Yesterday I was at a local event to co-facilitate training for the “Sit and See” observation of care tool in our community health care trust. It was developed by the wonderful Lynne Phair.(http://sitandsee.co.uk)
I’ve used it a few times in wards and a minor injuries unit to look at the nature of the interactions between staff and patients. Fascinating and instructive.
A health care assistant walks over to a patient lying in a bed, holds his hand, smiles and asks if he would like a cup of tea. Soon she comes back, pulls up a chair and helps the woman as she struggles to eat lunch. She takes her time, goes at the woman’s speed, slowly. She smiles a lot. She tells a few things about what’s going on. She connects.
A Physio sits down beside another, shares a joke about family, listens, smiles, looks at her, asks about her feelings abut going home, what she is anxious about, takes her time, gives her time.
A radiographer tells a boy to keep still during an X-ray. The machinery clunks and clicks, moves around. She goes behind her screen. He’s alone in the machinery filled room. There are two minutes delay. Silence. She asks the boy to stay on the bed for a few more minutes. She returns and repeats this. She’s not horrid or aggressive or impatient. She just doesn’t get it. The boy has an injury, he’s in pain. He doesn’t understand the machinery and the noises. He’s being brave but he’s alone.
A doctor arrives on a ward for a lunchtime round. He talks to the nurses at the station. He strides purposefully across a bed bay, picks up a file of notes, and walks back out. Three men in their beds watch him. They don’t see many people. They don’t get much chance to talk. To say good morning. To brighten up their monotony. The doctor says nothing, doesn’t look at them. They don’t exist. They’re on a production line.
An anaesthetist walks through the waiting area outside a theatre. He comes over to the patient and smiles. He stops and shakes his hand, asks how he feels. Puts him at ease. The patient is about to be cut, probed, wrenched, put right. And awake throughout. It’s disturbing. But the man who will be looking after him has made contact, smiled, chatted, built a relationship of trust and warmth.
“Sit and See” allows me to see this happening. To get inside the mind of the patient. How would I feel if I were that patient? How do I feel when a nurse turns away while talking to me? Or calls out hiya petal as she strides across the bay.
I look at connection, compassion, understanding, listening, taking time and trouble, attending to little things that matter to patients.
Not at technical stuff. Other than washing hands and things like that.
It’s interactions that matter.
In a hospital, or a consulting room, or a waiting room, or outpatients reception, or an X-ray room, we are vulnerable. We are usually in pain, or have long term illness. Our worlds may be about to turn upside down. We are frightened to be assertive, to ask, to enquire. They know best. They hustle and bustle around. They don’t have time. There are all these people waiting. I can’t take up their time. They’ve got better things to do.
Er, well, no.
But it’s hard to change that dynamic, that relationship of doctor patient. Knowledge. Power. Education. Style.
It’s hard to change the vulnerability of lying in a bed on a full, busy ward.
It’s hard to change behaviours that are embedded in busyness.
It’s little things that change the world. A smile, a touch. My name. Stopping to say hello, close up, looking at me.
Thinking, what would I be thinking and feeling in your place? What would I want now?
“Sit and See” is about the little things that change the world.
Compassion, empathy, kindness.
Have a look at this blog by Jane Jones of the Health Foundation about compassion in care.