliver the People Driven Digital unAwards – a celebration of people and solutions that come from the ground up. We had the award ceremony on Friday 3rd July (you can see the nominated people here) and its humbling to hear about people finding solution to problems for themselves. Yet we do little in the way of supporting these people, our systems are bureaucratic and laborious, almost impenetrable – we need to take some of this red-tape away to let the smouldering passion burst into glorious flames – this is how we can find new solutions. By the way the solutions came from everywhere, not just ‘patients’ but from staff, students and citizens with a drive and ambition to make things better. It was humbling.

5     Networks

connections 2I think John Kotter is right that in addition to formal systems we need to have in place there is a role for networks that sit alongside. The role of networks is the more creative change work, whilst letting managers get on with making sure the books balance and the operational services remain on track. These networks need to operate beyond the boundaries of organisations and may be populated with unexpected people. These will be the people who want to make a difference, the ones who are smouldering with the passion to do things differently and they will drive the change. Gone are the days when networking was just about careers now it’s about doing real business, making connections that drive and shift the whole system ecology.

So all in all the last year has been great for thinking. The last few years have helped me to perhaps evolve past the manager I was trained as in 1986 and I look forward with to the messy unpredictable future we face.

never stop learning

Charting the passage of time


 

My favourite shot from 2014

My favourite shot from 2014

Some of you will remember last year, on the final day of my 50th year I had some photographs taken with my best friend. We went to Scarborough and had fun having a series of lovely photographs taken in the fresh air at Scarborough Spa. I enjoyed it very much. I found Jess Petrie, the photographer, totally by fluke – I wanted a female photographer, who I thought was up for middle aged, some fun but also someone who did natural photography – no studio shots for us.

So one year on – I sometimes get funny ideas – and those photos and the pleasure they gave me, gave me ideas…. What if my BFF and I had a photo shoot with Jess every year for the next decade, charting our 50’s? A sort of record of our aging.

Leeds-Portrait-PhotographySo that’s the plan and I hope we make it, taking nothing for granted. I will count each year as a blessing and watch as we grow older, hopefully with grace!

Each year will have a theme – this year I chose shopping in Leeds, a place I love very much and Max and I used to work and have often shopped together.

Here are a sample from #Taketwo 2015

You can find out more about Jess Petrie, our photographer here. She is a wonderful photographer!

Leeds-Portrait-PhotographyLeeds-Portrait-PhotographyLeeds-Portrait-PhotographyLeeds-Portrait-PhotographyLeeds-Portrait-PhotographyLeeds-Portrait-PhotographyLeeds-Portrait-PhotographyLeeds-Portrait-Photographyanne max book shop

Trying to make it look easy


I stand. I’m not quite sure what to do, the lights are flashing, I look up to see if I can work out what I’m supposed to do but I feel confused. I know I need food but I also have to pay and I just can’t work out where the tills are. I don’t know how long I stand there, minutes, but I know I need to move.Diabetes

I had been busy, focussed, trying to fit stuff in and get everything done. I had popped out to buy a present for a girl who was leaving and we didn’t have too much time so we needed to crack on. I suspect I felt a bit light headed then but I was absolutely focussed on task, it was only afterwards that I realised I needed to eat.

No matter what everyone tells you about being prepared, that’s all fine, but when my brain is struggling and thoughts are fuzzy I am not always as logical as I could be. I did have hypo treatment tablets in my bag but I seemed to have forgotten all about those. Believe it or not in a city centre buying food, preferably fast acting junk food, isn’t as easy as it sounds. I bought some Jellies from Thornton’s and crammed a few into my mouth, barely chewing, merely trying to ingest as quickly as possible.

Sometimes, for some reason that doesn’t always seem to bear any relevance to logic, it seems harder to bring my blood glucose up. It’s a rare event but nevertheless happens now and again. I needed something to drink, something with sugar. I knew what I needed to do. I walked through the shop doorway and stood.drinks

I stand a while. No one seems to notice. I close my eyes and try to think. I walk a few steps, wander past the isles. I see a fridge and eventually a grab a drink. But where are the tills? I feel mildly panicky. I can’t drink the drink without paying can I?

This happened to me two weeks ago. I manage this day, as I have managed for 36 years. Eventually I feel marginally better and slowly make my way back to the office. I tell no one and get on with my work. I know that there will be an inevitable rebound high so I keep a close eye on my blood glucose but giving myself more insulin seems counter-intuitive and I worry – too little and I will feel rubbish through ketones, too much and I will bounce down again…. It feels a little bit like Russian roulette.

I tell no one because I don’t want pity. I get on with some work but pack up early and make my way home.

I feel like I have the worst hang-over ever. My head feels sore and slow, my brain reacting to the lack of glucose, objecting and asking me to slow down.

Somehow it seems worse, the recovery, as I get older. It takes me longer to bounce back, to be on top form. This time the feeling of other-world-ness and being in a different space to everyone else persists for another day.

Type 1 Diabetes is hard. It’s a bit hard every single day but that’s OK. But just sometimes it’s more than hard, it’s disabling and frightening.Jelly babies

Do you know what it’s like to feel seriously hypoglycaemic?

Here is what a few of my twitter friends with Type 1 said when I asked them:

IMG_3687

Me and my unofficial carer! He looks lightly scared I know!

Reflections on becoming a befriender


I think it was the autumn of 2013 but it may have been earlier; I watched the Hairy Bikers presenting a programme about trying to set up a meals on wheels service in Slaithwaite (pronounced Slawit) which is not so far from where I live. There was an old gentleman who cried when they arrived as he hadn’t seen or spoken to a soul since they had been the previous week; my heart broke.Loneliness empty bench

I mulled it over. Thought about it. I knew I wanted to do something but what?

I find the thought of loneliness distressing. This article from the BBC website  shows how people in 2001 were less connected to their communities (anomie) in 2001 than back in 1972. Age UK campaign to bring attention to the loneliness amongst older people:

 Loneliness is key indicator of social exclusion/disengagement and is a significant problem for older people. Approximately 10% of those aged 65+ in England report severe loneliness with a further 32% moderate levels of loneliness which represents 777,690 and 2.2 million individuals respectively. Loneliness has important negative consequences for both older adults and society being associated with a range of negative health, social and service use outcomes. Rates of mortality for older people who are lonely are reported as 50% higher; emergency hospital admissions are a third higher and GP consultation rates 3 times higher compared with their non lonely peers.

http://www.ageuk.org.uk/documents/en-gb/for-professionals/research/loneliness.pdf?dtrk=true

But Age UK, as I do, also recognise it is a complex problem.

As a result of these musings I decided at the start of 2013 that I would become a befriender. I made a public declaration on Twitter as I know if I say things out-loud I am more likely to do it.

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Friends

The story of my quest to do so is described here  on the blog site of Gill, otherwise known as @whoseshoes .

I did eventually find a way of helping. A great local charity that primarily offers Childrens’ and Learning Disability Services eventually found me on Facebook.

This is my reflection of the journey since then. I have thought hard about writing this down as I did not want to breach the confidence of my friend so the blog is focussed on the reflections from inside of me.

anniecoops Grandad and Trixie 1979

Granddad and Trixie. My grandparents were lucky. we had a close family and they lived in a great community.

The process of being matched to someone who may be lonely is an odd one for the use of the word ‘friend’. You are first (and rightly) checked over and then matched by the charity to someone who you might be able to help. I was complicated to match as I have little time – I’m time poor generally especially during the week – so it had to be weekends. I was almost matched with someone who needed some relief while they were caring for their partner with Dementia. But the be-friending service don’t like you to do that as its seen as more then be-befriending; that made me feel bad as I knew I could easily do that if I had more time. Eventually though I was matched with a lady who is much younger than I had anticipated.

It’s very surreal – my friend is so little like me. We have little in common. Our life patterns are so very different and even our family backgrounds but it’s amazing what eventually creeps through. The relationship is not what I expected. I suppose I expected it to be cosier really, more like the elderly people that I have cared for over the years but it’s not that, not that at all.

At first I found it quite hard. I had to draw on my natural communication skills (Yikes) but has time has passed its getting strangely easier. I try to go at least once a week and if I can’t go I try to ring. Even that is hard now I’m back to working full-time but we manage. When I arrive the kettle goes on and I am presented with my coffee in the same blue mug each week.

I know she likes me and my company – I can tell. I always ring to say I am planning on a visit and she always sounds pleased. I always do what I say I am going to do, keep my promises. We are not allowed even to take gifts but I sneaked two cheese scones down once and she said she loved them. Last week she had some photographs out to show me, her family past and present.

The thing that I have learnt is that loneliness isn’t always what you think it might be and you can be a comfort for people by just showing you care. My friend has family who visit rarely and can get to the shops but I think she is lonely despite these things.

I’m glad I made the commitment and intend to carry on for as long as I can and she wants me to.

When I retire I also plan to do more. I would absolutely love to set up a #henpower project and who knows, now I have said it out louds perhaps I will. You might want to as well if you watch this video – the Hen Men . See what a difference it can make – this project is also a great example of impact.

If you want to explore being a befriender Age UK have some information here:

Or check out Contact the Elderly here:

And look out for more information about hen-power here:

If you want some help if you are lonely please check out the Mind site here:

My little talk for #PDDigital15


This is the warm up talk I gave the evening before #PDDigital15 on 13th May 2015

I happen to have Type 1 Diabetes.

That means by default I am a data monkey; what I mean is someone who is concerned with data all day long, every day.

Raw data

A pile of test strips. Each one a finger prick. Each one a data point.

Diabetes is all about information. Yes, it’s also about your toes and their potential to fall off but it’s also about how we as individuals manage (or don’t) lots of information. This little bag is full of real raw data – a pile of test strips. Each one represents a finger prick and a result showing my blood glucose.

I’ve never been very good at meticulous writing down of numbers. Perhaps my attitude to my diabetes is the issue; it’s not my life, it’s just part of it. When I was diagnosed (in the olden days) the GP came to the house and knocked on the door to say I needed to go into hospital (we didn’t have a phone) but I was out with my boyfriend on his motorbike. I’m not sure my attitude to my health has changed very much!

In the years that followed I was never very good at it. I did test, sporadically, my blood sugar but was always poor at writing it down. It seemed to be the biggest pain in the bum ever. First of all I had to test my urine (yep in a test tube) and then it was what were called BM sticks. Each test took around 5 minutes from start to finish. Five minutes is a long time when most of it is spent watching the colour changes on a small stick. I had lots of things as a young person I would rather be doing! I had a blood spotted book I tried hard to write things down in…. boxes on forms in a little book.

But I never did.

new meter 2

My new meter – they do get better every time :0)

Innovation has always been important in diabetes care. The move to near patient testing where we were given blood glucose meters was a brilliant shift. It was almost life changing and is a great example of Christenson’s disruptive innovation – putting the power – information – in the hands of patients. Suddenly we had a meter that was accurate and over time the time taken to run a test got less and less. But we still had the little books, the need to write things down remained. I know I started testing more when the testing time gradually went down to the 5 seconds it takes today.

What health care professionals think matters isn’t in my experience actually what matters to patients and that’s part of the point of ‘People Driven Digital Health and Wellbeing’. Patients/people/citizens driving developments in the things they think are important.

So I test up to say 8 times a day; 8 data points every day plus all the data from my beloved insulin pump, the other innovation that has changed my life with diabetes.

Yet here we are in 2015 with few ways to analyse my data. Many of the solutions still involve multiple data entry – the 2015 version of writing things down in a little book. It’s just not the answer.

Why? What are the issues?

The first is that there is analytical software but the suppliers seem to think my doctor, who I see once, or maybe if I’m lucky twice a year, needs the data and the analysis tools more than I do – makes no sense. I make micro and macros adjustments every day to my regime – staying well and managing myself. The suppliers have created a system that allows the technology to send data to my doctor and them to use tools to manipulate it but only gives me the most basic functionality. The suppliers market to the doctors and nurses in an old paternalistic model where the clinicians are ‘in-charge’.

The second reason is they are trying to fix the wrong problem. Designers make assumptions about what matters, create solutions, then try to lock us into their system. In my experience they rarely listen*. I want something that is focussed on simple speedy collection of data – no duplicate entry please, and something that allows me to do trend analysis, that’s why I call myself a data monkey.Jelly babies

To cure these issues we need open APIs and standards that allow systems to talk to each other and allow us to move our data around!

Of course there are some very clever people who have diabetes or have children with diabetes, why wouldn’t there be? Brains are not exclusive to those people in the system. In the USA a movement started called #wearenotwaiting. A group of people with a vested interest who decided they would hack into the back of all the equipment we use, pumps, testing meters, analysis software and create something for us. They believe they can create the first closed loop system for diabetes faster than the system can. Of course I know this is a risk but I do believe this is the best hope for us for someone to create something that works for us and gives us more control.

Sadly we still have a long way to go. I know from my professional life that people in the system still think we should be creating solutions so doctors can see the data we enter and that is seen as the issue, whereas I believe we should start with the person with the Long term condition and meet their needs first. Taking a look at #wearenotwaiting would be a great start.

So, for those of us in the data game, every day, even Christmas day, we survive doing ratios, trend analysis, and measuring. We need better solutions and need to be more involved in their development, even in control, in order to get the pace and scale of development we need.

#PowertothePeople

  • Just a postscript to say I collected my new insulin pump the day after the conference – it has some nice new features so perhaps someone is trying to listen! Thank you Medtronic but please can I have the better analytical software? I think I might want it more than my Diabetes Specialist Nurse!

Diabetes