I will aim in this blog to report objectively without adding my feelings.

Prior to the operation the patient and his wife were asked to sit for around four hours on an examination couch in a small airless room.

The patients wife stressed to three people involved in the surgical procedure not to forget to insert a catheter – they still forgot so the catheter was inserted in haste during recovery.

Post operatively the patient felt very unwell (there are concerns about his heart and he faces other challenges) – the patient was not written up for medication that it could be predicted he would need – this led to distress and delays.

The experience on the ward was mostly somewhere between indifference and subtle hostility – I could feel the tension rise when some of the care team entered the side room.

There were occasional moments of kindness – these were so welcome. On day 5 a nurse smiled and asked the patient how he was feeling.The second in command on the ward was kind and thoughtful but was rarely seen.

The ward sister enjoyed a reputation at the hospital for leading a compassionate ward. The patient did not meet the ward sister until very near the end of his stay (the patient had given feedback to PALS a few minutes earlier). The ward sister asked the patient about his experience but didn’t listen well, interrupting to defend the care given and to explain her ethos.

The patient was particularly distressed and vulnerable one evening – he felt unsupported and then unsafe with the nurse who attended and was threatened with a telling off if he didn’t ‘behave himself’

Nurses routinely dispensed medication and walked out of the side room without seeing that the medication had been taken – there were moments of confusion where the patient could not recall when he last took his pain relieving medication – the data the nurses spent so much time writing up was unreliable

The physios were focused, skillful and warm

The patients wife (a nurse) was surprised to see the HCA taking on tasks she would have assumed were the domain of the nurses

The nurses were remote and distant – both emotionally and practically (rarely seen and not engaging the patients in conversation)

One of the HCA’s was hostile and rude, admonishing the patients for not reminding their visitors to return their plastic visitor chairs to the stacks where they belong.

The same HCA raised her voice to the patients wife to tell her she should not be visiting on a saturday morning – she was right- but the patient and his wife had been given some paperwork that indicated that the ward was open to visits at this time

The discharge summary lacked any of the detail re what the patient experienced and what treatment was required in the hours and days following the operation – another operation is due in 6 weeks time

Thoughts about what this experience means

It is 2013 – months after the Francis report, years after the avoidable deaths it reported on.

It pains me to write this, I believe in the NHS and those who work within it; I am not judging those involved. Zimbardo in his powerful and insightful analysis teaches us that when ‘good people do bad things’ (film here) it may be dis-positional (the bad apple), situational (the bad barrel) or sytemic (the bad barrel) – my assumption is that most people want to be good and kind and given the right circumstances they will show the kindness they feel – my sense is that the culture the patient found himself within (which added to his suffering) was a result of continuing sytemic failings.

So what is to be done?

Culture change programmes led from the top – CEOs and non execs and board members looking patients in the eye and asking them about their experience of care and listening without interputing, daily – if it is good, the leaders should thank the care team, if it is poor they have some leadership challenges to rise to.

Compassion and safety come together to set standards for zero harm

All care givers, medics, administrators and leaders in every area are encouraged to care for themselves (mindfulness and self compassion) and are offered regular safe spaces to reflect on their role and the impact it is having on them. During these reflective sessions (an hour a month is enough) with a skilled facilitator all take turns to share the most compassionate care they have witnessed or offered

‘Experienced based co-design’ is used so that lives experiences like the one described above are heard and lead to ‘co-producing’ continuous improvements the care given (in terms of both competence and compassion)

The compassion system (or versions of it) should be fully implemented so that when inspiring leaders move on the practices that embed compassion remain

When we feel vulnerable and we find ourselves relying on people who are paid to care we should be able to rely on those people to be consistently kind (and of course competent) This call earned me the tag of a radical – one of 50 in Britain identified by The Observer and NESTA. It still feels strange for me that this call for consistent kindness is seen as radical – what other mode  should we expect from our health and social care services?

There remains much to be done – I will continue to join gentle forces with others and will stand for compassion.

Your thoughts and experiences matter as we work together to release compassion

Andy

I am noticing in my work and my life alongside my family and friends that compassion is more fully released and expressed through adversity and grief being acknowledged and validated. Our shared experience of pain and loss unlocks the energy and intention to meet suffering with kindness; this is our loving nature. Compassion is not partial, it should not be ‘reserved for patients’ – this is pity and is smothering. Compassion is all round us, literally right under our noses as kindness is never more than a breath away.

In health and social care there is a paradox – a subtle violence is done to those who struggle daily to show compassion (often in spite of the task and process driven system and culture) by not asking them about the impact of what they do. I think of this as the heroic struggle. Somehow care givers are asked to leave themselves at the door to inhabit their competency and to play by the rules. As a result the wholeness of the people giving the care may not be felt, their full humane generous nature may not be expressed.

To antidote the process driven culture my suggestion is that all who are involved in the giving of care should have an hour a month in a safe space  (a standard should be set) to reflect on their self compassion, the impact of their work and pressures outside of work and to share stories of the most compassionate care they have witnessed or offered that month.  Patients should be invited too, equality and humanity expressed together; the space is safe, challenging and enabling as the learning is rich and the connections made move all to act more compassionately.

These ‘compassion circles’ enable all to have equal air time with the support of a trained facilitator who draws on simple mindfulness practices to allow the breathing space that is longed for to energise, reflect and renew – all are encouraged to quieten their mind, to be succinct and to ‘listen with delight, knowing they will never have this moment again’

The thinking behind these safe practices in inspired by Nancy Kline, Jon Kabat-Zinn and Paul Gilbert. The compassion circles are an element of the compassion system developed here which integrates energy, safety, growth and equality to embed a culture of compassion.

There is so much talk in the aftermath of Francis and so much continuing pain for those who have suffered when the NHS and other parts of the care system have failed to keep people safe,  failed to respond with competence and compassion.

Acknowledging that all who work in health and social care are whole human beings, validating their experience, appreciating what they do day after day seems to me to be the very least we should do.

‘When we are feeling vulnerable we should be able to rely on those who are paid to care to be kind’ – this simple call earned me the tag of one of ‘Britains New Radicals’ – I still find this strange as what other expectation should we have?

I believe in the power of culitvating a quiet mind and an open heart and in joining gentle forces to create and sustain compassion

Andy

Hurting dehumanising words

Toileting

Feeding

Safe GUARDING

Infection CONTROLLING

Manual HANDLING

Risk ASSESSING

Care of the elderly

Dementia sufferers

Residents and visitors

Care Plans

Care Assistants

Many of these terms are not intended to harm but if we take a moment to reflect we can see that human beings can live a life in which they become defined by their need for care and not by who they are and the value that is inherent in their humanity. We think of this kind of hurtful language as part of the ‘furniture of separation’ – the subtle tone of the institution, collective terms which rob us of self.

Healing Language

Deep care

Community elders

Compassionate leader

Empathic touch

Compassionate care giving

Loved ones

Becoming an elder

Community wisdom

Keeping each other safe

Language which respects and responds to individuality, the wisdom of experience, the power of love and compassion and our shared need for community re frames the way in which we may think about ensuring that our elders may be able to rely on compassionate care giving as part of a rich and meaningful life.

Home managers we are privileged to hear and work with are increasingly seeing themselves as compassionate leaders – this shift is full of quiet power as they realise that the communities they are part of are full of unlimited compassion and that all have a part to play.

Always love to hear your thoughts

Thank you for your continuing interest in releasing compassion in the places we care for each other

Andy

1. Values alignment (posh term for all caring deeply about seeing the same change in the world)

2. Hospitality – the warming feeling that goes with a home being opened and visitors becoming friends

3. Courage – to step into the unknown as people who have never met trust their intuition that this is a place I must be

4. Surprise – brings a sense of joy and energy for deeper connection

5. A little light touch structure – most of this takes care of itself but having a gentle intention that all are heard seems to matter

6. Sharing stories of adversity and standing alongside each other – social change is tough, if it was easy we would have done it already

7. The digital magic – the easy connecting resonates as the synchronicities are noted and we can feel our gentle forces joining

8. Inspiration and celebration – we felt an elevated sense of the possible as we heard our friend and ally Edana sing her heart out and witnessed the virtuoso talent in her band that lies untapped in so many of us

As we melted away into the warm Brighton evening we knew that we had co-created something with quiet magic.

We are planning the first compassion catalysts days which we want to co-create with our wonderful friends at The One Leadership project. We will be mindful of yesterdays recipe.

Till the next time, thanks!

with love

Andy

An opportunity to ‘raise awareness’ – will it remain raised or fall back to its current level. I feel sure that these days and weeks in which we focus on a particular group of people who are united by a condition do a lot of good but there is something in me which is uncomfortable.

In my awareness as I write this is that dementia is constant for those who live with it and the people who love them. We must all do we all we can to close the gap between those citizens are not living with dementia and those who are – many who are not at this time will develop dementia. Many families will have to accept dementia as an unwelcome guest – some will never come to terms with the losses involved, whilst others will learn to embrace it; as they know that arguing with reality is a fight we are all doomed to lose and they find some way to making peace.

The nature of dementia is that it teaches us all about this one precious life, that we only have moments in which to do our living, that worrying about the past or living for the future means we miss out on what is right under our noses – this life, one moment at a time. If we awake to it people living with dementia have much to teach – rich enduring lessons about joy, and pain, the creative spirit, the value of nature,  stillness and kindness – the value of our deep caring connections with each other.

Maureen writes about her beloved mother Jean

Reflecting on the powerful vision for host leadership shared by Steve Onyett, the radical work of Helen Bevan and colleagues on energy for change and social movements and the invitation of Cormac Russell to release the assets in ourselves and our communities; together with our work on the Compassion System has resulted in support from senior NHS and Social Care leaders in central London for the first Compassion Council.

The Compassion Council will transcend the usual challenges of making system shifting change in institutional life as local community catalysts (elders, youth, disabled people, unpaid carers and others at risk of being left out) sit with positional catalysts from health and social care to commit to compassion and rise to the inspiring challenge of releasing compassion within and beyond the local  institutions. The challenges of energy and sustaining change are met by inviting the councils to engage in a process of:-

Learning

Leading

Inspiring and 

Enabling

Compassion Councils will be facilitated within a disciplined humane structure so that all voices are equal and an energetic engine room for compassion and community generosity is founded and supported.

It is easy to blame when a health and social care system fails catastrophically (Winterbourne View and Francis – see the psychology of evil here) but what is to be done? I detect a moment in time, a fork in the road – I am hearing about rushed submissions to boards about response to Francis and perceive a risk of tokenism and more reactive thinking.

Our partners at the One Leadership Project have been instrumental in the journey to realising this first Compassion Council as their vision for ‘enabling catalysts’ becomes more real and they move towards their ambitions target of being part of making 1 Billion positive impact on the planet and its people by 2020. We are very proud and humbled to be aligned with this vision.

It is time to take a breath, slow down and tune into the deeper challenges of creating a local and global movement for compassion. Closing the Compassion Gap talk is here.

We are now hearing daily from community and positional catalysts expressing passion for seeing a compassion council where they live and we are building our capacity to respond and support.

The compassion councils are the beginning, a compassionate culture in which we can all flourish is the end.

always a joy to receive your comments

Andy

I wanted to write a short piece on the compassionate Practitioner course – which I found a truly very positive experience.  Here it is:

I first had met Andy and Frameworks 4 Change in March 2012 when I attended a course (as an observer).  I was genuinely moved by the effect that his discussions and exercises had on care workers.  I was even more moved by the dedication and genuine sense of feeling that care workers had for the people they give care to.  I was also concerned about the issues for care workers in especially around their working conditions and rewards.

A few further meetings with Andy and Frameworks 4 Change had really helped me feel positive about the future of dignified and compassionate care for all (including those who deliver care).

When I attended the ‘Compassionate Practitioner’ Course I felt back-to-square-one again.  I didn’t feel particularly compassionate.  I was late for the course due to a delay with my train and rushed in with a coffee and almond croissant. It didn’t take me long to find my space in the group.  I was encouraged by the people I met who were all care workers or team leaders – I was the only commissioner. They were kind, caring and definitely compassionate but obviously felt undervalued and stressed by the pressure put upon them in the challenging role of delivering care. They actually seemed pleased that I had made the time to attend.

By the end of the first day I began to see a transformation.  I already felt back in my compassionate state.  People who initially spoke very little suddenly opened up – they felt valued and listened to.  People were bubbling with enthusiasm – everyone was in a compassionate space.  I felt very confident in the abilities and spirit of these kind and generous people to deliver compassion to others – I just hope they are given the space to do it.  I also witnessed their facilitation skills (and mine) improve rapidly.

By the end of the course I felt in a very good place.  I felt safe and empowered and I think it’s fair to say that everyone else felt the same.  I often find when I attend courses that inevitably some will find it hard to invest and commit emotionally and mentally but that wasn’t the case with the ‘Compassionate Practitioner’ course.  Everyone seemed united in purpose and state.

It’s very important to me that those who receive care are treated with dignity and compassion but equally I believe it’s important that those who give care are also treated in a dignified and compassionate way and that they and their work is valued by society itself.  The ‘Compassionate Practitioner’ course makes everyone feel equal and valued.

I want to offer a huge ‘thanks’ to Frameworks 4 Change.  It is a very special organisation which has the potential to change the lives of many people. I look forward to it going from strength to strength.

The words are shared here anonymously as we join forces to make commissioning culture safer and more routinely compassionate.

In my experience commissioners are often demonised and seen as part of the problem of a lack of compassion. My feeling is that there are pressing issues to address about the way services are commissioned, contracted, monitored, evaluated and supported. We need to be in the room together (assuming we are all full of compassion) to figure out how to create a world in which the most compassionate services will thrive in an environment which commissions for compassion

Your perspective and experience matters, do add a comment here

many thanks for your interest

Andy

I experienced Harry as a gentle, inspiring, humble and curious man and found our dialogue a joy. Harry wrote movingly about the compassionate care received by his mother (click here to read piece in the Guardian).

Harry has recently been ‘out in the field’ alongside social workers and the people they serve in an effort to deepen his understanding of the lived reality of social work – to move beyond the classroom and conceptual thinking to ‘be with’ and hold up a mirror re what he witnesses. The stories he tells as a result need to be heard so that social workers can see themselves in the stories and feel validated and known.

When a person is feeling threatened, living a life of subtle or complete chaos, not thinking straight the kind of attention they need is spacious – not patronising or controlling, not sympathetic in tone – the feeling of space gives opportunity for some ease to be felt and voices to be found. It is a little difficult to articulate here in writing but it feels like walking alongside in an unhurried way. Here I am, I am with you. Present. Non judgemental. In solidarity. 

I perceive that some readers will already be thinking that there isn’t time in health and social care and I respect the real world challenges people face but my experience is that this spacious giving of your self offers  something to the person you are with to use, a glimpse of possibility and often takes less clock time as trust can become a feature of the relationship more quickly.

In another context the attention is given to signal to a person who may be familiar with being left alone for long periods demonstrates an intention – to move from separation to togetherness. Harry had encountered my work through watching this film (made in 2009) in which I am reflecting on who really has the choice in Health and Social Care. When we shift into a more self aware state we can choose the kind of attention we give.

Reflect on the kind of attention you give to yourself – do you allow space to be, to feel into how it is to be inside your skin, watching the flow of your thoughts. If this kind of space is elusive for you it may be difficult to sustain for others. Maybe you give it to others but at a cost to you and perhaps even your family and those who are close to you. 

I hope these words are helpful in some way.

They are written with that intention.

Always wonderful to hear your thoughts

Andy

The purpose of the pack is to enable the home managers and their teams to realise a vision for a consistently compassionate community in which everyone belongs, knows that they are safe and respected and can contribute their gifts and capacities. The people who live in the community, their families, the care staff, local people and leaders – everyone matters. Young and old, the environmental, spiritual and creative community –  all will be integral to the compassionate community.

Imagine yourself living in one of these compassionate communities of the future, feeling safe, happy and valued – telling your friends and family what a wonderful place this is to be, to spend time, to visit, to work – to live out your days knowing you matter so that you can die in peace.

I want our community to imagine these compassionate communities into being – I want to ‘crowd source’  the vision.

So please take a few minutes to quieten your mind, perhaps close your eyes and imagine your future self in this place….what can you see, hear and feel. What do you love about living there?

Please write down what you imagine as a comment here or via an email to 

andybradley@frameworks4change.co.uk

Please write your name and age and where you live.

I plan to include people of all ages in the vision for the compassionate community.

I spoke about this vision at the Thinking Differently about Dementia event – you can see the talk here.

The pack will  be published this autumn – I have the next 6 weeks to write it so get imagining and writing!

with deep appreciation

Andy

After Francis and Winterbourne View it is my conviction that we are at a fork in the road and that decisions taken now re how to respond will make our services more or less human for years to come.

The time for a paradigm shift has come – we have been looking through the wrong end of the telescope, using entirely the wrong map to navigate our way through the challenges of modern health and social care.

We need to see through a new lens.

The shift can be characterised in four ways:-

Compliance to Compassion

Fear to trust

Service to Community

Scarcity to Abundance

I worked with the board of large national care provider yesterday.

Inspiring people paying attention and being willing to involve their hearts in their leadership.

“It starts with us” was the theme of the day.

The greatest leadership challenge of our time is to stand for compassion – this requires courage, conviction, tenacity and presence.

The change wont happen by either waiting or blaming, it is time to act.

A wave of compassion is building – the catalysts need support, we will be part of providing it.

Thank you for your commitment to compassion

Andy