Are you digitally ready?

The essence of the session I presented at #NIPEC18 today

Are you digitally ready? I am hoping I am!

Maybe you are expecting a technical presentation; this is not that. That’s because I actually believe that this whole agenda is about people. Its not about a list of technical capabilities – its about how people respond to technology and its about everyone in this room, so how do you know if you are digitally ready?

First of all, for context, I would like to reflect back.

Its 1983 and I am a fresh faced student nurse. Much of the technology we have now didn’t even seem possible then. We had no mobile phones and as a patient I was boiling my insulin syringe in a pan in the kitchen.

Over the decades since then I have assimilated technology into both my professional and my personal life, as I am sure you have too.

I have had no training in any of these things but I bank online, I order my meds online, I look loads up on google, I have an insulin pump and a Continuous Glucose Monitor. I love the connections I gain on social media and I use this in both my social and professional life.

I feel I am digitally ready in many senses.

But what is it exactly that makes me so?

Here are the 5 characteristics that I think make me digitally ready:

The first is that I am change positive; that is I have a positive professional orientation towards change, seeing it as an opportunity rather than something to be avoided. I like doing novel things. I was the first complaints manager at our Trust, I was part of the team that set up NHS Direct, a nurse led telephone triage service and I think was one of the early nurses to work in an informatics role. I experiment (safely of course) all the time, like I am experimenting today with you, presenting without slides. You will have to let me know how it goes!

For me being change ready means exactly that, prepared to try new things, experiment and play.

I believe that all nurses need to be change positive as nursing as its taught today is unlikely to be the nursing of the future. The pace of change is ramping up and technology is a large part of that, for example genomics and personalised medicine is likely to be come a reality in my lifetime.

I have already seen significant professional change. I used to be a staff nurse on a cadiology ward. The only way we could do surgery on someone’s lungs was a large incision in someone’s chest. It took days for them to recover. It was painful. Now, today they can do this type of surgery using keyhole surgery. Think of the massive difference it makes. It improves recovery but just think about the changes it makes to caring for these people! It shifts the focus for nursing too. And I predict it will be robotics next.

Being change ready is a good life skill as well as a professional skill too!

The second trait is Curiosity, when I mentor people I always advise them to remain curious.

Curiosity drives progress. If we are not interested in ‘what if’ then things will always stay the same.

Curious people can be intimidating though – they challenge the status quo and make people feel uncomfortable. I have often asked developers difficult questions about the art of the possible and hopefully driven better outcomes for patients as a result. Its part of being able to see a wider perspective and to be able to see how technology and data can be used to a fuller strategic perspective.

So what am I currently curious about? If we want to care for more people at home how can we lever technology to help? I visited a brilliant care home near Coventry last week where these are using noise detectors in a large home to help to identify when things happen at night. This increases rather than decreases privacy as it prevents the night staff having to actually go in to rooms at night for checks which in turn frees them up to support people who don’t sleep and focus on their ‘Wide awake club’ meaning care overall improves (and falls have reduced too). I am interested in technology like Alexa and exploring how we can use it with patients. Artificial intelligence too……. I could go on…… technology is a rich seam of interesting stuff for a curious person.

Curious people often have great imagination too and can describe how things might be, having conversations, visioning, and leading strategic change.

The third trait is a relentless focus on improvement.

I care deeply about the experience of people we care for, their carers and families. This is fed from my own long term condition but everyone has the potential to empathise.

Sometimes the status quo is fine when you are on the right side of the service. But it might be less so when you or your loved ones are unwell. It changes the dynamic and you suddenly have what I call ‘real skin in the game’.

An example:

This week I received a letter from my GP. It pointed out that I have a prescription for pre-filled insulin pens but I have no prescription for needles and it enclosed a leaflet on how to give injections. It concluded that they had set up an prescription for me to have needles.

What they failed to do was check my record.

The data they hold about me should have told them that I have an insulin pump. I only use pens as a back up and rarely use them. I have a box of 100s of needles prescribed 10 years ago that I have yet to use.

If the people focused hard on improvement using data they would have realised a number of things:

I am a pump user so don’t need many needles

I have had diabetes since 1979 and maybe sending me a leaflet about giving injections was slightly patronising (I suspect I have given more injections than the practice nurse).

I think using data is an important part of improvement science. But use it well. Focus on outcomes and do proper PDSA cycles.

I would love to know what outcome they expected when they sent me the letter.

Improving my injection technique might be the aim and I am grateful for that but they need to use the data in a better way.

Data is the lifeblood of improvement science.

If they wanted to make things better what outcome are they measuring? And how will they judge if they have made a difference.

Nurses who are digitally ready focus on service improvement informed by data! I can’t stress strongly enough that a digital ready nurse understands the value of data and the contribution it makes to better outcomes.

My fourth point is resilience. Its quite a trendy word right now so what exactly do I mean?

Resilient people keep trying. They are bouncy and in this instance keep advocating for the technology no matter how many times they are shouted down or doors slammed in their faces. When you innovate using technology it doesn’t always go well but you have to keep adjusting, reframing until you get the best outcomes.

Its OK to say ‘That didn’t work did it? Now how can we try to make it better?’ It takes a particular tenacity and resilience to safely fail and keep trying. It’s a mind set. I suppose another word for this might be an optimistic mindset.

I honestly think that technology and data create a great opportunity to make the lives of patients and nurses better. But it’s a journey. Its not a one off. It takes hard work, as an ongoing endless journey.

I have been in this space for 17 years and I have often felt like I was talking to myself.

Things are changing but digital nurses need to not fall over at the first hurdle but believe data and technology CAN make things better.

Finally trait five!

Networking and learning from each other.

I believe in stealing other peoples good ideas and building on them, if it improves care. I don’t mean stealing patents, and those type of ideas, but I do mean the sort of mentality that looks around to see what other people are doing to see what you can learn!

Social media is one way of doing this. Digital in this sense has created a whole new way of learning and communicating across the world.

Networks are a fantastic way to feed your curious traits, or your creative skills. I urge you to connect and look around. Are you well connected? Do you have fantastic networks?

I am lucky that I am often these days asked to judge awards. It shocks me how often nurses describe their projects to us and see them as unique, special – when in fact the trust in the next county or in NI or Scotland or wherever, are doing the same thing better! Just think of the potential of networks when they are cumulative for the development of ideas.

Networks are generous spaces; if you don’t believe me take a look at the Fab NHS Stuff site where people are generously sharing their ideas.

So, finally – why do I think I might be digitally ready?

The five characteristics:

I am change positive, curious and relentlessly focussed on improving the experience of service users and importantly outcomes. I am resilient, prepared to try new things and learn from others.

How are you digitally ready?

curiosity and my cat 🙂

#5things

A good friend and colleague, Dr Mark Davies, blogged this week and set me thinking. His blog was his reflections on leaving general practice having been a GP for 21 years; what things had he wished he had known at the start of that journey. This blog is my attempt to guide 19 year old Anne on her journey and career in nursing that started on 31^st January 1983 – what #5things would I like to tell myself.

They are not listed in any particular order:

Put your hand up

It took me a while to learn this but I did get it in the end – when there are jobs to be done, projects to develop and deliver – put your hand up. It doesn’t matter what the project is really and in many ways the projects that no one else really wants to do have been the most rewarding. I learnt slowly that my nursing career was often enriched by un-expected things. I think the point where I really got it was when I became fascinated by complaints from patients and their friends and families. I didn’t think what we did with these precious letters was right, so I set about looking into the process as a project for a management course. I ended up telling the Chief Executive that the organisation should have a complaints manager and that should be me. He offered me the job and I never looked back – it was one of the best opportunities I have ever had to really understand the experience of patients.

Never fail to volunteer – you are unlikely to regret it.

2. We never know the impact of what we do

I remember once meeting a nurse on a platform at a local station. She knew me but I didn’t know her. She approached me and told me that she had been a student on the ward where I had been a ward sister many many, years ago. I, sadly, couldn’t remember her. She went on to tell me how that ward experience had been fundamental to the choices she went on to make in her nursing career.

I think it’s scary to think that people watch us all the time and we may make an indelible mark on their lives. Patients will remember if we were kind, or not. Relatives will remember if we were helpful and smiled. Students will remember if we were patient and supportive.

Being watched all the time can be a burden but it can also be a fantastic opportunity to make a real difference.

Hold that thought in your head in everything you do.

3. The importance of rehabilitation

My Grandad who had COPD and always wanted to do as much as he could including walking Trixie

I learnt this far too late in my career, I wish I had known it 30 years ago – the importance of rehabilitation and letting the patient set their own targets.

I have worked in acute settings for nearly all my hospital career. I was always in settings where we were dealing with the most acute type of medicine; chest pain and respiratory failure in the main. Looking back it strikes me that we had a ‘fix them up’ attitude and ‘get them home’.

More lately I have spent a small amount of time working with a fabulous advanced nurse practitioner in elderly rehabilitation and I learnt so much.

The most powerful thing was asking an elderly patient ‘What’s the best that you think you can be?’ then working with them on helping them achieve their goal.

I believe that we should have patient driven care – the phrase patient centred care no longer satisfies me.

My learning – how can we support people to take as much control as they feel able to take and achieve their own goals?

4. Politics (small p) is not a dirty business

When I was a fresh faced staff nurse I didn’t believe I needed to understand or get involved in politics, but I was wrong. Over time I came to realise that power and politics go hand in hand and even if you don’t want to dabble in the Machiavellian arts you need to understand them. It’s naïve to think that you can get difficult things done unless you understand where the power is and how it all works. I still think it would be simpler not to need to understand these things but I now know that that is unrealistic.

Get to know where the power lies and how the system really works if you want to do things for good.

5. Love yourself and be kind to yourself

Like many people there is no one harder on me than me. I drive myself hard, I take on too much and I hate it when I do something that hurts someone or is tactless; beating myself up through sleepless nights and tears is not unknown.

But I have learnt that no-one is perfect and that I know I am essentially a good person and although I still find it hard I can forgive myself more readily.

I have learnt to love myself a little and try harder to be kind to myself.

#5things I wish I had known. I am sure there are more and these are the things that came into my head today – I am sure my learning is not done yet!

Passing on the baton

For 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.

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! 😉

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.

I started my nurse training on 31^st January 1983. As it turns out 1983 was quite an important year for the NHS too. On 6^th 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. Managers 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

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

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 3^rd 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

I 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.

Social media and me

I think I joined Facebook in 2007; not exactly an early adopter but not a late-comer either. I can remember who sent me the link and why she said I would like it. She was right I did! Before that I was a user of ‘Friends Reunited’ too – you remember that? Where you could look people up from school? I became a Facebook fan and, as smart phones came into my life and I spent increasing amounts of time travelling with my phone in my hand, social media an increasingly important part of my personal life.

A little while later, in 2009, someone at work suggested I join Twitter. I am always curious about new things so I duly logged in and created my account – @anniecoops was born.

In February 2009, when I started my Twitter journey, I took ages to warm up. Like many people who I speak to I didn’t really ‘get’ it and after around 3 months of trying I gave up. Here is my illuminating first tweet :0)

I can’t remember what made me go back but after those 3 months but I suspect it was a challenge from someone who probably said ‘If you don’t get it, you are probably not trying hard enough’ and I absolutely can’t resist a challenge like that! I met some important friends along the way and by April 2015 I find that I have tweeted 74K times and now have 8600 followers. With the launch of a social media film that I have worked on with @NHSIQ I thought it was time to reflect on that journey and what has happened.

Here is a link to the film

Annie was never my name, I always thought it was a bit twee for me, more of a nice girl name rather than the firm, straight and solid name Anne. I always say Anne is a good name, you can’t shorten it and it’s hard to mess with but I had no idea how ‘Annie’ was going to become part of my life. I had been called ‘Coops’ at work for quite a while and my son in the Cadets was called the same. When I tried to register @annecoops it was gone as was @annecooper. The addition of the ‘i’ to my first name was simply a pragmatic thing to do. I had no idea what was going to happen and that, by 2015, more people at work would call me Annie than Anne!

My social media journey has been a great addition to my professional life. Later in September 2012 started my wordpress blog and I re-discovered my love of reflecting through writing. By then AnnieCoops had taken hold as my ‘brand’ and also became the name of my blog.

I completely accept that social media is not for everyone – I dislike those who behave as zealots trying to pressurise people into using social media, particularly Twitter. It’s not for everyone but quite often there will be a platform that works for most people – I know lots of people who love Pinterest for example but I personally don’t get it as I clearly prefer the words and feelings that blogs evoke for me. I love Blipfoto as well but I am too ill-disciplined to be properly focussed on trying to improve my photography skills.

Social Media has been a positive experience for me and I thought it might be helpful to say why:

Professional inclusion

Working in informatics is hard. It’s like the geek club and most of the time I don’t actually belong in it – I’m tolerated and valued but not quite part of it either. Additionally in nursing informatics still feels peripheral. Back in 2009 I didn’t really think I was part of nursing, I had the sense, rightly or wrongly, that people didn’t really get the digital agenda and as a result I wasn’t really part of the nursing ‘family’ – I was labelled a geek* and therefore not part of where the nursing action was. Twitter changed that for me, I started to talk to other nurses and soon established a new network where I felt like I belonged and I continue to feel part of that family. It has given me a real opportunity to feel professionally re-connected and valued and to re-profile myself as more than the perceived ‘geek’.

Creating bridges

Social Media has been great for me in making connections and creating bridges to new spaces. New spaces I have been given a glimpse into include connecting with more professionals including doctors, midwives, pharmacists, medical educators, people who working in housing and local government, the voluntary sector, leadership development, organisational development, education – the list is so long I can’t list everyone and I value all those connections more than I can explain. It has given my personal and professional life a greater breadth and depth that would not have been possible without social media. I value the eclectic nature of my connections and social media friends.

Being a patient

Being a professional who happens to have a long term condition like T1 Diabetes can be a challenge. I think for many years most of the time I ignored it. Social Media allowed me to not only find a Diabetes family but also to try to add value to that community. I have enjoyed blogging about my condition and also sharing via Twitter some of the ups and downs. I have tried to help others too and to share my expertise as a patient. I wish I had found this opportunity earlier in my life.

Access to resources and expertise

One of the very best things about Twitter is the generosity of the people I connect to. I have learnt more in the last few years about so many things and I believe that this is likely to make me a better professional but also a better person. Sharing is not just the technical stuff but thoughts feelings and emotions that help me to understand in a deeper way – it’s a better learning space than any lecture I have ever had at university.

* there is nothing wrong with being a geek it’s just that I’m not one by this definition: ‘”someone who is interested in a subject (usually intellectual or complex) for its own sake”

#labelsr4jamjars

A few weeks ago I was very lucky to be invited to speak at the annual Diabetes UK Professional conference. I do not have any involvement in Diabetes in my professional life and as a consequence I very much felt like I was attending as a patient, who happened to be a nurse, and the conference almost felt like it had been ‘flipped’ for me; I was an outsider looking in. (Here is the link to our presentation on Social media).

I am more used to being a more integral part of a conference these days and even though on this occasion I was also a speaker it felt very different. I was there in my own time, rather than as a professional, so that was part of it, but it led me to see the conference through a new lens.

I have noticed before how people who have a long term conditions are often referred to by professionals and always had a sense of unease. For example overhearing a doctor refer to ‘the diabetics in the clinic’ makes it sound like those people are a separate species, almost a sub- species, that the professional sees them as separate and different from themselves. This has long led me to think about labelling theory and how it might apply in these contexts.

At the conference I yet again experienced this dissonance around the use of language. People with Diabetes referred to as ‘Diabetics’, ‘Subjects’ (of research), and cohorts. That data points were not really about people but abstract concepts that are of interest. This type of language seems to place these people outside of what everyone else ‘is’ and although labelling theories seem to have fallen out of favour, I can see how certain groups are placed out of what might be considered as ‘normal’.

I am no sociologist and I hesitate to link my observations to any theories – I know someone will pull my thinking apart – but what I do know is that there is both a good part and a negative part of being labelled in this way.

Some people wear ‘Diabetic’ as a badge of honour. I understand why this might be so. It allows people who may be similar to group positively together and own that individual and group identity. Others, like me, see Diabetes as a part of themselves, but perhaps not the most significant, and prefer to be seen as person first (who happens to have x or y condition). There are many conditions where these language labels are used: Diabetic, Epileptic, Schizophrenic, Bulimic, Anorexic…..

Those who say labels don’t matter and its just the language we use are often people who have not experienced any stigma associated with a condition. My experiences are low level but nontheless present. When I was younger I never had to explain that I have T1 Diabetes, the assumption was I was young so I would be ‘one of those diabetics who injected’. Later in my life things changed, as a rotund middle aged woman, now I have actually been told ‘You should stay thin and then you wouldn’t be a Diabetic’. Other low level stigma includes conversations like ‘You shouldn’t be eating that (cake, chocolate, etc) should you?’

I feel labels don’t help, in fact they get in the way of empathetic relationships, they create a perception of what matters to the individual based on their condition. As Brene Brown says empathy is feeling ‘with’ the person and not applying judgements. I strongly believe that empathy should be person focussed not condition focussed. I am, however, expressing a view that may not be popular and others may challenge. In a study by Ogden and Parkes (2013) they found no difference in the beliefs of those with and without Diabetes using the word ‘Diabetic’ vs ‘Person with Diabetes’ although they do recognise that their methods may have impacted the outcome as they used a scenario based assessment to test their theory. I could probably have told them what they would find using this method. There is more evidence in mental health that labels are perceived as unacceptable – I think there is more debate in this area and also a deeper understanding of the impact of stigma.

I know that not everyone holds my view but I believe #labelsr4jamjars – we should always say the person first ‘Annie with Diabetes’. A long time ago, when I was a ward sister, we had labels we applied to beds to label the person in them ‘Diabetic’ in red letters. I didn’t like it even then and I removed these from the ward and talked to staff about how I expected everyone to know who happened to have diabetes and that the labels would not be reinstated.

As an anonymous person with diabetes at the conference I did wonder how far we had moved on. Looking at it from the outside, through a new lens, it did feel like we still had a long way to go.

Thank you to Dorcas Lambert for the inspiration and courage to write this blog – its been brewing for a while – here is her blog on the same.

‘A diabetic’ versus ‘a person with diabetes’: the impact of language on beliefs about diabetes’ Ogden J, Parkes K, (2013) Eur Diabetes Nursing 2013; 10 (3): 80-85

Nursing workforce planning: are we just playing a numbers game?

Most people who read the news in the UK are likely to have read recent articles that point to the possibility that there is a shortage of nurses[i][ii][iii]. In a time when we are talking about reconfiguring the way care is offered and moving care into people’s homes it is also well documented that we have an aging nursing workforce with particular concerns in community nursing. In a report by the RCN in 2012, it was identified that almost 60% of the community nursing workforce could if they chose, retire in the next decade. Of course, it’s not just about the numbers of nurses who leave – it’s also the level of expertise that the system loses when these experienced nurses, who are likely to have up to 3 decades of experience, retire.

There are steps in place to try to attract nurses who were once registered but left the profession back into practice. This work is being led by Health Education England with a concerted public campaign to attract once registered nurses to undertake a period of updating to encourage them to return. You can read more about the campaign here.

Whilst workforce planning as a numbers game is important – we need to make sure we have an adequate flow of newly qualified nurses – what could be just as important is retaining those with the long years of experience to help to pass on their tacit knowledge and skills before they leave the profession through retirement.

Bearing this in mind a paper by Liebermann et al (2015) caught my eye. They discuss that, as well as adequately addressing the recruitment of new nurses, we also need to make sure we retain new entrants and encourage older nurses to postpone their retirement.

I am now 51 and in the last year or so I have thought about the prospect of retirement more than ever in my life. I realise this is a natural progression, that looking forward is a good thing; I also recognise that if every one of my generation does this, there could be an inevitable skill gap. There are ways less experienced nurses can be supported to offer safe care such as decision support technology but even I (as a nurse with a passion for technology) know that this can never replace decades of practice experience. So what do we know about why it is that nurses seek to leave the profession early?

Liebermann et al undertook a longitudinal study via questionnaire that sought to understand what conditions were most likely to encourage nurses to stay, with a focus on the possible differences between younger and older nurses. In other words, do we need to do different things to encourage younger nurses to stick with nursing and for older nurses to encourage them to put off an early retirement?

In some ways the conclusions are not surprising – nurses need good management support to stay and to help them to keep up to the hard demands that nursing places on us. What is perhaps more interesting is that they found differences between the younger and older nurses. The researchers concluded that ‘supervisors [managers] should foster nurses’ expectation of remaining in the same job until retirement age by providing age-specific job resources’ (Liebermann et al 2015).

By Ministry of Information Photo Division Photographer [Public domain], via Wikimedia Commons

We know that a multi-generational workforce may require different leadership styles, so called ‘baby boomers’ may differ from ‘generation x’ or ‘millennials’, but do we equally need to look at what conditions keep nurses satisfied with their work conditions in this generational way too?

I think this is a fascinating thought that we may need to think about. So, it’s possible that any efforts we make to encourage people to stay in nursing, if we don’t understand the needs of particular generations, may fail. My final point is are we just addressing a numbers game, when we need to start to focus in some detail on how we can retain nurses, recognising that different generations may have different needs?

Liebermann SC., Muller A., Weigal M.,Wegge J (2015) ‘Antecedents of the expectation of remaining in nursing until retirement age’ Journal of Advanced Nursing doi: 10.1111/jan12634

With thanks to Dr Susan Hamer for bringing this journal article to my attention :0)

PS thanks to Ruth Auton for pointing out this paper from HEE http://hee.nhs.uk/wp-content/uploads/sites/321/2014/05/Growing-nursing-numbers-Literature-Review-FINAL.pdf

[i] http://www.theguardian.com/society/2014/dec/17/nhs-nurse-shortage-health-service-overseas

[ii] http://www.rcn.org.uk/newsevents/news/article/london/nursing-shortage-pmqs

[iii] http://www.telegraph.co.uk/news/nhs/11349403/AandE-units-will-be-forced-to-declare-nurse-shortages.html

Golden silence

I learnt a lesson years ago about silence, you know, those empty space between words; I learnt that I didn’t need to fill them, that I could be comfortable in deep wells of silence. This week I reflected that I need to practice more.

When I did my leadership programme all those years ago we did a much hated exercise called ‘large group’. There was no structure, no agenda, no objective, just us and time. At first I was so uncomfortable I had to speak. I wasn’t the only one. Some of us shuffled and worried and spoke out filling the minutes and noiseless space. After the first couple of times I reflected on mine and others behaviours and decided I would experiment. I became a silent observer and spent my time listening and watching. I proved to myself that not only could I do it, it actually didn’t feel so bad. I know it improved my listening and observing too.

When I feel anxious or stressed I know I am more likely to dive in with words. I go really fast and have a reputation for being able to talk for England. This week a couple of things happened that made me think I perhaps need to practice silence more.

The first was a great session by @heatherhenry. She talked about how to engage in communities and about giving people space and time, about not barging in with (probably the wrong) answers. She made me smile and gave me a tool for practice – she told us that if you want to be sure you have given someone time to answer, sing a whole chorus of Happy Birthday in your head – that’s just the right amount of time. I’m practicing and although it feels like a long time in my head it doesn’t seem to raise any eyebrows and actually people may well have told me things that they wouldn’t had I not given them time.

The second is I spent a great day with a student nurse who is a self-confessed introvert. I reflected that I needed not to talk quite so fast, as, unlike some other colleagues, this conversation couldn’t be like a pacey game of tennis, where I serve the ball and they bounce it back. Perhaps it’s a bit more like golf with quiet walking time between hitting the ball.

Being mindful of silence has always been a positive thing for me but I do need to focus on doing it as my brain darts backwards and forwards and round about and it all tumbles out of my mouth. My son tells me all the time that I ask questions in 3s and it drives him mad – he just says – I can only answer one at a time and which one will it be? :0)

I know that for some people, like me, we are creative when we are bouncing ideas around verbally with others but I respect others right to time and silence. I promise I will continue to try as hard as I can to give people time, careful quiet listening and golden silence.

I had to post this! Silence is golden from the Tremeloes 1967

Standing out or fitting in – matters of dress and heels.

I was rushing about this morning getting ready for work and I reflected that it was much easier when I wore uniform; choices were simpler and there was less need to think.

Putting on my blue sister’s uniform was one of the proudest things I can remember; I never tired of it along with my silver buckle that my husband bought me. If I close my eyes I can put myself back there and feel myself sit up straighter, it really was very special. I liked wearing uniform. I enjoyed the feeling of identity it gave me.

All of this led me to think about the symbolism of dress and where I find myself as a middle aged, rounded sort of person. Clothes inevitably have played an important role in my life for lots of reasons.

I recall in the 1990s progressing to a non-uniformed role for the first time. I was in my mid-twenties and it was after all the 90s, where power dressing was still very much de rigueur. I had shoulder pads, tight pencil skirts, frilly blouses and heels – lots of stiletto heels. When I walked through Leeds tonight on my way home the fashions of 2014 have some of those echoes – it made me smile. It’s interesting when life places you on the second time around – I just wish I had saved some of my best clothes from back then.

[An interesting note – when I looked for pictures of me in the 1990s I can find none. My son was born in 1990 and all I can find are dozens of pictures of him. I guess something changed in my priorities then!]

Interviews have always been a time for me where I almost get superstitious about what I wear; always new clothes and silly as it may sound best underwear. I had a friend who always wore red knickers for interviews. I guess in these types of situations we all want to stack as many of the cards in our favour as we can.

New jobs too, demand a close focus on the way I dress. Who do I want them to think I am? Feisty Annie in my slightly hippy tastes or a more serious moderate Annie? What I do know it this situation also demands some new clothes although in some ways this is just like the emperor’s new clothes – I’m just waiting for someone to find me out!

Today I am lucky that I get to visit many different areas of the healthcare system and find myself moving in and out of different organisational cultures but I notice patterns. In big acute trusts it still feels like there is a sort of power dressing going on, albeit the 2014 version. Contrast this with community and mental health services where the styles feel more relaxed and individualistic. I always think, now where am I off to, and which version of Annie do I need to wear today?

Annie at 50th Birthday Bash

Being on platforms and speaking raises interesting issues – mainly those of heels. My lovely ex-boss and now friend tells me that I should always wear heels. I try, I really do, but I can no longer do it. I find myself choosing more moderate heels and go for colour and class rather than the stilettos of the past. It’s also part of the lot of someone with type 1 diabetes I think that a focus on removing the risk of sore feet somehow feels more important.

Informatics is a really interesting place to work; male dominated and lots of suits and yes, mainly grey ones. We do have the occasional GP floating around who has a slightly more relaxed mode of dress. What is a girl to do in this space? I go for ‘middle of the road’ and then, sometimes, in the evenings or for events, dress up in colours and sparkles, like a peacock. I think it disconcerts them occasionally and I like that!

So what does all of this mean? Conversations of late have been making me reflect on why I always seem to choose roles that are a bit unusual. I do it because I like it. But then why do I seek to conform with my dress and shoes? I think it’s probably part of what can be referred to as cultural capital – assets that lead to social mobility. I need to fit in to be taken seriously and dress may be part of how I do this. Do I give up my identity as a result? I’m not sure. I think I express my identity in different ways – a business like suit with my tiny pea-pod necklace or a beautiful scarf.

My reflections are leading me to take a look again at how I present myself – am I expressing myself in the way I want to? Are you?

Storytelling, tacit knowledge and a leadership Indaba

“If history were taught in the form of stories, it would never be forgotten.”

Rudyard Kipling

Stories matter; everyone seems to be taking on board storytelling – is it a fashion, a fad?

Human beings have been telling stories, transferring knowledge, values and history through hundreds of years and generations of tribes. Attention seems to be turning back to our delight in oral histories and stories. Even in electronic forms we see videos and read wonderful blogs that continue the ancient tradition of storytelling through generations, transferring some of our oral traditions to new digital media. It makes me glad – I enjoy stories and they make me laugh and sometimes cry – and I have learnt so much from these stories – they expand my mind.

My personal experiences tell me that stories are a powerful way for me to share my stories, find meaning and knowledge in what I know, that they have a power that charts and sterile traditional business words sometimes miss. My blog has become a place where I try to share stories and in doing so try to unearth some of my tacit knowledge that I wonder if has any value in the world. My stories and reflections are part of my endeavour to share and to move from ‘stuff that is in my head’ to sense making, making it social, transferring and transforming thoughts to a deeper understanding.

Tacit knowledge is deeply personal and hard to extract and measure. It flies in the face of much scientific study and is known to be hard to draw out and share. The spoken and written word, gestures and emotions are in my view part of its transfer and the recipient of it needs to be able to listen, watch and actively participate in the story to sense-make, participate and share.

It is also my view that it is a social activity for many, but perhaps not all; marrying together story tellers and listeners in networks creates a more fertile space for the development of concepts, ideas and taps into our imagination to assess possibilities and create new ‘castles in the air’. I understand that scientific enquiry is vital in our world but I believe that stories allow us to share and interpret experiences in a way that complements our more logical and scientific understanding.

This week I attended a Leadership Indaba.

Indaba is a South African word, with its origins meaning ‘gathering’ or ‘meeting’. More recently they are styled as conferences where there is space for creative thinking and where story telling is likely to have a strong role.

So this week a group of people with an interest in leadership gathered in Leeds as part of an Indaba organised by Centre for Innovation in Health Management in Leeds. The Indaba has an international flavour with colleagues from South Africa and the Netherlands – a great opportunity for story-telling across different cultures and experiences, a chance to collide our experiences and stories together in a way that creates new meaning informed by the people in the groups.

So, I went to the day thinking I knew nothing, I knew no theories, and that I may not be able to participate – that I might not be up to the task (Imposter syndrome at its most active). But Indabas are not styled that way…. Story-telling is what I think they are about. I came away bursting with stories and new ideas taken and processed alongside stories from others. It was a social activity, sharing stories, processing meaning and this was just the very first day we had met. I know not everyone was comfortable with the unstructured social nature of the day but I found it liberating. Telling stories links us to emotions that create new ways of thinking and behaving; maybe a creative way to find new and different solutions to complex problems?

So what happened at the Indaba? Storytelling started the process of weaving us together and started us on a new journey. For me it was, and remains, exciting; the chance to hear others talk about their experiences and to weave those stories through mine to create new understanding and meaning. Its early days, we are still building trust and confidence and we also need to work out how we share this learning more widely – I will blog more as our journey unfolds.

Finally, I think that there is a risk in having a single internal story. In this wonderful Tedtalk by Chimamanda Ngozi Adichie she explains about the danger of a single story. If you don’t think that storytelling and sharing is important watch the video – it may just change your mind.

	David Neal on Speaking the Right Language –…
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anniecoops

The thoughts of a nurse with type 1 diabetes

Tag Archives: leadership