Friday, 31 October 2014

Transition and technology

Blue thistles
Vounaki, Greece, June 2014
I went to a study day last week, which has sent me into a spin. It was great, it was really interesting, there were loads of new ideas and people sharing their experience, and ever since coming back I have been vacillating between wanting to change the world, and wanting to keep my head down and just do my job.

In my previous career, I reached some people of influence, and feel that I made a bit of a difference in their thinking. That was on a few special occasions. The majority of the time I felt very much as though I was beating my forehead against a very solid brick wall. Not so much because of external resistance (although the resistance is always there), but because my own approach often missed the doorway, hence the brick wall. If I could only have found the way in, maybe I could have made more of a difference than I did.

It is a reflection of my own self-knowledge of what I am good at, and much more importantly, what I am not so good at. I am very good at remembering. I can do analytical thought. Give me a set of principles and I will derive pathways and outcomes, and I will make them practical, realistic and achievable. I will listen very hard, and make sure that people understand what they need to understand and try to ensure they feel supported and positive as they do so. My inherent pessimism lowers expectations, and rather than assuming "this will work" I imagine "what's the worst that could happen?" and try to make everything simple and failsafe.

But I am not a salesperson. I cannot spin the truth into a persuasive argument. I cannot achieve my own ends or the greater good by manipulating the listener out of their own entrenched position. I am no politician.

An example: the parking regime where I work has changed. Parking for 30 minutes is free; up to 3 hours is £1.60, 3 to 5 hours is £4.50 and more than 5 hours is £7.00. We run a course which lasts for about 6 hours, from 9 a.m to 3 p.m. or thereabouts. If you were coming on our course, how would you pay for your parking? Would you pay £7, or could you imagine an alternative payment option? Would you be keen to get away promptly at the end, or take the opportunity to linger to get the most out of the healthcare professionals who are leading the course?

From about 11.45 a.m. all of our course participants stop paying attention to what's going on in the room, and start thinking about getting out to their cars to avoid getting parking fines, and then up they get and excuse themselves one by one. This also happens to be the most intense period of the day, when we are covering the most difficult and yet important aspect of the subject. It's the part of the course that demands the most concentration, not the least. And at the end of the day they can't wait to get away, to make sure to avoid a parking fine.

I have spoken to the hospital management about how to avoid this disruption to our course. I have not yet found a way to convince them that it would be better for patient care to allow our participants to pay an acceptable amount in some other way. They have suggested that we restructure the course to build in a break at the critical time. I have lots to cover and little enough time as it is, and giving them a 15 minute break just makes everything run late. I haven't even been able to persuade my colleagues to support me in my one-woman campaign.

Anyway, this is just an example to demonstrate that my powers of persuasion are weak and ineffectual. Attending a study day that highlights all sorts of ways that we could improve our service just makes me tired, because improvement implies change, and persuading people to change is not what I do best. Add to that the fact that I haven't even been in my current job for a year, so am not yet 100% sure what it is that we do, let alone whether we do it effectively or in the best way that we can. I am also working with experienced professionals who have been doing their jobs for a very long time indeed, which means that they are fairly sure of themselves and somewhat more resistant to the upstart pushing for change than they might be if they were young and dynamic and a little insecure.

Spotty purple flower
Peckover House, August 2014
The study day was about Transition, which is defined as a planned move from paediatric to adult services. This is a difficult time for young people with diabetes - not only are there many physical, emotional and social changes going on, but it is a time of rebellion and trying to fit in, hormones are raging, they may be changing schools, moving to university, getting a job for the first time, leaving home, having new experiences including sex, drugs, alcohol, tattoos, piercings, gigs and music festivals. Where does long term management of a chronic disease fit in? What is the role of the parent in managing or giving up control of blood glucose monitoring and insulin administration, and who is in charge - the adolescent or the parent? And what about leaving behind healthcare professionals you may have known all your life to attend appointments with a brand new team of complete strangers?

Let me be clear. I have no idea whether we run transition well or not in our service. I know that one of the Diabetes Specialist Nurses attends a transition clinic over at the main hospital, but I don't really know what goes on; I am not involved in any way. So should I be involved? One of the speakers made the valid point that those who are diagnosed as children may actually have a poor knowledge of their condition because most of the education and help was aimed at their parents. They may be going through a pretty tough time as adolescents, and are not likely to want to attract a whole lot of attention to a health condition that is difficult to manage at the best of times. So if we aren't helping them through this and we could be doing better, then surely we should try harder?

And then, I think, why don't I just do my job and keep quiet? Nobody will thank me for getting involved, I don't really know what I'm talking about, I don't even have two years of experience in diabetes and know virtually nothing about paediatric care.

As well as the technical aspects of the transition service, the day also covered a new approach to insulin dosage for Type 1 Diabetes based not only on counting grams of carbohydrate but also fat and protein. We heard about a project in Scotland which has developed some really interesting and useful materials for use in transition clinics. There was also a focus at this study day on the world of young people and the use of social media in the management of diabetes.

This social media and technology that young people are so comfortable with - well, the building where I work doesn't have wi-fi cover. We don't even have a mobile phone signal to speak of, and I don't have a work mobile phone. Our computers are so old that the operating system is no longer supported by Microsoft, and locked down so tightly that many useful websites either fail to display properly, or we are simply prevented from accessing them. The idea of using Skype or Facebook or Twitter or even text messages to improve the service we provide is laughable.

We were told that Pinterest and Instagram are the rage, Facebook is a bit old but Twitter can be quite useful. On the back of this, I have now set up a Twitter account and 'followed' a very select few diabetes-related people and organisations, but so far it has matched my expectations (which were very low). I haven't learned anything useful or gained insight into the lives of people with diabetes, but it's early days and I'm not even sure I understand what it's all about yet. And of course I can't do anything with it at work - it's blocked on the PC, and there's no mobile phone signal so I can't access it on my phone.

One of the diabetes consultants has been identified as an Innovation Champion for the Trust. That is the obvious place to start, talking to this doctor about what might be possible, realistic or necessary. But I am still in two minds. Perhaps I should just keep quiet and do my job.

Two colourful flowers
Temperate House, Leamington Spa, October 2014

1 comment:

  1. Doesn't your course include loo and lunch breaks? Are they at the right times? Even a "working lunch" can let people go out for a quiet smoke......


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