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Patient Safety Tool Box Talks© Theme 1 talks - Person centred care and supportre and Support Patient Safety Tool Box Talks© Theme 2 talks - Effective care and support Patient Safety Tool Box Talks© Theme 3 talks - Safe care and support Patient Safety Tool Box Talks© Theme 5 talks - Leadership, governance and management Patient Safety Tool Box Talks© Theme 8 talks - Use of information

When driving to work at the beginning of the pandemic, I felt a sense of worry and apprehension of what I would be faced with. As a critical care outreach nurse I never know what I may be faced with, but this has never bothered me. However, during the pandemic it did bother me. I worried how I could do my job; would I get sick and how would I navigate my way through the new ways of working? Seeing the brightly coloured rainbows in people’s windows gave me some hope. I knew that the public were thinking of us; they knew the risks we were putting ourselves at and our families. For a time, I felt special. It sounds pathetic, I know. For a time, I felt valued. Valued by the public, valued by the trust I work for and valued by politicians. As NHS staff we had priority shopping, we had discounts from big stores, we had free parking, we had donations of food every day while we were at work, we were donated hand creams and toiletries. School children drew us pictures to put on the walls of our staff room saying ”thank you”. What made me feel valued more than anything was staff wellbeing being at the forefront. Extra staff were redeployed to work on the ITU, we were made sure we had all our breaks and we were made to feel that each and every one of us counted. Relatives of patients wrote and expressed their gratitude, even if they were unable to visit their dying family – they were truly grateful to us. The ITU where I work received so many beautifully written letters and cards. We pinned every one onto the wall so we were reminded that we were shining bright despite the darkness. Then there was the Thursday clap. Personally, I thought this was an odd thing to do, but it seemed to bring people together and have a shared purpose – even if it was for a fleeting 5 minutes a week. When I think back at those months, it seems like a lifetime ago. Eve Mitchell’s recent blog on the hub highlighted that care homes are receiving complaint letters and some are even receiving threats of litigation. “Not enough PPE”, “lack of care given to my family member”, “my family member was neglected during the pandemic” – frustration and anger are palpable. Frustration and anger because families were unable to visit their relatives in their last days, frustration and anger that these precious moments have been denied from them. If it were my mum or dad would I feel the same? Of course I would. I would be the loudest voice there. Is it the fault of the care home? Should they be vilified for the protection of their residents? And now it’s the turn of the hospitals. We now have over a million people waiting on lists for operations, procedures, appointments. Some have already waited months before the pandemic started. Some have already died as a result of not having surgery at the right time. Patients have received surgery and treatment late and this has led to complications and a longer hospital stay – which then increases their mortality. At some point the gratitude from the public will turn to anger and frustration, as it has with the care homes. Would I be angry if my mum was waiting for an operation and died as a result of a prolonged wait? Yes I would. It is a natural response to blame the very people who should have helped – the NHS staff. I now drive to work and see faded rainbows in windows, I will be paying for parking again in the next few weeks, the donations of food have dried up, staff are back at ‘normal’ levels and I am back to having no breaks some days, not to mention that nurses were not included in the recent pay rise. I feel that we have served our purpose. ‘Thanks very much – now get back to normal, sort the waiting lists out and work harder to make sure it happens’. I don’t envy our senior leaders in acute Trusts. They are stuck in the middle of the Department of Health and Social Care and NHS England who are trying to fathom out a strategy to get the waiting lists down, and support frontline staff who are exhausted and a frustrated public that may erupt at any moment. Frontline workers have been through it the last few months. Navigating our way through complaints and litigation and an angry public who feel that they are not receiving the care that they expect in the coming months fills me with dread. We are not equipped. Faded rainbows – is this a representation of the fading support we are receiving in the NHS?

Ever have one of those days when you feel you are constantly walking up the down escalator, when it just feels tougher than it should? It is hardly surprising that we feel like this during COVID-19. Our previous routines for our work, leisure, friends, family have all been thrown up in the air and are continuing to change. I do not have a miracle cure (if only). However, taking a moment to think about the way you are naturally wired, and how others may be wired differently, can be helpful. It can take away the irritation and frustration and help us develop a few coping strategies. Or, to put it in the words of Swiss psychiatrist, Carl Jung, ‘everything that irritates us about others can lead to an understanding of ourselves’. We all have a ‘type’… The theory of psychological type comes from Jung who said that what appears to be random behaviour is actually the result of differences in the way people prefer to use their mental capacities. In 1921 he published Psychological Types, introducing the idea that each person has a psychological type. However, the academic language of the book made it hard to read and few people could understand and use the ideas for practical purposes. Isabel Briggs Myers and her mother Katharine Cook Briggs set out to find an easier way for people to use Jung's ideas in everyday life. The Myers-Briggs Type Indicator (MBTI) personality inventory makes the theory of psychological types described by Jung understandable and useful. I have used this both with individuals and teams over the years and, more recently, as people get used to different routines. To do an MBTI assessment properly you do need to complete a questionnaire and have a follow up conversation with an MBTI practitioner – all practitioners are trained to administer the tool properly. However, in these tricky COVID times when some of those resources may be less readily available, this blog is to help you reflect on your preferences and how these play out in practice. The four ‘dimensions’ of MBTI 1 How you gain your energy and re-charge your batteries Some of us gain energy through interaction with others, others through quiet reflection. Our work settings are often designed for extroverts, the noise and the constant interaction, not great for introverts who do their best work in a quieter setting. People with an extroverted preference will ‘speak think speak’, whereas those with an introverted preference will ‘think speak think’. Just recently you may have noticed natural extroverts on Zoom calls – the people doing a lot of the talking. The downside of course is that others cannot get a word in edge-ways. If you don’t know what an extrovert is thinking, you have not listened. If you don’t know what an introvert is thinking, you have not asked. And, crucially, you may be missing out on some key information. 2 What type of information you prefer to take in, trust and offer to others When I talk to people about dimension, I often show them a Salvador Dali picture. People who have a strong preference for factual concrete information will give me a list of the painting contents – an apple a knife a bird etc. Others will be reading between the lines and creating possibilities, ‘something has happened here, it’s unsettling’. If I prefer the big picture, any presentation of my ideas with a compelling vision but no detail to back it up is going to raise more questions than it answers from those who prefer realistic and concrete information. It is normally best to think through how to balance the more abstract and the specifics, maybe asking yourself, ‘what’s missing here?' 3 How you prefer to make important decisions Some of us prefer a logical lens. We look at the pros and the cons, we want to help people to solve their problem. Others are concerned about how what is about to happen will impact on others, their values. If you have ever tried to have a pros and cons conversation with someone who appears (as far as you can tell) to be taking this all a little too personally then it’s this dimension that’s rearing its head. There is a difference in your preferences. In MBTI this is the ‘thinking or feeling’ preference. This does not mean that ‘thinking’ people cannot feel and that ‘feeling’ people do not think. It is just about where you start your decision making. People with a thinking preference take a big step back, start with a detached view and then step in. People with a feeling preference do this in reverse. Both are important. 4 How you prefer to live your life Some of us are natural planners, others spontaneous, sometimes VERY last minute. I learnt many years ago that asking for things at the last minute was a great way to hack off your colleagues. We don’t live in a perfect planful world, but a little consideration goes along way… If you like structure, if the word ‘finished’ inspires you, spare a thought for others who may lob something in at the last minute. Your last minute contributor may have come up with the best idea since sliced bread. If you shut them down they may not bother you again with their great ideas. Your loss. And if you love the words ’just finishing’, try where you can to minimise how often you let things run on until the last possible moment and apologise when you do – it can very stressful for colleagues, friends and family who like to plan. In MBTI all these four dimensions come together for us into 16 different types. MBTI then paves the way for us to better understand our responses to conflict, stress, our contributions within our team and how we can be even better. And, particularly relevant now, it can also help us understand why some are really wired to deal with change and others less so. Final thoughts And finally, I wanted to add a few more things that are useful to bear in mind: This is simply about understanding your natural preferences and sometimes adjusting them. People sometimes say ‘I do both of these’. We learn that adjustments to our natural preferences can be helpful. For example I am very planful in work settings, but for me at home it’s all a bit last minute.com unless I try hard! Which leads into my last point. Expect to be more tired on occasions. If you are required to deal with a lot of detail when you prefer the big picture, be aware it may feel surprisingly tiring. It takes your full concentration, just like folding your arms the other way, also surprisingly tricky for most people I know. Try it! In the meantime I hope my blog helps you to get your head around why you may find some of the super people around you not so super at times and how you can adjust your approach to accept and value their differences. If you are interested to learn more, go to your local NHS Leadership Academy to find your local MBTI practitioners and take a look at the Myers Briggs website. Previous blogs by Sally Leading for improvement Immunity to change How a single piece of paper could help solve complex patient safety issues The art of wobbling: Part 1 The art of wobbling: Part 2 Looking after each other in times of change

My original plan for this blog was to explore why change is a bit Marmite – some of us love change (the ‘bring it on’ group), and others less so. Then the COVID-19 jar was opened and everything changed. We are all impacted in different ways, both staff and patients. Whether it’s even more time at work, less time with those we love, wanting to be at work but having to self isolate, loss of our identity as the one who always does x or y, how as patients we interact with our NHS, or the loss of those we love. Transitions are challenging William Bridges says it isn’t the changes that do you in, it’s the transitions. Change is something that happens to people, even if they don't agree with it. Transition, on the other hand, is internal. It's what happens in people's minds as they go through change. Change can happen very quickly, while transition usually occurs more slowly as we internalise and come to terms with the details of the new situation that the change brings about. Stages of transitioning include: Ending - letting go of the old ways and the old identity. The neutral zone - going through an in-between time when the old is gone but the new isn’t fully operational, when the critical psychological re-alignments and re-patterning take place. New beginnings – when we come out of the transition and develop a new identity, experience a new energy and discover a new sense of purpose. 3 tips for dealing with transition So what can we do to ease the transition? Here’s my three As for the day: Acceptance Accept that we will each make our transition at different paces. For some shock and denial through to acceptance and hope is rapid, for others it may take longer. So more than ever looking after each other is key. Steve Covey’s talks about making a deposit in the emotional bank account: understanding your friend, your colleague, a small act of kindness. What will be a deposit for you, may be a valuable withdrawal for them. Appreciation There’s already a zillion examples of people moving hell and high water to do what needs to be done to best respond to COVID-19, positive energy is thriving. Appreciating this is just as important. We can show our appreciation locally in our teams, on an individual basis or by joining the nation in clapping those who are helping to keep our world turning,. Awareness Be aware of high levels of anxiety and exhaustion in yourself and those around you. We are all stressed by different things. For some it’s spending too much time alone. Others ambiguity and uncertainty. Some will struggle most with decisions they think are illogical, last minute or require super human endeavours. Knowing our own limits and triggers and those of people around us is key. When you spot them, pause just for a vital moment, take a brief step back before anyone keels over and think through next steps. Explore information and ideas and talk them through with others. And where you can see that someone isn’t in a good place, give them permission to re-charge their batteries so their brilliance can continue to shine. “Not in his goals but in his transitions man is great.” —Ralph Waldo Emerson References William Bridges, Bridges Transition Model, 1988. Stephen R. Covey. The seven habits of highly effective people. Franklin Covey, 1990. Previous blogs by Sally Leading for improvement Immunity to change How a single piece of paper could help solve complex patient safety issues The art of wobbling: Part 1 The art of wobbling: Part 2

As a working parent, life has always been a juggling act… during this crisis I’m dropping a few balls and I feel totally out of control. I have always been an organised person. When I say organised, I mean that the kids get to school, I get to work, dinner is cooked, clothes are fresh, the house is clean, and we have time for fun. The last few days our worlds have turned upside down. The kids don’t go to school, my work is not what I know anymore and I’m too scared to go, dinners are not the usual (we had spam fritters and tinned potatoes last night), clothes are boiled washed, the house stinks of bleach and we can't go out. We shall get used to this new normal, I know that we all need to find a routine that will comfort us, even if that is making up new house rules or putting up a timetable for the kids (that went in the bin after 48 hours). I’m getting used to being a bit of a crap mother at the moment. I’m getting a bit shouty, more than usual and I don’t like it. We are eating weird stuff I have found in the back of the freezer as I am limiting the amount of time I go out; I don’t recommend a frankfurter curry… bit salty. I'm trying to home-school the kids as the school will only take the boys when I’m at the hospital – this is to make sure everyone can get to work. If anything, this is what is going to send me over the edge first! The boys are fighting, they refuse to do the work set by the school, I try and help but I can’t understand it, they ask for snacks constantly, they want to go out with friends and, what with everyone online, the internet is slow. It’s been 48 hours of lockdown and I think I shall have an 'inset' day tomorrow. I know in my last blog I spoke of my husband and his business going a bit t***s up, it’s the least of the worries at the moment. The government has set out lots of support for him and his employees. He will be ok, his employees will be ok, we will be ok. This was a huge part of the stress we were under last week, but things have changed. I have been doing extra shifts at the hospital to cover sickness. Many of our outreach team are in self-isolation due to family members being unwell or they are unwell. During these shifts I have witnessed the very best of our NHS and the Trust I work in, so why am I dreading my next shift? Fear. Never have I felt that my life is at risk during my 24-year nursing career. I have worked all over the world. Working in a refugee camp, being the only blonde, white woman, you would have thought I would feel scared or threatened. No, I was welcomed and respected. I have been driven at high speed in taxi in South Africa, racing away from armed car jackers when I was a repatriation nurse (admittedly this was a brown trouser moment), but it was one isolated incident. Being fearful of a job I love is so upsetting. The medical admission unit is filling up with ‘red’ patients (COVID positive) and the ITU is starting to see its first patients. As an outreach nurse we are seeing the sick patients. They cough all over me. I have no idea if they have the virus or not. I am not wearing scrubs; I wear my outreach uniform which I launder at home, but I do have access to surgical masks, aprons and gloves. A sick patient who is positive needs to go to the ITU. It’s my job to transfer them. I turn up with the ward nurse in an apron, gloves and surgical mask. They are wearing powerhoods or the N95 masks, scrubs, full plastic covering from head to foot, they have access to a shower after work and they have support from intensive care doctors. I feel totally underdressed and ill equipped. The nurses on the ward have been caring for this patient while wearing a surgical mask, apron and gloves. This patient was not receiving aerosoled treatment and the personal protective equipment (PPE) guidance is being followed, but I can’t help thinking that the wards are getting a raw deal. They are working in a 'soup of droplets'. I caught a glimpse of one of the cleaning staff changing the curtains of the COVID positive patient who had left the ward to go to the ITU. He also had just a surgical mask and his normal uniform. I felt sad. I can’t help thinking that this isn’t right. I don’t think we have the right protective equipment. Surely, we should not be wearing and laundering our own uniforms? We get told by our management, who get guidance from the Public Health England, so should we just accept it? If it feels wrong, it usually is wrong. Would they come and work a shift here in their clothes and be happy washing it at home? Probably not. There are not any showers for nurses at work. We bring this virus in to our homes on our uniforms, risking our children, our family and friends, not to mention ourselves. I feel filthy. I rush upstairs to shower while the uniform is boiling in the washing machine. Scrubs are at a premium. There are not enough to go around. I am upset over many things; I feel I can't do anything properly and feel useless. Everything we have ever known is different. I would like to end this blog on a high note… The sun is shining, just in time for lockdown.

Kegan proposes that there is a deep need for us to understand what it is that gets in the way of a person's genuine intention and what they can actually bring about. He looks at how we might address this gap, which he refers to as an 'Immunity to Change'.