Tag Archives: Liz Somerville

Heart Transplant  – A Shining Example of How We Should be Doing things in Practice

 Three years ago today I was sitting in a family room at the Golden Jubilee Hospital in Glasgow surrounded by my family waiting to hear if my dad’s heart transplant had been successful. The initial call had come from my Mum at 1.30am to say the team had found my Dad a potential heart and we had been on a rollercoaster of emotions over the last 12 hours. 

In reality this rollercoaster had started for us 6 weeks earlier when after accepting that my Dad wasn’t going to get better we were referred through to Glasgow for what we were told was a complete re-assessment of his case. Little did we know walking into what is affectionately called ‘the pod’ that we were on Scotland’s only specialist heart transplant unit. 

So how is this relevant to the veterinary industry and my blog? The medical profession has invested significant sums into human factors and their impact on errors and patient safety, on culture within the NHS, teamwork and leadership. This type of research is seriously lacking within the veterinary industry but I believe we can learn a lot from the NHS.  

There is a multi-disciplined approach to transplant assessment at the Golden Jubilee and each patient undergoes a full medical assessment from cardiologists, surgeons, renal consultants, psychologists, dieticians and physiotherapists. You name it my Dad had it, every test you can think of and more. The whole process takes about two weeks and then the team sit down together and make a decision based on every member of the team’s assessment. Everyone’s opinion is valued and considered. For the family it can feel like an eternity as you put your faith in their decision making process. 

It became obvious after the first 24 hours of being on the pod that there was a very clear system for the team to follow.  It started with a mere mention of transplant as the very last option, before they started gradually introducing the concept to the whole family. Looking back it is clear that they were drip-feeding us the information in small bite size pieces so that we could absorb what they were saying. What was impressive was that the whole team were involved in the process, they clearly understood each stage and were communicating as a team throughout.  Even the ward assistants knew what was happening and what to say when the word transplant was mentioned. Each nurse that started a new shift knew exactly where we were in the process and we were never once told that they would have to double check for us. How often do we fail to communicate and hand over cases in veterinary practice? 

I think it would be fair to say that during this process my Dad was in complete denial as to how ill he was! Feeling out of control he would try and argue his case but the team always had an answer and kept gently shoving him towards accepting that this was our only option. Their empathy was remarkable, and they knew when to sit and listen to my Dad’s seemingly well-reasoned argument that he should be allowed to go home, and when a more blunt approach was required. 

Acceptance of his situation finally came when 5 weeks after admission and now with a balloon pump trying to keep his heart going, my Dad had a cardiac arrest. Save for the fast and swift response from the nurses on duty he wouldn’t be here now. 

Incredibly one week on from this we got the call, one heart had already been assessed and ruled out as not suitable, and my Dad was now at the top of the urgent list. Teams were working in the background all over the UK to find a suitable donor. Given the extremely sensitive nature of organ donation there are strict protocols to adhere to.  Transplant co-ordinators are assigned to the donor family and to the recipient and they work tirelessly in the background at all times of day and night. 

Out of theatre and on ICU we spent two days watching as the team slowly woke my Dad up and got him off the ventilator. The team on ICU were outstanding but I remember it as a time of fear and panic, every time a machine beeped my heart skipped a beat. 

I can still remember walking back down the corridor to the pod after my Dad had been moved out of ICU and feeling relief that we were once again in an environment where I felt safe and secure. We were in the same hospital run by the same Trust but somehow the team in the pod had created this incredible, safe and secure place for the patients and their families. 

Culture within an organisation can be difficult to define.  The leadership from the head consultant was clear, and his team spoke incredibly highly of him. The whole team were involved in decision-making and had clear, defined and valued roles to play in each patient’s care. 

Compassion fatigue is a well-recognised factor in burnout and stress in both the medical and veterinary profession.  Every day the team on the pod are dealing with life and death, there is no in between grey area. Their patients either go on the list or go home to die. They either get their heart in time or they don’t and they either recover from their transplant or they don’t. That’s the reality of their job, day in day out, and yet the empathy and compassion that they showed us over many months was remarkable. 

There are so many veterinary practices who are doing an equally amazing job, building a culture around mutual trust, with systems and processes, and where their team feel valued and that their well-being is a priority.  I am also sure there are many examples of less positive experiences in the NHS. However I think we can still learn a huge amount from the medical profession and our experience of the team at the Golden Jubilee was a shining example of how we should all be doing things.

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My amazing Dad enjoying life three years on from his transplant all thanks to the wonderful team at the Golden Jubilee and an incredible act of bravery and kindness from a grieving family #organdonation 

 

Setting Goals and My New Bible!

Do you feel like you are working really hard, achieving nothing and have no spare time to do all of the important things that you love? Do you write endless to do lists, tick off the small easy jobs and end up moving the bigger or more difficult projects from one list to another?

This was me six months ago, my to do lists were legendary! I’d have jobs that had been on my list for so many months they were no longer relevant. I came home from work each day feeling that I had achieved nothing and I became more and more frustrated. To make matters worse I was up working at 5.30am and finishing at 11pm to try and fit more and more in each day.

Then I discovered my bible!! It is called the SELF Journal and is designed so you can set yourself three goals over a three month period. These might be a life-time goal or a short-term goal that is going to help you achieve your bigger life time goals. Goals are pointless though if we don’t have a plan on how we are going to achieve them and the journal allows you to break down your goal into three progress goals. These progress goals are then broken down further into actions and tasks with a ‘commitment page’ where you can make a pledge to complete your goals, identify how your life will improve and choose how you will reward yourself when you achieve your goals.

My day now starts and finishes with my journal and it comes everywhere with me. Each morning I read my goals again and plan my day based on what I need to achieve. I particularly love the gratitude section which forces me to appreciate everything that I have and reminds me just how lucky I am. Every morning and evening I write down three things that I am grateful for before either planning my day or reviewing how it went. At the end of each week there is a section to review the week, celebrate three big wins and assess my progress towards my goals.

It is very easy to fill our days with the routine things, add in the odd urgent job and forget about the important things. Ask yourself does it really matter if the washing is put away every day or the house hovered? With two boys, a husband who is a vet and myself who is happiest mucking out stables our washing machine never stops. I used to spend valuable time every day putting it all away, time that could have been spent on the important things. These are the things that matter, the things that make us happy, the things that get us out of bed each morning and the motivating factors behind our goals. I’ve come to realise I’d rather be doing something that is important to me and as long as we all have clean clothes it doesn’t really matter whether they are hanging up or still in a pile on the floor!

The SELF journal won’t be for everyone and you may prefer to find another way to define your goals and record your progress. Take some time out to work out what your days are made up of and what bits are routine, urgent and important. Set some goals based on what is important to you, write them down and find a way to hold yourself accountable on a daily basis.

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An Annual Pilgrimage with a Difference………

Every year for the last 10 years I have made the trip south to the VPMA Congress or as it is now known the SPVS/VMG Congress. It has become an annual pilgrimage for me, time to get away, get some head space and surround myself with other practice managers all keen to learn and network. It’s a bonus that congress has been held at The Celtic Manor in Newport for the last few years which is the most fantastic 5* hotel and the gym, swimming pool and cocktail bar all help to relax the mind.

For the last seven years my best friend and partner in crime has come with me. The seven hour car journey gives us the chance to talk none stop, without our little people interrupting our chat. We usually spend the whole weekend bouncing ideas around, wondering what the hell happened to the last year, setting goals for the new year and drinking rather too many cocktails.  Our return journey is spent chatting non-stop about our plans for the business and what we have learnt from the lectures and importantly from speaking to others I practice. During the 14 hours of driving we have never run out of things to talk about but then that’s pretty normal for us both!

This year for only the second time Hugh came with me. His first visit was years ago when congress was relatively small and it would be fair to say he was not a fan. I can still remember feeling completely deflated as I am so passionate about practice management but for Hugh it was everything he’s not. He still talks about the opening speaker now but for all the wrong reasons which says a lot about the quality of the talk!

So I was slightly nervous setting off with him, I can’t say we chatted non stop the whole way but given we have been together for 18 years (god how did that happen) I think we did pretty well.

Being a 5* hotel the staff are incredibly well trained and nothing is too much trouble. I had spent a lot of time telling Hugh how it is a fantastic example of top class customer service, and I know from a lecture with their HR manager a couple of years ago they invest a huge amount in training their team and it usually shows.

Unfortunately for me when we arrived there had been a cock up with our room that took some time to resolve. As we were sitting in the foyer waiting for them to sort it out Hugh remarked about the ‘not so good customer service’ and suggested that any 5* hotel worth their salt would have taken us to the bar and offered us a complimentary drink. Queue a member of staff who did exactly that…….a free drink will always help smooth things out especially for a Scotsman!

Thankfully SPVS and VMG have seriously upped their game with the opening speakers since Hugh’s last visit and this one didn’t disappoint. We were treated to a fascinating and very funny talk from Benjamin Mee who is the author of the book ‘We bought a Zoo’, which has now been made into a Hollywood blockbuster.  The highlight for me was the story about an escaped Jaguar that jumped into the tiger enclosure clearly fancying his chances against the big cats. The fact that this happened on only day four and involved a work experience student who neglected protocol and decided to crack on with cleaning out the enclosure on their own, in the process forgetting to lock the door, just made it all the more amusing.  But humour aside, his story is one which includes tragedy, hard work, risk and opportunity, and whilst most of us can’t say we have bought a zoo and had Matt Damon play us in a Hollywood movie, we can relate to many of the every day issues that Benjamin and his family have encountered.

So for me this was Congress with a difference, thankfully Hugh came home as inspired and motivated as I did and perhaps the take home message for me is that sometimes change isn’t all bad…….although I’d be lying if I said I didn’t miss my partner in crime a little bit!

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Coach, Mentor or Both?

This question came up on the recent Vet Your Life Webinar and follows on nicely from my last blog. I hadn’t really given it much thought until someone asked the question “what’s the difference between a coach and a mentor?”

Coaching is aimed at getting us to work out what we want and how we’re going to achieve it. The important thing to know is that a coach won’t tell you the answers. I can remember coaching sessions where my coach just kept asking me questions, challenging me to come up with the answers and I sat there blankly, desperate for her to tell me what I should do! Sometimes it would be a week later before I had that light bulb moment and knew what the answer was.

For me coaching was really tough, I hated not having the answers straight away. If I relate this to my riding I have always loved training with instructors who tell me what I need to do, it fills me with confidence and if I am doubting my own ability gives me the kick up the backside to just get on with it. But the very word ‘instructor’ implies there is quite a difference between the ‘coaches’ that we are seeing teaching now, many of whom have come through the UKCC accredited system and the instructors who came through the traditional BHS exams.

A mentor on the other hand by definition is someone who gives a lesser experienced or younger person help and advice over a period of time. Years ago when Hugh was locuming down in the south of England I met his then Practice Manager. We stayed in touch and over the years she has become a both a friend and a mentor to me. What she doesn’t know isn’t worth knowing and no matter how busy she is I can send her an email or pick up the phone and she will always offer me some pearls of wisdom. A couple of years ago I spent a couple of days shadowing her and I can honestly say I learnt more in that two days than I had learnt in the last two years.

I would love to see a proper structured mentoring system in place for those of us working in veterinary management positions. So often it is the time spent over lunch at CPD meetings where we learn the most, discussing our struggles and how we overcome them. I think practice managers can feel quite isolated at times as you are the one member of the team who doesn’t have their own team to fit into. There is usually a vet team, nursing team, an admin team, and probably some directors but it the PM who is responsible for keeping everyone happy.

So in answer to my question, coach, mentor or both I would definitely say both….. BUT be ready to dig deep in finding your own answers with your coach and make sure you are willing to listen and accept some tough love once in a while from your mentor!

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Asking for help……

In January 2017 I reached my breaking point. For someone who has often thought she was superwoman the realisation that I wasn’t was pretty bloody tough. There had been wobbles over the last couple of years but the culmination of too many challenging situations to mention, left me feeling anxious, panicky and completely unable to see the woods for the trees.

Having watched others suffer from mental health issues I knew I needed to act before things progressed. I wasn’t depressed but I had completely burnt out and the panicky feelings were starting to scare me. I had been trying to cope on my own for so long, believing I could manage and not wanting to appear weak, and situations that were completely out of my control kept appearing to challenge me.

I now know that autonomy or control over our situation and the support that my family, friends and work colleagues could offer were the most important factors in starting to not just feel like I could cope but actively enjoying life’s challenges again.

I was very lucky to be introduced to a lady called Carolyne Crowe. I would really recommend either having a look at her website www.carolynecrowe.co.uk or contacting her through the VDS Training Services. I signed up to do some personal coaching with Carolyne and spent the first few sessions mostly blubbing down the phone…….sorry Carolyne! We covered far too much to write about in one blog but I thought I would just share a few of her little gems with you:

  •  One of the things I constantly struggle with is balancing work, family time, and my horse. When my boys are sitting in the office after school I feel guilty, when I am at home with the boys and not in the office I feel guilty and when I am riding my horse I feel guilty. Carolyne uses a phrase called ‘being responsibly selfish’ which has completely turned my guilty feelings around. Riding is for me, my time, when for a hour (ish) my head is free from everything but Splash and my ambitions for him. It is so important and I now realise just how important. There is always a balance to be had and as much as I would love to ride all day every day, I am now very content with once a day, six days a week!
  •  I am by nature a worrier and for a while it consumed me. I worried about everything, what happens if another practice does this or what happens if that person leaves………. Carolyne would constantly remind me that some things are completely out of my control and that I should focus my energies on the things I can control.
  • Another saying of Carolyne’s which I have taken to using on a fairly regular basis is “It’s not the problem that is the problem, it’s our attitude to the problem, that’s the problem” So often I found myself being consumed by a problem, it grew bigger and bigger until it felt impossible to overcome. Carolyne taught me to work out what I could do about the issue, break it down into manageable chunks and to stop worrying about the things I couldn’t influence. So by changing my attitude to the problems I have felt far better equipped to deal with the inevitable challenges life throws at us.

 

On call… just part of the job or an unfair expectation

Work/life balance is a particularly hot topic at the moment both in the veterinary industry and in most other businesses with lots of articles being written about how to achieve that all important balance.

In our industry it is even more relevant given the out of hours service that vets have to provide. Twenty years ago it was widely accepted that being on call was just part of the job, vets signed up knowing it was a necessity and got on with it.

But with time comes innovation, small animal practices have developed dedicated out of hours providers who act as a central hub for emergency cases out of hours and vets now have more choice about the hours that they work.

Unfortunately because of the distances that equine practices cover, this isn’t a viable option which leaves us with a major problem long term, as more and more vets go in search of that all important work life balance and move back into small animals.

It’s a massive frustration for me knowing that as an industry, equine practices need to think outside the box to solve the problem, but are still unable to come up with a workable solution. Hugh and I have spent hours discussing the possibility of moving to a 7 day working week and implementing shift patterns to remove the extra weekend work for our team. The clients would benefit from having vets working at weekends and no out of hours fees but the extra costs to the practice would be astronomical. We would need a minimum of two extra vets, and an extra admin person and nurse, which makes it unaffordable for our clients.

To add to problem the demographics of the profession is changing with a survey by the BVA in 2016 reporting 81% of vet students are female. A survey by the RCVS in 2014 that found that the number of vets working part-time is continuing to rise. In addition we have equine vets who are working an average of 40.4 hours each week plus 32.6 hours on call per week in a profession where we know stress and working hours contribute to dissatisfaction with vet work, and are common reasons for people choosing to leave the profession (RCVS 2014).

As wife to a vet who works on call and with a young family I understand more than anyone the impact on call has on families, relationships and individuals. In contrast as the director of a business that has to provide on call to our clients I also feel frustrated and concerned with the way the profession is developing. Should the profession be better at managing students’ expectations of the commitment that is needed for on call? Someone has to do it and for every vet that decides to move away from out of hours work, someone else is left to cover.

Frustratingly I don’t have the answer but with a high proportion of woman entering the profession, many of whom will want to have families of their own and work part-time to fit in with family life, the problem isn’t going away… I would love to hear from you if you have the solution!
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Breakfast with Chris Tiso…

To me walking into a room full of people that I don’t know is my idea of hell! When I here the word ‘networking’ it makes me go cold and feel like I should run for the hills. I have spent much of my career knowing there are huge benefits to networking but avoiding it at all costs.

However in my mission to challenge myself professionally I decided to attend a networking breakfast run by Kinross-shire Partnership. This group has been running for several years now and arrange monthly meetings for local businesses at a fantastic farm shop nearby. We were treated to a full Scottish breakfast and then much to my horror everyone was invited to stand up and introduce their business for all of 60 seconds. Unfortunately no alcohol was provided for dutch courage but I dually managed to stand up and string a few sentences together.

Each month they invite a speaker along to talk about their life and business and this month Chris Tiso from the Tiso Group talked to us about his family business that he has been running for the last 25 years. I always find it fascinating to hear people’s stories, how they have ended up doing what they are doing and what gets them out of bed in the morning. Chris runs a huge company but much of what he has had to contend with is relevant and can be applied to both ours and other small businesses.

Market changes happen to us all and although it hit them slightly later than others the recession was one challenge Chris discussed with the group. Retail businesses found themselves faced with a decision. Increased competition from new entrants coupled with the effects of the recession led Tiso to make some tough business decisions including refocusing their position at the high end of their market. This proved to be a good strategy with retailers at the high end of the market and at the value end such as Mountain Warehouse doing really well, whilst those left stuck in the middle found themselves swallowed up by their competitors.

One of Chris’ s key take home points was that throughout any difficult decisions that were made, they stayed true to their founding principles. If we apply this to our practice we set out to provide a specialist equine veterinary practice that placed us at the higher end of the market. We have never aimed to be the cheapest and yet at times it can be easy to react to what others around us are doing and forget what we set out to achieve.

Chris also identified how important it is to surround yourself with brilliant people allowing you to focus on what you are good at and let others do the bits that you either can’t do or have no interest in doing. That and investing in the business infrastructure are key to keeping the wheels turning.

So all in all, it was a great morning, I pushed myself out of my comfort zone, made some new contacts, had a delicious breakfast and learnt a bit about one of our local businesses, who happen to sell fantastic clothing ranges and where I often spend far too much money!

Read my previous post here.

Liz munro