Northern Light

Why don't we put nurses in charge? Lessons in culture, values and leadership

One thing always puzzles me about healthcare in the UK. Why do we never ask nurses to run anything?

I thought I would end 2020 with a story from an SDI sponsored digital health visit to Denmark and Finland. That was back in March just before COVID-19 brought travel and much else to a halt. It reminds me that there are simple, practical ways to make things better. Let’s hope we get back to that positive agenda in 2021.

Barbara and Langgadehus

I met a lot of interesting people on the short trip. The stand out individual was a lady called Barbara Lisemose who is the manager of Langgadehus Nursing Home in Valby, Denmark. 

Barbara is one of the most impressive leaders and managers I have seen in a long time. She is also a nurse.

Langgadehus is an incredible, inspiring community and facility under her guidance. Its a great example of the strengths of the Danish healthcare system.

Leadership, culture and values - Simple examples

Digital technology is a part of this and I will come to it. The key though is simple things around leadership, culture and values. Listening to Barbara talk, it was clear that almost everything she did could be replicated tomorrow. Without adding a single penny to the budget.

Explaining this in full might be an entire book. Let me just give a few examples to reinforce the point:

• Nothing is one size fits all. People are different so they receive different support and care. Including using a different selection of technologies depending on their needs. Equal healthcare means giving different things to suit the needs of each citizen. The same thing for everyone is NOT equality.

• Learning and adopting change is a continuous process. It needs to be bottom up and people led. One simple example. Langgadehus trains night shift workers on new equipment first. They have the most challenging time handling patients so if it works for them it will be easier for the rest.

• Another simple example. The home adopted new rinse and dry automatic toilets. They were installed in staff toilets first so that care workers could experience and evaluate them. This is impossible to imagine in the UK.

• Barbara is a Nurse. She speaks well. But her focus is on doing, not talking. Everything in our healthcare system is run by Doctors or professional managers. They are not bad people. They mean well. They are great at talking. But not so good at doing.

• Barbara is the manager of Langgadehus. She is in charge of everything. In the UK she would be called a CEO. We worry about job titles and we inflate them along with the salaries. 

• The process of change is consensus led. I heard this again and again. From policy makers down to front line implementation in sites like Langgadehus. It is a deep cultural habit. Simple and very hard at the same time.

• Leaders know there is no secret. Progress requires good leadership, good process and patience. 

Digital health - Change not complexity

Adoption of digital technology is driven by the same simple, practical philosophy. Three key messages shone through:

• Identify the most practical areas for improvement and start there. For example, care technology includes devices to put on compression stockings. Its small but it matters to carers and patients. So it gets done.

• All technology is about change not about the tech itself.  Change is about making life easier for patients, clinicians and carers.Build consensus about the things you want to try. Test them out, prove they work then roll them out. Then move onto the next thing and build on that.

• A founding principle of healthcare is to be able to share data. Security and privacy are important and managed. Data sharing is essential for effective care both at patient level and system wide.

Tech is everywhere but not often the focus of conversation. Culture, process and leadership rule.

Their last home

There is no better way to summon this up than to return to Barbara Lissmore. Everything about the culture and the value that Danes put on people is summed up by one quote. When she talks about what Langgadehus means for any resident or patient:

“This is their last home."