Another Way

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.

Waking Up

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

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 – Week 6 RPR

“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

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 3 RPR

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 patient flow 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.

WPW – week 1 RPR

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.

Compassion in practice.

Start of a Journey #AnotherWay

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 …