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Ged’s blog on…The Six “Small Cs”

28 April 2014

Theo Paphitis, serial entrepreneur and star of Dragon’s Den when talking to new staff always asks the same question; “Who is the most important person in our business?” He says that the new employees always reply with the same answer; “the customer” to which he replies; “No! YOU are!” I think he has a point. How is it possible for a customer to be happy and receive and outstanding service if the person or people they are dealing with are unhappy, feels disenfranchised or bullied? Likewise, how can a business reach its full potential, deliver the highest quality service and maximise its productivity if the staff of that company are miserable, weary with change and uncertainty?

The NHS faces the biggest crisis in its history. As well as the need to transform its activity to meet the needs of a rapidly changing population, it has to change with less money. Moreover recent high level reports such as Francis (2013) have highlighted chronic institutional deficiencies in skills, behaviours and attitudes reducing in poor standards of care for our patients.

Given the need to change (never easy for anyone) the downward pressure on finance and an already deficient system, are we approaching a ‘perfect storm’? How can we avoid each of these challenges exacerbating the others leading the NHS in a downward spiral of inefficiency and poor quality?

Our Chief Nursing Officer, Jane Cummings (Many of you will remember Jane as the SHA Director of Nursing) is still passionate about patient care and in her three-year strategy ‘Compassion in Practice’ has developed a vision based around six values – care, compassion, courage, communication, competence and commitment. The vision aims to embed these values, known as the Six C’s, in all nursing, midwifery and care-giving settings throughout the NHS and social care to improve care for patients.

Whilst these values are without doubt crucial to the quality of care that we give to our patients, I wonder if they can be delivered and embedded if our workforce still feel undermined, disenfranchised and undervalued because of poor working culture combined with the uncertainties of change? With these things in mind, I wonder if, in addition to the 6Cs for compassionate care we may embed 6 ‘small cs’ to help all of us manage transformational change and be ‘the best that we can’. Perhaps the 6 small cs would look a bit like this:

  • Care: If care is our core business and improves the health of the whole community then we should strive to create an environment which cares for our staff, is responsive to their needs and challenges and accepts that change is difficult for us all. Caring for each other will be reflected in the care we give to our patients.
  • Compassion: If compassion is how care is given through relationships based on empathy, respect and dignity then we should have respect, empathy and care for all of our colleagues who are affected by change. We should strive to be ‘intelligently kind’ to our colleagues at all times and thus kindness will become part of our culture which will be felt and appreciated by our patients.
  • Competence: Those who are responsible for making changes must have the ability to understand each affected member of staff’s needs. It is surely wrong to make change without having the expertise and knowledge to deliver effective change. Changes should not be made unless there is evidence that they will improve our ability to deliver high quality care.
  • Communication: If communication is central to successful caring relationships and to effective team working then we much be honest and open with each other during times of change. We must strive to engage all our colleagues in driving change for the good in the same way as we should be open and transparent with our patients.
  • Courage: If courage enables us to do the right thing for the people we care for, to speak up when we have concerns, we should promote the same courage when facing change. We should be prepared to speak out when we think change is wrong, when we think things could be improved in the ways that we work and listen to others who have the courage to speak out themselves.
  • Commitment: As well as a commitment to our patients and populations, we should be committed to each other, our teams and our organisations during times of change. is a cornerstone of what we do. We need to build on our commitment to improve the working lives of our workforce as well as the care and experience of our patients.

Posted by Ged Byrne, Director of Education and Quality, Health Education North West