Exploring New Territories

It was a usual morning with an early start at 6 o’clock to get the train from Wakefield to London. It was all pretty much typical, Costa coffee in hand and sat waiting patiently, shivering, on the station platform, as I always arrive early. As is also usual, I’m filling in those pockets of time with my Twitter feed on my beloved iPhone and I notice that the HSJ were announcing their first ’Social Pioneers’. As I do, I flick it open and the first thing I notice is a lovely picture of the lovely Teresa Chinn. Then as I scrolled down, there I was: gobsmacked – me a ‘Social Pioneer’?

I am passionate about how information empowers. Information can bring independence and create changes and shift in social order. So bringing information to nurses can enable them to improve their practice, see things in new ways, revolutionise and encourage improvement as well as spotlighting where things might not be right. For citizens, information can drive real change, be disruptive in creating new paradigms of systems and behaviours; I think that ‘Patients Like Me’ is one of the best examples I can think of that shows this; have a look at this story to see what I mean:

Frustrated ALS Patients Concoct Their Own Drug’ The Wall Street Journal, April 15th 2012

This powerful very short TedTalk from Stanley McChystal is about how having the confidence to open up information can make significant differences to what happens and illustrates my point too.


‘Information is only of value if you give it to the people who can do something with it’ Stanley McChrystal 2014

‘Sharing is power’ Stanley McChystal 2014

So what has this got to do with me being a ‘Social Pioneer’?

In around 2010 I discovered social media. I’m naturally curious and experimental so, curiosity prompted, I wander into social media. Wandering is a good description – I had little knowledge beyond being a Facebook user, no skills and little insight = scary!

What I discovered was a space that I think has huge potential for nurses but also those people who have health needs – it has the power to transform some aspects of how we use information.

What I also discovered amongst the nursing community was a reticence, anxiety and resistance and sometimes all of these things are still present. It frustrates me sometimes that I sense a lack of professional confidence about using social media and experimenting with its potential amongst many nurses. I also discovered people who I now realise are social pioneers, people with long term conditions and experiences of the health system that I started to follow and watch – I was amazed.

I saw the huge untapped potential that I believe social media offers us. Yes, it breaks down boundaries and flattens hierarchies, but it also has the real potential to change the very nature of the power based relationship between systems and people. I also believe it still has untapped public health potential but it has to move beyond broadcasting to achieve the possible.

So in 2010 I decided that one of the things that was needed were some role models in nursing that showed what could be achieved and as no one else (other than a few notable exceptions like Teresa @agencynurse and a few other pioneers) were taking that on, I decided that I would. If I was to show the power of social media I needed to ‘show’ it, not just point at it; doing presentations about social media is one thing but living it is another. So my ambition was to be a good role model for nurses in social media. That’s when the real pioneer journey began. My delight on being identified as a social pioneer was partly to do with feeling that it was evidence that I had, at least partly, achieved some of what I had set out to do.

In my journey I also discovered a very eclectic diabetes community and I am proud to say that I have also been part of that, making I hope, a contribution based largely on my 35 years of living with type 1 diabetes but of course combined with my other skills and knowledge. I have written with another social pioneer – @parthakar (whom I have never met in real life but know that I will 🙂  )  about the use of social media in the professional interface between professionals and patients – this would never have happened without Twitter. Here it is:

‘A New Dawn: the Role of Social media in Diabetes Education’

pionee signpost

Famous signpost with directions to world landmarks in Pioneer Courthouse Square, Portland, Oregon

That’s why the word ‘pioneer’ was the part that gave me the most satisfaction when I read the piece in the Nursing Times and Health Service Journal supplement. I was also cited alongside many people I greatly admire – each has made a unique and significant contribution. I was delighted that the write up picked up some of the very things I was trying so hard to do, rather than just my level of frenetic activity! That’s exactly what I set out to do, to start to chart the new territory of social media for patients and nurses and other people who are part of the big NHS and social care extended family and I hope I am a little part of an enduring story.

FlorenceI also came to realise that being called a ‘pioneer’ gave me great satisfaction for other reasons; I have always taken on roles in leading (and sometime ‘bleeding’) edge environments; complaints management in 1990 (listening to complaints then was not what it is now), NHS Direct, the National Programme for IT and informatics is still, in its own way, pioneering. There is also the point that nursing has a strong history of pioneers like Mary Seacole and Florence Nightingale – fantastic role models.

So on Wednesday I celebrated with a very large piece of cake!

Anne Cooper – ‘Social Pioneer’ – who would have thought it! Now where is the next territory to explore?

So that’s enough about me (a very self-indulgent blog this week AnnieCoops!): A very big thank you to everyone who was kind enough to nominate me (you know who you are), the Nursing Times and Health Service Journal and the lovely judges: Jenni, Andrew, Shaun and Emma. But also I couldn’t be social without conversations and it is those people who increasingly have the confidence to share, debate, support and push conversations in social media that I need to thank. Your conversations, blogs, video blogs inspire me, help me to grow and learn, support me and enable me to see new futures – thank you.




My response to NMC and the revised Code

The Nursing and Midwifery Council in the UK is consulting in a second round on ‘The Code: standards, performance and ethics for nurses and midwives’.  This round of consultation follows a 6 month consultation on revalidation and links a revised code to the revalidation process.

The Code is the foundation of good nursing and midwifery practice, and a key tool in safeguarding the health and wellbeing of the public.

Since the last drafting of the Code social media has become an increasingly prevalent part of modern society; not just for nurses but also for the public they serve. As such, I am grateful that there is a reference to social media in the re-drafted code – it is important that the regulator and the professions recognise the emerging need for digital professionalism, that is the need for principles of personal and professional nursing practice to be applied in a digital space.

You can see the draft code here

This blog post contains the consultation feedback I will be offering in relation to point 114 relating to social media.

First of all it is important to point out that the code is also supported by NMC guidelines relating to social media that can be found here:

This is the current draft wording in The Code:

‘114. You must ensure that you use social networking sites and other forms of electronic communication responsibly and in-line with our guidance, in particular by not referring to employers, colleagues or past or current people you have cared for’ (page 19)

Of course the use of social media is also governed by other parts of the code, for example:
Maintain clear professional boundaries (page 7)
Uphold the reputation of your profession (page 8)
Be open and honest and act with integrity (page 8)
You must respect people’s right to confidentiality (page 10)

The main issue that concerns me relating to point 114, and what I consider to be responsible professional digital behaviours, is the draft wording ‘not referring to employers’. I do not see how this is needed as part of the code. Social media platforms often allow professionals to include details of their employer in a profile statement and indeed LinkedIn (a widely used social media platform) allows the use of an on-line CV where past and previous employment is cited. If nurses and midwives are also following the other parts of the code detailed above then the addition of ‘employer’ in this list seems overly restrictive.  I do not understand why nurses and midwives are unable, should they wish to do so, give details of where they work, in an open and transparent society.

I would propose that more appropriate wording could be:

‘You must ensure that you use social networking sites and other forms of electronic communication responsibly and in-line with our guidance, in particular by respecting the confidence of colleagues or past or current people you have cared for’

I would also recommend a subsequent review of the guidelines for use of social media by nurses who are skilled and understand the medium to take account of the emerging use of digital media in supporting patients, for example school nurses who are using Facebook to support young people and the use of social media for providing peer connections for patients with long term conditions.

If you would like to make your voice heard as part of the consultation – whether you be a member of the public or a professional – you can do so here:

These is my personal consultation feedback, as a registrant, and may not be the view of my employer.

social media network

On being a ‘hard done to’ bottom

Learning is a funny thing isn’t it? – The things you remember and then those things you don’t. I’ve had my learning muscles tested recently as part of my Organisational Development Practitioner Programme which I chose to do as part of my Florence Nightingale Foundation Burdett Leadership Scholarship. My instinct was right, by the way, there is much useful learning in OD for people interested in leadership. I know that some of the theories passed me by and weren’t retained in my pooh bear sized brain but some things have stuck and some of the systems thinking from this week has definitely stuck; it’s all about tops, bottoms and middles.

organisationsThe theory is quite simple; people in organisations adopt very predictable patterns of behaviour and that breaking out of these is what we need to do before we can really achieve but of course changing behaviours is a real challenge for all of us. Systems thinking is from work by Barry Oshry that explains that organisations are broken down into ‘Tops’, ‘Middles’ and ‘Bottoms’ and that each of these, naturally as part of a system, moves back to unhelpful behaviours that create many of the organisational issues we face. This week we did the organisational workshop to experience the system workings of organisational life in a way designed to magnify these natural and unhelpful behaviours that manifest in the worlds of Tops, Middles and Bottoms; before you say you are never a ‘Top’ etc we all occupy these roles at one time or another, they do not necessarily reflect organisational status (but they might). I had great fun 🙂

The process of allocation to a role in the workshops was random and I was delighted to find myself as a ‘bottom’. That’s where the fun started! I have to say that although in my role I wasn’t unhelpful nor was I as focussed at first as I should have been and I did revert to the behaviours that Oshry would have predicted, for me this was to withdraw to almost a playful space. I was experiencing true ‘bottomness’.

Those of you who have done the organisational workshop will understand significance of this picture :)

Those of you who have done the organisational workshop will understand significance of this picture 🙂

Oshry predicts that people will revert to an unhelpful behaviour and unless we can break from this we will perpetuate the same issues over and over again. Tops at times of pressure suck up responsibility and become ‘burdened’. Middles slide into the middle between tops and bottoms and become weak and ‘torn’. Bottoms hold higher ‘ups’ responsible and become ‘oppressed’. Oshry also explains that Customers also fall into a pattern of unhelpful behaviour where they become ‘righteously done-to’.

Sure enough, as the great workshop panned out, all of these behaviours were exhibited. My bottomness centred on a feeling of no one telling me anything and therefore I didn’t know what I was supposed to be doing so along with my mates we had a grand old time – playfulness as withdrawal.

Oshry goes on to explain that we chose how we behave and that these patterns do not need to persist – we can chose to be different.

Partnership is the key and changing and transforming our relationships can stop these behaviours and stop recreating the organisational patterns.


A relationship in which we are jointly committed to the success of whatever project, process or endeavour we are in.’

Partnership 2We can chose to be part of what he describes as the ‘side show’ where we make up stories about it and evaluate others as malicious, insensitive and incompetent or we can take the centre ring and have understanding and empathy for others, staying focussed on the best outcome and take a wider view where you take into account the perspective of others. Tops should take a position where they focus on developing responsibility throughout whole organisation. Middles should maintain independence of thought and act in service of the whole system. Bottoms should take responsibility not only for their thing but also for the whole thing.

I think I recognise Oshry’s organisation in many places I have been in my career, where ‘stuff’ happens and I also recognise my own unhelpful behaviours in those he describes. I can also adopt some of the more helpful behaviours that move to a better position of partnership. If you ever get chance to do the organisational workshop I would recommend you jump at it; it certainly fits with my experiential model of learning.

There is no way I will forget being a hard done to bottom and also the need to stop those old behaviours developing, even without thought, and I will try to take a more helpful partnership position.

You can find out more about the organisational workshop and Barry Oshry here and here.

Nursing, research, knowledge and practice

knowledgeI had a really interesting Twitter conversation yesterday.  It was about research and evidence, stemming from a conversation where I said I would be unlikely to attend a research conference. I suspect that I am now also going to appear very stupid although I am not sure I am – I know I can synthesize information and indeed reach robust conclusions from information presented to me – but I often find understanding research papers challenging.

I find the way many research papers are written impenetrable. They use language where I have to look up the research terminology to enable me to understand. And I just don’t get it – surely passing on the knowledge is the single most important thing that you have to do? Research that adds little value as its meaning is lost in complex and obfuscated language is also adding less value than a well written and clear piece of research?  That is, of course, assuming the research is well constructed, undertaken, analysed and presented!

I know I can understand the evidence, after all I scored well at University having done a systematic review and I actually enjoyed my dissertation once I got going but some of the research papers just do not hold my attention if I have to work too hard to find and evaluate the meaning.
There are materials around that can help – I came across this blog by Calvin Moorley, that is clearly written and helpful but understanding these things isn’t necessarily the answer. This assumes research papers are well articulated and clear – but often in my experience they are not!

magazinesAlmost everything we do in nursing should be based on knowledge – that is the critical space between experience and applied evidence. The speed at which new evidence and materials comes available is also a challenge – how can I possibly keep up to date in all the areas of nursing practice that I am interested in, and synthesise it with my existing knowledge?

When I started writing this blog I went to explore some evidence to see what I could find to illustrate points but I found some good stuff, stuff I didn’t know, and I could understand, but I would never have found had I not been writing this blog! It’s impossible to be on top of the whole evidence base and live and work! It would be a full-time job 😦

So what does it all mean? Well, I think this is now about nursing knowledge management; an area of practice that we discuss little in nursing but I believe is increasing in importance. Benner describes the development of skills through novice to expert but in 2014 the ability to practice at expert level taking account of new emerging evidence is challenging.  We need knowledge workers to help us find meaning from new emerging areas of research.

There are some bright spots on the horizon. The recent find of the Evidently Cochrane blog site has encouraged and motivated me to be more engaged with research. The knowledge management part is taken care of, studies assessed and evaluated on my behalf in order that I can assimilate the research evidence quickly and develop knowledge in my practice. For example, I have always been cynical about risk assessment, always feeling that perhaps it wasn’t quite doing what it intended to do, and up pops my friends at Cochrane bringing my attention to this work that was debated on a great @wenurses chat recently – you can see the chat here. Another example of taking evidence and using a twitter chat to increase nursing knowledge.  I also value highly the KCL Policy+ that is published regularly, aimed at current areas of policy focus for nursing.

So what does this all mean? It means that researchers need to write research findings in an accessible way that can be quickly turned into knowledge by practitioners and we need more knowledge brokers like the brilliant Cochrane people who work hard to help everyone access new evidence. Writing in simple accessible language is not dumbing down, in fact I think it’s much harder to write clearly in non-technical jargon so perhaps that’s the real reason research papers are often difficult to understand – writing simply and well is much too hard! The Cochrane site aims to translate evidence in to meaningful understanding for everyone and thank goodness I found it!knowledge 2

Where is your change preference?

figure headSometimes life throws you an opportunity to explore something new or even explode things you thought you knew. Often you think you know what enthuses you but then you surprise yourself; I once surprised myself white-water rafting in the Ottawa River – I was like the figure-head on the front of a ship, holding on bravely – but I digress! This time it was a new opportunity to explore and expand some knowledge.  As part of my Florence Nightingale Foundation Burdett Scholarship I have been very lucky to spend some time at Roffey Park  and a few weeks ago I was there looking at change management.

So we looked at a number of theoretical change models. That was interesting enough; I knew some and was less familiar with others. Then the interesting bit started, we tried putting them along a scale according to what I have termed humanist > mechanistic approaches. What I call humanist are what is termed ‘relational’ where enabling techniques like World Café, Future Search and Appreciative Inquiry have their place. At the opposite end of the spectrum was more mechanistic project management type approaches, that are less messy and are organised in a more logical flow led by theorists such as Lewin and to a degree Kotter; they have a more linear and analytical style with techniques like business process mapping and lean methodology. Of course the scale is not a scientific one and it is matter of personal interpretation and perspective.


I had a sudden moment of clarity. The process of learning led me to think about my personal preferences and how I liked to think about change. I discovered that although I see that different approaches have different strengths and weaknesses, I had a personal preference for the type of approach to change that I liked to be involved in. I also saw that not only had I personal preference for any approach to change, that I worked in organisations that equally had a culture with a leaning towards an approach, and finally that there was an opportunity for discomfort and tension in this.

BridgesMy favourite model was a new one to me and is a model called ‘Transition Management’ based on the work by William Bridges. It refocuses change into transition, which is the psychological transition and reorientation required in response to change. I loved the idea that before we can transition we need to address endings and then we inevitably experience a neutral zone, a period of chaos and an in-between time. Then the process of renewal starts. I loved the language of this model. Words like: endings, relationships, resistance, disorientation, beginnings and new identity. If you want to know about Bridges have a look at this article here.

Gant chartSo, I like a particular approach to change but I work in an area that clearly can’t use that approach, you can’t introduce new software using appreciative inquiry – you need good Gantt charts plenty of them! If you work in the large scale programmes I work in you are nobody if you don’t have a Gant chart or a RAG status!  But I survive there despite my preferences – I had to think hard about why!

My conclusion was that I am able to see that its appropriateness that matters most and having people around who have the skills to use the right approach. Organisational development people are not one-trick ponies they need to be able to work out what is the best way and then use it. I’m just glad that with my preferences for relational models of change I work with some great people who have skills at the other end of my change spectrum – It made me think about difference and value it even more!

At a time where there is a need for unprecedented change in the NHS, understanding our personal preferences and leanings as well as the embedded culture of organisations and their almost instinctive responses to the need for change has to be important learning.

standing out from crowd

The importance of partnership and mutual respect

knowledgeI think I’m probably a ‘knowledge worker’. I didn’t know anything about being a knowledge worker until I got a new brilliant boss who has the brain the size of a small planet. Once she got to know me and how I did my work she told me I was a knowledge worker and one who capitalised on networks, building relationships and connecting people. The work on knowledge workers and the role in how we organise work is quite interesting but it isn’t the focus of this blog – if you want to read a little bit more then there is a link here to work by Rheinhardt et al (2011).

One of the downsides of being a knowledge worker, along with the need to be up on your game at all times, is it can be quite lonely – you sit at the edge of most groups; your role is to move around and bring and take knowledge. It’s true that I am often not a central member of a team; I move in and out and hopefully add value along the way.network

Working as a nurse in informatics means that my role is often to act as a translator between IT folk and nurses; I have to have enough knowledge to be able to explain the perspective of the other group and work hard to bring the groups together, as I know that if people from technical backgrounds work more closely with the clinical and patient communities then the success of any project is more likely or it is more probable that a better solution will be found. It’s also a bit like a facilitator of co-production! If you want to know more about this I recommend this video. The need to see it from both sides is essential and the knowledge worker uses knowledge to facilitate learning and understanding from both perspectives.

Unfortunately in informatics it leads to seeing both the best and the worst of people. Over the last few weeks I have become frustrated by how people blame others about lack of progress. I have worked with some brilliant IT people; clever, caring and dedicated to working to make health services better, their drive to do the right thing sometimes shocks me, even now after 10 years of working with them. Clinical staff are not the only ones who care. Of course nurses are like this too, most nurses strive to do the best that they can and improve and I have witnessed this many times in the last 30 years.
Why is it then that I still hear one group blaming the other for a problem?

  • ‘The IT staff don’t understand us and what we do!’
  • ‘IT just give us the kit and walk away – they never listen’
  • ‘The nurses are not interested in IT really because they will never engage’
  • ‘Nurses never come to our meetings’

What I see is that all these things are true. But there is a risk that if we continue to blame we fail to recognise that the single most important thing that we need to do is learn to work productively together; for nurses that means making the IT folk your friends and listening to their ideas and plans and for the IT folk, it’s respecting nurses and helping them to understand the potential of IT.  Why not go out with a district nurse if you want to understand or get down onto those wards?

The boundaries that seem to exist are not real but I am getting exhausted climbing over the wall between nurses and IT!

partnershipSo my piece of knowledge that I’m trying to share is that if we are going to innovate using technology the relationship between clinical staff and technical staff needs to change to one of partnership, mutual respect and trust. It’s the only way we can do this.

PS Shhhh: Dear nurses – I always find that cake is helpful when you want to have a difficult conversation with IT 🙂  I make a mean Victoria Sponge 🙂 Cake

Seasonal gifts of learning

2013 14Well another year is almost coming to a close. I quite like the sense of endings and new beginnings, although I confess that these days I’m much less of a party animal and am much more likely to see the end of year out in a quiet and hopefully thoughtful way, with a bit of feasting maybe and looking forward!

lightbulbThis last year has been a great one for me (#Annies50th) but it has been also stressful and frantic, with new jobs, extensions at home and a fantastic exploration of the social media world. One of the things that this digital world has been great for, second only to the amazing people I have met both virtually and increasingly face to face, is for learning; that is expanding my thinking, sometimes blowing a hole in my previous ideas. It’s been a wonderful exploration, that I hope will continue.

So my gift to you are the three (almost 4) TED talks that have made the most impact on me, along with a couple of Vimeos.

The first is a TED talk that I first saw this year while I was on my Organisational Development Practitioner Programme. I have watched it many times since. The talk is about perspectives, how life is made up of overlapping stories of contrast and truth – and is well worth the 20 minutes. It’s a stunner and worth a reflection for all leaders and healthcare practitioners:

Chimamanda Ngozi Adichie: The danger of a single story

The second is Brene Brown, after my last blog I was pointed back at her talk about vulnerability.  This is about humanity and our acceptance of vulnerability.  Again for Healthcare Professionals (but everyone too) its worth a listen.

Brené Brown: The power of vulnerability

The third is Susan Cain; for me this TED talk is about understanding others and taking at deeper look at myself.  I am definitely not introverted; I love people and always think out loud with others.  In fact I’m terrible on my own, a weakness I know.  Watch Susan Cain  to think about yourself and how you connect to others but also and probably more importantly how to value difference.

Susan Cain: The power of introverts

Now a couple of Vimeo videos:

The first I have mentioned in a blog before.  I remain convinced that in the future co-production, sharing, integration, and social responsibility will become the most important things we do.  This video by explains why co-production helps:

The Parable of the Blobs and Squares

The final Vimeo video is from the wonderful @wenurses where they created a celebration of why people are proud to nurse. It is important that as a profession we keep our identity and be proud.  Its been a difficult year but this video gives a sense of what we have and how strong we are:


Finally I would like to wish anyone who reads this a happy, healthy and successful 2014.

happy new year

Post Script

There was another TED talk that I considered including but its not for the faint hearted.  This talk by Philip Zimbardo is about why nice people might turn ‘bad’.  It contains some hard hitting images.

Philip Zimbardo: The psychology of evil

The hardest thing to say out-loud

It’s not very often I’m asked to talk about having Type 1 Diabetes – I’m usually in some nursing or informatics forum or talking about social media – but a few weeks ago I was delighted to be able to go to talk to a group of MSc nursing students in Nottingham. I had a great time. I came away with a real feeling of optimism for the profession. I hope they enjoyed it – some of them are likely to read this and I have no doubt they will tell mDiabetes sugare…..

While I was telling my story something strange happened, something cathartic and afterwards I realised I had never said some of the things I said to this group out loud, in fact when I said them I could almost feel the group do a sharp intake of breath, a moving back, a sitting up straighter; I don’t know, something shifted, moved as if they started to really listen.
So what was this revelation that I made? Difficult as it is for me I have decided to write it down.

Moving homeIn 1989 we moved house. It was the first time I had ever moved and I found the whole experience exhausting. We started early and finished late, running around, packing, unpacking and dealing with problems. I remember that I probably didn’t stop for food but my husband’s Mum made us some tea (that’s dinner in the North – just in case I am confusing you), I suspect I didn’t eat so much of it, as I was so tired – too tired to eat. I remember we hadn’t had chance to assemble the actual bed so we fell exhausted onto our mattress on the floor of our new bedroom. I woke up some hours later with paramedics in the room and no idea why they were there or indeed where I was.

It transpired that I had had a hypoglycaemic attack (a very low blood glucose) and I hadn’t woken up, caused I suspect, by my acute tiredness and lack of eating. I had fitted, a full blown seizure, and it was the scariest thing you can imagine. My poor poor husband had called an ambulance – I had been in a full-blown non-epileptic seizure, with loss of consciousness and convulsions and he was also very scared – it wasn’t one of the things I had warned him about!

Home - I didn't let it happen the second time we moved to this house.

Home – I didn’t let it happen the second time we moved to this house.

I can’t describe how this feels even now. I am someone who likes to be in control and to think that I was in a state whereby I didn’t know what had happened still makes me feel frightened. When people talk about avoiding hypoglycaemia at all costs, even when it means poorer control and all of the things that go with that, I completely understand.

This is hard to say out loud. I have no idea why. I fit at night if my blood glucose is low and if I am so exhausted that I don’t wake up. Why do I find that so hard to say? I think I know why and it’s the reason why I am writing this down.

Even though this is still hard to say – ‘I fitted’ – it wasn’t actually this that created the tension in the room with the students – so what on earth was it? When I fitted I was incontinent of urine and I wet the bed. I used exactly those words – ‘I wet the bed’. The room felt different and they were listening to me in a different way.

There are some things that still feel taboo, that carry a stigma and I think that having ‘fits’ is one of them and that I have internalised this based on my experiences and society around me during my lifetime. Internalized stigma is felt within the person with the condition and reflects their feelings, thoughts, beliefs and fears about being different (Muhlbauer, 2002). The fact that the students seemed unfazed by this confession was counter-balanced by what happened when I said that I had ‘wet the bed’. It wasn’t just me that noticed – there was someone with me on that day who commented afterwards, independently, ‘Did you notice what happened in the room when you said you had been incontinent of urine?’ I don’t know what made me say it – I had never said it out loud to anyone before – not even to my other half. So here we seem to have another social taboo, one that I had internalised.

Urinary incontinence is a really common condition affecting more women than men. If you simply google ‘stigma urinary incontinence’ you will find a plethora of articles about it. So, it seems that some topics are still hard to discuss. Writing this down is hard and it feels difficult to say; I feel that I might be judged as different and that this might mean people treat me differently.
tabooI have not experienced a seizure, or indeed urinary incontinence, for years now, mainly through improved control, because of my beloved insulin pump, and through more care and diligence around testing. But the fact is that it has taken me almost 15 years to say the words out loud make me feel sad. Many people live with conditions such as incontinence and as a result of the stigma attached to this do not report it to healthcare professionals who may be able to help. My hope in writing this down is that it helps to create conversations about some of these taboo topics that impact on so many people lives.

To find out more about urinary incontinence here is the link to the NHS Choices webpage.

Muhlbauer S. 2002. Experience of stigma by families with mentally ill members. Journal of the American Psychiatric Nurses Association 8:76-83.

Perceived Weirdness Index and Leadership

Sometimes I think I can be seen as being a bit eccentric and to be honest I quite like it; although it doesn’t mean I am fond of being the centre of attention. I often feel on the edge of things, not quite mainstream, sometimes it’s fun, other times it’s lonely. But is my eccentricity something that can be a help?who are you

I have been studying the practice of Organisational Development (OD) recently as part of my leadership scholarship and am learning lots of things that I think have equal applicability in a leadership space. OD practitioners use the concept of ‘self as instrument’, understanding that any intervention has an impact and think carefully about how they act, think and do – their presence. I think leaders could usefully think like this too. I started to wonder if my perception of ‘self’ and my presence might be something to do with how I affected things around me. Presence can be thought about as impact created by personal appearance, manner, values, knowledge, reputation, and so on. So, if ‘self’ is important in leadership interventions, is my possible eccentricity an advantage or a disadvantage?

There is a fascinating idea first described by Halafin (1976) called the ‘Perceived Weirdness Index’ (PWI) that I came across exploring the OD literature. Your PWI may make you more or less effective as a change agent. The PWI is a spectrum of behaviours with a ‘sweet spot’ where you are not in the mainstream of the organisational culture but just weird enough to be at the edge, the theory being that if your PWI is just like everyone else’s you are less likely to be successful at effecting change as you are absorbed into the organisational culture but if you are in the ‘sweet spot’ then you can be more effective as a change agent.pwi

Are the people who you think are change agents just a bit weird? Where do you think your PWI score is in your workplace? How different are you? All very interesting thoughts!

odd one out

How to make a good idea great

ideaI love it when I have a great idea; I want to offer a unique contribution in life that makes things better for people but I don’t know about you, I often find out that something I thought was a great idea has already been thought up by someone else.

It’s hard to identify truly unique ideas, especially in health where many of us are thinking as hard as we can about how we can do it better. I spend a lot of time with people who are enthusiastically thinking up plans and ideas about really important things. But there is one thing that struck me recently – why do people not ask around and join up with other people who may also have thought up the same idea, make the idea great?

 “The whole is greater than the sum of its parts.” Aristotle


Sometimes it’s about self-confidence, the confidence it takes to ask. I see much great work going on and I spend many hours trying to connect people together. I see people struggling with the same issues as their neighbours in other hospitals, communities, homes and work. I think we need to work harder at connecting, at liberating ideas and allowing them to be solved by networks and communities.

For once I’m not just talking about the power of social media – I mean literally talking to each other. I don’t believe anyone needs permission to find collaborators and to share. Why do we persist in thinking in organisational silos?

So, my musings for the last couple of weeks lead me to the conclusion – we need to get out more!

So, if you have a great idea:

  • Talk to as many people as possible about your idea;
  • Look around and find out if anyone is working on the same idea or problem, the internet (and twitter) make this so easy!
  • Has someone already had your idea – can you elaborate their idea and make it even more fabulous?
  • You don’t need permission to chat to other people – go on, seek out networks and communities;
  • Ignore hierarchy – good ideas come from everywhere and your idea may well be the unique one everyone is looking for; and
  • Don’t be afraid to share – my grandma used to say you will always get back more than you give.

DreamsAll those nurses and midwives out there that I meet – go and talk to your neighbours; wards, hospitals, communities and never be afraid to keep dreaming new dreams.