For the first time in several days, the pain receded. A calmness settled on me. Calm, and cool. The fan was silent, the ward noise abated. Calm, cool, quiet. Peaceful. I could feel my body relaxing. Then came the sun. Bright, light, white and warm. It broadened its reach and neared its touch. Advancing towards me, I found I was wrapped in a warm, soft embrace. It felt so good. Peace at last. Respite from the pain, the uncontrollable shaking, the sweating and shivering. Finally comfortable. So warm, so soft, so bright. The light intensified and was mesmeric. Spreading all around me, it engulfed me, enticed me, called to me. ‘Come,’ it said, and I wanted to. Wanted to go towards it so much. The beautiful, warm, calm light.
Yesterday I read a heart rending news story about a man who had the same infection and spent four months in a coma, losing both arms and legs and part of his face. He describes himself as lucky to be alive. But I wonder, was he lucky to survive or unlucky to develop sepsis from a cut in the gum?
Everyone says I was lucky. Lucky to have survived what could have been a life altering – or even life ending – infection. If I hadn’t gone to the GP that day, if she hadn’t sent me to the specialist clinic, if they had not admitted me, if there hadn’t been a bed, if the nurses hadn’t looked after me round the clock……I had a lot of luck!
Serendipity is a wonderful thing and occasionally the right things happen at the right time in life, but on reflection a year after my infection and resulting stay in hospital, I have come to realise that my survival and rehabilitation was not down to luck. It was down to individuals doing their jobs properly, for which I am grateful, but most of all it was down to a system that worked. An NHS system that followed the frameworks it had been set up to follow, and which did so with appropriate pace and communication. Most NHS systems involve several professional groups, many locations, much communication and a timeframe that often numbers a wide variety of individual tasks and a surprising number of people.
For example I was seen by a GP, two GP Core trainees in ENT, a registrar in ENT and possibly a more senior ENT surgeon who corroborated the decision to admit me. My care was monitored closely by the two GP Trainees for four days as an inpatient and then for several post discharge visits in clinic. A number of nurses looked after me, and their care was round the clock, hourly to begin with. A pharmacist issued the collection of antibiotics I was given, both intravenously and on discharge, and microbiologists would have identified the type of infection I had. There were in addition people who cleaned the ward, brought food, not to mention the wonderful HCA who helped shower me. And that is without even mentioning the behind the scenes people who deliver supplies to the hospital, keep the buildings safe and do a whole host of things I am probably not able to list here.
I lived not only because these people did their jobs, but because the place where they work enabled them to do their jobs at a sufficient pace, with sufficient communication, and sufficient forethought. For example, I had to wait over four hours for my bed, but the antibiotics and paracetamol to reduce the temperature were started whilst still waiting, which would have reduced the risk of the infection reaching the point at which it would not respond to the medications.
The local GP Core Training programme ensures that all GP trainees complete a placement in ENT, and the locum GP who saw me first had done such a placement and was therefore alert to the possibility of an ear infection turning septic. She had an experiential relationship with the ENT department and when she called them, they in turn could be confident that she was referring appropriately, and gave me an appointment that day. Neither this feature of GP training, nor the commencement of medication before ward admission were down to luck; they were down to excellence; either in the structure of the training system or in the training of the staff who cared for me.
This was about good people people being well trained and then being allowed to get on with their jobs, trusted and respected in their judgements.
The Learning from Excellence initiative not only recognises this but advocates that we learn from the times this happens. Their website says:
“Safety in healthcare has traditionally focused on avoiding harm by learning from error. This approach may miss opportunities to learn from excellent practice. Excellence in healthcare is highly prevalent, but there is no formal system to capture it. We tend to regard excellence as something to gratefully accept, rather than something to study and understand.”
There’s the concept of ‘luck’ again – we will analyse what goes wrong but not what works. It seems quite disingenuous, doesn’t it? If you wanted to buy a new car you would look at other examples of new cars, not an old banger that was the antithesis of what you wanted. So why are we so preoccupied with what goes wrong at the expense of what is done well? Not only are we possibly focusing on the wrong thing, but we are also creating a negativity we do not need:
“Our preoccupation with avoiding error and harm in healthcare has resulted in the rise of rules and rigidity, which in turn has cultivated a culture of fear and stifled innovation,” say Learning for Excellence and we agree.
Not only can looking at excellence help us learn, possibly quicker and easier and happier, but it can have a positive impact on wellbeing, morale and resilience. Maybe the best learning is right in front of us. Rather than lengthy root, cause, analysis meetings, and a culture of blame, divide and rule, we can instead analyse and celebrate what is working, with the express desire to spread the understanding of why it works, so that everyone can do it with ease.
Do have a look at the Learning from Excellence website and blog, and try it out for yourselves. Excellence is all around us. Actively seek it out, watch your colleagues, consider what the alternatives could have been to their excellent practice and you might be pleasantly surprised about how much you learn. It really is time we gave up chasing after the bad and embraced the good.
Link to Learning from Excellence website: