Write first time… just write

 

There is a new hatching of Churchill Fellows for 2019. Some of them will already be out of the starting blocks. They will be all around the globe connecting and sharing, learning and reflecting. Having amazing adventures.

Some of them though will still be planning and getting a bit panicky. They will read that their fellow Fellows are blogging or tweeting. That’s when they might start to wonder “What have I gotten myself into? or “Can I really do this?” or “Am I good enough/smart enough/ brave enough?” or that old chestnut “How will I find the time?”

So 2019 Fellows, please listen when I say that  you are good enough, you are strong enough and you are smart enough. You can do this and the WCMT team and the Churchill Fellows alumni have got your backs.  Don’t waste another second worrying about the small stuff. Go and be the extraordinary humans you have already proved yourselves to be by coming up with a great idea that has the potential to improve peoples lives somewhere and actually doing something about it. That is amazing.

As a 2018 Fellow, I had all those thoughts and feelings at some point or another over the last year or so. And now I am having them again as I struggle to get my report written.

I have absolute confidence that the learning from my Fellowship is having an impact on me and those around me in my community in a positive way, pretty much every day. Absolutely no question about that.

I am however struggling to find my voice for my report. I’m using this blog to try and give myself a kick start. The problem, other than that I am a champion procrastinator,  is that I don’t want to miss the opportunity to make a difference. And there it is. I am back to “…but what if it’s not good enough?”

I was checking out the Twitter feed of someone I connected with during my trip to New Zealand . I suggested quite vociferously that she needed to go to the SCF Nuka Conference this year and I was really delighted to see a photograph of her in the front row! I also saw a tweet about Derek Feeleys’s plenary session. http://www.ihi.org

Derek closed his presentation with a piece of poetry by Ijeoma Umebinyuo. I hadn’t heard of Ijeoma.  I urge you to check out her book of poetry “Questions for Ada” and her TEDx talk on Dismantling the Culture of Silence.

Ijeoma Umebinyuo tackles the Culture of Silence in this thought provoking and articulate TEDx talk which explores how remaining silent trivalizes people’s struggles whether it be with mental health, sexual harrassment, or another topic deemed taboo by the society in which we live. She divides the Culture of Silence into the three C’s: culture, code, and cage. Iljeoma suggests we escape by taking ownership of our stories and our struggles and by encouraging others to do the same.

One of the themes of my report is the need to own and share our stories, to know and make peace with ourselves in order to be open to connection with others in the community we live and work in, in a way that is person-centred. This is not easy for many reasons some of which Iljeoma talks about in her TEDx.

I was reminded last week that our capacity as humans to make decisions depends on many factors such as social class, education, religion, gender, ethnicity, subculture, etc that can limit or influence the opportunities that individuals have and the decisions that they can make. It’s too simplistic to say that people should take greater responsibility for their own health and wellbeing. Life matters but not everyone has a happy life with meaning, purpose, direction and joy. Collective action will be required by our communities with individual responsibility sitting alongside social responsibility and the right social actions and social policies to support individual healthcare that helps people own their stories and find the life that matters to them.

I end my reflection with advice from Iljeoma and hope that I can make peace with myself, remember that I am enough, that I have a story to share and that I can get my report submitted.

 

Kia ora New Zealand

I first took notice of health and care services in New Zealand after reading a couple of Kings Fund publications on whole system redesign and accountable care.

As someone working in an organization that was delivering integrated health & social care, these publications gave me a lot to think about.

I’m eternally curious so went to a Kings Fund Integrated Care Summit. Commissioners & providers across public, private & third sector from around the UK plus international delegates discussed ways to meet the growing challenge of population health & wellbeing. The holy grail of effective & efficient person centred services. Whole system redesign. Some amazing projects were described but it was the stuff about housing & homelessness that still sticks in my mind.

At the time I wasn’t really paying much attention to the social determinants of health & wellbeing.

An organizational restructure later & I find myself responsible for care & support services in 3 extra care housing schemes. It’s all pretty straight forward. Won’t add much to the workload. Hmm…

It’s no cliffhanger that that wasn’t really the case. Don’t get me wrong we have a great team and great properties but it takes sustained effort to create and maintain a community. People with a level of need that meet the criteria for extra care living can easily shift from independence to dependence.

The question I couldn’t stop asking was but what gives their life meaning? This is not a care home. How do we help people connect or reconnect with their purpose?

Nearly 3 years later and we are very slowly nudging forward in supporting people differently on this bigger stuff.

My Fellowship has provided me with the opportunity to learn from others about their communities and identity, their traditions and rituals and how this impacts on how they deliver health and care services. It’s been a window into cultures I didn’t expect to look through.

Yesterday I shared my story of my experiences and learning so far with Te Puea Winiata and her team at Turuki HealthCare in Auckland. Te Puea and I met in Anchorage where she and some of her executive team and Board were also learning about the Nuka model created by SouthCentral Foundation.

Te Puea and her team are creating a relationship based care model that meets the specific needs of their people.

In my time with them it was clear that they have many of the fundamental elements already in place. They are standing in the gap for a community with complex health and social care needs. Their work around preventive health through the FitKids programme and support with housing shows a breadth of thinking and response that is truly integrated and person centred.

It was great to discuss my observations of how elements of the Nuka model could be adapted and adopted in other systems. We talked about the challenges of funding, how a whole system approach requires excellent data systems but that’s not very easy to achieve and how we need to pay attention to appreciating ourselves and each other.

We talked about the role of sharing story in relationship based care systems and how powerful it can be. I described a personal experience of sharing too deeply with people who were unprepared to appreciate my story. How that that made me feel and the potential impact on them. We need to tread carefully in developing these approaches in our own systems with the right support, training and assurances.

We had an interesting discussion on language and how we need to find ways to communicate with people that makes sense in our cultures but also explains the changing model and expectations on both sides. Not easy stuff.

Thank you Team Turuki for a thought provoking afternoon, your great hospitality and my lovely gift!

There is no size fits all but if we all connect and share our work we are stronger together.

Next week I will be in Hamilton with Pinnacle Health. It will be fascinating to see how their Health Care Home model works and what we can learn from that.

Travelling to learn

Last September, encouraged by the Queens Nursing Institute,  I applied to the Winston Churchill Memorial Trust for a Travelling Fellowship. Over 1000 applications were received. Along with about 240 others I was shortlisted which was an amazing achievement! I wnet for an interview in January and I am delighted to say that I was selected to become a 2018 Churchill Fellow.

I will be using this blog to record my experiences during the year ahead.

I live in Guernsey in the Channel islands which is in the English Channel but nearer France than England. We are a Crown Dependency but have our own assembly called the States of Guernsey. Our health and care system is completely different to the UK. With a population of around 62 000, we have the potential to design systems that mean people in our islands live happy, healthy and purposeful lives in engaged and prosperous communities.

We have the same challenges of most developed countries in trying to meet the increasing demand for health and care. I hope we stop seeing this as a negative but find new ways of harnessing the potential for older people in our community to help us build thriving communities. A Partnership of Purpose is being created which will need courage and creative thinking to succeed. I applied for the Fellowship because I wanted to connect with communities who have started to think and work differently around community health and wellbeing.

I plan to visit Southcentral Foundation in Anchorage, Alaska and Canterbury District Health Board in Christchuch, New Zealand. Both of these organisations have been cited by the Kings Fund as exemplars of new ways of working.

My first trip will be to Anchorage in June to learn about the Nuka System of Care. I have been interested in the Southcentral Foundation since reading about their improvement journey through the Kings Fund. I attended a Masterclass in 2016 where Steve & Michelle Tierney explained the history behind the system redesign and the fundamental shift made to put the customer in charge of the health system. What was interesting to hear was how with this came a personal responsibility to health and wellbeing that reached across the community. I was fascinated to hear how prioritisation happens and what this means for population health.

My second trip will be to Canterbury District Health Board in Christchurch. This area of New Zealand had already begun on a journey of transformation when a devastating earthquake caused a crisis in the health and care system which accelerated the rate of change. The Canterbury model is fascinating because of how they have achieved integrated care through a single unifying “one vision, one budget’ approach, finding new ways of working with a clear aim of increasing community care to keep people well and healthy in their own homes. On the face of it there are many similarities between Canterbury District and Guernsey so I am excited to be able to make connections we can learn from.

I am incredibly grateful to the Winston Churchill Memorial Trust and the Burdett Trust for this once in a lifetime opportunity and I can’t wait to get started!