This morning I fell down the stairs.


Here is the latest blog post from Alison Jones, our LfE fellow:


This morning I fell down the stairs.

I woke up and my first thought is always ‘a nice cup of tea’ so I got up and headed for the kitchen.

As my heel slipped over and beyond the edge of the second step I realised this was not going to end well and in that often-reported, slow-motion sort of way, I crashed bottom first, toe and groin twisting second, forearms third, bump, bump ,bump into the stairwell.

I knew, as I righted myself that there was no significant personal injury but my goodness I was shocked.

My 2 boys were still asleep and blissfully unaware. They would need breakfast and guidance for their home school day. A work day for me too, thankfully: zoom teaching, data crunching and emails so no need to ‘let anyone down’.

I’m really sore now. I think I’ve responded to everything I really needed to today as well as I can. Plus, my boys have been kind to me, they’ve eaten, done school work and we managed a short dog walk (knowing that I needed keep moving and stretch my aching muscles).

So now it’s 10pm and I’ll admit, I’ve had a relaxing glass of wine.

This experience has given me a new analogy, a fresh insight.

We ‘got up’ wanting our usual days in March 2020 only to fall into the stairwell of CoViD19.

Copied and pasted from above: ‘I knew, as I righted myself that there was no significant personal injury but my goodness I was shocked.’

I am incredibly blessed that no-one in my closest circle of family and friends has passed away this year. However, as healthcare professionals, we are dealing with a pandemic. For many there have been considerable personal consequences plus everything else that life can throw at us like loss/hurt/conflict/illness other than CoViD and serious social and political concerns  …

I thought, as an active member of the LfE movement, research and well-being teams, I understood or at least empathised with much of what was being experienced. Still, it took a profound shock and the consequent physical limitations to help me understand more deeply the real impact of all the anxiety and threat we are managing at this time.

Copied and pasted from above: ‘I’m really sore now. I think I’ve responded to everything I really needed to today as well as I can. Plus, my boys have been kind to me, they’ve eaten, done school work and we managed a short dog walk’.

In the last 48 hours I have felt anxious, tearful and rather fuzzy-headed and I have been forced to pay attention to these symptoms. Of course this is an entirely human, even predictable response to a tumble down the stairs. But it has made me wonder – how many of us are currently functioning at this level which feels ‘less’ somehow and compromises home and/or work as necessary as each day in CoViD recovery unfolds?

So this is my opportunity to ask ‘How are you?’ ‘How are you really?’ and to say ‘Take good care of yourselves and each other’. Here are few Appreciative Inquiry-style questions for you to play with when you have a minute:

How can I use the current slower pace of life to notice feelings and emotions in myself and others?

What resources do I have to help me cope (or even to thrive)?

How am I expressing gratitude, moving my body, getting outside, helping others today?

Which stories do I want to be part of in 2020?

Alison Jones

There is no error?


I recently attended a FRAM workshop. FRAM is a form of resilience engineering, which allows us to create a model of a complex system. It stands for Functional Resonance Analysis Model; but don’t let that put you off! I spent the first half of the workshop feeling rather confused, but ended up with a basic understanding and an enthusiasm to try the method to create models to better understand my work.

FRAM is underpinned by several principles, the most striking and interesting is: the equivalence of success and failures.

This may not seem intuitive, as we are conditioned to evaluate failure as more significant than success. (E.g. see loss aversion, from Kahneman). But actually, I believe this principle is true for work in complex systems. And it is profoundly important as it provides us with a way to understand our work (and improve it) without having to apportion blame for error. The tendency to apportion blame is, in my opinion, a major hindrance to progress in safety and healthcare in general.

If you make a serious attempt to make rules for every aspect of your work, you will soon realise that is impossible to explain every single action for every possible environment and situation. Thus you will see that in order to go about your work successfully, you will need to continuously make small adjustments. (In FRAM this is called ‘approximate adjustments’). These adjustments are usually successful but occasionally they lead to failure. But whether or not they lead to success or failure, they are essentially the same adjustments.

If we are able to understand this part of our work we will start to have a method for removing blame from error. In fact, this approach removes the idea of error. There is no error; there is only adjustment which may lead to success or failure.



Could Learning from Excellence be enabling compassion to flow?


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


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

Building Resilience


Today’s blog is by Dr Emma Plunkett @emmaplunkett

I read an article by a psychologist called Marytn Newman recently. It was called “What’s the No. 1 skill children need to succeed?” The answer: resilience.

Resilience is a term increasingly bandied about in healthcare. What does it really mean? There are complicated definitions out there but, as is so often the case, google comes up with a good answer.   Resilience is “the capacity to recover quickly from difficulties”. It sounds good to me. I think we all need it to succeed.

So what gives us resilience? Some people seem to naturally have more of it than others, so a certain amount must come down to personality. But some must be related to learned behaviours and there is no reason why we cannot develop our resilience as adults. In Martyn Newman’s article he lists 7 ways we can help our children to develop resilience, he calls them his 7 rules. Rule number 3 is building “The Twin Towers”; self-liking (self-esteem) and self-competence.

Having a sense of self-esteem and self-competence is crucial for us functioning well at work and it can be easily lost if we are constantly told that we are doing things wrong or could do better. Those of us who work in the NHS can testify that morale is low. There is only a certain amount of motivation that can be done with a stick. Building our self-esteem and awareness of our self-confidence is essential to motivate and enthuse us. Not optional. Essential. We can develop this by learning from what it is that we have done well. We can build our resilience (and that of our colleagues) by learning from our moments of excellence.   So let’s start telling each other about what we do that’s good. Let’s learn from excellence and build our resilience together. After all, it’s the workers who make the NHS and a resilient team will make for a resilient organisation. We all want that.

PS If you’re interested the article I read – you can find it here: