The graph says it all. As the third wave of Covid hit Ireland, it was all hands on deck. Projects had to take a back seat.
Now as we move through the Spring Equinox, it feels like the time has come to get back on the horse. People and projects have had a bit of time to mature and adapt to a new healthcare world of long term Covid. The tracking system I mentioned in my last post is in place. And I see at least a few green shoots of renewed interest amongst our registrars and some managers to improve ED-hospital systems (beyond Covid).
The unsaid risk however – the proverbial elephant in the room – is recognising the huge toll Covid has taken on healthcare staff who were already over stretched – even before the pandemic hit. An Emergency Department nurse from a near by county provides an unfortunately accurate first person account – that resonates across hospitals all over Ireland.
A delicate journey lies ahead. What Joan Halifax describes as an edge state – where the “five virtuous human qualities” of “altruism, empathy, integrity, respect and engagement” can either lead us to courage and freedom – or slide into a mire of destructive suffering …
Any concerns I may have had about losing momentum were easily laid to rest this week. The ED registrars leading on different projects are moving forward with a core energy that is a privilege to nurture.
It feels like the time is right to set up a new page tracking progress more formally than these end of week blog entries. Work for the week ahead.
Closing this weekend with the personal nourishment of attending a Peaceful Hearts retreat and understanding more deeply the roots of compassion.
This week’s surprise lesson for me was experiencing how it can be quite stressful to be kind to oneself. Might sound paradoxical, yet this was my direct experience.
Simple practices – like letting the computer screen hibernate for the 5-7 minutes I have lunch, finishing my shift on time, allowing myself to not eat the fast food brought in by a well wisher and instead have a salad pre-prepared for work… Simple practices of self compassion and self care that should feel easy – but didn’t. Similar to the initial discomfort that comes when (re)learning a skill.
A big positive for the week – recognising this week’s ‘pause’ provided the team with the kind of time and space that nurtures psychological safety. Will this be at the cost of losing project momentum ? Or will individual and team motivation be boosted instead ? We will find out as the new week dawns …
“I saw the angel in the marble and carved until I set him free.” Michelangelo
The stand out moments for me this week have mostly been around 1:1 development time with different members of our wider ED clinical team. Letting them grow and spread their angel wings as I hopefully reinforce their sense of autonomy, authenticity and ways to engage.
The most precious encounter was with one of the registrars taking care of a patient who visits our ED frequently. This time though, the registrar was able to shift his focus to work with that part of the patient that keeps coming back to the ED for help – instead of the part of the patient that makes her relapse into destructive behaviours as soon as she leaves. This change in intention opened a whole new path for both the patient and the registrar (who had seen her several times before with the same problem.)
Compassion in practice, one patient at a time.
From a systems point of view, the ED older patient flow pathway we put forward last week has been accepted and the pilot starts tomorrow. A record breaker for getting stakeholder engagement (not to mention agreement !) so quickly.
For the week ahead, my intention is to prioritise some self care and self compassion. To remind myself of what I share so often with my team – when we pour for others, we must sometimes stop to fill our own cups too.
The external growth this week has mostly been in the intellectual and physical energy domains. Notably – delivering the first session of a training program I am offering to ED clinicians interested in quality and clinical audit. And upgrading a proposed ED geriatric referral pathway to a patientflow pathway – shifting the central focus back to the patient.
Diminishing psychological safety at the organisation-ED interface has been the challenge for a second week running. I find myself coming back and taking refuge in the spiritual domain of our work – a purpose and perspective that helps me acknowledge the suffering without it becoming overwhelming.
Serenity to accept what I can not change, courage to make the changes I can, and experiential insight to recognise the difference. Compassion in practice.
Positives this week – seeing leadership and new confidence express itself in an ED registrar’s board round. Plus nurturing the leadership wings in a member of an ED Frailty Intervention Team (that I am responsible for).
The monthly ED journal club continues to mature, in particular relationships and shared learning between the registrars. An opportunistic teaching moment this week – reinforcing the ethics/integrity that must be at the heart of everything we do as clinicians – research and beyond.
My most difficult moments this week – experiencing the physical symptoms and the hit to psychological safety that arise from management meetings without good governance. Observable changes in concentration, mood, energy levels, headache – not dissimilar to carbon monoxide poisoning!
Personal area to grow – allowing myself the self compassion to focus on what matters most and let go of career aspirations that necessitate carbon monoxide type toxidromes.
Feels like a good week. The Europe wide research study our department is participating in connects us with a bigger picture and higher purpose, nourishes social engagement and provides a channel for physical action.
Also protected some 1:1 time with ED Quality Improvement Project registrars. Helped them understand the difference between medical research and quality improvement. Reinforced the importance of a moral compass – looking deeply and understanding where our (project) volition comes from.
Personal positive – concentrated most of my time and energy on my sphere of influence. Action and agency.
Personal area to grow – meeting people where they are, and not where I want/expect them to be ! Balancing the real life time pressure of delivering on research and departmental change while still providing young minds a safe space to learn.
What does “human factors” mean in an Emergency Department world of Covid 19 and how can my ongoing training in it make a difference to where I work ?
As a first step, I am introducing Zoom based sessions on quality improvement methodologies, adapted to my local setting. Gently redirecting attention from our circle of concern to our sphere of influence – individually and collectively.
My belief – action and agency in these difficult times help relieve suffering and maybe even promote well being in the workplace. Compassion in practice.
It’s a little over three decades since I joined medical school and I find myself starting a new journey – exploring deep compassion in clinical practice.
I will be doing so through a Masters program “Human Factors in Patient Safety” offered by the Royal College of Surgeons of Ireland from this September. A little nervous, and very excited.
“Human factors” can mean different things to different people. For me, it is about exploring how compassion influences the interdependence between human beings and clinical systems. Anyone who has experienced genuine compassion knows the effect it can have on clinical outcomes – how might it be possible to reproduce this at a “system” level ? And if we did, what kind of effect might it have ? In short – could there be #AnotherWay to how we deliver care ?
I hope to share what I discover over the coming months through this blog …
As I prepare a resilience workshop, I would like to offer you a simple tool called the three breath Traffic Light.
In essence, you keep an image of a traffic light somewhere easy to find – like your phone or on your desk. Have an alarm prompt you every so often to look at this image.
The Red Light – is to remind you to just stop and breathe.
The Orange Light – to breathe and be aware you are breathing.
The Green Light – to breathe and then go.
While this may sound childishly simple, it’s power can be immense. Neurophysiologically speaking, “stopping” interrupts fear and flight or fight circuits from continuing to spread beyond their origin in the amydala. Becoming aware of the feeling of our breath, strengthens the links between the right and left sides of the brain. Finally when we breathe mindfully and “go” it restores brain function and control to the executive centres in the pre frontal cortex.
Or put simply, it gives us the power to choose how to respond, rather than be driven by subconscious lower brain impulses.
Faced with the breaking point pressures in the NHS as we have been for 3 years, it is worth remembering tools similar to this have helped rebuild inner strength and resilience in children exposed to much worse – the devastating trauma of 9/11. If it can work for them, it can work for us. Will you give it a try ?