Planning for the unexpected:
January has been a particularly difficult and challenging month for the NHS. There hasn’t been a day since Boxing Day when the challenges of emergency access and bed management haven’t featured somewhere in the news headlines. Some of what has been reported is accurate, some of it is of course sensational. What it has highlighted is a system under significant strain and staff working incredibly hard to deliver high quality care within a very difficult environment. The brunt of the reporting has been based around the emergency front door, the challenges of seeing patients quickly, treating everyone with appropriate levels of privacy and dignity and ensuring that, when someone needs to be admitted into a hospital bed, they are. The challenge is incredibly hard for any hospital system running with high levels of bed occupancy, and whose buckling physical infrastructure does not easily allow for effective patient flow or expert resources to be directed quickly to those most in need.
While Moorfields has not had to deal with all the challenges seen by many of our colleagues recently, it is clear that our accident and emergency (A&E) department at City Road, and our support to wider emergency care networks across the north and south of London, is under considerable challenge. It is under challenge to adapt and flexibly support the changing needs of our patients and the partner and host trusts we work alongside. I had the pleasure to spend some time in January in our A&E at City Road with Lola Ogunbowale, our A&E service director. Spending time in A&E is like no other experience. What I saw on my visit reaffirmed to me the tremendous challenge of planning for the unexpected. Demand is variable, sometimes very busy, sometimes less so. Acuity of patient need is variable, as are the requirements our patients feel they need from an emergency service which is designed, let’s remember, to support those whose sight is at risk.
In many respects I felt our A&E department was a microcosm of all that is positive at Moorfields. I witnessed cohesive team work in action, a focus on performance (consistently achieving the 95% four hour target) and ensuring the right people with the right skills see our patients. I also took the opportunity to speak to a number of these satisfied and very well supported patients. I know all days aren’t necessary like the one I witnessed but the team’s commitment to support those who need our care quickly, effectively, expertly, and with as much privacy and dignity as possible, was unfaltering. Providing expert care well in a physical environment that isn’t necessarily designed to see 110,000 patients a year is also a true testament to the flexibility and innovative thinking of our staff.
Our expert care can of course only be delivered with collective effort. As critical as our doctors and nurses are to delivering high quality care, their job is made so much easier by our administrative and support staff who I saw busily pulling notes, meeting and registering patients and ensuring GPs receive timely discharge summaries. No high performing system works in isolation and our A&E is a classic example of this.
Planning for the unexpected is never easy. It is however intrinsic to the DNA of a good hospital and a good healthcare professional. It’s critical in times of heightened scrutiny for us to continue to provide support to our colleagues and, very importantly, provide our patients with the absolute confidence in our services. I very much look forward to my next trip to see the A&E team.
I’ve always admired brave people. When I was young, like many, I was inspired by reading about people like Emmeline Pankhurst, Anuerin Bevan and Rosa Parks. These were truly brave people who challenged the status quo and stood up against the perceived acceptable ‘norm’ because they believed in something and were willing to bravely fight for it.
Hospitals are full of brave people. Our clinical staff are brave; they make brave decisions every day to ensure our patients are looked after with expertise, carefully and safely. Our clinician scientists are brave; they work to prove a hypothesis others don’t necessarily believe and, in turn, make life better for those we look after now and for generations to come. Our non-clinical staff are brave; a group of people working together to ensure our network of sites are safe, clean, managed, prepared for all eventualities and often not receiving the level of praise they truly deserve for the hard, long hours they work. Our patients are also incredibly brave; dealing positively sometimes with terrible disease; smiling and being upbeat to not upset their partners, grandchildren and loved ones while feeling nervous, lonely and anxious. That’s brave.
Hospitals, like society, require brave people. Over the past few months I have met some true examples of brave Moorfields staff. These are staff who have been upset about the way something is organised and want to change it; offering solutions and leading change. I have huge admiration for what I have seen and what I continue to see from our staff. Being brave is part of what makes Moorfields a very special place.
The hierarchy of need:
Anyone who has ever enrolled on a management training course will tell you about Maslow’s Hierarchy of Needs. Abraham Maslow wrote a paper in 1943 describing the hierarchy of needs he believed we all work within and are motivated by. At the base of the hierarchy is the most important level; to be content and happy. The next level focuses on the desire to be safe and secure and so on until the final level which is grandly named ‘self-actualization’. Self-actualization meant a number of things to Maslow and to other scholars over the years. For me it’s relatively simple: it’s achieving all you believe you can and reaching your true potential. Maslow believed we all strive for self-actualization and we are most happy and content when we reach this stage in our lives and careers.
March has been a fantastic month to meet and speak with colleagues on the journey to self-actualization, or achieving their true potential. It started with the Moorfields’ Stars awards ceremony; an afternoon and evening glittering with individuals and teams focused on doing the very best they can, never taking a step back and constantly wanting to improve and develop. Stars has become the highlight of my year and this year’s ceremony certainly didn’t disappoint. All the nominees and winners should be immensely proud of their efforts.
This month I also had the pleasure of spending time with our apprentices whose career paths span a number of specialities. One commonality they share is their focus on achieving more and excelling at what they do. It was incredibly uplifting to see people dedicating so much personal time, effort and focus on developing their skills and abilities. This was further heightened towards the end of the month when I was fortunate to join colleagues to celebrate their graduation from the Mary Seacole leadership development programme. Mary Seacole herself was an incredibly determined, driven and visionary woman and many of the men and women I met at the graduation celebration demonstrated to me a steadfast desire to succeed and reach their true potential; all we could ask from a Moorfields employee.
Unrelenting determination was demonstrated recently by the London Project to Cure Blindness whose first stage results attracted national and international media attention. Having an appreciation of the journey Professor Lyndon Da Cruz, retinal surgeon, Professor Pete Coffey, University College London, and their team has had to achieve in the first stage of this pioneering project, I am not sure ‘determination’ fully explains the extent of their efforts. I hope like me you were immensely proud to be part of an organisation with such pioneering individuals and a team so dedicated to doing the very best they can; always striving and not just climbing over obstacles but often smashing them down. Following the media coverage I was contacted by people from across the globe wanting to celebrate their and our success and by many patients hoping that this ground-breaking work will one day support them or their family. There’s very little in a working life more uplifting than that.
This month I have seen examples of achievement and personal and collective determination to do better and be the very best from our staff like I have never done before.