There is a famous Bruce Lee Quote from one of his interviews in the year before he died.
The TV talk-show host asked Bruce, ‘Some people say you are amazing at martial arts, Bruce, just how good are you?’ (Or word to that effect).
Bruce’s legendary response, ‘If I tell you I’m good, probably you will say I’m boasting. But if I tell you I’m not good, you’ll know I’m lying,’ encapsulates some elements of his personality, his confidence, competence and skill.
Yes, Bruce was that good.
Now, I am just a doctor.
In medicine we are advised to be as good as the average.
Indeed, there is a principle enshrined in law that the way to judge as doctor is on the basis of what he peers would have done in a similar situation. It is called the Bolam Principle.
I know most people think and would certainly want their doctor to be better than average, and like the ‘better than average’ (Illusionary superiority) heuristic the average person or doctor thinks or believes they are better than average that whatever they do (diagnose, cook, drive, tooth-brush), the reality is that most of us are average, sitting bang in the centre of the normal distribution.
Where am I going with this and what does it have to do with team-working?
Well, I work in several teams.
Indeed, you could say that teams are the basis of most of the successes of human society – we perhaps say that Steve Jobs was why the iPhone is successful or Elon Musk the Tesla, it is really, the teams that are work with and support them who are outstanding. For the most these guys are just loudmouths and good self-promoters.
I work with some amazing teams.
I don’t know if I am considered the Steve Jobs of nursing homes, certainly not, yet, some of the work I have supported has been outstanding.
I want to take one example.
For the past two years I, as part of my role working at Manor Field Surgery in Maltby, Rotherham, South Yorkshire (details provided for international readers) have been visiting the 70-bed nursing and residential home, Layden Court once a week throughout this time.
Over the first wave of Covid I went video but since then it has all been face-to-face.
As I mentioned above, if you asked me if I or the team were doing a good job, my answer would be, ‘Certainly!’ This, you might call it, is the psychologically healthy way to respond.
Yet, the only way to know how good good is, it through measurement.
We in health and social care are not very good measurers.
We tend to measure when things go wrong – falls, complaints, incidents.
And, for all these are only a fraction of the goings-on, they are the standards by which we are judged.
I haven’t measured the rates of falls in Layden Court since I have been attending although I could probably get hold of this data if I had the time to do so.
I’d like to think fewer people are falling.
Having said this, a reduction in falls (one of the single biggest healthcare associated harms) is important, it is not the end of the story.
You can stop people falling by doping-them up so much they can’t move, or like Singapore or Holland, tying people to beds and chairs would stop falls, yet in the UK we would see that as unecessary restraint and an infringement of human rights (the evidence behind restraint is that it doesn’t work, in that it might prevent falls but the harms are so great the people tend to experience other negative events – dehydration, malnutrition, depression, etc.)
I am getting off topic.
You see, a year or so ago I was interested in the numbers of 999 calls from the home.
I felt, if I could show we were having fewer of these, I could then demonstrate the work I was doing was avoiding people (residents/patients) getting into situations where the nurses/carers had to call for an emergency response.
I tried contacting some colleagues in Yorkshire Ambulance Service (YAS) without success, I even submitted my first and only Freedom of Information request to the organisation. This got me some data but not what I wanted and took so long and so many emails that I gave-up.
It was only six months ago when YAS appointed a team to support avoidance of unnecessary admissions from care homes that I was able to ask for and receive the data.
It came in two forms which I will show you.
The first has demonstrated that one of the teams I work with has provided phenomenal input and support to care homes across Rotherham.
The data indicates, if you live in a care home in two other parts of South Yorkshire which are of an equivalent population, you are significantly more likely to have an ambulance called to you and consequently be taken to hospital, and, given what we know about the experiences of older people in A&E’s anywhere in the world, you are also more likely to be admitted to hospital and receive all the interventions (and potential harms) associated (particularly when medical care is provided to people who do not need to be in hospital but are perceived by certain doctors to require hospitalisation). (Rotherham is the red line).
The second graph below, is, you might call it my personal graph.
It indicates the 999 calls to the care home I have supported since starting there in June 2019 (I have cut this graph so that it is equivalent to the time-line above).
There has been a big drop in calls and the same applies to these individuals as to those living across the town.
Now, the point.
Is Rod really great?
Sure, I believe I am better than average (healthy ego), yet, I am not responsible for this work.
I have played a small part in the overall Rotherham Care Home work and a little bit bigger part in the Maltby Care Home work, yet, no, I am not responsible.
It is the team.
The team are what has made the difference.
The way I have worked with the teams of staff – managers, healthcare assistants, cleaners, nurses, therapists, residents and families.
Collectively we have improved things. (And we will continue to improve!)
Take any of us out of the equation and the results will not be the same, they will likely be worse.
This is part of the reason it is harmful to say he or she or they are great.
It is very often difficult to define who they are.
And so too when things are not so good.
If quality starts to fail, you could call ‘everyone’ out for failing, report the lot to the ombudsman and so on.
This sometimes happens. Often it is the result of miscommunication, misunderstanding and frequently in individual cases grief or guilt.
The system response to tarnish the whole team can however be detrimental to that team and the people they support.
Sure, you can’t let bad things go unreviewed, you can’t let bad practice pass, yet, tarnishing everyone can be ineffective.
How have I arrived here from Bruce Lee in a 1970’s Hong Kong TV studio?
Most of us want the best.
We want to be associated with the best – the best team, country, organisation.
Others don’t really care.
Some see the whole of the moon.
I’ll leave it there.