Ian Smith
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Ian Smith made a comment
This has been helpful and is a reminder about how useful reflection and self-awareness is. Certainly a journey of many destinations!
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Ian Smith made a comment
1. Organisation ethos
2. Staff working extra hours to make up for pay deficit
3. Not enough staff from local pool and relying on importing staff from abroad
4. Less investment in local hospitals and more in diagnostic services = less beds -
Ian Smith made a comment
Where there is personalised care it is not driven by the system - this is the most important aspect! when patients don't fit into a box then they are truly being seen and heard! This is a great goal of care!
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Ian Smith made a comment
Population health management really asks the big questions - where and what is the environment in which dis-ease and illness occupies? Who are the people that suffer from inequality? And How do we target services based on the landscape of need not just on clinical presentation which is often late. This really gives us the opportunity to treat illness as a...
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Ian Smith made a comment
The idea of stepping outside of our immediate department is very interesting and a goal for our team on a day to day basis. I am involved in service analysis looking at our teams impact and our key performance indicators. This information is immensely valuable to other teams in our distributed network. When we discuss the raw data, it is clear that we all have...
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Ian Smith made a comment
Efficiency - driven systems
Team-work and bonding
Human factors - poise
Allowing for the fallibility of human needsThese themes reveal that we are moving more towards a system that is oriented toward a mechanistic world but this does not always work as can be proven easily. We need to remember the truth of the world we live in and practice a safe and...
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I think that the flight of the many would surely be better than a few - when we bring in other birds we can use our different adaptations and specialisms, we fly in many different ways. Not only must we bring in the new starlings, but to enable them to steer and lead and decide on our destination because nothing is fixed. If we don't make our work how we want...
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Ian Smith made a comment
Solution-focused thinking instead of problem-focused thinking.
The skill is for those aware of the problem to trust the systems that can see and understand the wider problem and contribute to the solution rather than feeding into the problem. -
Ian Smith made a comment
Legislation is a dynamic and changing field. What does one do when you come across an area of work that has never before been bench-marked or guidelines don't yet exist!? This is exactly where we are within our organization - leaning of multiple sources of incomplete data to define what is good to ourselves. A frustrating but exciting area of work to be part of!
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Ian Smith made a comment
This information is all incredibly illuminating and revelatory.
However, I think of those cases where a person has won the EuroMillions and three years later has spent it all on cocaine and fast cars and landed a claim from the bailiffs.
Resolving inequality is not so much about money as it is knowledge and this is important to remember. I believe if...
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Ian Smith made a comment
In our workstream, we often see high intensity service users - care home residents who attend multiple times for similar reasons; falls, recurrent UTI, mobility issues and feeding issues. These patients put a strain on the NHS because they require repeat investigations (CT, Xray, MRI, bed spaces) when this is not in fact linked to any clear benefit. Because...
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Ian Smith made a comment
My consultant colleague often says "health is not an absence of disease, and disease is not an absence of health - they are not mutually exclusive" and this is something that often helps me to re-think about our aims in a distributed system.
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Ian Smith made a comment
There is a tremendous investment from the NHS in everyday roles and it is something we must not forget. To be able to go to a role in healthcare in the NHS means that we are part of an economy that serves the people and minimises pain. The NHS is a wonderful thing and we must see the value in frugality, economy, efficiency and investment in our respective...
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Ian Smith replied to Thomas Nunn
This comment seems very inspired now that there are widespread public service strikes and the Daily Mail claiming death directly as a result of the brave steps towards saying no to unreasonable working conditions. Is this the sort of stand you were referring to? I also work with majority Frail and elderly, and the idea that frailty is complex and difficult, is...
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Ian Smith made a comment
Non-linear connections - where flow is defined by progress, cirection and movement, new problearise due to stasis.
Feedback loops - failure to flow makes systems focus on redundant processes and the secondary consequences!
Unpredictability - cvoid has lead to unpredictable consequences - waves and peaks ahve had a seasonal variation which has pushed...
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We all feel depleted, but there is a foreboding sense of an organisation that needs to respond to crisis and emergency. "Once bitten twice shy". This = stress. The birth of rapid reviews and international implementation has brought public health into social contract and the worried well are more prevalent. Services that are used to routine and high output,...
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Ian Smith made a comment
The numbers show a deep cultural trend towards preservation of the status quo. This is something that should be challenged as it will benefiot the whole health system and we see more and more a challenge to equality and justice in the media because it is a topic that we are coming into awareness of. It is important that services are fair for all and provided...
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Ian Smith made a comment
The sick role is well circumscribed in these patients! There is a clear role for interactions to be holistic but at the same time services often run to 10 minute very brief interactions. The combined effect of multi-morbidity alters communities and services structure - and is a reflection on our attitude and ehtos of work. There are many that suffer and die...
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Ian Smith made a comment
If services aren't planned to grow then they will simply fade away. The old way of sustaining present service demands is simply not effective enough. If we aim to grow each service and increase output and increase staffing and resource, then we can anticipate to stay the same. If we are not growth focused, then we will lose to the changing times. The shift to...
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Ian Smith made a comment
Challenge - Changing ethos of care when demographic and economic data rules the service.
Work - moral injury - having to act in ways incongruous with our best intentions.
Personal life - change in the family structure and values around elders living alone.
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Ian Smith made a comment
For people to remain integrated in increasingly complex webs, roles need to be incentivized. There has long been the image of those who are 'domestics' or 'cleaners' to have more menial roles than those who are high functioning clinicians - this is clearly not the case when we work together to support hospitality. Covid showed the importance of resilience and...
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Ian Smith made a comment
Sometimes and often, when we look at animal models - we can understand the primacy of ideas and behaviours that are otherwise lost within complex logic webs and remain otherwise hidden.
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Ian Smith made a comment
When we see distinct boundaries between roles we lose sight of the reality of sharing a working environment, sharing objectives, and sharing emotions that unite and resolve conflict. A big part of our role in healthcare is to target the burden of being oriented to new patients, new adversity and conditions that cause disease to many. If we can find a way to be...
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Ian Smith made a comment
"Quick wins"
"burn out"
"burning the candle at both ends"
"work-life balance" -
Ian Smith made a comment
Attachment clouds the mind and leaves is feeling secure in our ignorance. If we can leave our assumptions and clear our mind to approach our work differently, then we will be able to excel, without even moving a finger.
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The solution does not always require ALL of the tools ALL of the time! This is why I am so passionate about the Physician Associate role - seeing my experience of social care, rehab, laboratory, hospice work all translate into practical and advanced skills in my role, and comparatively seeing other over-qualified roles not enjoy the same satisfaction because...
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Gaps = Spaces for Roles that require true trans-professional thinking and working. This means that individuals in healthcare need to have experience in multiple settings and apply common sense to fill the gap.
Know well - the key performance indicators related to flow and logistics.
How does that influence = a culture that pushes for early perhaps...
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Q1. Can you think of an example where you, or someone else, have tried to change something in a system and been unsuccessful?
- trying to shift the agenda at my hospital to make the workflow more focused towards geriatric patients because they are by far the majorityQ2. How helpful is it to understand this as the natural behaviour of living systems?
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There in of the past I want you to let you know that the world has changed and when you start on your way into a professional career that everything around you is shifting faster than you realise. About all around you people are finding out that they might be replaceable that services need to be changed and adapted but one thing remains the same and that's the...
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Ian Smith made a comment
We know that the idea of leadership implies wisdom, experience, knowledge being shared amongst others. This is not a linear or straightforward relationship. In groups, often we need and seek novel solutions through adaptive, dynamic and emergent routes. No one person knows or can lead, its by iteration and trial. When we are all looking for solutions we often...
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Ian Smith made a comment
The system is not so straightforward. By focusing each day on work streams, taking the patient perspective each day, this tires us in terms of understanding the work in place that support our roles. The system is complex, putting people on opposite sides of the same problem, and therefore sometimes needing a new language to process and understand what we see....
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This systems response is clearly in place in healthcare. underpinning all of our roles in the care and compassion that leaves the patient free to be themselves and be a part of the whole - each patient is a starling too. We - as agents - often might need to take decisive action and steer the group - we are also starlings - each one pulling with equal power...
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Ian Smith made a comment
What brings you to this experience at this time?
- To learn how to get support where we need from teams cut off in physical space but with the same objectives.
What sense do you have of an ‘ideal outcome’?
- Better able to navigate the workplace, better resourcing, using infrastructure and enabling others. Being connected to workplace matters. Being able... -
Ian Smith made a comment
I can see that in a well-oiled machine like the NHS - at times the service provides at the point of care - but we may neglect to the notice that care was needed may suggest more than meets the eye. Unless we ask, we may unfortunately miss out on understanding the underlying causes. I will take time this week to look at the subtext of all patient encounters.
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Adults are allowed to make unwise decisions - unless you suspect that they will come to harm. I have encountered this and needed to put together a 'package of care' in a different county and a new identity for a youngster - 17 yo who refused to give police information about stolen goods, despite having death threats to his family. Very frustrating.
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Ian Smith made a comment
Unfortunately some types of abuse are highly correlated with concealment - making the role more difficult - ie. controlling others, language barriers, the need to remain autonomous, fear of further abuse, lack of knowledge, cultural barriers. Identifying opportunities for early intervention and regular support with home visits is essential. This requires a...
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Ian Smith made a comment
The different perspective serve to highlight the gaps between care and the fact that each is accountable for her as a person, a whole, an entity in her own right and therefore each responsible for her well-being at the point of care -we have a Duty of Care.
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Ian Smith made a comment
Hi I am a Physician Associate - now working in Hospital but recently from GP and before this role I was a care coordinator for CYP services. I have lots of experience - significantly making the switch to work from CYP to older adults. Often we hear that we are too paternalistic - different sectors ahve different approaches. for example - in enabling young...
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Ian Smith made a comment
We protect ourselves and therefore all those we come in contact with. We raise the median and mode and bring the world to a safer standard with shared knowledge.
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Hi - yes there is lots if you search for Value based practice. Obviously values can be different and often its about sharing values where possible and working out what matters to others. his can be tricky but often by removing barriers - ego, opinion, politics - it can become easier. I must admit I do often have to go home and remind myself what my values are...
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Ian Smith made a comment
Whilst I was working for the Allotments in my locality, I ran a program ensuring that all children within our division of care were given an opportunity to trial an allotment and to grow food locally. This was a fantastic opportunity to enable impoverished locals to reconnect with agriculture.
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Many children are never able to travel and leave their home towns in the united kingdom and learn very late in life what culture is - taking much for granted. In a diverse culture where the very poor are the least worldly - there is bound to be extortion.
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Ian Smith made a comment
We are all responsible for our own human rights. We are also responsible as agents of humanitarianism to protect the community. This sometimes mean we need to see beyond our experience. Having a good attitude to culturing the 'right and perfect way' a community should function and thrive is very important. It is better to be a proactive positive leader, but...
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Its a really good question! I remember reading about value based practices and learning about the different ways to approach these situations. Seeing others taking issue with unfairness is a powerful motivator - and this is something with cultivation - anyone can have is an excellent communication skill.
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I always found it very shocking to read about Syria and Iraq (and Eritrea, Sudan, Kurdistan, etc) and then to find myself working very closely with 15-18 year old Asylum Seeking Children and that we as a society have no answers to the Crimes committed. Unfortunately my explanations to these children lacked - and it always felt as though we were merely...
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Ian Smith made a comment
I always found it very shocking to read about Syria and Iraq (and Eritrea, Sudan, Kurdistan, etc) and then to find myself working very closely with 15-18 year old Asylum Seeking Children and that we as a society have no answers to the Crimes committed. Unfortunately my explanations to these children lacked - and it always felt as though we were merely...
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Ian Smith made a comment
I tend to play into roles that are created for me and written in to my being. At the flat I am often the older middle class white male, the educator, host. At home I am the younger brother or the conscientious son. At work I am the methodical analyst whilst others enjoy the instinctual leader role I have enjoyed in my personal hobbies. It is impossible to...
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Ian Smith made a comment
Everyone is entitled to be different and also to be treated the same... This is surely the greatest stimulus for communication! However, some differences and individual choices are isolating and secularising and this can be very difficult. If equality is a shared definition amongst everyone, taught in schools and in a constitution then it is equal and fair....
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Ian Smith made a comment
We each honour one another's existence and ensure that we treat one another the way we would be treated.
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I have suffered discrimination and persecution in South Africa for growing up as an English person. Then in England I have always been ear-marked as someone who has seen Apartheid and therefore is not able to speak about race. A very frustrating dialogue.
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Ian Smith made a comment
Discrimination happens because there are limited resources and competition pushes individuals with the same inclination to group and class together and through communication to control growth. This forces the alternative solution to restructure, rethink and try again. The reason why discrimination happens is also because of history of selection and evolution....
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Ian Smith made a comment
Discrimination makes me feel at the raw end of unfairness. I have recently come to understand the most difficult discriminations are the invisible discriminations that most people carry everyday - disability, grief, social difficulties. Discrimination is so often made to be something obvious - but this is not true. I remember studying with a fantastic group of...
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Ian Smith made a comment
The Absolute and Extreme of any single Human considering the rights of another Human more valuable worth up-holding in a court of law- jeopardising their own - outside of marriage or nepotism - can only represent a submission and without careful attention to is likely to result in a fundamentalist agenda. This must be carefully managed. It is not for every...
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That's exactly true! Then it may appear that the wherever there is a source of great wealth the 'owners' monopolise upon the opportunity to get the greatest price over the opportunity to simply enjoy. It lacks one of the principals of Kant's moral philosophy - there is always a secondary gain. And one mans gain is another's loss. It is very important that the...
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Ian Smith made a comment
I often want to cling to primary research because of the case-by-case and work ethic - the chance to question method. However, the evidence shows that meta-analyses are the most broadly applicable to practice and inclusive of broad learning. I have learnt to select the tone of the article for the application - if it seems exploratory, then its not for...
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Ian Smith made a comment
Physician Associate working in Acute and General Practice.
I am keen to stay ahead of my learning and excel to meet the needs of my new team. I have planned to spend a few years working in the Hospital to emulate my colleagues training and I have taken on additional roles recently which have broadened my scope of practice. I want to be able to work... -
Ian Smith made a comment
I am Ian a Physician Associate in Acute Care of the Elderly. I am interested in keeping ideas about QI and service design and delivery fresh in my head.
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Ian Smith made a comment
When something like the recent protests breaks out, gains popularity and becomes part of the status quo - there will always be the other side waiting to be heard. This one-sidedness is really the problem if we are aiming for true diversity of thoughts and universal rights. Everyone agrees about human rights in extremis, but the actual respect for one another...
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Be careful because there has been a documented link with Facebook and reluctance to self isolate and use PPE due to conspiracy! It is important that we respect the need for accurate, speciality specific journalism. I agree that social media can be empowering - but it is also often very short bits of information, lacking context. For example, you can hear a...
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I think there is a complex interplay between respect and fear for a tribal type leader and the respect for self and other that is required in a dignity as an indivisible, inalienable right. I agree, from brief reading there seems a fraught history in Africa and I think Africa must with the African Congress and other Continent wide efforts tap in and find...
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Ian Smith made a comment
The rights exist in and of themselves and, whether a theory or a reality, it is for reference and for society to be aware of. Not everyone will use the same rights, therefore inequality is very deeply ingrained indeed. As an example, It is also a positive / negative claim right that if you want to you can steal a loaf of bread to go to prison... I will not...
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Ian Smith made a comment
Without us taking an audit on an individual level, comparing for size with others, then how can we know!? But does not the undisturbed tribes of Africa or the Amazon not have the right to live in their own system of ethics? Is an international ethics system not unjust to the creator who will have to foot the bill?
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If someone couldn't exercise their normal day to day, then there will be consequences! However, it is important that there is the right someone to listen - someone to act - as much as we support the person to speak up!
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The right to work is a bit abstract and in isolated communities or even workforces this can easily slide into adverse terrain. When there is poverty, enslaving the poor is equivalent to paid work by another's standards? Look at the price of coffee. Work is easily sold and can become absolute loss of liberty / dignity. Inequality is too universal for this...
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Ian Smith made a comment
We will only ever be as low as our lowest common denominator. There is little point celebrating the rights of celebrities and footballers, whilst our poor starve to death without an option to mobilise to a better future. It is important that we remember ourselves in others and strive for the ideal society that some day we will reach, if not universally now,...
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Dignity is the quality of not having anothers' rights interfering with your rights. One cannot be alienated by your higher rights as according to Locke. The inalienable rights grant dignity and this is fair and the same for everyone. If ones freedom means another loses freedom, dignity is compromised. This to me could mean respect for elders, or education for...
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Ian Smith made a comment
Hi I'm Ian. I completed the Justicex course on Edx.org some time ago, and loved it! I am very interested in moral philosophy and human rights. I am very interested in rights- and values-based practice in healthcare. I work in health as a physician associate. I am going to work with Frail and Elderly patients and wanted to better inform myself about the rights...
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Ian Smith made a comment
Well IP's is something that is as essential and universal as the skill to making a cup of tea - but if the recipe isn't right it can be disaster! Seeing inter-professional work is a great experience. Sometimes as with nursing and medicine in general - the parts are more in depth than any one role and so divide and conquer is the best solution. My role is...
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Ian Smith made a comment
Hi I am Ian and I recently graduated from UEA as a Physician Associate. Very excited to part-take in this MOOC - a follow on from a previous and very high quality MOOC hosted by Veena and the team. This time I am proud to say I have been lectured directly by some her team including Katie Ellis. Great! Wonderful to see such great material coming from the UEA...
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Ian Smith made a comment
Hi I am Ian - I recently completed an MSc and I thought I'd like to touch base on some essential people skills as this suddenly seems a distant and challenging place to be - looking for employment.