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On a rainy morning in Sydney, Australia, I'm at a meeting for senior leaders in the New South Wales' health system, and we're talking about the dynamic, culture-changing power of stories and story-telling.
The focus of the meeting, organised by the NSW Clinical Excellence Commission (CEC), is on building leadership to promote 'patient-based' (what we'd call 'patient-centred') care.
Cliff Hughes, one-time cardiac surgeon, now chief executive of the CEC, takes to the stage to give a master class on the power of story-telling. He tells us about a Tuesday evening, early in his career, when he was called back to the hospital to see a patient who had been operated on earlier. The patient was bleeding internally; his condition deteriorating. As Cliff drove in, he called his consultant colleagues for advice. By the time he arrived he had established that nothing could be done to save the patient.
Cliff sat down with the patient: he explained what was happening, told him he had spoken with his colleagues, and that there was nothing anyone could do for him. He told him he would die. The man wanted to know when – 'In the next few hours. Is there anything you want?' said Cliff. The patient asked Cliff to stay with him, so he sat with him through the night. They talked about the patient's life as a truck driver; about his estranged family; about football; their shared passion for engines; and about dying. In the course of the night, they managed to contact the patient's daughter who came in to see her father before he lost consciousness.
The next morning, Cliff received a call from the director of nursing who wanted to see him. Heart sinking, he went to her office. Before she could speak he began, 'Matron, I'm sorry about last night. There really was nothing we could do to save the patient.' 'No,' she said, 'you've misunderstood. I wanted to tell you that what you did last night, sitting with that patient, is all over the hospital. You have given us a gift. You have shown all of us how to care for our patients properly.'
Cliff's story illustrates the extraordinary, immeasurable value of an action by a notable member of staff that embodies empathy and compassion.
The story affected the rest of the leaders' meeting that rainy day, and there was a rare seriousness and openness in the discussion about patient-based care. One doctor regretted the 'empathy by-pass' he perceives among fellow doctors, and talked about 'unconscious incompetence' in this area. Others, in a similar vein, regretted that nursing has 'lost its soul'.
Coming from the UK, the discussions felt familiar to me. But if the issues are the same, in Australia the proposed remedies are different. Here, the 'consumer' presence in health care is much stronger. The Australian Safety and Quality Framework for Healthcare, produced by the Australian Commission on Quality and Safety, provides a national standard for partnering with consumers. Every hospital has a statutory consumer advisory body and yes, it is true that some treat consumers in a tokenistic way: the chairman of one such body told me disgustedly that his hospital had started out with the annual pruning of the roses as the sole agenda item at their first meeting. But other organisations take it more seriously: they include patients on recruitment and selection panels; involve them in staff appraisal; and invite them into routine meetings of multi-disciplinary care teams, because they recognise – as Alicia Wood, consumer adviser to the CEC, says – 'you can't fix things with only half the story.'