Guest blog by Yvonne Sawbridge, Senior Fellow at the Health Services Management Centre at the University of Birmingham
The much awaited Berwick report makes a number of insightful comments about what is good about the NHS whilst also acknowledging that there are things that need to change.
Whilst recognising that misconduct does occur and demands censure, Berwick also recommends abandoning blame as a tool. “Errors do not demand punishment” he states. The report also highlights the need to get the balance right between dealing with wilful and irresponsible actions, and finding time and attention to address the underlying causes about why “good people deliver poor care”- a concept Iles explores further.
Our research at the University of Birmingham on emotional labour is precisely an attempt to do that- to find out whether there is a system that could be put in place which recognises the hard emotional work of staff (we focus on nurses- but suggest it is transferable) and what can be done to support them. It developed from our policy paper when we explored solutions to poor nursing care, and identified some models that were being implemented both inside and outside of the NHS.
Our work has given us the privilege of being able to meet and talk with many nurses, both within and outside of the project. In fact I have been collecting stories throughout my time in the NHS, about the daily working lives of staff which are largely invisible to the outside world. They are not the stuff of dinner table chatter. For example, nurses who are involved in unsuccessful resuscitations (let’s be clear, this means watching someone die though doing your best to save them)and then talking to the bereaved family. These nurses are under such time pressures that they are then unable to take the time to have a cup of tea, or talk about their experience of helplessness, distress or fear. There is no safe place for them to sit and be offered human kindness and collect their thoughts before getting back to work – looking after the next patient.
Or the nurse who watched someone bleed to death, cleared up the blood and left the ward without anyone asking them how they were, put their two small children to bed and sat in a bath with glass of wine, before returning to work the very next day, carrying on as if nothing had happened.
Or the Healthcare Assistant who lost their dad as a very young child, who watched another family go through the same terrible experience and was trying to comfort them. They did not know how, and there was no-one around with any time to guide them, or to understand how this triggered a reliving of a traumatic event for them. They were left to answer the next buzzer as if nothing had happened.
Now let’s compare this to the Samaritans approach (our partners in our research) of sharing their expertise in supporting each other as volunteers. They work in an environment where two volunteers have a duty to support each other as well as their clients. They systemise this support- not leaving it to chance, or to the intuition of the ward leader or team on duty. The organisation takes responsibility for making this happen. They are required to debrief at the end of the shift, by calling the (off -site) team leader. They talk about how they feel. If they are feeling upset, they are called back the next day to see how they are feeling now. Their health and well being really matters to their organisation. Reality, not rhetoric. Imagine that!
Our action research is small and embryonic, and it is too early to tell if it will work. There are many others working in this area, implementing Schwartz Rounds or Restorative Supervision (Wallbank S and Preece E. (2010) Evaluation of Clinical Supervision given to Health Visitor and School Nurse leadership participants. NHS West Midlands and Worcester University) for example.
Our mission is to raise the profile of emotional labour to get boards of organisations to understand that their responsibility for health and safety goes beyond buying hoists on wards to care for nurses’ backs. They need to look after their hearts too. If we can’t offer kindness and compassion to those delivering the care, how can we expect them to deliver it to others? It is a tribute to the staff of the NHS that so many do, and Berwick may just have given them hope that others will now listen and help them give their patients the care they need. For our patients’ sake, it truly is time to care.