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Compassion debate :nature or nurture & why it’s worth considering the bigger picture before rushing to “fix” the NHS through more rules & regulations


Compassion in NHS is big news this week. The Francis report is out, and all branches of healthcare are considering its implications. This article discusses the fragility of compassion once the environment becomes stressful. When resources ( time, nurses, cleaning staff, etc ) are in short supply then group survival mechanisms kick in.

Article from Health & Social Care journal discussing compassion in NHS. Please read the comments at the end of the piece by the Professors

It’s the old nature vs nurture debate, and it had its routes in the biological evolution of societies and culture. Tribes of people & staff develop ways of differentiating themselves from the people who are not in their tribe. This is done through words (jargon & abbreviations), appearance (uniforms), and rules or regulations which may not be obvious to the uninitiated.

Regional accents have been attributed to this phenomena. As the piece says the same hormone that is responsible for increased compassion in a mother to an animal like her self, can cause aggression towards people who are not like her.

Maybe if healthcare can find ways of reducing the barriers & improving the flow of information, knowledge and understanding then compassion will stand a chance.

I have read that the Francis report could mean minimum staffing levels are prescribed for hospital wards & midwifery units. These are environments where a body of work is share between a defined workforces at the same time. What should the implications be for jobs that involve one individual seeing a series of people in a clinic.

Who decides on the optimum length of appointment or what can be achieved within it?

The department of health is currently negotiating with doctors leaders about how to change the GP contract. It looks like they plan on more work being added to the current list of “things that your GP could or should be doing for you”.

Proposals include discussing exercise or diet with patients who have long term health conditions. It’s a good thing – but it takes time , and will not be done better because I have an extra box to tick.

Asking the health care system to do more of something – without telling it what it can stop doing, in order to free up time to do the new thing, will increase stress.

Our society needs to consider what it wants from its health service & then resource this adequately. Greater compassion will emerge more naturally when patients can build up relationships of trust , over time, with their health care providers. This needs time.

Time is money – but it’s worth it ! It’s also pretty difficult to measure the financial value of courtesy or having a polite & friendly receptionist.

Time & good staffing levels & communication with patients in all forms including social media , can help fix the problems identified in the Francis Report 2013

Please feel free to comment below.

Dr Stuart Berry @stuartberry1

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5 comments on “Compassion debate :nature or nurture & why it’s worth considering the bigger picture before rushing to “fix” the NHS through more rules & regulations

  1. Geektapestry
    10/02/2013

    Stuart, Good blog and thanks for the pointer to the other blog post I’ve got three hats on here – ex practitioner, patient and former (atm) information and communication postgrad student.

    Where do I start with this? *g*

    I trained 25 years ago – before resource management, before hand held maternity notes at a very traditional (red brick) University Hospital. The matrons had gone but the night sisters were of that ilk. I trained in the hospital nursing school – but we were mixing (when they’d let us as they were *better qualified* ) with the first of the degree nurses (different uniform and everything and obviously supernumerary to the ward staff. I think the most useful part of our training was the fact we did the lot, obs, dressings, made the beds, turns, fed the patients oh and the wards were those panopticons – Nightingale wards. From the central table you could see everything. Whilst this might seem a hearken back to the ‘good old days’ I do feel we have lost something in the modern wards of today. The staff are very much task based and present only in the bay if there is a task to do. Made me laugh actually when I was in for ‘observation’ because I was stable, I was in a four bedder round the corner… As a night nurse we were always up and around – and we did get to know our patients!

    Patient wise. I’m a diabetic type 2, who is also years post menopause, who has ‘revolving’ mild depression and a mother of two special needs kids. At my diabetic apps, consultation runs by the template (apparently my Cardiac risk is quite low… despite LBB (?cause) and no oestrogen for ten years or more) , i’m told to diet and ‘watch’ my food intake, pressured to add medication when my condition is ‘not meeting targets’ (complications come second) . No asking how the stress levels are – I just get referred to the dietician who counsels clean a drawer instead of eating. No understanding of the complex being that is me and the quite complex medical history I’ve had until now. Its all by the templates and the PHQ9 scores not by how I look or what I say. When I was late getting a diabetic checkup (their fault) by months – I wasn’t called up by the clinician responsible for the diabetic clinic to see if I had issues getting to the clinic – no I was sent a letter demanding that I complete a form that would excuse me from their QOF lists and any further follow up by the practice with regards to my diabetes. The QOF really has shattered into smithereens the concept of holistic, high quality GP care and does so in hospital medicine – which I’ve had experience of too.

    I have a great problem as an I & C academic with the programs for Information in the Health Service. My understanding of what information, communication, data and knowledge is a very different from what is presented by most IT whizzes to transfixed health professionals. And I think this technological, systemic view is invading health care. Information flows are presented with nice neat flow diagrams, with nice neat parcels of data flowing along the cables or through the air to link in with other flow diagrams, ad infinitum. But… communication isn’t like that in real life, people miss things out, tell you more than you want etc etc. This flow chart ‘culture’ has invaded hospital speak with patient pathways etc. These imply an effortless flow of a patient down a pathway to treatment, without any pesky detours or delays that a patient might want to put in. And once on them, it would seem it is very hard for a patient to step off this factory production line. A case in point is the newly minted RCP report – Action on Obesity, wonderful, detailed report but without (as far as I could work out) a patient voice but full of lovely diagrams about when a patient would see a GP and then exit the care of a GP and move into the care of Bariatric team or be passed along as a detour from another specialism…

    Another point is that I view knowledge as only being able to exist within a human (huge debate I know but too long for here) where the human is informed, the information is filed and links made with existing knowledge and the ensuing resultant knowledge turns into a series of actions. This cannot be encapsulated into technological networks – again we are back to prescriptive pathways that do not make room for the holistic human present on both sides of the consultation.

    Probably well off the beaten tracks – but thanks for the opportunity to ramble!

    • @stuartberry1
      11/02/2013

      Thanks for taking the time to comment. Eventually technology can evolve to a point where it truly augments the human experience. Good quality info graphics are one example – a really good one conveys info on many different levels without reuniting much extra “brainwork” from the reader. Or the stats & visual representation of data that can help a clinician see how their use of drug x , fits in with their colleagues.

      I couldn’t work without computer based notes – but these systems (Emis web) is not intuitive enough for all users to be using it in the same way. If the “best” way of using it was the most obvious – then that is what people would do. People take the most obvious , shortest route possible.

      It must be useful to be able to reflect on the different changes in those 3 spheres of your experiences. ( nursing , parent , diabetes patient , and cyclical mild depression). All 4 will have had a big impact on you and those other spheres. If you were still working as a nurse I’m sure they would have an impact on your interactions with patients. It would be hard to measure – but there would be the potential to share some of life’s experiences with the people you meet – providing you had the time.

      • Mandy Hall
        11/02/2013

        I’m always happy to contribute to anything – :) And if it helps to make things better for others then all the better. I’m basically twiddling my thumbs at the moment – hence lots of time spent on Twitter, Facebook, Blogging …

        I’m one of those natural joiners!

        I think the thing that bothers me about computerised systems used to consult is that they are great (paper notes had a lot of shortcomings ) for collecting information but it does have an effect on structuring the consultation. I’m not sure if there have been any studies on the way this affects the consultation – does it inhibit seeing the patient as a whole person, narrow the consultation down to *problem solving* ? How can such a structured session become a conversation where something not wholly connected to the template / problem in hand might spark a connection in the HCP’s mind?

        My PhD (not completed) started off with a case study of a GP surgery who were changing their systems – coincidentally this change ended up being a total and dangerous disaster. But this isn’t to say that I am anti computerised systems – I am not but I wish developers and implementers started off with the question of why not we can do this because we can. (the thrust of the degree was going to be an examination of the use of IT to shape the Health Service into a *modern organisation*) Again, something that is not widely recognised, imho, is the fact that changing the information systems fundamentally changes the organsiation, it changes the way individuals function and does thier job.

        There is also the old canard (for me as an academic anyway) that one of the fundamental problems in this area is that us Informatics professionals (IT & the ‘softer’ people leaning ) use the same words to mean very different things!

  2. englishyogi
    11/02/2013

    Dear Simplestuff – i have nominated you for the liebster award – you can find out all you need to know about this award from my response to my nomination here: http://averyenglishyogi.com/2013/02/11/gosh-im-liebstering-it-thanks-to-fortheintolerants/
    Hope you are ok with this, best wishes
    a very english yogi

    • @stuartberry1
      16/02/2013

      Thanks English Yogi for the nomination – I will get my thinking caps on. It may take a while to come up with my nominations, as its a busy time of year. I have enjoyed reading the other nominations.

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