Another Dimension

February 22, 2026February 22, 2026 ~ ED Compassion ~ Leave a comment

It is an old aphorism: you cannot solve a problem at the level at which it was created.

There is also the more management-friendly version: every system is perfectly designed to produce the results it gets.

I still remember the feeling when the truth of this first landed for me.

Decades later, I see that this is only part of the truth.

These phrases tend to frame the problem as something actively produced: the problem is created by this; the system generates that result. And yes, that is often true.

Yet sometimes the deeper issue may be less the presence of something harmful, and more the absence of something essential.

Perhaps a little like malnutrition: the symptoms may not arise from what is present, but from what is missing.

Over the years, I have found one image from Leading Large Scale Change to be foundational: the five domains of energy.

Across three decades, I have borne witness to the ever-increasing emphasis on physical, intellectual, social, and, more recently, psychological energies in efforts to improve health system outcomes.

And yet, it often seems that the more we do, the further we move from the outcomes we are trying to achieve.

Which leaves me wondering whether a deficit in spiritual energy is at the root of our limitations in health and social outcomes.

There are many reasons why spiritual energy has been de-recognised or de-emphasised in health and care. There is no blame in this. The reasons may be understandable in themselves.

Yet the outcomes in healthcare systems worldwide are clear, certainly in Emergency Medicine, the canary in the coal mine. The system cannot bear the growing strain and imbalance between capacity and patient demand.

I wonder – if a systemic problem arises from a lack of spiritual energy, can it really be improved by overcompensating with the other energies, or does that risk deepening the problem further ?

Over the coming weeks, I hope to share some reflections on what spiritual energy might be, and perhaps what it is not, in the context of healthcare.

Thank you for sharing this journey.

Opening the Door to Patient Safety

May 14, 2023February 22, 2026 ~ ED Compassion ~ Leave a comment

The interview from last year resonates with me as a whirlwind of emotions, weaving together moments of insight, humour, challenges, and risks. Looking back, it was like the bold act of an unsuspecting child knocking on the door of an ogre’s castle. The slumbering giant wakes up and consumes the audacious child, yet in doing so, the once seemingly impenetrable castle door swings open. Facing the giants of bureaucracy and politics may have come at a personal cost, but the subsequent influx of much-needed investment and oversight into my organisation honours the purpose behind it all.

So, what lies ahead in this continuing journey? With the shift from a clinical role to a managerial position no longer necessary, I find myself free to refocus on the core purpose that brought me here: compassion as the foundation of patient care and safety. Exploring how cultivating collective mindfulness can inspire organisational compassion and pave a new way forward …

Another Way

October 31, 2022February 22, 2026 ~ ED Compassion ~ Leave a comment

Our hospital is in difficulty. There is no getting around it.

A Zen insight my teacher once shared is as our meditative practice deepens, our ability to hear the cries of the world also grows. Hearing those cries our deep bodhicitta (heart of love) is touched and (in time) leaves us with little choice but to respond.

It seems that time may have come for me. Hearing the cries of my hospital, sometimes literally in its corridors, I put myself forward recently to take on a new role, well outside my traditional boundaries. The interview was last week and here is a brief summary of what I presented.

I started with where we were as a hospital. This was straightforward enough. Four different reports (three within the last year) make clear beyond argument how difficult the current situation is. Yet a report can at best only touch the surface of what is happening. To understand the real human suffering underlying any report we must be able to open our hearts with compassion and courage.

Embracing the suffering, instead of denying it or finding someone to blame, opens not only our hearts but also our minds. It creates the space where we can explore why and learn from it – strengthening the roots of understanding of what can be and how to get there – in a partnership of equals.

For me, I have the aspiration of seeing our hospital become a high reliability organisation. Where at any moment thousands of errors could happen but don’t. A system and culture that have been nurtured in a way to prevent potential catastrophes from manifesting. In a word, an organisation that has developed its own “collective mindfulness”.

Where does an organisation find the energy to do this ? The literature on large scale change provides a clear answer – there are five sources and each of them play a crucial part in the journey.

Nurturing and directing these energies require a different kind of leadership as well – technically referred to as “ambidextrous”. Where we use both our logical and our creative human strengths to let our best selves shine – as an individual and as an organisation.

The journey is not easy. Even more difficult might be acknowledging the harsh reality of how our hospital reached this moment and facing this with honesty, hope and patience. Yet only by doing so can we give birth to the foundation of a compassionate culture, a clarity of systems and a loving community.

I closed with a message of hope and the belief in a future our hospital could move towards. In the words of Nobel laureate Rabindranath Tagore, (a hospital) where the mind is without fear, and the head is held high …

The decision now lies in the hands of a chosen four. Regardless of the outcome, my personal aspiration is to continue growing a heart of love and finding skilful ways it can express itself in my community.

Images – Canva
Reference links: Leading Large Scale Change; High Reliability Organisations

Waking Up

August 12, 2021August 12, 2021 ~ ED Compassion ~ Leave a comment

“Waking up, I smile …” Thich Nhat Hanh

The last few months have been a time of personal and professional awakening.

Waking up to the physical reality of being human. Of having to accept I am not immune to the impact of the relentless pressure of the pandemic on my Emergency Department, nor to the devastation of the HSE cyber attack. And that even if I pretend otherwise, my body knows and sooner or later illness is inevitable.

It’s also been a time of pragmatic awakening. To the reality of life as a coloured doctor in Ireland. Acknowledging the presence of a systemic discrimination that is so deeply embedded it is practically invisible to those who perpetuate it. And more importantly, adapting to what is and isn’t deliverable to patients when their care is provided for by someone of colour.

Awakening is true when accompanied by action. And actions are true, when they come from a place of love, rather than from one of fear or hate.

For me, a first step is coming back to the core practice of loving kindness (“metta”). To hold in love and understanding the pain and suffering I see in and around me. And from this place of compassion, to explore how I can best use this precious life energy to alleviate suffering and discrimination.

Resilience 3.0 and Refugee Boats

May 22, 2021May 22, 2021 ~ ED Compassion ~ Leave a comment

A lot has been said about the “unprecedented” nature of the Covid-19 pandemic and of its impact on health care.

An Emergency Department perspective on Covid however is perhaps a little more nuanced. While the scale of the pandemic was certainly unprecedented for EDs across the world, the scope of Covid-19 wasn’t. Emergency Departments have regularly dealt with and / or prepared for viral outbreaks – influenza, SARS-Cov-1, Ebola among others.

To me, what is truly unprecedented in both scale and scope is the impact of the cyber attack on the HSE. Never before would we have imagined shutting down an entire network of computers across a national health care system.

As we move into week 2 of the shutdown, this is my perception of its effects on departmental energy levels.

Social energies are up. Replacing emails with actual conversations and a sense of coming together in a crisis are boosting connections.

Intellectual energies are recovering. From an initial feeling of “cerebral nakedness” – not having access to patient records, previous reports, test results or online clinical references – to finding work arounds and coming back to good old fashioned clinical medicine.

Physically, people are tired. This is a labor intensive environment – there is no getting around it. For now at least.

Psychological safety has taken a big hit. The timing of the cyber attack – just as Ireland was coming out of a lockdown that stretched since December – could hardly have been worse. National activity is rising, accidents and emergencies are rising in tandem, Covid measures are still in place – all while the ability of the ED to respond to this surge has been dramatically reduced.

Why am I writing about any of this ? Partly to keep my own note of these events. And partly to explore – how should I / do I respond ? Is my inability to gauge the spiritual energy level of the department a reflection of current conditions – or of me ?

Academics and researchers have written much about resilience. Yet for me, what a world wise friend shared this week is what resonates. Resilience is simply surviving. Surviving 15 months on the frontline facing Covid, surviving this cyber attack, surviving what else may come and doing so with spiritual strength. A spiritual strength that comes from remembering – these conditions too are impermanent.

So coming back to the root question of this reflection – what compassionate wise action can my best self bring to this situation ? I am reminded of a story from Thich Nhat Hanh and the answer emerges – presence and solidity.

“When the crowded Vietnamese refugee boats met with storms or pirates, if everyone panicked all would be lost. But if even one person on the boat remained calm and centered, it was enough. It showed the way for everyone to survive.”

WPW – Beginning Anew 2021

March 21, 2021March 21, 2021 ~ ED Compassion ~ Leave a comment

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 …

WPW – Week 6 RPR

December 6, 2020December 6, 2020 ~ ED Compassion ~ Leave a comment

*“For wood to burn and release its light, it must be given space.” Zen teaching*

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.

WPW – Week 5 RPR

November 29, 2020November 29, 2020 ~ ED Compassion ~ Leave a comment

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 …

WPW- Week 4 RPR

November 22, 2020November 22, 2020 ~ ED Compassion ~ Leave a comment

“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.