Transcript Document

The Search for Compassion
Paul Lumsdon- Chief Nurse, Executive Director of Nursing and
Quality
@Paul_Lumsdon
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The Search for
Compassion
Serious
Untoward
Incidents
Quality
Visits
Centre for
Compassion
Compassion
Training
Coaching
Compassion
Metrics
Compassion
Focussed
Therapy
Research
and
Development
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What is Compassion?
Definition:
“…a sensitivity to the suffering of
self and others , with a deep
commitment to try to relieve it.”
The Dalai Lama (1995)
It is not a new concept. The work which is
demonstrated here is the culmination of many years of
research and development.
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Compassion
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The Search for
Compassion- Aims
• Compassion Focussed
Theory
• Compassion into
Clinical Care
• Compassion into
Management
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The Search for
Compassion
Serious
Untoward
Incidents
Quality
Visits
Centre for
Compassion
Compassion
Training
Compassion
Focussed
Therapy
Coaching
Compassion
Metrics
Research
and
Development
6
The local context
Professor Paul Gilbert (O.B.E ) a Professor of Clinical
Psychology University of Derby, an internationally
renowned researcher and therapist who has
worked for our trust for over 25 years.
Paul is leading the way with the team at the Centre
for Compassion to build on the work that has
already been achieved within our Trust to benefit
the people who access our services and staff
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The human brain is the product of many millions of years of
evolution – a process of conserving, modifying and adapting
Why we have complex brains and minds that are difficult to
understand regulate
1. Old Brain
Emotions:
Behaviours:
Relationships:
Anger, anxiety, sadness, joy, lust
Fight, flight, withdraw, engage
Sex, status, attachment, tribalism
2. New Brain
Imagination, fantasise, look back and forward, plan, ruminate
Integration of mental abilities
Self-awareness, self-identity, and self-feeling
3. Social Brain
Need for affection and care
Socially responsive, self-experience and motives
What happens when new brain is recruited to pursue old brain passions?
Types of Affect Regulator Systems
Content, safe, connected
Drive, excite, vitality
Non-wanting/
Affiliative focused
Incentive/resourcefocused
Safeness-kindness
Wanting, pursuing,
achieving, consuming
Soothing
Activating
Threat-focused
Protection and
Safety-seeking
Activating/inhibiting
Anger, anxiety, disgust
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Components of Compassion
WARMTH
WARMTH
WARMTH
WARMTH
Adapted from Gilbert (2009)11
Compassionate Mind – Alleviation
ALLEVIATION
Warmth
Imagery
ATTRIBUTES
Attention
Sympathy
Sensitivity
Care for
wellbeing
Feeling
Warmth
Warmth
Compassion
Non-Judgement
Reasoning
Distress
tolerance
Empathy
Behaviour
Sensory
Warmth
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The Search for
Compassion
Serious
Untoward
Incidents
Quality
Visits
Centre for
Compassion
Compassion
Training
Coaching
Compassion
Metrics
Compassion
Focussed Therapy
Research
and
Development
13
Compassion Training
Compassion training has been split into levels
1.
2.
3.
4.
1 hour basic awareness training for non leads.
1 day training for lead staff.
3 day introduction to compassion focussed therapy.
36 week Post Graduate Certificate with Derby
University.
Training has been conducted in a compassionate way with
flexibility to allow staff to attend. The training content has
been guided by Professor Paul Gilbert and Dr Rayner.
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Compassion Pathway Training
• Compassion awareness training delivered to a whole care
pathway including:
a) Acute inpatient ward
b) Crisis Resolution and Home Treatment Team
c) Outpatients accident and emergency liaison service
d) Occupational Therapy and Recreation
e) Hotel and Reception Staff
f) Locality Pathfinder and Recovery Service.
• 95% success rate in terms of delivery.
• Positive feedback confirmed that it achieved the stimulation
of interest, encouraging people to attend further training:
‘Well structured, enlightening and very thought provoking’
‘feel like I want to learn more, need more information’
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Compassion into Practice
Melbourne House is a 10 bedded rehabilitation gender specific service for
women with complex mental health needs. Primarily it is designed to
provide a transitional step between secure and community based services.
• The Trust has taken a whole service approach.
• Two staff are undertaking the 36 week course with plans for a further
two.
• Training delivery will include:
a) Coping strategies and surviving stressful environments to all staff.
b) Professor Paul Gilbert to provide monthly supervision sessions to
staff.
c) The compassion trained staff will provide awareness training to
existing staff and as part of inductions for new staff.
d) Staff will undertake regular de briefs to discuss feelings and concerns.
e) Networking with Cygnet who are using a similar approach.
f) All staff will have access to the psychologist at Melbourne House.
g) Pre and post assessments will be undertaken to assess the benefits of
this approach.
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Serious
Untoward
Incidents
The Search for
Compassion
Quality
Visits
Centre for
Compassion
Compassion Training
Coaching
Compassion
Metrics
Compassion
Focussed Therapy
Research
and
Development
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Serious Untoward Incidents
• Traditional approach
• Compassionate approach
• What we did differently
a)
Reduce anxiety/ threat
b)
Stimulate green thinking
c)
Start with the team description and reflection
d)
Share findings with the team
e)
Co-produce conclusions and recommendations.
• Advantages
• Disadvantages
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The Two Psychologies of Compassion
Compassion can be defined in many ways:
As a sensitivity to the suffering of self and others
with a deep commitment to try to relieve and
prevent it
Two different Psychologies
– To approach, understand and (how to)
engage with suffering
– To work to alleviate and prevent suffering nurturing
Each more complex that might at first seem
Types of Affect Regulator Systems
Content, safe, connected
Drive, excite, vitality
Non-wanting/
Affiliative focused
Incentive/resourcefocused
Safeness-kindness
Wanting, pursuing,
achieving, consuming
Soothing
Activating
Threat-focused
Protection and
Safety-seeking
Activating/inhibiting
Anger, anxiety, disgust
Threat and Compassion
Suicide investigations are, by their nature
threatening and therefore will stimulate threatb a sed emotions a n d ways of p ro cessin g
information –mostly defensively
Compassion-based investigations understand the
nature of this threat, seek to contain the threat
and be mutually supportive to all involved and
collaborative, with attention to non-verbal
communication and the intention of creating nonpersecutory, open and supportive learning
Threat vs Compassion investigations
Threat-based
Desire to fault find
Top-down –fear of down rank
attacks criticisms
Desire to punish and condemn
Backward looking –blaming and
shaming
Emotions are anxiety, fear anger,
frustration contempt.
Threat-based minds give rise to
threat-based solutions –mostly
avoidance of harm and threat
Compassion based
Desire to understand and recognise
suffering in all ( staff and family)
Collaborative, genuine exploration
–bottom-up and shared solutions
Desire to become one’s best – open
to/learning from one’s mistakes
Shared learning and support for
improvement
Emotions are regret, sorrow,
sadness
Compassion-based minds are open
to suffering and struggle, openness
to difficulties and building
mutually supportive systems
Shame
Guilt
Rank Mentality
Caring mentality
Attention is on damage to self and
reputation (inward)
Attention is on hurt caused to the
other (outward)
Feelings are of anxiety paralysis
confusion emptiness - self-directed
anger
Feelings are ones of sorrow
sadness and remorse
Thoughts focused on negative
judgments of the ‘whole self’
Behaviours focused on submissive
appeasement, escape, apologetic
denial, avoidant displacement,
self-harm
Thoughts focused on the other,
sympathy and empathy. Focus on
behaviour – what one did
Behaviours focused on genuine
apologies, reparation, making
amends
Serious
Untoward
Incidents
Quality
Visits
The Search for
Compassion
Centre for
Compassion
Compassion Training
Coaching
Compassion
Metrics
Compassion
Focussed Therapy
Research
and
Development
24
Quality Visit Programme
Drive, excite, vitality
Content, safe, connected
• Teams are in
control
• Teams are
connected to their
topic
• Allows teams to
promote what
they do well
• Supports them to
improve
• Rewarding
• Ward to Board
• The visitors go to the
teams
• Visits are facilitative
with a problems
solving element.
Anger, anxiety, disgust
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QUALITY VISITS
All teams are visited in each season by teams of 2-4 people comprising
Executive Directors, Non-Executive Directors, Heads of Service,
Divisional Nurses, Trust Governors, Commissioners and the Coroner.
• In the paper presented to the Trust Board in October 2010, 8 expected benefits
from the quality visits were set out.
• The Trust is now in season 4 of the Quality Visit Programme.
• Each season has had a common theme.
Season 1- Dignity, Season 2- Staff and Patient Safety, Season 3- Patient
engagement, Season 4- The Trust Values
4. Increased
sharing of best
practice and
learning lessons
2. Improved
Outcomes for
Patients
1. Increased
Staff Morale
and Staff
Satisfaction
3. Increase in
use of
innovation
8. Increased
embedding of
Quality as the
Trust’s
organising
principle
6. Increased
visibility of
senior
management
5. Increased
patient and
carer
engagement
7. Increased
Board
awareness of
service delivery
to inform
decision making
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For each season we have sought the views of
the teams:
1. What they considered to be good about the quality visits in the
previous season.
2. What they would like removing from the Quality Visits for the coming
season.
3. Any other suggestions for changes for the coming season.
4. What should be the common theme for the next season? Teams
choose the theme and are given a free reign on how they
demonstrate this in their practice.
5. Any other suggestions for the coming season.
6. Their views of what the external viewpoint in the previous season
brought to the visits ( eg. Trust Governors, Non-Executive Directors,
Commissioners, the Coroner).
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Team results across seasons 1-3
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Serious
Untoward
Incidents
The Search for
Compassion
Quality
Visits
Centre for
Compassion
Compassion Training
Coaching
Compassion
Metrics
Compassion
Focussed Therapy
Research
and
Development
29
Structure for Compassion
How It Supports
Trust Strategic
Direction
Research
Audit
External
Internal
Training
Patient Experience
Outcome
Clinical
Development
Centre of Compassion
Comms
(Aim, Who, Where, Plan
How to contact and be
involved
Structure
Clinical
Director
Head
Board
Fellows
Admin
Reporting to:
Clinical
Cabinet
Governance Board
Physical
Identify
Verbal/Read
K
E
Y
Outcomes
Enablers
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Centre for Compassion
• Not a physical centre but a Hub.
• A team of people working to progress compassion and compassion
focussed interventions.
• The service is available to all staff.
• It will support and help staff to participate in research into practice,
practice-based evidence and evidence based practice in compassion
and compassion focussed intervention.
• The centre structure consists of:
a)
b)
c)
d)
e)
f)
g)
h)
Clinical Director
Clinical academic Director Lead
Head of the Centre
Clinical Experts
Service user representatives
Research and Clinical audit representatives
University of Derby programme leads
Administrators
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Serious
Untoward
Incidents
The Search for
Compassion
Quality
Visits
Centre for
Compassion
Compassion Training
Coaching
Compassion
Metrics
Compassion
Focussed Therapy
Research
and
Development
32
A combination of Co-active coaching and CFT
Ingredients:
1. Co-active Coaching
2. Compassion Focused
Theory
3. Jacob L Moreno
Incentive/resourcefocused
Wanting, pursuing,
achieving, consuming
Affiliative focused
LISTENING
Soothing
Activating
CURIOSITY
Directions:
1. Blend together
2. Add a dash of Jacob L
Moreno to complete
the mixture.
Safeness-kindness
INTUITION
SELFMANAGEMENT
ACTION
LEARNING
Threat-focused
Protection and
Safety-seeking
Activating/inhibiting
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Serious
Untoward
Incidents
The Search for
Compassion
Quality
Visits
Centre for
Compassion
Compassion Training
Coaching
Compassion
Metrics
Compassion
Focussed Therapy
Research
and
Development
34
Compassion Metrics
• It is critical that the compassion metrics capture the “felt sense”.
• Compassion metrics add extra layers to existing systems and
processes.
• They are part of a collaborative approach, which is represented by an
agreed view based on a panel decision.
• The compassion metrics help to close the gap between targets and
perception.
• Compassion will be measured against the 6 attributes in the following
4 domains of the organisation:
1.
2.
3.
4.
Clinical Patient Outcomes
Management and Leadership Outcomes
Environment outcomes
Staff relationship outcomes.
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Compassion Circle 3 variations
Attributes
Self Compassion
Compassion to
others
Compassion from
others
1. Sensitivity
I notice when I am
distressed
I would notice that the
person was distressed
The person noticed when I
was distressed
2. Sympathy
I have a sense of wishing
to help myself when I am
distressed
I would feel moved to help
the person
I felt that the person was
genuinely moved and
wished to care for me.
3. Non-judgmental
I accept, rather than judge
myself, when I am
distressed.
I would accept the person
in their distress
The person accepted rather
than judged me.
4. Empathy
I am able to makes sense
of my feelings
The person’s feelings
would make sense to me
I felt that the person
understood my feelings.
5. Distress Tolerance
I am able to tolerate my
distress.
I would be able to tolerate
being with the person
The person was able to
tolerate my distress.
6. Well-being
I actively invest in my own
well-being
The person’s well-being
would be important to
me.
The person was clearly
concerned about my wellbeing.
Ref: Professor Paul Gilbert, The Compassionate Mind.
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Compassion Metrics
10
9
6. Well-being
8
1. Sensitivity
7
6
5
4
3
2
1
5. Distress Tolerance
2. Sympathy
1
2
3
4
5
6
4. Empathy
7
3. Non-judgmental
8
9
10
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Serious
Untoward
Incidents
The Search for
Compassion
Quality
Visits
Centre for
Compassion
Compassion Training
Coaching
Compassion
Metrics
Compassion
Focussed Therapy
Research and
Development
38
Research and Development- Useful links.
The Centre for Research and Development:
The Centre for Compassion:
The Trust Values:
The links for all the above can be found on Twitter:
@Paul_Lumsdon
The Centre for Research & Development
Ashbourne Centre
Kingsway Site
Derby
DE22 3LZ.
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Next Steps
• Grow the model, train the whole Trust.
• Dynamic DVD resource created to improve the flexibility of
learning.
• Compassion in everything we do- Care Quality Commission
visit.
• Further Develop research into clinical application, management
application and environmental application.
• Networking and working with partners in other organisations.
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