Thursday, 28 July 2011

NHS - The engine's idling but the meter is still running

There’s a great scene in ‘Bridget Jones – The edge of reason’ where Bridget is en route to declare her undying love for the gorgeous Mr D’Arcy. A taxi is stationery outside her apartment, engine ticking over, meter running as our heroine tries out various outfits for her big moment.

It’s a dilemma many of my female readers can identify with – the ‘wardrobe on the bed’ syndrome where everything you plan on wearing just doesn’t seem right and the panic rises as the clock ticks.

It’s a pretty far stretch to liken Andrew Lansley, UK Secretary of State for Health, to Renee Zelwegger, but where the NHS is concerned, the dilemma bears some similarities.

The Health Service Journal ( this week divulged that the cost of Lansley’s reforms to the NHS are already ‘near a quarter of a billion’. The bill includes redundancies, payments to GPs for commissioning work and attendance fees for transition meetings. That’s £250 million to keep the engine running while we go nowhere.

Murdoch-watching as ‘Hackgate’ continues to unfold, the tragedy in Norway, and other headline-grabbing events do not detract from the fact that there is a major news story that will have a huge impact on the UK still unresolved.

Two of my contacts in the NHS independently used the word ‘stagnation’ to describe where they are in their particular roles. Others - clinicians and administrators alike, have mentioned frantic activity with no discernable goal or defined outcome. The meter continues to run, the bills mount up and we still have no clear vision of how the NHS is actually going to work. Or how the planned restructure will deliver higher quality care at lower cost. The only theme that appears to be constant is ‘cuts’.

A friend of mine attended a skin clinic to have a cancerous growth removed the other day to be told the minor op couldn’t take place because, according to the consultant ‘we are pretty thin on the ground’.

If only it were as simple as choosing an outfit for a big date. At least Bridget got her happy ending.

Monday, 25 July 2011

Amy Winehouse – a legacy even greater than her music.

It would be difficult to write a blog today without mentioning the tragic events of the past weekend. 76 innocent victims murdered in Norway. 43 killed and hundreds injured in a train crash in China. And last, but by no means least, the untimely death of the extraordinary singer Amy Winehouse.

The thread that links all three of these tragedies is that they were pretty much impossible to prevent. How can a country defend itself against unimaginable acts of cruelty perpetrated by someone who on the face if it seemed just a little unhinged? The train crash was caused by a lightening strike, a force of nature, or, in insurance terms – an ‘Act of God’. And Amy, poor Amy. We still don’t know the cause of her death, but we do know that the last few years of her short life were very troubled.

There has been some commentary about ‘a wasted life’, how friends or family ‘should have done more’, how ‘her management should have protected her’ bla bla. But all these comments demonstrate a fundamental misunderstanding of drug or alcohol addiction. Amy was suffering from a life limiting, life threatening disease, harder to treat than many cancers and socially still unacceptable and difficult to comprehend. I was deeply touched by the tribute that Russell Brand, the actor and comedian, and recovering addict, placed on his website. Here is an extract:

When you love someone who suffers from the disease of addiction you await the phone call. There will be a phone call. The sincere hope is that the call will be from the addict themselves, telling you they've had enough, that they're ready to stop, ready to try something new. Of course though, you fear the other call, the sad nocturnal chime from a friend or relative telling you it's too late, she's gone…..Frustratingly it's not a call you can ever make it must be received. It is impossible to intervene. …..The priority of any addict is to anaesthetise the pain of living to ease the passage of the day with some purchased relief.
Now Amy Winehouse is dead, like many others whose unnecessary deaths have been retrospectively romanticised at 27 years old…….. All we can do is adapt the way we view this condition, not as a crime or a romantic affectation but as a disease that will kill. We need to review the way society treats addicts, not as criminals but as sick people in need of care. We need to look at the way our government funds rehabilitation. It is cheaper to rehabilitate an addict than to send them to prison, so criminalisation doesn't even make economic sense. Not all of us know someone with the incredible talent that Amy had but we all know drunks and junkies and they all need help and the help is out there. All they have to do is pick up the phone and make the call. Or not. Either way, there will be a phone call’ 

Maybe this will be Amy’s legacy – not just an amazing collection of hauntingly beautiful music, but the start or a deeper understanding of this terrifying disease.

May she rest in peace.

Friday, 22 July 2011

Mindfulness in the workplace – brilliance or baloney?

I have just joined a Linkedin group called ‘Mindfulness in the Workplace and Mindful Leadership’. The fact that this group exists demonstrated the growing interest in the ‘soft skills’ for business.

For the uninitiated, Mindfulness stems from the Eastern spiritual traditions of Zen Buddhism and can be summarised:

Mindfulness refers to being completely in touch with and aware of the present moment, as well as taking a non-evaluative and non-judgmental approach to your inner experience.

Thich Nhat Hanh a Buddhist Monk states ‘The present moment is the only moment in which we can be alive’

Basically, the aim of this state of being is to concentrate on the now, appreciate it and use the moment to best effect. I have been interested in mindfulness for many years and try, with varying degrees of success, to practice it in my everyday life. But how does this discipline translate to the workplace?

As the fall-out from the News International phone hacking scandal continues to touch more lives, we have seen only too clearly the devastating effect of a ‘toxic’ work environment. Truth or lies, the corporate culture appeared to enable individuals to believe that their extreme behaviour would be tolerated. But can mindfulness training improve the workplace culture and enhance employee’s lives?

The short answer would seem to be ‘yes’ but like all training programmes, this needs to be positioned carefully.

In my communications training and leadership development programmes I include elements of personal responsibility, accountability and sensitivity to others. But this all has a tangible and understandable effect on improving internal and external relationships and ultimately enhancing corporate growth.

Something as ‘touchy feely’ as mindfulness may be a bridge to far for some companies although apparently major organisations such as Apple, Google, Yahoo, Nortel and Commerzbank have integrated mindfulness in their workplaces. Apart from the challenge of persuading budget holders to invest in this type of training, return on investment may also be difficult to assess. At the very least, pre and post session (maybe six months later?) questionnaires are useful.

In the cut and thrust of business in the 80’s, the nearest we got to mindfulness was time management training. I attended an excellent course, which included thoughts on how one could spend leisure time as well as improve workplace efficiency. My boss at the time, (and this is absolutely true) didn’t turn up for the two day course because – you guessed it – he didn’t have time!

And there you have the rub. Mindfulness – considering every moment, achieving peace and serenity, needs to start at the top. Although the health and wellbeing of individuals could be truly enhanced by good mindfulness training, for an organisation to see tangible gains, I believe the leaders must buy-in to the programme.

If it’s good enough for His Holiness the Dalai Lama – it should be good enough for captains of industry….

Tuesday, 19 July 2011

The Murdoch testimonies – a human story

I have been glued to the T.V. all day, firstly watching the grilling of the two recently resigned senior police in the home affairs select committee swiftly followed by an action packed afternoon with the Murdochs.

The parliamentary select committee investigating the phone hacking scandal held my attention all afternoon.  I spent longer watching these public interrogations than the Royal Wedding and apart from the lack of champagne, in many ways it was as gripping. What promised to be an enlightening and entertaining humiliation of power-crazed heartless businessmen instead took on a very human spectacle.

Perhaps I’m a sucker for handsome intelligent young men, but I found James Murdoch compelling and believable. I really felt he was telling the truth. His father, Rupert, on the other hand appeared surprisingly frail, doddery and at times confused. As he started to try without much success to answer Tom Watson’s gentle but persistent, questions one began to sense embarrassment in the room.  Rupert’s wife Wendi sitting directly behind him looked anxious and kept leaning forward as if she wished to take his place. James was equally protective reaching to touch his father’s arm occasionally. Twitter went mad with tweets suggesting dementia, and wondering if the next resignation would be Rupert’s, as NewsCorp board members would observe these frailties.

One has to question (as did the select committee) how the men at the top could be ignorant of major transgressions such as bribery of the police and hacking of innocent victim’s phones by those in the pay of News International and clearly they are ultimately responsible. But whether it was good PR training, arrogance, or excellent interpersonal skills, this experience was no means a blood bath for the Murdochs.

However the story that will grab the headlines is, of course, the idiot who lunged at Rupert Murdoch with a foam filled pie. His intent could have been far more menacing and for a moment, those around the ageing mogul seemed frozen to the spot. With the exception of Wendi Murdoch. Arms flailing, she flew forward, intent on protecting her husband landing a blow on the assailant with no thought for her own safety.

Call me a romantic, but whatever Rupert Murdoch has or hasn’t done, however many billion dollars he’s worth – with the loyal support of a son like that and the obvious love of his wife, he is a rich man indeed.

In healthcare it’s often the small things that make a big difference.

I was heartened to read a news story yesterday about the use of painkillers for patients suffering from dementia.

Agitation is commonly associated with dementia and often treated with antipsychotic drugs which can accentuate the symptoms of the condition and cause excessive sedation. These drugs can rob Alzheimer’s or dementia patients of the last vestige of interaction with the world around them and reduce them to ‘zombie’ status.

One of the tragedies of dementia is that a patient is unable to tell his or her carers how they are feeling and bearing in mind that many elderly people experience painful arthritis or similar conditions, it is logical to assume that a high proportion of patients may be suffering undiagnosed pain. 

In a recent study, researchers the UK and Norway found that there was a 17% reduction in agitation symptoms in dementia patients given painkillers.

This is a wonderful initiative in easing the suffering of our most vulnerable patient community. My mother suffered from dementia for nearly ten years before her death but was fortunate to be cared for by an amazing team of people. During a routine discussion on her care, the matron advised me that they were giving my mother paracetamol four times a day. I asked them how they knew she needed this medication and they simply said – ‘her joints look painful so we thought it best to see if we can ease her discomfort’. The transformation was dramatic. Within a few days she was calm, and content. Her antipsychotic medication was discontinued and she became more alert and aware of her surroundings. I wrongly assumed this was standard practice so I am delighted to see that this ‘breakthrough’ is being made public.

How often we find a simple solution to a complex problem.

Andrew Lansley, please take note – to improve care and outcomes – you don’t always have to deliver complicated and expensive strategies. Keep it simple!

Saturday, 16 July 2011

How to say sorry in business

My interest in human behaviour and the effect it has on business means that the News International story becomes more compelling by the minute.

First we have the scandal, the shock and the disgust at the bribing of police and the multiple hacking of phones of vulnerable individuals. Then we have the denials, the admissions, the closure of a major newspaper and the potential involvement of families of 9/11 victims. This transatlantic dimension was probably the tipping point for the Murdoch empire as Rupert Murdoch accepted Rebekah Brooks’ resignation and hired a major PR firm for belated damage limitation.

Hence the start of ‘the apology phase’. This weekend, Rupert Murdoch placed advertisements in major newspapers ‘apologising for the serious wrongdoing’

We are sorry.

The News of the World was in the business of holding others to account. It failed when it came to itself.

We are sorry for the serious wrongdoing that occurred.

We are deeply sorry for the hurt suffered by the individuals affected.

We regret not acting faster to sort things out.

I realise that simply apologising is not enough.

Our business was founded on the idea that a free and open press should be a positive force in society. We need to live up to this.

In the coming days, as we take further concrete steps to resolve these issues and make amends for the damage they have caused, you will hear more from us.

Rupert Murdoch.

(published in the Times Newspaper, and other publications 16th July 2011)

But how genuine and how effective is this apology? As Poirot, Sherlock Holmes or maybe even the later great Columbo may say – let us examine the evidence…

Speed of apology:
Stephen R Covey in the 7 Habits of Highly Effective People says that to ensure personal integrity you should apologise quickly and sincerely. The story of the hacking of the phone of murder victim Millie Dowler broke on 4th July. Twelve days ago

Depth of apology:
Covey also refers to an Eastern saying – ‘if you are going to bow, bow low’. I’m not convinced that seven lines is the equivalent of a low bow.

Language used:
In Peter Collett’s fascinating ‘The Book of Tells’, the author outlines how much you can tell regarding someone’s sincerity from their choice of words. Any ownership of the situation and truth in meaning should include personal attachment – i.e. the magic word ‘I’. This demonstrates that the speaker or writer genuinely feels the sentiment expressed. The heading for the apology advertisements was ‘WE are sorry’. Of the 7 lines in these statements, only one contained the word ‘I’ as in ‘I realise that simply apologising is not enough’. Yep, Rupert, we guessed that you realised that when you closed the paper and sacked the editor (sorry – let her go). No personal ownership with any of the other statements though?

Taking the rap (or not):
In the ‘Rules of Management’, Richard templar states that the good manager will always take the rap. Mmm – I still can’t see any evidence of any personal ‘rap-taking’

The perfect apology format:
In business, quick apologies and direct action to rectify mistakes can actually have a beneficial impact on the client relationship. To be fair to News International and their PR advisers, this was always going to be an uphill struggle. But how should you formulate an effective apology strategy?
·         Give a clear overview of the situation and circumstances
·         Acknowledge the damage caused
·         Take responsibility for the issues
·         Express genuine regret and seek forgiveness
·         Offer recompense if appropriate
·         Outline the actions planned to rectify the problem
·         Give reassurance that there will be no repeat of the issue and outline the plans to ensure this

Murdoch’s PR people - take note.

Thursday, 14 July 2011

Facts are stubborn things but statistics are more pliable (Mark Twain)

I’ve always been a bit of a fan of statistics. It may be due to a love of maths from an early age or my pharmacy training where accuracy and precision can be literally a matter of life or death. I often use stats as part of a presentation or business case and find them a very useful way to emphasise a point.

But I am feeling increasingly bewildered with the plethora of public health warnings and disease-specific numbers published on a daily basis. I sometimes wonder if each health related charity or government department is engaging in an unspoken competition to see who can scare the public most severely in order to raise funds or win extra budget allocation for their particular cause.

This may sound harsh – and I would certainly not presume to undermine the fantastic work undertaken by healthcare charities. Thanks to clinical trials funded by Cancer Research UK, my late husband was given an additional three precious years of life. And charities such as Alzheimers Society, Diabetes UK and the British Heart Foundation have achieved a great deal in raising awareness and improving treatment and prevention.

But what should we do with all these statistics? The most recent press release by Macmillan Cancer Support states that four in 10 people will get cancer at some point in their lives. Despite the increasing cure rates for many forms of the disease, this statistic is still shocking and frightening for many. As the charity states – this poses a ‘massive challenge for the NHS’

The figure is based on estimations of death rates, past incidence and analysis of lifestyle trends. This is purely a projection and only time will tell if this prediction is accurate. We can certainly assume that with improved prevention, detection, and treatment regimes, many of these cases will be either completely curable or at least manageable as a chronic condition.

We have also been faced with the fact that 40% of adults are obese, 5% of the population are diabetic (expected to rise dramatically) between 30 and 40% of men and women will have heart disease and to cap it all, because many of us are going to live longer (despite all these diseases) – 1 million in the UK will be suffering from dementia in the next decade.

And so health organisations will continue to share their facts and figures. They hope that the general public will be scared into adopting healthier lifestyles and support research and public health initiatives.

Whatever you take from these statistics, there can be no doubt that the need for immense funding and robust management of the NHS will continue to stretch the national pocket.

In the meantime I think this quotation from Professor Aaron Levenstein sums the dilemma up beautifully:

‘Statistics are like bikinis.  What they reveal is suggestive, but what they conceal is vital.’ 

Tuesday, 12 July 2011

NHS Reforms – who do you believe?

I took an active decision to limit the number of postings on NHS reforms recently as I was worried I would start to bore my readers (and myself) as I tried to unravel the fact from the fiction and unbiased judgement from personal opinion. I thought I would enjoy my own version of ‘listen, pause, reflect and improve’.

I had no idea that the News International hacking scandal would provide me with a welcome diversion and potentially rich seam of material. Who could have thought that the dishonest and illegal activities of a bunch of (in my opinion) seedy and amoral perpetrators could be seen as light relief compared to the current state of the Health and Social Care Bill?

But where are the rights and wrongs on NHS Reform? There remains an uncomfortable lack of clarity. Still under discussion, each day a new list of submissions and comments regarding the amendments to the Bill is published. These include contributions from bodies such as the Royal College of Surgeons, Chartered Society of Physiotherapists and National Voices (a patient advocacy organisation). Many of these submissions feature statements of support for the revisions to the Bill, mostly tempered with additional recommendations or reservations.

Today, the Royal College of General Practitioners (RCGP) submitted their comments which make very interesting reading. Included is a survey of their members where 85% of respondents stated that they were not reassured by the planned amendments to the Bill. Over 50% disagreed that the revised model of clinical commissioning groups would lead to a patient led NHS, improve patient outcomes or reduce health inequalities. Conversely, the body of the RCGP response includes the phrase:  We welcome placing General Practitioners (GPs) at the heart of planning services for their patients, and increasing professional and patient involvement in health service design and funding decisions…’

Likewise with statistics on the current state of the NHS. The Guardian website ( datablog has outlined some fascinating discrepancies on statistics – all true, but presenting a very different message. The Guardian quotes Lansley, UK Health Secretary - ‘Waiting times have been kept low, with the average time patients wait for their operations lower’. Closer inspection of statistics shows that the number of patients waiting in excess of 4 hours in Accident and Emergency has increased by 76% and that an extra 2,400 patients every month are waiting for more than 18 weeks for treatment compared to last year.

What does all this conflicting evidence and opinion mean? Time, and hopefully statistics,  will tell. The listening exercise and Future Forum consultation process has had a positive effect in forcing the government to amend some of the reform plans. But what happens as the Bill proceeds through parliament and on to the House of Lords continues to challenge commentators and those tasked with implementing the changes.

Give me a good old fashioned scandal any day…..

Sunday, 10 July 2011

How do you spot a toxic corporate culture?

"Organization culture is like pornography; it is hard to define, but you know it when you see it." Ellen Wallach (health adviser to the democrat, Jerrold Nadler)

You would have to be living in a bubble in the UK at the moment to miss the blanket coverage of the closure of the News of the World newspaper, in the midst of phone hacking and bribery allegations. A word that keeps cropping up among commentators and distressed employees is ‘toxic’.  One of the 200 plus staff members who have just lost their job accused  Rebekah Brooks ‘…You’re making the whole of News International toxic..’

How can you define and recognise a toxic corporate culture?

There are many complex descriptions including ‘One with which behaviours which poison, are disruptive, destructive, exploitative, dysfunctional and abusive are pervasive and tolerated’ (Michael Walton, Fellow in the centre for leadership studies University of Exeter))

I have a more simplistic handle on this problem:

A toxic culture in an organisation creates an environment that can damage the emotional, physical or financial wellbeing of employees, customers and those associated with that organisation.

How does a toxic corporate culture develop? The cause of this negative environment in a company is ultimately down to leadership. Even if the leadership team has not originally created a problem, if they allow it to continue or turn a blind eye, they are ‘enablers’

Here are some of the causes of a toxic corporate environment:

Authoritarion or bullying leadership: If the head of the gang is a bully, then those who flourish or profit from this environment are likely to be bullies too. A leader who is authoritarian may not actually be a bully, but expecting total obedience has the same effect. No room for creative thinking, a culture of fear and subservience. Not healthy. This type of leader often creates a team of ‘henchmen’ (or women!) to ensure that his or her wishes are complied with. The effect that this type of management has in the health and wellbeing of staff is well documented.

Competitive, win/lose environment: Win/win is good, win/lose is bad. An environment where good work is rewarded and the introduction of well designed incentive and recognition programmes can have a significant effect on company growth and morale. Some leaders from the ‘divide and conquer’ school can create a deeply unhealthy atmosphere where power struggles, especially among management teams, are rife. This unhealthy competition spreads to the rest of the employees and create a divisive, unhappy workforce.

Weak leadership: Show me a parent who doesn’t discipline their child from an early age and I can show you an unruly adolescent! Leadership is in so many ways like parenting and employees need guidance, boundaries, affirmation and censure where appropriate. Unchecked bad behaviour within one division can spread to other divisions. A charismatic manager who creates an exceptionally successful and happy culture within their division can, unwittingly, create disruption if their boss cannot demonstrate equivalent leadership qualities.

Dishonest/corrupt: No need to say much about this. The root of this culture is based in ambition and greed. Hollywood has created many stunning movies demonstrating toxic environments at their worst. As Gordon Gekko famously said in Wall Street ‘Greed is good’ (but for those impressionable souls reading this – please note – he ended up in prison!) The Firm and Erin Brokovich are also great examples.

Change averse: Leaders and leadership teams who are averse to change can create a stifling environment where innovation and creativity are discouraged and pandering traditionalism is feted. The good thing about organisations such as these is that they are unlikely to survive!

So what can you do if you recognise any of the above? The subject of another blog I think. But in the meantime – if you work for an organisation with a toxic environment – try to leave. If you lead one – try to change. And if you are offered a job with one – run for the hills!

This posting is dedicated to the employees from the News of the World who have lost their jobs. I know that most, if not all, of you are innocent of the sins allegedly perpetrated by your predecessors and bosses and I wish you all the best for the future. Choose your next employer well.

Thursday, 7 July 2011

I'd rather write about Kate than Rebekah...

I must confess to getting very little work done this afternoon. The breaking news item that flashed up on my computer sent me rushing to my T.V. to watch the news channels while keeping one eye on Twitter.

So Rupert Murdoch was pulling the plug on The News of the World. In the light of this gobsmacking development about the closure of the newspaper with the biggest circulation in the UK, I wanted to write a post about corporate social responsibility and ethics in the workplace etc etc..

James Murdoch, son of Rupert, and News International Chairman, stated that in closing News of the World he was ‘committed to doing the right thing’. He went on to state that he is satisfied with the conduct of Rebekah Brooks. That would be the same Rebekah Brooks who was editor of the newspaper at the time that alleged hacking of the phones of murder victim, Milly Dowler, relatives of the London 7/7 bombings and loved ones of soldiers killed on active duty. The same Rebekah Brooks who keeps her job as 200 employees of the newspaper lose theirs.

And how did they hear that they were losing their jobs? On the newswire, just as the rest of the world received Murdoch’s statement. No staff meeting, no courtesy, no consideration for these people who are completely innocent of the heartless and tasteless activities that a few ‘rogue individuals’ undertook on behalf of the tabloid several years ago.

I started to write this blog with indignant commentary about how corporate culture is shaped from the top – that the regime where Brooks and her sidekicks were known as ‘the princes of darkness’ should be brought to account. The alleged hacking, invasion of privacy and potential interference of a police investigation all took place on Rebekah Brook’s watch.  

As the news coverage continued I became more depressed. This was a clear example of how the big boys play nasty and the little people get bruised.  But I have very little to add on this tragic story.

So I switched channels and watched a delightful programme about William and Kate’s visit to Canada. The love that shines between them, the joy that they both seemed to bring to every public occasion and the positive way they represented this country  is clear for all to see.

What a wonderful antidote to the murky goings on back home.

Tuesday, 5 July 2011

My birthday wishes for the NHS

So the NHS celebrates her 63rd birthday today. She’s a little battle weary and ragged round the edges, but as every aging film star will tell you – 60 is the new 40 and she’s a game old bird with plenty of life left in her – we hope. She’s a bit old-fashioned in some of her ways, but has embraced technology in many areas and has been a key driver and pioneer in medical research and treatment innovation. She’s got a good heart and has been doing her best, coping with diverse masters. If only I could – these would be my gifts for the state funded health system.

Clarity: However the reforms pan out, as the listening, tweaking, and reviewing continues, I wish for a clear instruction and guidance from the Health and Social Care Bill. I would wish for ‘Limbo land’ to be brought to an end and a clear picture of how the NHS will operate to emerge. Soon.

Rejuvenation: So much about the NHS is tired, the buildings, the people, clinical staff, managers, support workers. There are significant new, well equipped facilities to be celebrated, but dilapidated and shabby amenities, including community centres and hospitals remain. This isn’t just about money or resources. It’s about taking care of your workplace and your colleagues.

A communications trainer for every facility: Now wouldn’t that be great! Administrators could be taught how to relate to their peers, nurses to doctors, doctors to patients, Chief Execs to commissioning boards, hospitals to their community, carers to relatives. The list is endless. The key to the utopic vision of integrated pathways is communication.

Tolerance: I believe that one of the most damaging impacts of the NHS Reform plans so far is the divisive effect in creating conflict between clinical peer groups. GPs and Hospital Consultants feel they have to compete for funds and the potential shift of power is uncomfortable for many. A variety of stakeholders feel sidelined and undervalued. As resources are stretched, tolerance levels between colleagues and even tolerance for patients is tested. A little tolerance for the private sector wouldn’t go amiss either. Competition is here to stay, better to embrace it, and use quality assured external providers wisely, to reduce costs and mange capacity issues.

Innovation: One of my biggest fears is that the reforms may undermine the opportunity to innovate. Ground breaking treatments, innovative regimes and new techniques are better to be tested in the NHS than anywhere else.  A precious birthday gift indeed.

Performance Management: Not much of a gift some would say. But we cannot escape the fact that a public sector job is not a sacred cow. Poor management, sloppy clinical practice, or substandard work should be properly addressed.

And finally…
I wish the NHS a long and healthy life and many happy returns!

Sunday, 3 July 2011

Do bad manners constitute bullying?

There’s an amusing story circulating the UK this week about a woman who has written a scathing email to her stepson’s fiancĂ© criticising the girl’s manners.

The irony which escapes the writer of the diatribe is that she has been guilty herself in displaying exceptionally bad manners with her cutting remarks about the girl’s breeding and upbringing. Had this criticism been verbal, it may have been passed off as a misunderstanding, but in hard print this insulting and rude email has gone viral, discussed on TV news and widely distributed on the web.

Apart from the obvious mother-in-law jokes that are circulating, (A policeman was asked what he would do if he had to arrest his mother-in-law – ‘call for back up’ was the reply) the word that is used in many of the headlines is ‘bully’.  I would love to add a few personal recollections about my own mother-in-law but my good manners and excellent breeding prevent me!

In the workplace, co-workers and bosses often pass off snide remarks and blunt put-downs as harmless banter or constructive criticism, but it often constitutes bullying.

A definition of bullying is Bullying may be characterised as offensive, intimidating, malicious or insulting behaviour, an abuse or misuse of power through means intended to undermine, humiliate, denigrate or injure the recipient.’ (ACAS)

Bad manners can be offensive, malicious and intimidating. A friend of mine  used to work with particularly unpleasant woman who, although they were both part of the senior management team, talked to my friend and her peers as though they were all something that had crawled out from under a stone. She was insulting and intimidating to her staff and wasted no time on the pleasantries and consideration that good manners demand. Her emails were all in bold capitals so it was like being shouted at. One of her staff received 33 such emails one Sunday night prior to the start of another tricky week. When challenged on this behaviour, the perpetrator insisted that she wasn’t bullying – it was just her way. She saw no reason to defend her behaviour stating that she wouldn’t waste time on niceties – and she ‘says it like it is’ and people should ‘stop being so sensitive.’

The organisation in question allowed this behaviour to continue, hiding behind a bullying policy that didn’t appear to allow for consistent bad manners. The net result was that in the space of six months, 15 of the 30 employees exposed to this assault voted with their feet and found jobs with competitors. Those were the good old days when you could say – ‘stuff this’ (or equivalent) and walk into another job.

With the current economic climate, it is less easy to avoid such bad manners. Presenteeism, staying at work when you are unwell or emotionally compromised, is more common as employees fear for their jobs. This has the effect of reduced productivity and a culture of fear growing in organisations that do not address these issues.

There is an old saying – ‘manners maketh man’ – I think the workplace version should be ‘good manners is good business’. A little courtesy and consideration goes a long way in cementing workplace relationships and creating a cordial working environment.

So as we chuckle at the public spectacle of a mother-in-law from hell trying to intimidate her future daughter-in-law, we should consider manners when implementing a workplace bullying policy or assessing a colleague’s behaviour.

And my favourite mother-in-law joke from the late great Les Dawson? ‘I took my mother in law to Madame Tussaud’s Chamber of Horrors the other day – the attendant said – keep her moving sir, we’re stocktaking…’

Friday, 1 July 2011

Smoking – How can you change behaviour?

This week, the British Medical Association has called for a ban on smoking in cars, recommending tougher legislation. The main rationale behind this request is that research has shown that toxicity from smoking in cars is 27 times higher than in the home and young passengers are particularly at risk from passive smoking.

The  government has responded with  a call for a balance between legislation and partnership on improving public health. And there is the crunch. How do change people’s behaviour when they are indulging in activity or habits that are clearly damaging to themselves and those around them?

I have been enjoying the recent TV ‘docu-drama’ mapping  John F Kennedy’s brief and tragic spell in power. Love it or hate it, this series provides a fascinating snapshot of life in the early 1960’s. There is a shocking image of Katie Holmes, playing a heavily pregnant Jackie Kennedy writing a letter while smoking a cigarette. This would chill the blood of most reasonable observers today, but forty years ago it was unknown that smoking could seriously harm the unborn child. Yet now – through information, public pressure and maybe the passage of time, although it is not illegal to smoke while pregnant, it is far less socially acceptable. In the UK, following many public information campaigns and possibly pressure from family and friends, approximately 50% women now give up smoking while pregnant. We seem to be ahead of the US, where only about 20% pregnant women are estimated to give up and 17% of teenage mothers continue to smoke throughout their pregnancy.

There are other good reasons to discourage smoking in cars. Many years ago, I had just arrived for a business trip in Turkey and as my taxi driver was driving me to the hotel, he suddenly stopped the car, leaped out and removed his trousers! As all sorts of scenarios started to play out in my head and then I realised, with relief that his trousers had actually caught fire as he had dropped his cigarette in his lap!

Controlling the smoking habits of a population is potentially one of the biggest public healthcare challenges a nation can face. We know that, apart from the human loss and suffering, smoking costs the NHS and estimated £2bn a year.

In New York a few weeks ago, a smoking ban was introduced in parks and beaches. But this is supposed to be a ‘self-enforced’ ban and during a recent visit to the big apple I saw many a cigarette being smoked in Central Park and Union Square.
The smoking ban in public places in the UK has been pretty successful, partly due to the threat of prosecutions for corporate owners but also due to public pressure by non smokers. I would have no compunction in complaining to a restaurant owner of someone was smoking inside the facility.

So how does a government get a public health message not only to register with its audience but to convert that audience to make the required changes and to encourage those changes in others?

Celebrity culture is undoubtedly a powerful force to be harnessed for good. Tragically in 1991, a very well-known UK TV presenter, Anne Diamond lost a baby, Sebastian, to SIDS (Sudden Infant Death Syndrome). She stated a campaign highlighting the simple actions required to reduce the risk of SIDS, which included laying an infant on their back rather than face down, which many of our mothers used to recommend. The effect of this, and subsequent campaigns has been stunning. In 1990, there were 1.77 infant deaths per 1000 live births. In 1991, this was dramatically reduced to 0.61 per 1000. The figure is now dramatically 70% lower than before Anne’s terrible loss.

So let’s keep the pressure up on smoking. We shouldn’t demonise those who smoke but society should certainly censure those who put others at risk through their behaviour.

I hope the coalition can come up with some creative ways to not just educate the public, but to ‘engage’ them, and to encourage them to take more responsibility for themselves and those around them. David Beckham, Kim Kardashian, Justin Bieber? I don’t care who it is, as long as they get the right message across.