Tuesday, 23 October 2012

Patient-satisfaction or person-centred leadership?

We are all engaged with policy that emphasises person-centred care (for example, The Health Care Quality Strategy for NHSScotland). Reflecting on some of my previous posts, and the national focus on care, I am interested in unpicking what we mean by person-centredness when we work with students. Clinical leadership aims to create the conditions where person-centred care can thrive and the Institute for Healthcare Improvement discusses leadership within this context in its bulletin this week (for those who are not signed up to it, I recommend it as a forum where useful discussion and debate takes place). Morag Bisognano is the President and CEO of the Institute (and someone that I have seen present a couple of times - a good example of leadership impacting in practice) and writes in an article, "Perhaps the central questions for leaders are: What really matters to patients and families? Is our organization engaged in patient-centred leadership or patient-satisfaction leadership?" The general thrust of the argument is that when we are focused on achieving 'good' patient satisfaction, we may miss out on the issues that really matter to patients and families and may impact on improvements (where patient-centredness is not also a key driver). Some may feel that this is a matter of semantics, but I believe that the use of words reflects complimentary but differing philosophical perspectives. The measures of satisfaction are usually determined by professionals whereas person-centredness puts the patient (rather obviously) at the centre of any conversation about care. If we help our students to appreciate the need to genuinely listen to patients and families, and enable them to develop the skills to do this, we will push forward person-centredness as the way of being as a health professional.

Monday, 8 October 2012

Start of semester - and enthusiasm for learning

It's the start of semester - my second favourite time of the year (the first being graduation as I love seeing the students walk proudly across the podium to celebrate their achievements). I met with three of my dissertation students to get to know them a bit, discuss expectations (theirs and mine) and to work out how we can work together (and individually) to achieve their ambitions (they all want to achieve first class Honours degrees, and more importantly they are very clear that they want to make a difference to patient care). I always come away from these kinds of sessions feeling enthused and motivated - firstly, the women that I met are all seriously focused on achieving all they can and to enhancing care. Secondly, as a teacher I learn something from my students whenever I come into contact with them. The three of them are all going to be exploring very different subjects and I know that the learning journey for us all will be fulfilling and rewarding.

As a consequence of this meeting, I reflected (again!) on the issues surrounding poor care and the 'blame' that is sometimes laid at the door of pre-registration nursing education. Without going into the latter issue again (although I am sure that I will touch on it again as I am about to be getting involved in some interesting work around values-based selection of students), I am very interested in what sometimes happens when nurses have been in particular practice situations for a period of time. Do they really change their outlook and their approach to care? Do they move on from areas where poorer care is experienced thus leaving gaps where their knowledge, enthusiasm and commitment once were? Is poor care really related to their education, and have we simply not prepared them for what's ahead (not what I have experienced and the feedback that I regularly get about the students I know does not reflect this latter point). I know there are multiple arguments, theories, views on why poor care happens (and I have highlighted some of these in previous posting), but I remain baffled by the reports and the evidence that seems to demonstrate that sometimes nurses do not give the care that they should.

One of my goals as an educator is to provide a level of inspiration that students can hold onto and improve as they make their way into nursing practice as qualified practitioners. I know that my colleagues do the same. The photo is one of mine - a beautiful sunset over the Basin in Montrose - an image to reflect inspiration and what I believe is a need to continually work towards improving role modelling behaviours as educators and leaders in practice.