When I applied for a Florence Nightingale Foundation / The Dame Christine Beasley Leadership Scholarship, I planned to look at community nursing in different settings as my patient care improvement project. My hypothesis was that community nursing in England was not fully recognised for what it has the ability to deliver and I wanted to see if other countries or systems had made more progress. These ideas evolved over the first few months of the scholarship to focus more specifically on how nurses and health care were supporting the growing number of older people, through community based services. This is a significant issue in all developed countries and whilst responses to the challenges of an aging population reflect wider health and social systems and processes in place, at a time when the Five Year Forward View is encouraging the NHS to be creative and think differently about service commissioning and delivery, I felt that being exposed to different ideas could be beneficial.
During the year, I was able to visit the US and Japan to see nurses and others working with older people to support them living, as independently as possible, in their communities with access to services and health professionals who helped them to stay in control of their health. The systems were very different and each enabled me a view that has stretched my ideas of what care is and could be. In Texas, I saw how a primary care organisation focused entirely on older people delivered services to this group in a way that empowered individuals and which is delivering improving health outcomes. In Japan, I visited several small-scale, community services based in adapted houses and, in one case, a shop, which were delivered so as to dovetail with older people’s families caring responsibilities where they were involved and where they weren’t, provide a both care and support through communities. These would not have been in existence 20 years ago when a majority of older people’s care was family based.
In both countries, organisations and individuals were adapting the care they delivered to make it more personalised and to improve health outcomes. In Texas, these improvements were made through analysis of tracked outcomes of services and patient feedback. The organisation was information rich and regular reviews were held with teams in order to adapt and improve. In Japan, community based services for older people are much newer and there was considerable interest in what was in place in England. Nevertheless, the services I saw were developing and using international examples to guide this.
The scholarship also developed my leadership skills – in ways that I both planned for and did not anticipate. I undertook three formal courses, Leading Change by Organisational Renewal, the RADA Communication Skills for Leading and the NTL Human Interaction Laboratory programme but through contacts made in arranging my visits, also had the chance to present, with colleagues from NHS England, at the Japanese Embassy on New Models of care and whilst in the US, met with a group of lawyers and policy makers to discuss current healthcare issues. There were unexpected and somewhat challenging but helped me put my leadership training and goals into practice.
The Scholarship reinforced what is central to my leadership style and what I believe is at core of influencing for positive change: making and maintaining constructive professional relationships. The formal programmes focused on self-awareness around communication, interaction and reflection so as to improve relationships for the benefit of teams, individuals and, ultimately, patient care. The amazing scholarship experiences would not have been possible without others who take this seriously too. I am indebted to a number of people who were pleased to help me in putting a programme together for no reason other than they too understood the value of forging relationships ad sharing knowledge and experience.