Massive thank you to our very good friend and colleague Shaun Maher, Strategic Advisor for Person-Centred Care and Improvement. Shaun has been a great supporter of the project for the last few years, working with us as a partner in our Celtic Connections Concert last year. It is with great pleasure that the Dementia Carer Voices team at the ALIANCE display his guest post on our blog.
Thank you Irene, Tommy, Sarah and Laura #team #pledge #improvement
The intents and desires of the heart: turning good intentions into purposeful action
It has been both a privilege and inspiring to hear Tommy’s story and listen to his message – life is one big love story in which we all have a role to play. As caring professionals we are in an especially privileged position often spending time with people at some of the most momentous or traumatic times in their lives. A new life entering the world; facing up to serious illness; recovering from an injury or perhaps the loss of a cherished parent? These are the most memorable, meaningful and often challenging times in people’s lives and in our daily work we have the opportunity to support them, encourage them and walk alongside them.
Yet all too often in the hustle and bustle of a busy day we forget about this unique privilege – the honour of being a visitor in someone’s personal love story. Not taking the time to find out what really matters to them; a hasty response or a word spoken a little more harshly than it should have been. These lapses pass quickly form our memory in the bustle of the day, but what about the person? Do they forget so readily? The daughter seeking information about her Mum at a time of crisis? The young Dad (or Dad to be) that just wants to be close as he can to the most precious things in his life? Do they forget so readily? A careless response by us becomes an experience, even a trauma, carried by that person for the rest of their life. Amongst many things Tommy’s story reminds us of this truth.
The spirit is willing but the flesh is weak
So how do we take the highs and lows of Tommy’s story and turn them into something positive and lasting? How do we improve? It’s been wonderful to see the desire amongst those who listen to Tommy to make a pledge to “make a difference”. More than 3000 people have made personal pledges to keep the personhood of all those they interact with foremost. In one way or another people listening to Tommy have re-connected with their core purpose and recognised that the time has come to take action and make a difference. The “pledgees” range from support workers to chief nurses, from chief executives of national healthcare systems to porters and domestics – truly reflecting the message that person-centred care is everyone’s business.
The pledges are usually framed by the words “I promise to….” I will always…” These are honourable intentions and they are based on the strong values stirred up in the hearts of those who hear Tommy and Joan’s story. But what do they look like in action? Even with the best will in the world, do they always happen? I think if we reflect on our own experience we realise that despite our best intentions we are at best patchy – the spirit is willing, but the flesh is weak!
Transforming good intentions into actions and making these behaviours part of our daily routine is probably the single biggest challenge. Consider this example. Tommy asked me to write this blog in November 2014. With a strong desire in my heart to help I agreed and told him I would have it with him by the end of December. So what happened? My intention was good. I truly meant what I said. But absolutely nothing happened! The reality is that other things came along and the busy-ness of the day job squeezed the memory of my commitment and the desire to do it out of my consciousness. I would perhaps remember as I flopped down on the sofa at the end of a busy day and think: “ah I’ll do that tomorrow…” but as we know, tomorrow never comes! This is the reality for most of us. The scale, pace and technicality of the modern world, and especially the health and care system, means that we can’t take it for granted that we will always remember to do the right thing, to say the right thing and treat people as they should be treated. We need prompts and reminders to help us. We need to design a more person-centred system to support the growth of a truly person centred culture.
Purpose, Measures, Method
When we start with a strong sense of purpose we are in a good place. The pledges that we have made to Tommy reflect that strong collective purpose we feel. But to get that purpose into a reality the next thing we need is measures – DON’T stop reading just because I said measures!!
By starting with purpose measurement is made much easier and much more meaningful. In this context measurement can be as simple as observing (or reflecting on) whether the thing you wanted to do actually occured? Keep a tally or watch what goes on around you for 5 minutes. For example: “did I always ask every person about the things that are really important to them at this time?” Yes or No? If not, why not? And what could I do to remind myself to do it?
Your chances of success are much increased if alongside purpose and measures you have an improvement method. There are lots of methods out there – pick one and stick with it! We have widely used the Model for Improvement (MfI) in Scotland and I think it is probably one of the simplest and most adaptable methods out there. It starts with three simple questions:
- What’s the thing you want to improve? (your aim: how good do you want to be? And by when?)
- How will I know I’ve improved? (your measure)
- What’s the first step towards making this happen? (your intervention)
Once you’ve answered these three questions the second part of the MfI is to move to action – using a simple framework called the Plan. Do, Study, Act (PDSA) cycle. This structure to help you test your idea in a very small way to see if it works. Try it with one person on one day. Tweak it and try it again. Try it with two people, and so on. Once you’ve run a few tests you’ll be amazed at what you learn AND most importantly – your good intentions are turning into actions!
So let’s maintain that strong sense of purpose, but don’t stop there. Think about what your good intention would look like in practice and then measure whether it actually happens. Being fallible human beings we inevitably realise we’re not quite as good as we’d like to think we are – there’s always room for improvement!
Then move to the final step and think about the thing you can do to make yourself more reliable – a prompt in the notes, a “What matters to me” process LIKE THESE, or something particular to your care context.
Take good care of yourself!
This isn’t just about you changing the world. There are all sorts of other things that need to change in the wider system around us, but these things are outside the sphere of influence for most of us. In light of this reality we need to maintain good self-care and set our sights on the long view as we work on our small wins each day. Sometimes we will have set-backs and this type of work can feel difficult and challenging in the prevailing climate and culture. But don’t lose heart! the overall momentum is in the right direction. Maintain your strong sense of purpose, think about how you will measure your progress and then move to action.
It’s also important to find some like-minded folks so you can support and encourage one another. Start small and begin by designing some prompts and processes into your daily routine that will support you to turn the desires of your heart into your daily reality.
You can follow Shaun on Twitter at