We started Little Things TLC in 2016; a group of us passionate about person centred care. We felt that it is often the little things that make the biggest difference. We published a few blogs and saw a little bit of reaction on Twitter, but it is fair to say we did not manage to generate any waves or rock any boats! Work and life then took over, with all of us moving jobs and roles, and whilst every so often we would mention Little Things we did not quite have the energy or time to take any action.
However, our ambition has been relit! Last month I heard Chris Pointon, widower of the late Kate Granger, speak at the Royal College of Occupational Therapists annual conference. He gave a moving speech for which he truly deserved the standing ovation he received. He started at the beginning, about when he and Kate met, their normal and happy life, until her diagnosis in 2011. He spoke about the new turn in the road in their journey and Kate’s determination to make a difference to patient lives as a result of her experiences – both to the patients she treated as a geriatrician and to many thousands the world over through the #mynameis campaign.
Chris spoke about legacy and core values. He showed a video of Kate talking about her core values and it got me reflecting about my own…
I believe that our focus with patients should be on empowerment; on enabling them to take control of their situation or condition and focus on the things that are important to them. As an occupational therapist, I believe in helping people to help themselves; enabling and equipping them with techniques and tools to self manage and be able to do the things that are important to them. This value was re-emphasised during my involvement in the #imstillme research where older people told us that they do not want to be defined by diagnoses, they want to focus on doing the things they want to do, even if they need help to do them, and even where they know there is perhaps an element of risk such as having a fall. It is the need for choice and control that is important to them.
In my current role in Quality Improvement, we equip our staff (and increasingly patients) to make the changes they feel are important in their part of the system in order to achieve the improvements that they want to see and which motivate and are important to them. I truly believe in this bottom up approach to change- that it is our patients and our staff who are the experts in the system; they know exactly what works and what doesn’t, where the inefficiencies lie and what improvements could be made. Where we have had to focus on an organisational aim and have a clear idea of WHAT we need to focus on, we involve our staff and teams to help us work out HOW to do this and empower them to make the changes they feel will work in their area. This motivates and energises staff- so change does actually happen- and usually has the traction and sustainability that top down initiatives rarely have. At our graduation days, staff who have participated in the Quality Improvement programme describe this feeling of empowerment, of focus within their roles and increased job satisfaction. It is great to see successful project outcomes, but this change in how staff feel, about their empowerment, never fails to move me and make me feel proud of the approach that we are taking.
In my leadership roles I try hard to collaborate and involve people- implementing my ideas, by myself is not leadership. I think good leadership is about collaboration, engagement and empowerment of others.
The little things
In my clinical practice I have always tried to be holistic and person focussed. This requires understanding patients backgrounds, values and goals. We are never going to motivate someone with rehabilitation, which can be hard work and painful, if we don’t understand what someone wants to achieve. Developing this therapeutic rapport sometimes means engaging in some personal conversation, it sometimes means breaking from protocol slightly, it sometimes means doing something that is not in your official job role. But it is often these things that mean the most to patients; a smile, a few minutes listening, making a cup of tea, tuning their radio…. We need to remember as health and social care professionals we may be the only person someone sees or talks to that day.
I try to follow this in my personal life as well; not always so easy, especially in London where it is often ‘survival of the fittest’ or you just wouldn’t ever squeeze into the tube carriage during rush hour! But again small moments- a smile across the tube, giving a pregnant woman your seat on the train, a thank-you to the new member of staff in Pret struggling with the till, letting someone go before you in a queue because they’re obviously in a rush to catch their train, letting a car out before you at a busy junction…
I have a sign inside my front door which says ‘be the reason someone smiles today’. If we all tried to make one person smile in I busy lives, the world might be a slightly happier place. And often all it takes is a little thing…
In my Quality Improvement role again we stress the little things- the need to start small with tests of change. To try something out with one patient, one clinic or on one day. Starting small in this way lets us be brave, creative and timely with change and improvement. We then look to gradually scaling them up so that these small tests of change lead to large scale, sustained improvement.
We find that many of our staff need some reassurance of this. They often have big ideas and need to be convinced that starting small can lead to big change despite the growing body of evidence that it can!
Forgive me, I have perhaps gone off topic! I started by reflecting on how we had let Little Things fall by the wayside. Hearing Chris speak and my subsequent reflections, has made me realise that what we are trying to do with Little Things is too important to let this happen! In our busy lives we sometimes need reminding of what is important and what not to take for granted. Perhaps this blog will remind you also and make you reflect on your values, and what little things you can do to live those values. It can be difficult to generate those big waves, but if we all rock our boat a little bit we might just make a big difference.
Laura Stuart-Neil is Lead for Quality Improvement and Lead for Allied Health Professionals at NELFT