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What would it take to transform the quality of care given to people – and how much would it cost?
Well – the answer is pretty simple really – and it would cost virtually nothing to make it happen – except the actual will to do it.
The biggest problem is that in terms of quality, what is currently measured by bodies such as the CQC is presumed to be the standard to aim for. And frankly, this ‘quality’ is mainly window dressing.
No one seems to be focussing on the quality of the one to one individual interactions which are at the very core of what we do – and what actually matters most to those we are trying to help.
If I come to see you as a professional for you to help me in some way – I want you to be competent. I want you to know what you are doing – to have had sufficient training and experience to give me good, evidence-based treatment.
But I also want you to be compassionate – I want you to listen to me, to understand where I am coming from, what my concerns are and I need to know that you are actually trying your best to help me.
Our interactions ‘at the coal face’ are where the real stuff happens – and they need to be characterised by competent compassion.
One without the other leads either to at best lack of engagement and poor efficacy, or at worst to inappropriate, dangerous and risky treatment.
Competent compassion should be the gold standard of everything we do – the quality of any service should be judged primarily by this. It should also be the formative ethos by which we learn and develop as professionals.
Competent compassion is easily understood and remembered, and it is a unifying concept that enables us to clearly and comprehensively describe the essential quality of what we do.
How do you measure it though – surely, it’s a bit nebulous and difficult to quantify? Well, not really.
‘Competent compassion check-ups’ are available for the practitioner, the patient and an observer – and can be used quickly and simply by any or all of the participants as appropriate.
They seek to measure how competent and how compassionate the practitioner/patient/observer thinks they are – based on the one to one interaction.
There is a 1-10 rating scale for both competence and compassion with a brief explanation of what these mean geared to whoever is using the tool. There is also a space for specific comments for each parameter for the person filling it in.
So, for example, today during a consultation, I realised I wasn’t feeling very competent about antipsychotic doses, and my compassion was being tested because the patient tended to blame others for his problems. Recognising these issues, I could look up the appropriate information and make sure I didn’t let my feelings compromise the therapeutic relationship.
Far from being a stick to beat professionals over the head with, this could help us develop and improve in a non-threatening way. For example - if we just did them ourselves for a few consultations. This would be excellent evidence of reflective practice for appraisals.
They could also be used for patient feedback and as a measure of quality that the CQC are likely to see as evidence of good quality practice in an organisation.
This simple ethos could really transform healthcare – as well as social care and who knows – perhaps even management if people used it within an organisation as a foundation for working together.
I think we should be asking ourselves and the organisations that we are part of this question. What is to stop us using competent compassion as a core ethos - and why don’t we start doing it right now?
Joss Bray is the clinical lead for drug and alcohol treatment in the north east prisons for Spectrum CIC. He is the founder of Competent Compassion, which has a website setting out the concept and aiming to promote best practice in healthcare, particularly in helping those with drug and/or alcohol problems.
This sounds a great idea that could do with a wide range of practitioners piloting it to get some feedback on the difference it makes to the quality of patient care. I particularly like to simplicity of the dual rating that forces some reflective practice. If we regularly got feedback from service users this would help us to see that we may come across differently from how we see ourselves - which opens up the possibility of getting better in our practice. It sounds like it would lend itself to being put onto a phone or iPad with a bit of input from IT ? The way people book in when they arrive on a ‘pad’ for a GP appointment they could easily Check out from an appointment in the same way and check the Competent Compassion check lists.
In busy jobs working with people with complex needs their is lots of ‘burnout’ of staff which often gets acted out in lack of ‘compassion’ for the people we are paid to serve - I see value in this in pressing the pause button for us all and allowing us to think about where we are at - if I can be honest about both axis their is scope for skills development or improving ‘self-care’ to avoid burnout. I think one challenge will be developing TRUST within our services with colleagues to be vulnerable enough to share our self-assessments and others-assessments with others and open up a dialogue about where we are at and what might help us improve ? It is this kind of reflective honest discussions that can really help us develop - and these two topics seem ideal for “Good Topics” to reflect upon. I deliver a wide range of training to staff around complex needs as Workforce Development Lead for Fulfilling Lives and would be interested in seeing where this could be piloted (a comment space might also be helpful in addition to the rating? - to capture insights ‘on the job) - This has lots of potential and I hope a lot of services just have a go and try it out and give you feedback on what they think / experience ! - Dr Ray Middleton (www.ladder4life.com)
I wish it was used in all fields.
As a recovering addict I wish this type of practice had been used when I was engaged with services. I have been away from addiction to heroin for 8.5 years and surround myself with compassionate people but turn to competent people when I need guidance. Well the family I have surrounded myself with in a church family are a mixture of both. If this practice was taken on board in services it would give staff and service users a much better out look. When you feel that a service is compassionate about you getting well you are much more likely to truly engage with available support. When you feel they are competent you know you’re on a winner. You don’t want to go to a service with burnt out staff who are “miserable” you walk away feeling what was the point. If you feel cared for and treated professionally that helps keep you engaged. This should be rolled out as something that is a guide for staff and patients alike. Keep putting this out there and get it in to general practice and NHS services. All private services should have to have this as a template to keep their service on the right track. With out it recovery isn’t happening within addiction services. Not all but most are trying to be guided by the CQC so they don’t lose contracts, that is pressure that isn’t needed as it encourages pushing people through and ticking boxes to keep them happy. People are pushed through services and out the other side well or not as long as they have completed the check list. Where is the competent and compassionate side to that type of service. They are all trying their best but this system needs to change.
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