As Baroness Wheeler highlighted in the UK Parliamentary debate on NHS Wound Care (22 November 2017), two million patients are treated for wounds every year at a cost of more than £5 billion. “Stop the pressure” and “React to Red” were two of the initiatives discussed and much of the debate discussed treatments, the benefits of appropriate care and pathways to support improved commissioning.
Whilst it was agreed that a person-centred approach needed to be taken, it was disappointing that there was no focus on the prevention of force-related tissue damage – in both patients and their carers – which we believe is essential, especially during inbed care.
As Warren Buffett said, “What the human being is best at doing is interpreting all new information so that their prior conclusions remain intact”. This is known as confirmation bias and, as Peter Fuda explains, whilst we judge ourselves by our noble intentions, but we judge everyone else by their actions.
However, measuring customer satisfaction and customer experience are commonplace in non-healthcare industries yet the measurement of a patient’s journey through diagnosis, treatment and care is not.
This is expanded by Fred Lee, who used his TEDx talk to give the reminder that not all experiences are fun and in healthcare, it is patients’ perceptions that influence their satisfaction. Care can be technically accurate but it is the ‘soft skills’ (the conversation, gentleness and expectation management) that affect how that care is perceived. This is a point developed by Daniel Kahneman when he explains the difference between the ‘experiencing self’ and ‘remembering self’ and how a negative occurrence can skew the remembered perception. In the situation of inbed care this could include how people feel when they are moved and the consequences of that movement (such as force-related tissue damage). Katya Anderson refers to this as imago – in science, that’s the last stage of an insect’s metamorphosis. In psychology, it’s the notion of what we carry along through our previous selves up to now which can skew the way we see others and stymie our own ability to connect.
As illustrated in Kate Sheehan’s OT article, assumptions that our industry is taking the correct approach can mean, that the NHS is wasting money on equipment that is not best for the patient concerned.
However, improvements and making change is not that simple as 47% of all human behaviours are habitual, even when there are strong reasons to try something new. Also, as explained by Steven Shorrock, in professions with a protective purpose, the assumption seems to be that we learn from negative consequences. Yet there also needs to be a mechanism to learn from what is working – in this case, the best-practice products and processes that improve inbed care and safety for both patient AND their nurses/ carers.
Quite often, there’s a focus on just one or the other. Moving and handling guidelines for example will serve to protect the back health of nurses and carers, yet their development and introduction hasn’t taken into account the effect these new procedures have on the patient’s tissue viability.
Only when design is human-orientated will tissue integrity be maintained for both patient and carer. But that’s not all. The terminology used by governing bodies needs to promote this as well as having "stakeholders who will enable the spread” of new processes or products either regionally or nationally.
The good news is that just as a caterpillar already has all the parts it needs to become a butterfly without falling apart, so the healthcare industry already has the tools required to use a philesynergetic approach that will transform the care of patients inbed. As illustrated in the Safety Dance video, patients can be moved safely without any physical risk to the carer and without any risk to the patient of force-related tissue damage.
Strong leadership is required to start the metamorphosis process; to breakthrough habitual behaviours, sharing why it is needed and sift the essential from the non-essential so the emphasis is moved from one of managing risks to one of anticipation, prediction and prevention.
After all, protecting both patients and their carers should be a given, not a choice.