The same

News and Comment from Roy Lilley.

If austerity can give us innovation, pressure may give us team work.  When people work under pressure, two things happen.  Either the group falls apart in an ignominy of rows and bickering or, they come together, natural leaders emerge, a common purpose surfaces.  They achieve the amazing.

The sort of conditions the NHS is facing and surviving them, will be worn, like a badge of courage in the years to come.

'Do you remember the winter of  '18, we had patients on beds, in the corridors, on the floor, in ambulances.  I thought it would never end....'

Anecdotes will enter our folklore, become part of the history of the NHS.

Pressure can create disarray.  Out of disarray will come a way of coping... a system, organisation, structure.  Later a plan for next time.  If we are thoughtful and sensible the plan will be shaped around the experiences of the people who were there.

Working under pressure has its own curious reward.  Camaraderie, bonding, bringing-together in a way only emergencies can.  

Come back and do it again the next day?  Yes, it creates excitement.  The thrill of the challenge.  Being able to say; 'I was there and we came through it...'

Fall back on training to see you through.  Then instinct.  Then what...

Let it go on... watch performance drop.  People fall by the way side.  Physically and emotionally drained.  The challenge becomes a grind.  Wears down even the toughest and most motived.  

Right now the NHS is little short of heroic but it can't last.  Tiredness, tempers, mistakes, blame.  Toxic.  We are in the early part of January.  The end of the month and February are likely to be worse.

Where the impact is worse and the effects most obvious... hands-on care.  The potential for errors, judgement, attention, memory and decision making falling-off.  Small things become big things, it's called cognitive distortion.   

Problems get magnified.  In the best selling book 'Performing under Pressure', Weisinger and Fry, tell us; 

'... pressure comes from the outcome being important, but uncertain and the feeling you will be judged on the outcome.'

A combination that might as well be written in neon lights above the NHS.

Looking after staff; breaks, safe journeys home, thank-you's...

Yet, there's more.  We need to reframe our thinking.

Can we think about pressure in the context; what did we learn today that can we take into tomorrow. 

Decompression time, teams together at the end of a shift can make a huge difference.  Long days, late finishes and early starts makes this difficult but it's worth trying.

Something to celebrate, even something to laugh about.  Take home a happy thought.

... because today isn't the end.  It is the beginning of the next day.  We can either be overwhelmed by it, or recognise the best of it and take it, with us, into the days that follow.  Leaders celebrate success, however small. 

Good communications, like always... vital.  Everyone must know everything.  The bed status, arrivals status, what's happening... no surprises because surprises are destabilising, sap morale, drain optimism.  Take care of the little things before they become blow-your-top-things.

It's our job to create the time and space for good people to do great things.  Saying; 'You know the situation as well as I do.  So, what can I do for you, what do I need to know, what can I change, what do you need?' and delivering.

Now is the time for the Patient to Come Second.  Now is the time for the staff to come first.  Without them we have no care.  If they all have the flu... nothing.  Nothing happens until you care about the people doing the caring.

Remember, there is no such thing as patient centred care.  There is only the care the patients tell their family, neighbours and friends about; 'The place was choc-a-bloc but the staff were amazing...'

How we make them feel depends on how the staff are feeling.

What we are asking people to do, in any workplace, would be seen as unreasonable.  

Doing it and being responsible for life and death is totally unreasonable.  

Doing it in the full glare of publicity, criticism and censure... wholly unreasonable.  

Completely unreasonable is the thought that this time next year, it will all be the same.

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roy.lilley@nhsmanagers.net 

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