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.

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.

Reflections on caring - learning for education

My daughter has just been discharged after a short emergency stay in hospital. As always, it is absolutely fascinating to experience care from the other side and I always learn so much - both from what I have seen done very well and from those aspects of the experience that I think could have been done better. This experience led me to reflect (in the car on the way home) about the place of experience in student learning. There is much out there where patient stories provide meaningful accounts that enable learning (for example Patient Voices which I think I have mentioned here before) and I have used these kinds of resources effectively with students. But what about our own experiences - is there a place for us to use these experiences in some way to facilitate learning? I don't advocate that we should stand in front of a group of students and tell them about particular personal situations, but the learning that I have gained should be of some use, shouldn't it?

What I learnt over the past few days (things that I already knew but which were illuminated during this time):

• the way in which nurses speak to relatives on the phone (I was on holiday in Greece at the time of my daughter's admission) is so important. Letting the relative know that they are welcome to contact the ward at any time is so reassuring.
• providing information to the patient (and repeating that information if needed) with patience is crucial to the feeling of security in an alien environment.
• appearing to have time to answer questions etc at the point of discharge empowers both the patient and the relative.

All of these are small things but indicate the care and compassion that I have spoken about before on my blog. Being present in a ward (as a visitor) exposed me to the day-to-day interactions and actions of the nurses and others in a way that is so powerful. In England the Department of Health has developed a consultation/discussion document which aims to embed a culture of compassion (amongst other things) within nursing and other healthcare. I don't think there will be many things in the document that we could disagree with particularly - but what I want to do is really think about the proposals for the enactment of the intentions/vision. How can we make sure that the nurse provides a close interaction with the patient and the relative at point of discharge for example? And how can we ensure that the education that we offer enables students to work with patients and others so that they are empowered partners in the care experience?

Late winter sunshine - an academic's break

I am just preparing for my last-gasp 'summer' break - Kefalonia to set me up for the winter. I love  late summer sun and sea leaving me energised. I've got a few things to think about while I am away:
- my birthday resolution which is to read all the Booker prize winners (Margaret Atwood and AS Byatt are packed);
- the article I am writing with an Australian colleague - developing a theoretical stance on partnership working which we are going to test out collaboratively with my local Director of Nursing;
- the final part of my Florence Nightingale Foundation/Burdett Trust scholarship - bringing the learning together. If anyone out there is looking for any leadership development, you might want to consider FNF - an amazing experience for me personally and for the good friends that I have made over the year.
- my imminent (November) Malawi trip - anyone out there with experience of Malawi or of developing/evaluating educational and mentorship initiatives in developing countries..... please get in touch!
- the final report for my NHS Education for Scotland funded project on the selection of students.

I am looking forward to the clear blue skies, the sea and the mountains, and the time for thinking and relaxing. I know that I will come back ready for the new academic session. Exciting times! (Mind you, I'm not sure that even the Greek Islands can get much more beautiful than a sunset in Stonehaven with friends).

Missing NET2012.... And Tweeting

It's that time of year again - NET 2012 in Cambridge (and incidentally my birthday! - reminds me of when I went to school in England and I always went back after the summer holidays on or around my birthday...). I have a paper for presentation at the conference on the work of the NES Recruitment and Retention Delivery Group which Mike Sabin is presenting on our behalf. We think it will be of interest nationally (and more widely), particularly in relation to the work we have done on data enhancement and ongoing work on selection of students. There seems to be an appetite nationally to invest our energies in understanding values-based selection, and the Delivery Group is collaborating nationally on this area.

I am sorry to be missing NET for a number of reasons - it's always good to present one's ideas/research in a supportively challenging environment, along with the genuine opportunities to make meaningful connections with like-minded colleagues. As well as those important reasons, I love Cambridge where I did my own training.

On to Tweeting - As well as being quite new to blogging, I have taken to Twitter (@ruthft1). As an introvert (see previous postings), I am getting into Twitter in the same way that I do with relationships - slowly but surely. I have found it to be a fantastic resource for policy developments and wider debate as well as the creation of connections with people that I might not otherwise have been in contact with. If you're interested in 140 character discussion, I'd be delighted to see you following me so that we can 'talk' on subjects of interest. In the meantime, I will be keeping my eye on Twitter for the chat that will be coming from NET2012, and will look forward to catching up with my colleagues when they get back.

Other people's views - working with patients who are 'different' from ourselves

George Galloway finally seems to have lost the plot in his recent statements regarding rape. This blog post is not really about what he has to say, except to say that I am personally outraged by what he (and similar others) have been saying. It is hurtful and offensive. These feelings set me thinking about what happens when we work with patients who hold different views from ourselves - on issues that are fundamental to the way we see the world. How do we work with our student nurses to enable them to deal with the tension that can sometimes exist when we have to hear and experience the views of others that sit uncomfortably with our own world views? For me this issue relates to the focus on caring and compassion that I have had running through many of my postings. My perspective is that it is possible to offer compassionate care even in circumstances that are personally challenging. The education of nurses involves the development of self-awareness, interpersonal skills, awareness of others and their needs, and a real focus on person-centredness. Delivering compassionate care can be learned in my opinion - I think that as long as the nurse has the fundamental characteristics required for compassionate care, the skills required for the enactment of that compassion can be learned. We need to help our students understand that patients have many views, characteristics and values - and each person is a complex mix. So, even though I cannot bear the thought of George Galloway today, I know that I could deliver compassionate care to him if I needed to.

Willis Commission - impact for education

A brief blog as I am just back from Nice and settling back into a different mode of being..... Was interested and very encouraged to see that degree nurses are not 'too posh to wash'. In other words, enhancing the education of nursing students does not appear to compromise their ability to be compassionate. It's my usual soapbox but I (and many of my colleagues who I discuss this with) know this. However, it is great that these early findings seem to bear out what many of us have been saying - that we need to ensure that our nursing workforce are highly educated. Of course, we must all place an emphasis on person-centred compassionate care as we work with our students in the university and in practice.