Things are Going to Slide - Seeing into the Future of Nursing and Changing the Way We Change


Published: 10 January 2017

“Things are going to slide, slide in all directions…”
‘The Future’ by Leonard Cohen

2017: A new year and time that I had a new job. I’ve decided that my new role will be a ‘Nursing Futurist’.

Don’t laugh, I’ve been holding my wet finger up into the wind long enough to know what’s happening in the world and more importantly – what will happen in the foreseeable future.

Without giving too much of my game away, these are some of the bandwagons that will be rolling towards a health service near you soon:

An Integrated Health Service

What a wizard idea: just picturing having a community service that knows what a hospital sector was doing. Imagine an acute ward or unit that could actually communicate with a GP practice (and sorry but ‘sending a fax’ doesn’t count, nor does the dispatching of a carrier pigeon).

I’m seeing vaguely through the mist: a disability or mental health service that isn’t about as accessible or user-friendly as Dante’s 9 Circles of Hell, and a health service that isn’t funded by ten different bureaucracies all determined that nothing should ever come out of their budget. Watch this space.

A Patient-Focused Health Service

The light is a bit hazy here so I’m not sure if this is a ‘forward-facing’ service or maybe just a ‘slightly off-centre‘ one.

The gist is clear though and nurses everywhere will feel a genuine sense of achievement, if not outright victory, that patients are now to be the focus of our health services. As a concept this idea of person-centred care is about as radical as it gets and I’d be surprised if the ‘Big 4 Consulting firms’ aren’t already all over this like a rash.

The Need for Change

Well, you don’t expect the world of healthcare to stand still do you?

Change is the only constant that matters and no service will ever be allowed to just tread water for the next few years. Naturally, such change is difficult stuff and it would be a huge stretch to imagine that clinicians and care providers would be able to undertake or adapt to this without some serious ‘change management’ expertise and evangelical ‘change champions’ being brought in to support them.

Rediscovering ‘The Patient Experience’

Apparently, it matters what patients, families and service users think and feel about the services that they receive.

The good news is that we are moving beyond auditing the thank you cards and chocolate soft centres, to some serious hard data like PROMs (Patient Reported Outcome Measures) and technology that goes ‘bing’, such as iPads and touch screens at the bottom of every bed.

I’m seeing clearly through the clouds here that as funding becomes tied to patient experience, CEO’s and Executive Teams will become more and more interested in the topic.

OK, I don’t know that I can keep this up for a few hundred more words. The above nonsenses are not crystal-ball gazing. I have heard each of these promulgated seriously during the last two years by the great and the good at conferences and in print.

What is passing for vision and challenge in healthcare is almost beyond parody. An integrated health service is a ‘good idea’ that we should be ‘working towards’? What on earth have we been running or tolerating for the last 40 years: a chaotic or fragmented one?

Well, yes.

Can you even begin to imagine Apple having a system where an iPhone doesn’t ‘talk to’ an iPad or work with an iMac?

Can you believe Qantas not being able to take you and your luggage almost anywhere in the world using a series of codeshares and partners but on the one ticket and booking?

Apparently, however, ‘health is different‘.

Well, no it isn’t.

future of nursing

Yes it is complex and messy but so are dozens of other industries who have managed integration and seamless services infinitely better than we have.

In the same vein, patient experience is now important. This will be no newsflash to old phenomenologists like myself who, thirty-plus years ago were telling anyone who would listen that the ‘lived experience’ of patients, families, health professionals and more was not just soft data but hard reality in healthcare, and that we should be researching and attending to it with a much greater urgency.

As for telling health professionals that services should be ‘patient-focused’ or ‘person-centred’— I’m almost lost for words. Nurses have never focused on anything else and most would have no comprehension that a health service or hospital could ever be focused or centred on something other than patients, families and their lives. That this is now being touted as some kind of exciting new concept is another marker of how low we have plummeted.

All of the above nonsense will be sold as new and exciting in the coming years as will the need to change to address these new issues. What is unlikely to change, sadly is how we change. At a time when we have never needed to ‘change how we change’ more, our services will continue with top-down re-disorganisations that will give the impression of ‘something being done’ while little other than organisational charts, structures and headed notepaper will actually change.

Get ready for the future: it is murder…
‘The Future’ by Leonard Cohen