On ancient wisdom and LfE

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I recently presented on LfE at the 2019 Patient Safety Congress.  At the end of the presentation there was an interesting question from the audience:

(Paraphrased): “I was stuck by the similarity between LfE philosophy and ancient eastern philosophy; in particular, the common theme of kindness and compassion.”

I was drawn to this question, because I have recently started to think along the same lines.  I have been reading about meditation and mindfulness, and for the last few months I have been building meditation into my daily routine.

I am no expert, but I think the comparison with eastern philosophy is worth considering in two overlapping areas:

Firstly, the area of safety-II:  LfE is not safety-II per se, but there is a clear overlap, particularly with respect to recognising and understanding Work As Done through appreciative inquiry.  Considering Work As Done requires a mindful approach to daily work.  In order to recognise the day to day adaptations which underpin work, one has to “take a step back, and observe”.  This is akin to observing the mind when meditating, or practicing mindfulness.  When one engages in these activities, it is often surprising what is noticed, and with practice, it is possible to gain insights.  Taking the time to be still, and observe what we tend to take for granted is a necessary part of meditation / mindfulness and safety-II practice.

Secondly, kindness and compassion underpin both “philosophies”.  Through practicing mindfulness and meditation, one gains awareness of one’s mind, and over time it becomes easier to exist in a peaceful state, in which it is easier to be kind and compassionate to others.  Forgiveness also becomes easier.  Kindness reveals itself as our natural state.  LfE is a positive approach to patient safety, in which colleagues (and patients) highlight areas of practice which are working well.  LfE reports are almost always characterised by gratitude and appreciation.  The vast majority of reports focus on non-technical skills and interventions, and one of the commonest themes is kindness.

So what is the significance of this common ground between LfE and ancient wisdom?

I have always maintained that LfE is not a new idea, and we have always described the initiative as a “philosophy”.  I like to think that this reflects an underlying awareness that the ideas behind LfE stem from an ancient axiom: that kindness and compassion are fundamental to wellbeing, and therefore worth recognising and promoting.

 

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Could Learning from Excellence be enabling compassion to flow?

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I’m delighted to introduce a guest blog from Andy Bradley from Frameworks 4 Change.  Andy’s blog starts with his thoughts on a recent LfE event in London:

 

Could Learning from Excellence be enabling compassion to flow?

To change an organisation, change its stories

Gary Hamel, London Business School

I spent four minutes in total listening to an orthopaedic surgeon at a workshop on Learning from Excellence at a national patient safety conference. I did not find out the surgeon’s name but here is what I did discover:-

He had received some positive feedback in writing from a patient who had felt anxious about her planned surgery. The feedback thanked the surgeon for his calm, caring demeanour and the patience he showed in answering the patient’s questions and allaying her fears. As a result of receiving this feedback I discovered that the surgeon felt happy and proud. As a result of our conversation, in which he spoke and I listened, the surgeon had decided to go back to the team he works in to suggest that they start gathering data specific to how well prepared patients feel for surgery – he was thinking about a likert scale with space for a qualitative comment – he was thinking that the importance of preparation in terms of the patient experience could be overlooked and that by focusing on this area a range of improvements were possible.

We had been asked in our pair to think about:-

A story of excellence in care

How the story made the story teller feel

What could be done to create more of the moments shared in the story

The Learning from Excellence Philosophy

Safety in healthcare has traditionally focused on avoiding harm by learning from error.  This approach may miss opportunities to learn from excellent practice.  Excellence in healthcare is highly prevalent, but there is no formal system to capture it.  We tend to regard excellence as something to gratefully accept, rather than something to study and understand.  Our preoccupation with avoiding error and harm in healthcare has resulted in the rise of rules and rigidity, which in turn has cultivated a culture of fear and stifled innovation.  It is time to redress the balance.  We believe that studying excellence in healthcare can create new opportunities for learning and improving resilience and staff morale

Does pride helps us to deal with shame and release compassion?

Your mind is like a garden, whatever you focus on grows

Matthieu Ricard, Bhuddist Monk

The fear referred to in the Learning from Excellence philosophy drives the dominant narrative in health care – the rules and rigidity increase in relation to the fear which often manifests in the individual as guilt (I have done something bad), internal shame (I am bad) or both.

In their book the Archaeology of Mind: Neuroevolutionary Origins of Human Emotion Jaak Pansepp and Lucy Biven throw light on the neural sources of our human values and basic emotional feelings. The ‘primary processes’ which are located in deep areas of the brain include fear, rage, grief and care. The secondary process in which we make sense of these primal feelings and begin to integrate our experiences are empathy, trust, pride, blame, guilt, and shame.

Primary processing in medicine is complex – when culture and practice is healthy care is clearly central but when things go wrong fear and panic can set in and cultures can become toxic In these circumstances secondary processing in healthcare is dominated by blame, guilt and shame – which may help to explain why the system is experienced by many as institutionally defensive.

Learning from Excellence fosters pride in accomplishment and is grounded by noticing and giving voice to appreciation this may help practitioners to come to terms with guilt and shame. Paul Gilbert OBE, the founder of the Compassionate Mind foundation has concluded from research that the number one block to the flow of compassion (self to self, self to other, other to self) is shame.

So, here is what I am thinking now….

by generating pride and making appreciation explicit could Learning from Excellence help to balance the health care system by enabling the flow of compassion?

Andy Bradley

Frameworks 4 Change

Learning to care

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The following guest blog is from Mike Clift.  Mike spoke at our meeting in January 2016, on the topic of Compassionate Healthcare.

 

I was asked to write this blog shortly after presenting my compassionate healthcare work at the Learning from Excellence workshop event in late January. Nearly four months later, I’m finally doing it. I’m as prone to procrastination as anyone but this time some significant life events genuinely got in the way of writing this, and those events have given me more reason than usual to reflect on the journey I’ve been on with this work and where I am now.

At the time of the workshop I was just finishing-off an MSC and three months into a new job where I was directly managing a team for the first time. Two months later a young relative died after a two-year struggle with cancer. Shortly after that, my relationship broke down. Before you stop reading – don’t worry! I’m fine and there is a point to these perhaps uncomfortable disclosures. For a long time I was living with things in my life that are no longer there, which has cumulatively given me more head and heart space overall, but rapidly put me in a fairly unexpected place of reflection rather than fairly constant action. I’ve had big emotional investments come to a form of close while I’ve had to maintain my levels of focus and emotional engagement in a newly formed role managing a newly formed and growing team who need my guidance and strength if I’m to do this new job well. As with anything, I can’t claim to have done that perfectly, but without some of the skills I’ve partly learnt as a result of the professional journey I’ve been on with compassionate healthcare, I may have done it much more poorly.

When I present I often stress that to maintain and develop your compassion you need improved self-management of your thoughts and emotions. Mindfulness is a core skill in many approaches developed to do this, such as compassionate-mind training and acceptance and commitment training; and over this challenging period I drew on my growing skill in being able to draw my wandering, distracted mind and heart back to the present moment and the person in front of me, whether a member of staff, a patient or anyone outside work too. My final MSC module was an assessment of the impact of a conference on compassionate healthcare I led on in March 2015. My conclusion was that inspired and enthusiastic staff then need ongoing opportunities to learn further and practice the skills that were highlighted, including mindfulness. I created a big bang but only sketchy plans for the ongoing evolution. I was lucky. I coincidentally learnt meditation and mindfulness a year or so before my compassion journey started and have practiced them ever since, which has become another welcome piece of synchronicity between my personal and professional life.

My real challenge now is having learnt how to successfully engage an organisation with this work, I now need to work towards providing staff and students with accessible, ongoing opportunities to learn the skills which I’ve benefited from and have made me a more resilient human being. Whatever life throws at us as healthcare workers, we still need enough heart to offer our patients and the staff that need our support and guidance but some of us, like myself, need to learn how to do it better first and healthcare organisations and the leaders and managers within them can do more to provide those learning opportunities.

 

Michael Clift

RN: Child, MSC