Do the small things – St David’s advice for the NHS
As a Welshman I am proud that we are the only one of the home nations which has managed to produce our own patron saint. But what do we actually know of the life of Saint David (or Dewi Sant as we call him in Welsh)?
Dewi was a teacher and preacher living in the 6th century. From West Wales by origins, he ended life as a bishop and was responsible for founding a number of churches and monastic communities across Wales including the one which now bears his name at St David’s.
Dewi came from the ascetic tradition in Welsh life. His monastic code made few allowances for creature comforts, stating that monks should pull the plough themselves without the use of draught animals, should only eat bread with salt and herbs and should spend their evenings in prayer, reading and writing. He would have made an excellent defence coach for the Welsh rugby team!
According to tradition one of his maxims was “Do the little things in life” (Gwnewch y pethau bychain mewn bywyd). I have always been struck by this sentiment and believe it has a lot to offer in informing the task of improving health and care.
Much is talked about the need for transformation in our health and social care system and the scale of challenges around finance and affordability point to the need for some major changes in how we do things. However I would argue strongly that the little things should also be central to our focus. Why?
There are a number of reasons.
First because the small things really matter in healthcare. Whether it is relation to the administration of medication, or the taking of a mental health history, small errors in healthcare can literally be life threatening. That responsibility for getting small things consistently right is one the things which makes clinical practice intrinsically challenging and stressful.
The better we get at getting small things right the better our outcomes will be and it should be a key priority for those of us in leadership positions in the NHS to do as much as we can to enable clinical staff to get those small but crucial things right. As other industries have demonstrated very clearly, IT and real time decision support could have a big role to play in this respect. There is also room for psychologically informed interventions which help clinical staff to disengage from the stress of their roles and reflect constructively on their performance and the care they are giving patients.
The small things are also often the things which matter most to patients and their families. While we welcome the miracles which can be offered by modern medicine in terms of life saving or life enhancing interventions, we also want to be treated with dignity and compassion when we are unwell and when we are in need of care. Both of these are not single entities. They are product of many small acts of welcome, kindness and consideration which repeated consistently reflect the values with which we want to deliver and receive care.
Small things in this way can be representative of bigger attitudes. Nothing better illustrates this point than Kate Granger’s inspiring “#Hellomynameis” campaign. As Kate movingly describes from own experience what chance have we of delivering compassionate care if we cannot take the trouble to introduce ourselves and explain what our role is in providing care. A small act but so symbolic of the value base on which care is built.
Recently when attending A&E with my disabled brother I was struck by the gesture of providing patients and their family with tea and refreshments while they were waiting. In that instance my brother’s care (fortunately nothing serious in the end) breached the 4 hour wait but the cup of tea was a small and crucial gesture to show that the hospital recognised the value of our time as well as theirs.
Finally the small things matter because that is where we can do best in harnessing the contribution of front line staff for service improvement. Staff can be justified in holding a sense of cynicism about endless transformation programmes and organisational restructures given the track record that these initiatives have across many parts of the health and social care system. We need to make sure that these false dawns are not a barrier to engaging staff in making practical improvements in the immediate environment of car where their actions can make a difference. We should give front line staff the space, tools and responsibility to drive improvements and, while recognising the complexity of the systems we operate in, we should maximise the scope for local decision making which enables improvements to be implemented and sustained.
This should be mainstream activity but there is no doubt that as systems get put under greater strain and the focus of senior management is constantly directed to firefighting then the capacity of organisations to have an organic focus on improvement is diminished.
So in healthcare St David is right. The small things do matter. And while the challenge of some of the big changes we are going to have to make over the next decade in the delivery of health and social care can appear very daunting the world will always be better a place if we do the small things well.