We recently held an important event focusing on fundamental aspects of health care that I feel particularly passionate about: compassion, dignity and respect.
It was interesting to explore what these terms meant to those in the room (you can see some of this in our video of voxpops from the day). Despite some healthy differences in views, it was obvious that everyone agreed these were critical elements of care and that we need to do more to really understand patient and service user experience.
We often assume all is well if treatment goes according to plan, clinical outcomes are good and patient surveys appear positive. I suspect that by having these reassuring figures we may often overlook the hidden detail. We know that there are many ways to measure patient experience, but do we really hear about the nature and quality of each interaction as perceived by the patient or carer, or does that remain hidden?
I think as health professionals we often forget the significance of events for patients. I will always remember what a patient recovering from minor surgery said to me when I was interviewing her for a research study in the 1990s: ‘This may just be another routine day at work for the doctor or nurse, but for me this is not just an ordinary day...this has changed my life...turned it upside down...I don't think they remember that’.
At the event last week, we heard a very moving story from an acute hospital in the north, in which a dying man was too ill to travel home to die (his preferred place). The staff and family came up with an alternative that he was comfortable with. The man had been a keen gardener and never happier than when he was outdoors. So the staff ensured that all the hospital curtains overlooking the courtyard garden were closed to ensure privacy and then his bed was wheeled outside. He died peacefully a while later in the garden surrounded by his loved ones. For a busy acute hospital this was an extraordinary illustration of excellent and compassionate care, despite existing work pressures.
Obviously we can’t always do things like this for everyone and, as Mother Teresa once said, ‘We can do no great things; only small things with great love’. We know that often the simplest gestures make a difference, such as holding a patient’s hand before an operation or crying with bereaved relatives (this video from staff at Aneurin Bevan University Health Board in Wales illustrates this point nicely).
However, the smallest things can also mar an experience as I know, having recently been in hospital for spinal surgery. If I’d been asked to rate my overall care and experience, I would say that it was exceptional. I was fortunate to have a very talented surgeon and great support from the nursing and physiotherapy staff. However, if anyone had asked about the details of this experience, I would tell them that there were some exceptions.
One such example was having to remain on strict flat bedrest for 36 hours with my head tipped lower than my feet and having to use a bedpan, which you can imagine was a humiliating and undignified experience, and an almost impossible physical feat! Most nurses were very helpful and sympathetic, apart from one of the night staff – she tutted at me every time I rang the bell for her help me on to a bedpan and handled me very roughly as she bustled in and out of my room at great speed. She was obviously busy and left me under no illusion that she had more urgent things to do than to help me!
But where does the responsibility for this lie? Obviously each professional has a responsibility to provide care that is respectful and compassionate and no patient should be made to feel a nuisance. However the wider organisation has to take some responsibility as well. We need to do more to create conditions that enable staff to do the right thing. We know from international research that large numbers of health care professionals display signs of burnout due to excessive workloads. Our interview with Jocelyn Cornwell from the Point of Care Foundation examines this issue further.
So how can we do more to create the right conditions and to support staff under sustained pressure to remain mindful of patient needs? We’ve pulled together seven practical tools to get you started which I hope you find useful. And we’ve also spoken to Joanne Durkin at Oxford University Hospitals NHS Trust about their use of Value Based Interviewing, which helps to recruit people who share and support their organisational values from the outset.
It’s such an important area for all of us working in health care to remember – treating people with dignity, compassion and respect sits at the very heart of good care. We can’t forget that, or we’ll be failing those we want to help the most.
Jane Jones is an Assistant Director at the Health Foundation