Speaking on a recent Question Time panel, Lord Falconer expressed his despair at the failings in care unearthed at Stafford Hospital, saying he could not begin to think how to start to address such a failure.
I think I know where to start – by making people who work in hospitals feel more connected. Connected to their job, colleagues, workplace and crucially, patients.
I am a volunteer at one of the best hospital trusts in the country. During my time as a volunteer, I have witnessed acts of such tenderness towards patients, from nurses and staff, that I have been reduced to tears. But I have also seen behaviour that, while in no way constituting cruelty or neglect, can be described as personally ‘disconnected’ from patients.
It is that basic human ‘connectedness’ that forms the basis for building a more engaged and caring organisation and society. When that disconnection remains unchecked and permeates the culture, empathy and compassion dissolve.
The system, however, creates barriers to human connection, a connection that is crucial to nurturing a culture of care and compassion.
Below are five ways the NHS can use to start to break down these barriers.
1. Display the patient’s name over their bed
Being in hospital can be a dehumanising experience. When patients are admitted to hospital, they lose their clothes and personal belongings. Their world is reduced – sometimes for months – to a small cubicle in unfamiliar surroundings. Everything that defines them as an individual disappears.
At the very least we should not strip them of their identity as well. Their name serves as a connection between them and anyone who comes into contact with them. They are no longer just ‘ruptured disk in bed 22′.
2. Reinstate uniforms for doctors
White coats were abandoned in 2008 as part of the Government’s attempt to tackle hospital acquired infections. But wearing a uniform is a huge ‘connector’ to and within a hospital.
Among other things, uniforms connect doctors to patients. Because of the way they are dressed, doctors – and in particular female doctors – can be hard to identify on wards. Imagine how hard it must be for an ill, anxious, or confused patient.
But quite apart from the issue of identity, a uniform helps to inspire confidence. A survey of patients in 2009 found that patients across all demographic groups associated casual attire with a lack of ability.
3. Ban the use of phones on the ward by medical and nursing staff other than those directly used for the job.
Phones on the ward impede one’s ability to ‘connect’ with the job in hand, as well as with colleagues and patients. If you are looking at a phone screen, you are not looking up and connecting with the world around you.
4. Have formal induction programmes for every member of staff, emphasising their worth to the hospital and the role each person plays in helping patients. Ensure, through regular feedback, that these messages are reinforced.
There is a famous story of President John Kennedy bumping into a janitor during a visit to NASA. When he asked the janitor what exactly he did, the janitor replied, “I am helping to put a man on the moon.”
I remembered this story when I saw a tea lady half heartedly performing her duties on a ward, completely unaware of how patients’ faces lit up when she arrived. I told her she played a valuable role in making patients feel better. No one had ever told her that her job really did make a difference to patients. She swelled with pride to be acknowledged in that way.
5. Leaders must walk the talk and model the behaviour and values they expect from staff.
Anyone in a position of leadership must model good behaviour. Without modelling good behaviour and effective leadership, people will never know what ‘good’ looks like.
Patient-centred care starts with strong leadership. Managers and governors should routinely visit wards, not just to see that everything is ok, but to be seen to be engaged and to care. There should be one member of staff whose sole job is to ensure that staff and patients are happy and that all is running smoothly.
The chairman of the trust where I volunteer has twice accompanied me on my rounds, the chief nurse has spent a morning with me and the head of medical education and training has met me to hear my views, with my stories used in training of young doctors. They understand the importance of being on the ground, talking and listening to and connecting with staff and patients on a regular basis.
We ignore the signs of disconnection in hospitals at our peril. If we want to foster care and compassion in hospitals, we need to change the system so that it encourages – rather than thwarts – human connection.
Some of the challenges presented by the Francis report are so huge it is hard to know where to start. But we must start somewhere. We can start by taking small, positive steps forward, at ground level. And we have to start now.
Andrea Kennedy is a volunteer at University College London Hospitals NHS Foundation Trust