Debunking Midwifery Myths

New article published here: Oh baby: seven things you probably didn’t know about midwives

…please share it widely!

As I am now coming to the end of my PhD (With lot’s of new and exciting things on the horizon I hope), I have been delving into the depths of the largest global online survey of midwives to date – the voices of over 2470 midwives in 93 countries!

Not only is this really an awesome and very important piece of work… it also holds some quite harrowing findings for our beloved midwifery profession. Yet this report also indicates that – if the voices of midwives are listened to, and if midwives are enabled to overcome gender inequalities and assume positions of leadership – quality of care can be improved for women and newborns globally. Wow….OK…we had better get to work then!

ALSO…

“Professionally, 89% of respondents reported that a clear understanding of what midwifery involves is critical for change to take place. Concerns were also expressed over the perceived devaluing of midwifery combined with the increasing medicalisation of birth.”

 

Professionally, the participants expressed concern about a lack of understanding of what “midwifery” is, the devaluing of the midwifery profession combined with the increasing medicalisation of birth, and the underlying weakness in midwifery education and regulation.

Now, I don’t claim to be able to fix the world in a day..but there was one thing that I thought I may be able to do from behind my PC. I could get an article published in @ConversationUK about the midwifery profession…perhaps I could even debunk some myths and set the record straight!…

I had my article published…please share it widely via the link below:

Oh baby: seven things you probably didn’t know about midwives

Now I was limited in this article. Limited in words and in how many points I was able to make in one article…editors need to keep their publications engaging!..and so yes…I did not manage to publish everything in this article as I would have liked to…and yes there are many many more myths about midwives that need to be debunked. But I am hoping that this will the a start of a new conversation.

Midwifery is defined as “skilled, knowledgeable and compassionate care for childbearing women, newborn infants and families across the continuum from pre-pregnancy, pregnancy, birth, postpartum and the early weeks of life” and it should be celebrated at every opportunity.

Let’s keep the conversation going around the importance of the midwifery profession. Midwives are crucial to the delivery of high quality maternal and newborn care and subsequent reductions in maternal and newborn mortality around the world. Yet they must be celebrated, respected and supported.

The core characteristics of midwifery include “optimising normal biological, psychological, social and cultural processes of reproduction and early life, timely prevention and management of complications, consultation with and referral to other services, respecting women’s individual circumstances and views, and working in partnership with women to strengthen women’s own capabilities to care for themselves and their families” – Can we start to spread the word on this now please?

If you would like to follow the progress of my work going forward..

Follow me via @SallyPezaro; The Academic Midwife; This blog

Until next time…Look after yourselves and each other 

Reflecting on the #MaternalDeath report from @mbrrace as a midwife…💜

During the December of 2016, everyone involved in the provision of care for childbearing women (and the women themselves) began to reflect upon the findings of the latest Confidential Enquiry into Maternal Death. As a midwife, I am dedicated to supporting, protecting and caring for other midwives, childbearing women, babies their families. There is no doubt in my mind that these deaths have affected all of these groups profoundly, and society as a whole. But before we begin to reflect, let’s remember that the mortality surrounding childbirth (in the UK) is thankfully rare #savingmotherslives

#mbrrace #savinglives #MentalHealthMatters #MatExp #maternalmortality

 

When we lose mothers…we also tragically effect babies…The Stillbirth and Neonatal Deaths charity (Sands) responds to new MBRRACE maternity report here

There is no doubt that we must learn from all of these #MaternalDeaths as the president of the RoyalCollegeObsGyn ‏explains here. Clearly there is much learning to do and many improvements to make. These key messages should remind us all to ask the question…start the conversation…notice the subtle clinical cues which alert us all to danger, react to risk and remain emotionally intelligent to the needs of childbearing women.

However, what struck me most was the sheer number of women who die from mental health related causes. The MBRRACE report found that “one in seven of the women who died during the period of review died by suicide. Although severe maternal mental illness is uncommon, it can develop very quickly in women after birth; the woman, her family and mainstream mental health services may not recognise this or move fast enough to take action”.

You can read the ‘expert’ reaction to MBRRACE-UK report citing mental health as main cause of perinatal death here. Maternal mental health matters – toolkit now available from @MMHAlliance for those developing a community perinatal mental health service.

Learning to save maternal lives and making change happen will not only improve the lives of mothers, babies and families. It will also improve the lives of midwives, as they will be better equipped to give the care they would like to give as their job satisfaction improves. When the psychological wellbeing of midwives is left uncared for, maternity services may see less safe maternity care. When we care for midwives, the safety and quality of maternity care may also improve. This will in turn contribute to a reduction in maternal mortality rates. So when we are looking to improve maternity care for women, their families and their babies, lets make sure that we also look to support those who are caring for them. It really is two sides of the same coin.

What can we promote?

= That it’s “OK to ask”

How can we support women & midwives? = With trust, compassion & respect

How can we improve safety?

= Evidence based care & excellent communication

 

Looking globally?

Key messages taken from the evidence base

Preventable maternal morbidity and mortality is associated with the absence of timely access to quality care, defined as too little, too late (TLTL)—ie, inadequate access to services, resources, or evidence-based care—and too much, too soon (TMTS)—ie, over-medicalisation of normal antenatal, intrapartum, and postnatal care.

Although many structural factors affect quality care, adherence to evidence-based guidelines could help health-care providers to avoid TLTL and TMTS.

TLTL—historically associated with low-income countries—occurs everywhere there are disparities in socio-demographic variables, including, wealth, age, and migrant status. Often disparities in outcomes are due to inequitable application of timely evidence-based care.

TMTS—historically associated with high-income countries—is rapidly increasing everywhere, particularly as more women use facilities for childbirth. Increasing rates of potentially harmful practices, especially in the private sector, reflect weak regulatory capacity as well as little adherence to evidence-based guidelines.

Caesarean section is a globally recognised maternal health-care indicator, and an example of both TLTL and TMTS—with disparate rates between and within countries, and higher rates in private practice and higher wealth quintiles. Caesarean section rates are highest in middle-income countries and rising in most low-income countries. Although researchers partly attribute the increase and variable rates to a shortage of clear, clinical guidelines and little adherence to existing guidelines, multiple factors—economic, logistical, and cultural—affect caesarean section rates.

Quality clinical practice guidelines need to be developed that reflect consensus among guideline developers, using similar language, similar strengths of recommendation, and agreement on direction of recommendations.

Strategies for enhanced implementation and adherence to guidelines need multisectorial input and rigorous implementation science.

A global approach that supports effective and sustained implementation of respectful, evidence-based care for routine antenatal, intrapartum, and postnatal care is urgently needed.

There is much work to be done. Until next time, take care of yourselves and each other 💜💙💛

Why we should welcome feedback and listen to those who raise concerns in both healthcare and research

Criticism and feedback can feel uncomfortable to both give and receive. It can be an awkward exchange, where both parties may be reluctant to let their guard down, concede to oversights, reveal any flaws and relinquish any feelings of responsibility. It can also be incredibly frustrating on both sides.

But lets look at both sides of the coin rationally. Firstly, Why would someone offer feedback?

• They want to make something better
• They see an opportunity to improve something
• They want to help you
• They want something corrected
• You, or someone else have asked them for feedback
• They want to offer you their unique outsider/fresh eyes view of something that you may not be privy to.

These are all gifts, learning opportunities and avenues toward creating our best outputs. Here, we theorise that everyone who offers feedback has good intentions, which some may argue is unrealistic and naive. However, I am personally unwilling to lose out on the potentially invaluable gold dust of feedback for the sake of those who wish to meddle in mischief. The vast majority of those who enter both the healthcare and academic professions do so in order to contribute positively.

In order to feel valued and perform to the best of their abilities, healthcare staff must feel heard. This is the same for those in research. As such, whether we agree with the feedback we are given, it must be heard, examined, considered and then either acted upon or rebutted respectfully.

If you are doing your best, feel passionately about what you are trying to achieve and have worked hard to achieve something amazing, it can be hard to hear that there may be cracks in your work, despite all of your well intended efforts. You are also in the job to give your best and contribute positively. But you cannot know everything…so keep listening to those who have the ‘fresh eyes’ to see what you may not.

Denial only denies you an opportunity to do better.

Lets look outside the box:

What is going on here?

Restaurant owner:

• Wants her food to be good
• Believes she has done her best
• Defensive and protective about her achievements

Customer & Gordon Ramsey:

• Wants good food
• Wants mistakes corrected
• Wants things to be better
• Wants to be helpful and constructive
• Has a new ‘Fresh eyes’ perspective from outside the organisation

The negative response to this feedback could mean:

• The customer probably won’t return to the restaurant
• The customer will avoid offering any further feedback
• A missed opportunity to make things better
• The expert will at some point back away from offering further assistance
• The restaurant may fail to reach its full potential

FYI – These restaurant owners always achieve great things for their restaurants once they listen and act upon feedback

Reflection: Can we apply these roles to some of the roles active healthcare and research? (Including our own)!

Don’t despair!… If you get everything right, all of the time, you miss new opportunities to learn

Some of my early academic papers were really very terrible. Some of the work I do now is muddled at first. I make mistakes, everyone does. I am in no way perfect, nor do I alone have all of the skills to change the world. I need help. I welcome help and input from those who can fill in for the skills I do not have and the knowledge I cannot yet see. This is why I welcome feedback and listen to those who raise concerns. In fact I grab every opportunity to do so.

In exchange for this, my work improves, I see new opportunities to thrive, new ideas are generated and collective collaborations make our outputs much stronger. Success.

If I had been steadfast in feeling that because I was so passionate about the work I was doing, nothing could possibly be wrong with it, then I would have missed the chance to create something better. Yes, it used to be frustrating to hear criticism. But this frustration can be turned around.

Once you see that a criticism is not a personal attack, it becomes a welcome guest.

More recently, I had a paper accepted ‘No revisions required’. I was worried. I wanted feedback, I wanted changes made, I wanted other people to weigh in on my work and check for anything I may have missed. This is because I knew it would be a stronger paper having been ripped apart and then put back together again….made better.

Everything I have ever done has always been made better when others have offered their ‘fresh eyed’ feedback. Here are my top tips for making the most out of feedback.

• Welcome and invite it
• Listen to it, consider it and evaluate it
• Let down your defenses (It is not an attack – people want to help)
• Feedback on your feedback – Tell them how it was used
• Actively search for those who can offer a ‘fresh eyed’ perspective on your project
• Never attack those who offer you valuable feedback (They will avoid doing it again!)
• Know that it is OK not to be perfect, you cannot do everything all of the time
• Avoid blinkered approaches like ‘I know what is best’ & ‘Nothing can be wrong because I worked so hard for it not to be’.
• Offer your own feedback to others – It will not only help them, but it will make you feel good and contribute toward the collective goal!

We all want to be the best we can be. We need to role-model and make things better for everyone. We need to lift each other up with support and praise.

Let go of your defenses and welcome new opportunities for success.

Until next time, look after yourselves and each other 💙💜💚

 

Mentorship in healthcare and research: Role modelling for excellence

Mentoring, coaching, role modelling, training…. leading….Whatever you want to call it, I would be nothing without it. That phrase was once hurled at me as an insult…

YOU WOULD BE NOTHING WITHOUT ‘X’ – Well yes..That is true.

Workplace cultures in healthcare and research are created and shaped by what we do rather than what we say. Simply put, the way we behave is how we end up living. Although we can all be influenced by what we see, hear and experience …YOU can choose how you will and won’t behave. You can equally decide what behaviour you will and will not accept from others. But who will show us the way we want to go?

As I remember training to be a midwife, many people said …”‘take the good bits and leave the bad bits’ out of your own practice, as you develop and grow alongside your mentor”. I did this, and yet it took me a long time to define who I wanted to be as a professional. Some mentors were good, and some mentors less so – personal preference perhaps?… Many tried to direct the way in which they wanted me to go, and it took great courage for me to challenge this directive behaviour. However, as my career progressed, I was able to study Leadership in health and social care at Masters degree level. This really helped me to understand the theories behind good and bad mentorship…

A good mentor:

• Has confidence in you
• Trusts you
• Empowers you
• Gives constructive feedback
• Wants you to succeed
• Supports your new ventures
• Listens to your new ideas
• Identifies your strengths and helps you develop them into constructive outputs
• Identifies your weaknesses and helps you manage them effectively
• Shares their wisdom
• Gives you wings to fly
• Behaves with integrity, professionalism and dignity
• Inspires you
• Is kind to you (and others)!
• Feeds your passions and thirst for new opportunities
• Invites you into their network of expertise
• Grows with you as you as a professional

A bad mentor:

• Is concerned only with their own success
• Talks about doing things that never happen ‘All talk’
• Is always negative about everything and everyone
• Is never around
• Cannot commit to your development
• Bullies you
• Dictates how you must behave
• Doesn’t pay attention to the way you would like to develop professionally
• Never admits when they are wrong
• Refuses to believe that you may know more than them in certain areas
• Compares you with others (negatively)
• Never lets you progress
• Kills your confidence
• Makes you feel bad about yourself

Once you find your way, it is important to find the courage to decide which behaviours you are willing to accept, and to role model yourself for the benefit of others. These are important choices to make, as they will contribute to the cultures in which you and your colleagues will be working. Ask yourself the following:

• What do you need in order to be productive?
• What do you need from others in order to thrive professionally?
• How do you want to behave?
• What are you willing to accept?

The answers to these questions must be acted upon. Have the courage to communicate these needs…Others will want you to succeed, they will appreciate this information…

…If not…..are you willing to accept that?

My final tip for ultimate success is to find your flock. Gravitate towards those who inspire you… hang around with those who allow you to fly…. learn from those who lift others up and share your thoughts with those who seek out change.

I would be nothing without my ‘Flock’…my wonderful mentors and my inspiring colleagues.

Each and every one of us ‘mentor’ a growing professional every day (whether we realise it or not)! Therefore each and every one of us needs to decide how we want to behave every day..We all create the workplace cultures, leaders and workforce of the future. Lets create something wonderful…

Thank you to all of you wonderful mentors out there….

Until next time, look after yourselves, and each other 💙💜💚

20 Ways to Create a Thriving #NHS workforce: #Leadership Lessons from @BSC_CCG

One head of Midwifery and one clinical matron have come to me this week asking for hints and tips about how they can support their staff (Great!) – They reported high sickness rates, clinical errors, high staff turnovers and stressed out staff. I am, as always, sorry to hear this. So I thought I would put together 20 hints and tips which have been proven to reduce mistakes, reduce complaints, reduce sickness and absence rates, improve retention rates, increase innovation and enthusiasm and create positive working cultures where staff are happy to be at work.

I have been on my travels again this week, one leader I met with in particular inspired me to learn more about how every NHS organisation can drive improvement through leading with compassion and actively supporting their staff in the workplace.

Cherry Dale is currently working within Birmingham South Central CCG (@BSC_CCG)….and her journey towards promoting healthy working cultures and staff well being is truly inspirational . I believe that her example now shines as an exemplar model for us all to follow. She doesn’t just talk the talk either…Her sickness rates are currently down to 0.2% in comparison with 4.44% average within the NHS, her staff engagement is high, recruitment and retention rates are high and the way her organisation can now innovate is amazing.

As I listened to Cherry’s words of wisdom, trying to take it all in…She pointed me to her latest published paper and her transformation journey -> How to get apples, not cactuses: an organisation fit for purpose: Meeting the well being needs of staff and community. By Cherry Dale.

Cherry had a dream to create a “Very different sort of service”…Knowing that performance and well-being were “inextricably” linked, she looked to prioritise mental well being, and was keen to make sure that the needs and resources of staff as well as those using the healthcare services were “at the heart” of the way her organisation worked.

How can we all ensure that this comes to fruition? 20 Hints & Tips:

1. Ensure that decision making is shared between all operational staff so that everyone is empowered to “Lead and act upon good ideas”
2. Adopt the management style, promoted by the concept of the “Sunao Mind” (Untrapped, calm and highly adaptable)!
3. Ensure that there are “No Dark Corners” – Share all knowledge and cascade it throughout, right from the top….This actively promotes ‘no blame cultures’.
4. Embrace “Stand up meetings” Where staff are encouraged to share what went well, be down to earth and collaboratively share everything openly (30 mins in length).
5. Imagine your organisation as a “Jigsaw” in which everyone holds a vital piece of the puzzle – encourage them to nurture this and take responsibility for it.
6. Ensure there are no “Departments”, instead refer to “Natural working areas” so that boundaries are no longer in force and silo working becomes thing of the past.
7. Ask “Who has the capacity?” to perform a task and “Who needs help?” – staff may be reluctant at first to share when they are at capacity, but in time the culture can metamorphosise into a supportive and emotionally intelligent culture, where staff are given extra support by colleagues whilst they are stretched to capacity.
8. Ensure that staff realise that this is how you want and expect them to behave…You set the tone in communicating “This is how we do things here!”
9. Erase the concept of ‘Grades’ or ‘bandings’ – If someone has the talent, motivation and capabilities to do the task…They can and should be empowered to do it! (Follow this with active talent management)
10. See leaders as coaches and invest in training… for effective communication, ask coaching questions and avoid simply ‘directing’ people.
11. Ban internal emails! – (A scary thought!) – This promotes conversations, movement and positive staff relationships.
12. Promote open office spaces where senior staff are situated in the centre to promote open collaborations and discussion.
13. Listen with interest and encourage staff to speak openly about concerns.
14. Develop a ‘Human resources working group’ with members from each of your natural working areas to develop guidelines, policies and strategies with those at the top.
15. Recognise and celebrate achievements, new ideas and acts of kindness.
16. When staff are not quite themselves..Snappy…Tearful etc… encourage yourself and others to notice and check it out..”Is there anything you would like to talk about?…Feel free to come over and offload”
17. Consider training all staff in the ‘Human Givens approach’…from this develop a staff wellbeing strategy, wellbeing days and events.
18. Movable office furniture and bright colours inspire innovation.
19. Link with the community and #GetInvolved with local fundraisers, initiatives and activities.
20. Take this leap, make these changes and believe in them. Ripples will occur, people will notice…and your #NHS organisation can reap the same rewards.

As some of you will know… I have strong feelings about the term ‘Resilience’…But I do like this model below:

 

Things to ask your team on a regular basis…

Have you laughed today at work?

Do you have someone you feel you can confide in at work?

Do you feel able to contribute to decision making?

Do you know what is really happening in your organisation?

Do you feel able to influence the direction of travel?

(Discuss your findings and create an action plan in response to results…Monitor progress!)

“Don’t expect apples when you have sown the seeds of a cactus!”

 

Activity: Making the best of me…

1: Ask yourself how others can get the best out of you

2: Offer what you can realistically do

3: Communicate what inhibits your productivity with others

4: Actively describe what you need from others in order to thrive

 

A Sunao Mind: Having a sunao (untrapped or open) mind means being tolerant without selfishness, being open to the teachings of others, and being able to find joy in any circumstances. It also means being quiet yet dynamic, dynamic yet quiet. It is a state of mind that leads to the truth.

I hope we can all learn and embrace these lessons within our everyday lives. We know that the mental well being of #NHS staff directly correlates with the quality and safety of patient care…So let’s all create cultures in which we can thrive!

We are all leaders…so let’s all lead the way and leave our foot prints in the sand for those who wish to follow….

Until next time ❤

#BursaryOrBust & the #JuniorDoctorsStrike – Our #NHS staff under threat

I have been watching the various arguments upon social media in regards to the #BursaryOrBust proposals & the #JuniorDoctorsStrike. I cannot help feeling that our NHS staff (and students) must be feeling somewhat under threat. Our NHS staff need a nurturing environment in which to thrive. Rex Haigh has described the quintessence of a therapeutic environment as being one in which community members feel safe and have a sense of belonging. NHS staff must feel valued and nurtured in order to give the best of themselves and reach higher levels of personal achievement. We all want the very best for our NHS staff so that they in turn can offer the NHS the best of themselves…don’t we?

Here is a brief run down outlining the current predicaments for Nurses, midwives and junior doctors.

As the nation’s junior doctors go on strike, they talk about why they do their job, the challenges they face and why the proposed new contract will be detrimental to patient care in this video below….

The business case for a reduction in working overtime is clear. It can result in a cycle of exhaustion and actually limit productivity.

The proposed new contract would extend #juniordoctors normal hours, known as plain time, to 10pm on weekdays and include Saturdays until 7pm. There will be an 11% pay rise to compensate for the loss of overtime, but the BMA insists juniors would still be up to 30% worse off.

At the same time, student nurses, midwives and other health professionals have been marching outside Whitehall and Downing Street in protest against the government’s plan to scrap bursaries for nursing and midwifery students from 2017. This plan will see the bursary replaced by loans to cover tuition fees and maintenance costs. The argument is that this will allow the cap on student numbers of be lifted, creating up to 10,000 extra training places.

The key campaigners are @KCLNMS (the King’s College London society for student nurses and midwives) – They are certainly leading a strong movement. I salute you!

The petition against the reforms has attracted more than 150,000 signatures.

• Date set for parliamentary debate on student bursaries
• Keep bursary petition passes target needed for MP debate

However, MP’s have said that bursary removal risks NHS recruitment ‘disaster’.

So, what I draw from both of these situations is a sense that our staff are feeling/being undervalued. Whether this is true or not, the sentiment shines through. ‘We are making cuts to YOUR profession’ whatever they might be….YOUR profession is one we can make cuts to.

Does this send a message that we think we can stretch NHS workforce to extremes?… Value other professions more? …Test the resilience of this workforce as apposed to others?

A good leader will lead by example ‘Let me show you how we do things here’… Everything we do sends a message, and here, I fear that the message of ‘undervalue’ may become ingrained in generations of our NHS workforce. Striking is rare. The feelings are real.

Leaders must continuously create new opportunities for their valued and most outstanding employees – or their workforce may fail to thrive.

We know that some staff are more stressed by being undervalued than by workload So how might NHS staff be feeling right now? Worthless? cast aside? not worthy of reasonable working hours? or the right pay? dogs bodies? a Cinderella service? Whatever they may be feeling, I do not believe they will be feeling particularly engaged, productive or valued right now.

We currently have a recruitment and retention challenge on our hands, and one of my initial thoughts was that if new students are going to have to pay for their training, this may discourage those applicants who apply for a nursing/midwifery career as a secondary option without the burden of a student loan. I remember myself how high the student drop out rate was as a midwifery student by both young and mature applicants (16 started, 4 of us qualified)! If students have to pay and training placements increase, we may gain more control over plucking the best candidates for the job.

However, what if the best candidates can’t afford to pay/get a loan? I guess there isn’t enough money in the world to fix every problem. However, one thing is clear, whoever we recruit, employ, work with or manage, we have to value them in order to maximise their potential within the health services. When work is held in high value by the employees, turnover is not a big issue. Recognition, praise, and special incentives are tools that can raise the value of work to employees. If employees feel better about their jobs, they are less likely to leave. Even more importantly: they will try to be better at what they do.
By raising motivation levels, worker turnover can be reduced up to 53%(Steven et al. 2005). This is something we all want to achieve.

My concern is that the scars these changes are making in undervaluing of our NHS workforce will remain and run deep for a long time. They will be remembered in generations to come, and will take work to heal. As leaders demonstrate ‘How we do things here’ they are also demonstrating how we treat our NHS Staff. Lets hope they get it right in the end.

(Steven J. Condly, Ph.D. and Robin DiPietro, Ph.D. “Motivation in the Hospitality Industry” 2005)

 

Who am I and what am I doing here?

Brief update: Deep in data for another week after the 2nd round of data collection ends. Fascinating results and insights coming through, but not quite ready for sharing/publication yet I am sorry to say. Conference season also seems to be upon us, and so I have been applying to various events where I can share my results with interested audiences across the UK. If you would like to see the data presented then why not come along to either the 2nd Behaviour Change Conference: Digital Health and Well being: 24 & 25 February 2016, the Midwifery Exchange; Thursday 4th February 2016 or the ‘Great Minds Don’t Think Alike’ – Nursing and Midwifery Conference, in January 2016. I will be there and hopefully at other conferences in the spring/summer of 2016 to share these insights and develop this project on to the next phase.

Another exciting adventure I have been having is with the National Elf Service, who disseminate high quality research for busy working professionals to update their knowledge on the go. I have always loved this project, and so now I have the opportunity to become a part of the project #Excited!…Anyhoo, as a part of their interview process, they had asked me why I may make a good elf. In answering this question they directed me to take a theory driven personality test. I found the results fascinating and would thoroughly recommend that everyone explore this resource too! I personally had never felt so very much understood. The description of me was almost word for word accurate. It was so empowering, that I wanted to write here a little about who I am.. and what I am doing here.

Who am I?

So apparently, I have the ENTP PERSONALITY (“THE DEBATER”) ,  ENTP = Extraverted – iNtuitive – Thinking – Perceiving – Also known as ‘The Visionary’ or ‘The Intuitive Seeker’. I am amazed at how accurately this personality type fits the description of me (warts and all). This discovery has also made me feel quite unique in the fact that this personality type supposedly only represents 3% of the female population.

Others labeled with this personality include Socrates, Barack Obama, Steve Jobs, Stephen Fry and Catherine the Great (Empress of Russia). Who knew?

Now that I have come uncomfortably close with my own strengths & weaknesses, I intend to spend time reflecting upon how I might use these personality traits to influence my own goals and projects in the real world. As I come closer to turning my vision for an online intervention, designed to support midwives in work related psychological distress into practice, I am confident that my enthusiasm and drive for success will take this project into the real world.

Why am I here?

Although my enthusiasm for change and improvement within the #NHS will never wain, I sometimes find myself wondering whether I am alone in such passions for #NHS staff well being. However, a quick conversation about my research, or a glance at Twitter always quickly let me know that this is not the case. I am constantly looking for people who I may identify with, or who may identify with me and what I am trying to achieve. I do this I think, in order to validate the purpose and worth of my research…to begin to understand why I am here and why I am doing what I do….I realise that many people are galvanising support for the cause and an appreciation for the need for change.

I am here because NHS staff need to be supported for the benefit of themselves and the patients they care for. The organisations they work for have at times been seen to blame the individual rather than the organisation as a collective when failings occur. This does nothing to improve candour, open learning or effective communications. Where punitive blame cultures exist, nothing can be improved. Staff are reluctant to speak out where a fear of retribution is apparent. As such, a trade off may be required if we are to allow staff to be kind to themselves, ask for help and improve the health of the service as a whole. Then I ask myself…is there anyone else who feels this way?

Then I came across this magnificent quote…

Good people do bad things

“The public mood may demand individuals to put in the stocks, but mature reflection acknowledges that there is a more complex debate to be had around the limits of obligation for professionals, the factors that motivate or discourage, the disempowerment that is inevitable in a more highly managed service and the promotion of virtue. These are beyond diktat, guidelines, unread protocols on hospital intranets and managerial exhortation. Intelligent kindness,5 medical humanities and the lessons of psychological experimentation may have more to offer.6” John Saunders

Ultimately I am here to promote the notion of kindness and compassion for #NHS staff. The need for a compassionate #NHS has been patient focused up until now. I am here to ensure that it also becomes staff focused. Who I am means that I am excited to find out why I am here. I look forward to fulfilling my potential and my duty to apply my research in a way which benefits society as a whole. To reflect is good. It keeps me focused and ‘in the now’. I am half way through this PhD journey already. Here’s to the next phase!

#BeTheChange

#ImInWorkJeremy Campaign – Can we change the rhetoric @Jeremy_Hunt ? #NHS staff are Burning out!

So, I feel that I must blog about the #ImInWorkJeremy twitter campaign, which is currently in full force following Jeremy Hunts call for a #7dayNHS. Firstly, I believe that everyone is on the same page in terms of wanting the safest patient care possible. However, I am not so sure that the health and well being of NHS staff is being as valued at present, which as we all know, is surprising given the direct correlation that #NHS staff health has with the quality of patient care.

NHS staff are tweeting this weekend about how they are already working and keeping patients safe. They are doing so largely without breaks, food or a stress free environment – THANK YOU!

However, 65% of NHS staff have attended work when they have felt unwell enough to do so. I am concerned that this is not conducive to safe and effective quality patient care. If more pressure is put on NHS staff to perform for longer/harder hours, how will this statistic be affected? and how will that impact upon patient care? Will we find problems with the Wednesday service if we prop up the Sunday service? How can we deliver a #7dayNHS with more doctors if we don’t also have more nurses/midwives and support staff?

The challenges to achieve this are many… and it is clear by the many tweets I have seen this weekend that a #7dayNHS is already happening….

So why does Jeremy Hunt want NHS staff to work more unsociable hours? Well he has claimed that “Around 6,000 people lose their lives every year because we do not have a proper 7-day service in hospitals.” Yet there are further claims that there is yet to be a source for this claim. Confused yet?

I think the real problem here is that NHS staff may have been made to feel like naughty children who are being told what to do to make things better, rather that being inspired and carried forward by strong leadership. Everybody wants to make the NHS the best it can be. We are on the same team, so why have NHS staff been made to feel devalued?

The Secretary of State for Health (Jeremy Hunt Himself) asked Lord Rose to conduct a review into leadership in the NHS. The review asked:

• what might be done to attract and develop talent from inside and outside the health sector into leading positions in the NHS?
• how could strong leadership in hospital trusts might help transform the way things get done?
• how best to equip clinical commissioning groups to deliver the Five Year Forward View

This review reported that: “First, the NHS consistently delivers great service through a committed and passionate workforce of 1.38m staff in England . During my Review I heard many great stories (only a few not so great). Mostly I found staff motivated and focused, often running on goodwill in a tough environment; some places felt more positive than others.”

This was great to hear! Our NHS staff are being praised for the amazing work they do! Praised for the service they provide and acknowledged for the sacrifices they make to do so. We are all on the same page to do good things. The service is great! But yes, the environment is tough Jeremy..tougher than you may think it is….NHS hospitals are pushing young medics to brink of ‘burnout’ by relying on them to work extra hours…NHS staff want to work towards an even better service, but they need support in doing this, not be whipped and forced into doing so. Picking a fight is not in anyone’s best interest.

We know that engaging NHS staff will improve patient care and staff absenteeism ….so Jeremy I ask you…can we change the rhetoric here? Can we engage staff in this conversation rather than isolate them? They need to feel valued, inspired and driven in order to perform at their best. There is now an Outcry in the blogging community, calling for Jeremy Hunt to resign… However, I think what may be needed here is a new narrative, where staff feel valued and empowered to engage with the vision for the future NHS services alongside you, rather than feeling as though they are being dragged by their pigtails.

We are on the same team… Let’s be kind to each other.

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.