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Join the Gathering of Kindness in creating a better health system: a recommended LongRead

The damaging problem of bullying in healthcare features regularly in the news and on social media, most recently thanks to discussions yesterday at the AMA national conference in Canberra (check #amanc16) and to a new anti-bullying program at Royal Melbourne Hospital.

How different might our health system be if it was based upon kindness, trust and respect?

Earlier this year, a group of people with diverse expertise and experiences of the health system came together in Victoria to imagine just such a system.

The Gathering of Kindness was a unique opportunity for sharing stories, for listening and reflecting, and for creative discussions. Perhaps it will also come to be seen as a pivotal step for a fledgling movement for social change, reports writer and consultant Lea McInerney in a special Croakey LongRead.

[divide style=”dots” width=”medium”]

 Lea McInerney writes:

It’s a chilly morning and mist is hanging low over Macedon’s nearby mountains on the first morning of the two-day Gathering of Kindness. As I get off the train I spot three other people looking for someone. The organisers have arranged a lift for us to Duneira, a heritage house and gardens where the event will take place.

Lea McInerney
Lea McInerney

Soon we’re in a car with our driver, Sharee, one of the event’s many volunteers. She quickly puts us at ease and we introduce ourselves: psychologist, social worker, doctor, government policy officer, and myself, reporting for Croakey.

We’re all a bit sniffy, noses cold from the sudden chill. Sharee points to a box of tissues sitting on the console. “It’s colder up here in the mountains,” she says. “I thought you might need these.” Gratefully, we each grab one.

Two acts of kindness already and the show hasn’t even started yet.

When the organisers offered Croakey a scholarship place at this very first gathering of its kind, I must admit to feeling a bit sceptical. The promo said, “We’re inviting you to re-imagine a healthcare system that has kindness, trust and respect as core components.” It brought to mind Gandhi’s reply when someone asked him what he thought about western civilisation: “I think it would be a good idea.”

I’ve been both inside and outside the healthcare system. In the early 1980s, I registered as a nurse and specialised in palliative care, first in hospitals, then with people in their homes. I left a clinical management role in the 1990s and became a health policy analyst, then worked in organisation development.

I’ve been a client of health services and have cared for family members with serious illnesses. I’ve encountered kindness and meanness, care and carelessness, clarity and confusion. We all want things to be better, but when your hopes have flown high then crashed to the ground a few times, you go in a little warily.

“This will be two days where we design something that doesn’t yet exist. It will take courage, imagination, thoughtfulness, humour and cooperation.” So the invitation promised.

The organisers, healthcare entrepreneur Mary Freer and hospital-based doctor Cath Crock, had been talking together for some time about the increasing problem of workplace bullying in healthcare. Mary is the person behind Change Day, a social movement that encourages people to commit to making a single change that will bring better health outcomes in their work, while Cath has been involved in developments in patient-centred care for many years and was awarded a Churchill Fellowship to study practices overseas in 2010.

Both women were aware that bullying was likely to be a problem not only for the staff affected, but for the people they were caring for too. They talked it over with futurist Peter Ellyard who encouraged them to flip it on its head. Rather than try to get to the bottom of the problem, why not go straight to a preferred alternative. Not “How do we end bullying?” but “How do we create kindness?”

Around the same time, the Victorian Attorney-General’s Office had been conducting an audit of data from three reviews of bullying in healthcare settings. The findings were alarming – the incidence of bullying was high, it was poorly dealt with, many workers were caught up in an escalating cycle of poor behaviour, and they had little confidence that anything could be done about it. The audit concluded that stronger leadership and sustained commitment was required from health sector leaders to make things better.

The Victorian Health Minister Jill Hennessey is now overseeing a wide-ranging strategy within her department to create a culture that supports both patient and staff safety. Last year she approached Mary to see if Change Day 2016 would do something on bullying. Mary proposed the Gathering of Kindness and the minister was supportive, offering a small grant to get things rolling. Another early supporter was the Victorian Managed Insurance Authority, which provides risk advice and insurance services for state government departments, hospitals, health centres and community services.

Mary and Cath gathered together a large group of volunteers – the budget was too small to hire an events manager – and in late March found themselves welcoming 100 people from Australia, New Zealand, Ireland and the UK to Macedon.

Sharee leads us from the car park to the booking-in table and cups of tea and coffee set up on the patio outside the historic home. People are rugged up in coats and scarves, mingling and talking, shyly with strangers, relief on their faces when they meet someone they know.

Welcomes
Welcoming participants

While I’m standing there warming my hands with my coffee cup, I meet the executive director of nursing (DON) of a hospital in Sydney who becomes my ‘go to’ person for the current state of play in hospitals. We’re both about the same vintage and while I left the profession 20 years ago, she’s had a varied nursing career in the UK and in several Australian states.

We dive straight into the topic. Is it worse now than in the past?

She tells me about a student nurse who recently had her first experience of giving a patient an injection. The senior nurse had given her no time to prepare and it was much more stressful than it needed to be. “She just threw me into it”, the student said. If staff aren’t nurtured, the executive DON says, they can’t nurture patients.

I tell her I remember working with a senior nurse I’ll call Beth, during my first year as a registered nurse in a hospital. Beth was always grumpy and bossy, and was the trigger for the first self-help book I ever bought, Dealing with Difficult People. I don’t know if what she was doing was bullying – we didn’t really use that language back then – but her behaviour wasn’t kindly and it was certainly persistent.

A bell rings and it’s time to make our way to the marquee on the lawns. Inside are large round tables close together, nine or ten seats at each. We settle in.

Setting the stage

Mary and Cath are up the front and welcome us all. “If you’ve ever been to a conference,” Mary says, “forget all that now. This is an un-conference.”

More on that shortly, but first Mary-Anne Thomas, the local state member for Macedon, and Parliamentary Secretary for Health and Human Services, opens the gathering, after acknowledging the Wurundjeri people. She touches on the magnitude of the challenge and quotes Rosie Batty who, when a journalist questioned whether violence against women would ever end, said that you must believe change can happen, that it’s possible.

The un-conference starts off in an un-conference-like way with a performance of a play. Called Hear Me, it was written by Alan Hopgood in collaboration with the Australian Institute for Patient and Family Centred Care. It’s now been performed over 100 times in healthcare settings in Australia and New Zealand, and seen by around 7,000 people. (If Hopgood’s name rings a distant bell that’s because he was Wally in Prisoner and Jack Lassiter in Neighbours.)

The play deals with the aftermath of a young woman’s death in hospital after she was given the wrong medication. It’s hard to watch – a heartbroken mother, an arrogant physician, a devastated junior doctor, a nurse who doesn’t want to rock the boat, and a CEO trying to find a way through. (Watch a selection from the play at the end of this article).

The message that comes across at the end of the play – how critical it is to properly listen to people, patients and their families in particular – will come up time and time again during the conference.

When I was in my 20s, I worked in a small country hospital for a while. I nursed an old man who had advanced cancer. He’d had treatment in the city then returned to his hometown for care. His prognosis wasn’t good.

One day, as I was fixing his pillows, he said something that made me realise he didn’t really understand what was wrong with him, and how serious it was. Either no one had spoken to him about his condition or, just as possibly, somebody had when he’d been in the city hospital, but he hadn’t been able to take it in at the time.

In those days, in that place anyway, only doctors were allowed to talk with a patient about their diagnosis. I asked the doctor if he could talk to the man, let him know what was happening. We were standing in the corridor a little way down from the man’s room. The doctor said something along the lines of, “There’s no point in telling him, he doesn’t know what’s best for himself and there’s nothing that can be done anyway.”

I knew it was wrong, but I didn’t feel I could override the doctor’s orders. The dying man, who I can still picture, was one of the reasons I headed to London to study oncology and palliative care. There had to be a more respectful way.

This is what I remembered, as I watched the play.

When it finished, Cath and the actors invited people from the floor (or, more correctly, the grass) to offer their responses.

Someone quoted a state health minister who says the experts of the health system are at both ends of the stethoscope. Another suggested that we underestimate the skills required to have difficult conversations, whether that’s with a staff member or with a patient. Someone else’s take on it was that, too often, the individual agendas of health professionals step in over the real purpose of what they’re actually there to do.

A more personal response came from a philosopher who had recently been a patient. She was in hospital for a long time and said the nurses and doctors were fabulous and very attentive. The thing that bothered her though was the design of the hospital – the physical design as well as the systems, which she could see were often inefficient.

Because hospitals seem so concerned about safety these days, she said, patients are constantly being seen by different health professionals, and this gets tiring. She was also troubled by seeing elderly patients left on commodes for a long time, adding that obviously resources, and the lack of them, have a profound impact.

The fate of the junior doctor in the play isn’t pretty – she abandons her career, a not uncommon situation – and this triggered passionate discussion about the pressures on staff, young doctors in particular, and how easy it is for their confidence to be shattered.

A doctor now in his 50s spoke about how as a junior doctor under supervision, he’d administered the wrong dose of a drug to a patient who died. He observed that mistakes at the beginning of your career tend to be through lack of experience, while mistakes by more experienced doctors often come from being too busy and missing things.

In response, another older doctor talked about how inherently unhealthy the health system is, saying that the three words he’s heard over and over during his career are “Who needs sleep?” He added that we all know that people work best when they’re rested and fed and comfortable. The whole profession, he was starting to think, works in a zombie state.

Someone else said it’s important to recognise that health workers will get things wrong sometimes, that it’s better for the system to recognise this and build a culture of learning, rather than a culture of pretending that mistakes are never made, and coming down heavily on people when they are.

image005At this point I was starting to see the value of focusing on creating a positive culture of kindness, rather than trying to solve every individual problem.

Different people were canvassing causes: lack of resources, lack of leadership, inadequate management skills, poor role modelling, the way nurses and doctors interact, individualism, faulty systems, and more. It felt overwhelming. At the same time, many of the personal anecdotes were harrowing and were touching raw nerves for some. It looked like the two days might teeter between war stories and impassioned opinions about single fixes.

Perhaps sensing that, someone turned to the question of whether you can you teach kindness, to which Mary invited the philosopher to respond. She said she’s not convinced you can, that it’s a trait of character inculcated from a young age.

Mary then brought in a neuroscientist. His take on it is that kindness is contagious among humans because we’re a highly social species. We’re born helpless, we have to be fed and cleaned by at least one other human being at great cost financially and emotionally to them. If there was no compassion, he said, there’d be no next generation.

However, there’s another dynamic that can undermine this, and that’s often at play among professional groups – an unconscious agenda to maintain the status quo. If anything changes, he added, they lose the power they hold, and that’s a big problem to have to work around.

The play and subsequent discussions helped to set the tone for this event being different to business as usual. No keynote addresses, no individual speakers, not even any PowerPoint presentations.

Instead, there were Story Starters – an artist, surgeon, physician, philosopher, musician, futurist, entrepreneur, neuroscientist, actor, lawyer, patient advocate, former patient, politician, academic, video producer – who kicked-off what were called Open Conversations.

Four or five Story Starters would kick off a session by each telling a story based on themes like “Where have you met kindness and can we increase the likelihood of that meeting?” and “Kindness in strange places”. Mary or Cath would then open up the discussion to the whole gathering. The message was, if you want to join in any time, just do.

In a marquee of 100 people that could be a recipe for chaos. But from where I sat at the back, it seemed to work well, people listening intently, those doing the talking not hanging onto the microphone for too long.

In between the Story Starter sessions were Creative Clusters – small group discussions, where people met in groups of eight to ten dotted around the gardens (sunblock helpfully provided), and talked about their experiences of both bullying and kindness.

As I listened to the stories, I heard a few different angles on kindness coming through – it’s contextual, it’s important to consciously put people at the centre, that staff are people too, that listening is powerful. There were also lots of stories about acts of kindness that people had found very moving.

Kindness in context

What is kindness and do we all have the same picture of it in our minds?

As it turns out, probably not. Someone brought up the Christian teaching of “Do unto others as you would have done to you” and this opened up a discussion about different cultural ideas of kindness.

Sometimes there’s a mismatch between the intention of the person being kind and what’s actually needed by the person who is the object of a kind act. A doctor gave an example of not helping a man in a wheelchair struggle for ten minutes to get through a door, because he’d realised the man wanted to learn how to do it for himself.

Then there’s the question of how do we be kind when it’s a tough environment and other people aren’t being kind? In response, someone quoted Abraham Lincoln: “I do not like that man. I must get to know him better.”

A surgeon, an Iraqi man who arrived in Australia by boat 17 years ago and was held in a detention centre in the desert for a time, talked about how non-English speaking people can sometimes come across as rude. He said he went to a very good school in Iraq and was taught English, but instead of learning how to say, “May I please have a glass of water”, they learned to say, “I want water.” He said it took him ten years in Australia to learn to say, “May I please have the scalpel?” He added that he is married to a Russian woman and that when she speaks English she can sound abrupt.

The neuroscientist expanded on his earlier stories about kindness and compassion being central to how we’ve survived as a species. He talked about a recent discovery in neuroscience of ‘mirror neurons’, a cluster of neurons in the brain that seem to have a role in how we engage with others.

He touched on it at the gathering and later explained it like this in an email: