How might we apply Isaac Asimov’s “Three Laws of Robotics” to underpin the #NHS?

This week, as usual… my mind has been whirring with a multitude of issues relating to staff well being in the NHS. Except lately I have been trying to look at everything from a different angle. So, being a bit of a Sci-fi geek as well as a Tudor History fan and doctoral researcher, it suddenly dawned on me how I was, in my own mind, equating the professional duties of NHS staff with Isaac Asimov‘s “Three Laws of Robotics“.

This ‘Eureka moment’ happened whilst I was enjoying my morning dippy egg, and I shall translate my thoughts as follows:

In case you were unaware, Asimov’s laws were intended as a fundamental framework to underpin the behavior of robots in human society. These laws are intended to allow the safe use of robots as tools.

They were originally as follows:

1. A robot may not injure a human being or, through inaction, allow a human being to come to harm.
2. A robot must obey the orders given it by human beings, except where such orders would conflict with the First Law.
3. A robot must protect its own existence as long as such protection does not conflict with the First or Second Laws.

I shall now rewrite these laws based upon the analogy of this being applied to NHS relationships in my own mind.

1. Clinical professionals may not injure a patient or, through inaction, allow a patient to come to harm.
2. Clinical professionals must obey the orders or ‘needs’ of patients, except where such orders would conflict with the First Law.
3. Clinical professionals must protect their own existence as long as such protection does not conflict with the First or Second Laws.

In essence, clinical professionals are programmed in this same way to put patients first. I am not necessarily arguing that this is wrong. But again, in doing this we may paradoxically be putting patients at risk if we fail to value clinical professionals as humans too.

Are clinical professionals the subservient robots of humanity?

If clinical professionals obey the needs or ‘orders’ of patients at the expense of their own well being, then this may not be conducive to safe clinical care.

Later, Asimov added a “zeroth law”, that preceded the others in terms of priority:

0. A robot may not harm humanity, or, by inaction, allow humanity to come to harm.

Which in this analogy would become:

0. Clinical professionals may not harm humanity or, through inaction, allow humanity to come to harm.

If the well being of clinical professionals is not properly valued or addressed, the quality of patient care may be reduced through “malfunctioning” or “Decommissioned”  practitioners. Therefore, humanity is harmed twice – once in the harm of patients and once in the harm of clinical practitioners. Humanity suffers.

The three laws are intended for robots, and we need to remember that clinical professionals are not robots. We also need to ensure that the well being of NHS staff remains an issue of equal salience in the provision of safe care. If both NHS staff and patients are of equal societal value, then we must value #StaffExperience as much as we value #PatientExperience.

Should this happen, then we may see better quality outcomes for all.

Please let me know your thoughts… Until then, I shall be burying my head in an ethics paper and literature review!

Be kind to yourselves, and each other x

Is our own Secretary of State Jeremy Hunt damaging the psychological wellbeing of NHS staff?

I have been thinking a lot this week about how midwives may be over compensating for the fact that historically, they may have been unfairly held accountable for poor outcomes in childbirth. In fact I have just submitted a paper about it (hence lack of blog posts)!

Watching social media news this week, my paper seemingly came to life in reality! – The Times Newspaper published new facts, figures and commentary blaming the UK’s comparatively high level of stillbirths and perinatal deaths squarely on the NHS and midwifery care.

Cathy Warwick (Chief Executive of the Royal College of Midwives) responded… “When I read this article in The Times last Wednesday, and the newspaper’s accompanying editorial, I just felt angry”.

These articles explained that the annual bill for NHS negligence in pregnancy has reached £1 billion after more than 1,300 babies were killed or maimed last year. – Strong words and statistics indeed.

Following these articles…. I watched a torrent of complaints rain down upon these articles. Midwifery was again accused of being ‘Faddish’ in its pursuit of natural childbirth.

Has this reignited professional turf wars? the fear of natural childbirth? and the historical distrust of midwives?

It has certainly done nothing to promote healthy professional cultures.

“Perhaps the secretary of state will step in to make this right?” I thought hopefully…

And then he tweeted this….”Shocking that 1300 babies killed or harmed during childbirth last year: we must go further&faster to make the NHS the safest system globally”
— Jeremy Hunt (@Jeremy_Hunt) June 10, 2015

Is our own Secretary of State damaging the psychological wellbeing of NHS staff?

We already know that healthier staff mean healthier patients… these comments do nothing to facilitate a healthy workforce. In fact, we have to wonder whether they may be actually psychologically damaging to NHS staff.

If staff are not afforded the healthy experiences of attachment, containment, communication, inclusion and agency within any organization, this can result in unhealthy, or frankly toxic, psycho social environments (Haigh, 2013) .

Are these statements in the media conducive to creating therapeutic a environment/relationship with the NHS?

If not, then we must consider whether they may create a toxic environment/relationship which may actually inhibit effective patient care.

I do not see anything coming from our own secretary of State to facilitate a healthy relationship with NHS staff, in fact, I believe this may enforce further hostilities between the public, the NHS and our own leadership. A sad step backwards for progress.

In my opinion….The very words “Killed” & “Maimed” imply that horrendous actions have taken place deliberately, when in fact we know that the vast majority of NHS staff do not go to work to intentionally be poor practitioners, make mistakes and fall below expected standards (Denham, 2007).

This brings us back to the key principle that better staff experiences are associated with better outcomes for patients.

Does Jeremy Hunt believe that he is creating positive staff experiences with his words through tough love? Are his comments meant to shock the NHS staff into not Killing babies???…

No, because NHS staff do not go to work to do this. They go to work to make a difference and achieve something wonderful.

The NHS often has to deal with the fallout and consequences of wider government decision-making, and this is no different. Nobody wants to see mothers and babies put at risk and experience a poor obstetric outcome. Everyone is saddened for these 1300 babies.

Cathy Warwick has confirmed that the true reason for the UK’s comparatively high level of stillbirths, is related to other deep seated issues in the UK such as social deprivation, social, and health inequalities. This is a challenge for us all to come together to address. Mud slinging, blaming, naming and shaming really have no place in achieving better outcomes for mothers and babies… and I hope my next paper will encourage further conversations to address this.

Continuing to repeat the false message that NHS staff are ‘bad’ ‘wicked’ baby killers does not fulfill any area of public interest at any level. Furthering this conversation will only galvanize fear and misunderstanding.

Let us create a new conversation in partnership with each other.

We are on the same team.

(Fingers crossed that this paper is excepted for publication please)!!!

Denham C. (2007) ‘TRUST: the 5 rights of the second victim’. Journal of Patient Safety. 3(2) 107-119

Haigh, R. (2013) ‘The quintessence of a therapeutic environment’, Therapeutic Communities: The International Journal of Therapeutic Communities, 34 (1): 6 – 15.

values, ethics & individualism

heartfelt midwifery

Researchers say negative workplace relationships definitely exist and seem to flourish in large organisations such as the UK National Health Service (Stevenson, Randle & Grayling, 2006).

People say bullying is a strategic survival mechanism of the very insecure and the control over someone else grants a certain confidence and hides inadequacy.

Whether it’s called bullying, negative workplace relationships or intimidation, I would guess pretty much everyone has witnessed it in some form, if not experienced it themselves. They’re not random acts of impoliteness but more purposeful, targeted, and meant to harm. But what happens when we feel it, experience it or have to work in affected environments?

The artist Matt Mahurin is a US illustrator, photographer and film director. His work isn’t always easy on the eye as he chooses bleak and intriguing scenes depicting depravity and controversial topics such as abortion clinics and prisons. The illustration below is one…

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What is the Future of Psychological Support for #NHS Midwives? My interview with @MidwifeDiaries

This blog was originally posted by Ellie from www.midwifediaries.com on June 2, 2015. We spoke in May 2015 about my research project and the issues surrounding midwives (and student midwives) in psychological distress.

She wrote :”Who is this researcher?”

This was me, a few weeks ago stumbling across a blog. This woman was sharp, driven, and had all her energy focussed on supporting the mental health of midwives.

She really got how unchallenged the assumption is that midwives are ok to keep going 24/7/365.

Sally Pezaro is doing her PhD on supporting midwives in psychological distress. Her project is exciting, and if it gets launched, will be something we can all use to keep healthy.

In this interview, we talk about why it’s so important to look after midwives, bullying in midwifery, and some strategies for mental wellbeing.

Most awesome quote from this interview: ‘Don’t give everything you have until your batteries run out‘. Yep – must put that on twitter.

Here are the links we discussed, ’cause I bet you’ll ask!

• Sally’s blog: www.sallypezaro.wordpress.com
• Raising Concerns Guidelines, from the NMC (there is an awesome video from a passionate nurse that’s so worth your time here!): http://www.nmc.org.uk/standards/guidance/raising-concerns-guidance-for-nurses-and-midwives
• The post on bullying I wrote, that led me to Sally’s research: Bullying In Midwifery: One Small But Mighty Trick

What’s Sally’s doing is so brilliant because she’s noticed something that is wrong in midwifery – and is doing something about it. Her project reminds me of that quote:

“Be The Change You Want To See In The World”

It’s so good to know that we do have researchers on our side, trying to make things better.

Now, Sally and I would love to hear from you. What’s your answer to the question I posed at the end of the interview?

“What do you find most challenging in looking after your mental health as a midwife, and what do you think could be changed to help with this, both on an organisational trust level, and on a personal level?”

Thanks so much in advance for all the kind, insightful and inspiring comments that are left. I’m excited to hear what you find hardest, and what could help you look after your mental health better.

As always, thank you for your time and attention, sharing and being so brilliant. MidwifeDiaries is turning into an incredible, supportive place for midwives, and I’m so grateful.

Ellie xxx

-> I would also like to add a link to the newest NMC Code (2015) as midwives can now use the power of the code to challenge psychologically unsafe professional behaviour in the workplace. The code now states that midwives must be supportive of colleagues who are encountering health or performance problems. Midwives also have a duty to care for themselves under this new code, so please do not feel guilty for giving self care. We must all work to create therapeutic working environments….

Five experiences are judged necessary for health. Primary emotional development, attachment, containment, communication, inclusion and agency. These can be deliberately recreated in therapeutic environments to form a structure for ‘secondary emotional development’. Failure to recognise the importance of these qualities of an environment can cause unhealthy, or frankly toxic, psychosocial environments in various settings (Haigh, 2013).

Haigh, R. (2013) ‘The quintessence of a therapeutic environment’, Therapeutic Communities: The International Journal of Therapeutic Communities, 34 (1): 6 – 15.