I was just so excited this week with the promise of a two-week holiday looming large. I couldn’t believe how much I needed a break already. I blame it on all this learning… and blogging!

The week very quickly became about getting everything to the point where it can be left for a while, along with habitual wishful thinking of trying not to pick up any new work in the meantime.

I must say that I failed miserably on all counts and worked too many hours. However, I did finally gasp that great sigh of relief as I pinged the last set of ‘please can you do…’ emails off, closed down the computer and shut the study door behind me.

So what went wrong?

End of the week, Friday morning, I had a planned conversation with a colleague who has done this service redesign stuff before. I admire her passion for improvement and her enthusiasm for her work. She’s a nurse by background and has a great sense of humour with lots of realism thrown in.

I’ve asked, as a novice to the game, if I might pick her brains with regards to process and the whole -  ‘what worked for you?’ and ‘what would you do differently next time?’ queries. During the chat she asks me how I am going to market my project with practice-based commissioning colleagues. Then the killer question: ‘How can I be sure they will want to commission my newly-designed pathway next year?’

Gulp! That question was the main reason why I didn’t actually switch off my computer until later than planned. ‘Oh dear’ (or something similar), ‘I don’t know,’ was my immediate answer, but I can think about it and sort it, can’t I?

Thank goodness the commissioning plan’s deadline is still a short while off. Thinking about it more coolly I was reassured that the strategic fit is already established and I know the formal and informal communication routes.  I can set up a marketing campaign, I can persuade with hard statistics, details of poor health outcomes, benchmarked performance, activity numbers and high costs. I can add influential stories of patients’ experiences and provide details, if required, of ‘buy in’ from a variety of local health and social care professionals. What else? Have I missed anything out? (Please let me know. How have you done it? What worked for you?)
 
You’ve guessed it, back to the project plan, again…………………

This project continues to amaze me. I get myself on a two-day course. Then I find out I am the only commissioner amongst a sea of 39 providers registered to attend. The health and social care professionals were suitably intrigued.

On the first day we worked on how to support people who have suffered a stroke to set their rehabilitation goals (not our goals for them) and then on the second day we looked at developing skills and techniques to communicate with people who suffer from ‘aphasia’.

You can see what’s coming here can’t you? The alarm bells sound; it’s a nightmare scenario for a desk-based commissioner. What’s aphasia? Should I already know?

I had just summoned the courage (from my reserves, don’t all finance directors have these?) to say, ‘I’m afraid I don’t know what that is’, when the cavalry arrived and the trainers, ignoring the round of nods, explained the term anyway. ¹

On the second day a number of people shared their experiences post-stroke with us. Particularly, they talked about the battles they fought, and are still fighting on a daily basis, to communicate with a world that takes the understanding of information, the internal processing of it all and then responding to it, for granted. 

I sensed a number of people opening their eyes for the first time in a long while, many of us being gently reminded - in a most powerful way - that everything is not always as it seems and as we assume it is. This is especially important once we become experts in our respective fields and know the job inside out. 

What we think is best - because we are qualified, and then continuously updated and developed - may actually be someone else’s worst nightmare. It was a reminder to always make sure we had properly discussed things with, and listened to the patient, rather than assuming our best practice will suit all.

Everyone left the room that day with a list of things they were going to do differently when they got back to their workplace; me included. I’m  determined to stop taking for granted that my way is best, remembering that if I don’t shut my eyes I will learn from everyone, even those whom I am trying to help. That’s how our services will improve, that’s how we will drive up quality.

¹ Aphasia - a total or partial loss of the power to use or understand words.

This was the week I landed on the ground with a bump. I’m sure you’ve been there too. You start the new job and everything is so…new. There are lots of different people to meet, places to visit and procedures and systems to get your head around.

The first few weeks all blur into one, you are absolutely shattered when you get home at night. Then, there’s the repeating ‘wow factor’ of trying new stuff out and being proud you can do it, like my experience of working on Leicester General Hospital’s stroke ward.
 
The bumpy landing came when I realised that I would need to start feeding all this practical experience into my project initiation document (PID).
 
It hit me that I needed to make sure I understood exactly what it is I am doing and, perhaps just as importantly, what I am not doing. That way I can explain it to all those who keep asking and to those who are trying to help me achieve it.
 
As I worked my way through my project timeline it became clear just how much I have to do and at what pace to achieve my desired results in the time I have. I thought eight months was plenty of time, but once you start planning and breaking the individual components of the project down into do-able chunks, you quickly realise exactly what you have taken on.
 
What to do? I got a cup of tea, I sat back and I went back to my reflections on life as a healthcare assistant. I remembered how my time experiencing that role had highlighted the importance of teamwork, information, communication and social interaction. I went back to my plan and had another look. I double-checked the time I have allocated to the various project tasks to make sure I’ve concentrated the right amount of effort in the places where it will have the biggest impact. It took another couple of hours, but I changed the timeline quite a lot. I felt a lot more confident the second time around that the breathing space is where I need it, timescales are still intact and the deliverables will be produced. It’s a little tight in places, but then isn’t that life in the NHS?
 
All I can say is thank goodness for reflection and project management. I recommend them both to you.

Last time I shared my experiences from when I spent time as a healthcare assistant. If you read my last blog you’ll know what an impression helping out at Leicester General Hospital’s stroke unit made on me. Since that time I’ve reflected further on some of the key aspects of good service delivery.

First of all, good colleagues matter. The staff of ward eight were a great bunch of people to work with. Everyone generously welcomed me to the ward and immediately treated me as part of the team – how else can a group of people with both individual and team goals make the operation of such a complex unit work smoothly? Teamwork has to be the backbone of all we do in the NHS.

This was further demonstrated by the lunchtime routine. Protected lunch times were essential on ward eight. All staff on the ward stopped what they were doing and worked together to ensure that patients got their meal when it first arrived. On a basic level this ensures it’s warm for everyone but also that they eat together, which is more sociable. Mealtimes were an example of how when everyone works together we achieve so much more and this efficiency benefits patients and staff.

It also struck me how important it was to treat people as individuals, not just patients. Taking the time to chat to patients was one of the nicest and easiest elements of my role. The conversation wasn’t always about their condition and treatment. We all spend time chatting to patients, getting to know them as individuals, having ordinary conversations about what’s happening nationally, local events and even last night’s episode of Coronation Street. Social interaction plays a major part in securing a person’s wellbeing.

One of the patients I was looking after routinely lay in his bed all day and didn’t get many visitors. He asked me for something when I was in the middle of doing something else, so I told him I would be with him in five minutes. It was more like 10 minutes by the time I actually did return to him and he had already thought I had forgotten his request. So it’s not what you say, it’s how you say it. It’s all about what you hear, so make sure you listen. Don’t promise what you can’t deliver.

In fact one of my over-riding conclusions was the absolute importance of communication in general. Everyone spends so much time passing on information through patients’ notes, staff handovers and general ward procedures. This makes good quality information vital. It is worth taking the time to get communication right so it’s both accurate and clear.