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Dementia – what is it? by @dtbarron

November 25, 2014


Fear, shock and denial

Dementia, rather like the word cancer, can often stir negative emotions. There can be an element of fear, shock and/or denial when we think about it, the overwhelming thought of losing one’s identity or the impact on someone close to us can create a rising sense of panic. Despite this reaction, the term itself is not well understood. DementiaAlthough it is true to say that dementia will often be an irreversible, progressive and life long condition – that is, once you’ve got it you will always have it, it does not need to be a life limiting condition in the early stages, nor for that matter for some considerable time in most types of dementia.

In short, the earlier a diagnosis is made the better opportunity that exists to slow the progression of some dementias – medication has an important role to play in slowing down…

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Leadership in a digital world by @dtbarron

November 19, 2014


Over the past few weeks, because of various activities I’ve been involved in, I have been considering leadership within a digital environment, specifically related to social media. derek1

Instantly two questions spring to mind 1) what do I mean by leadership? and 2) what is social media?


Malby in 1997 described leadership as “an interpersonal relationship of influence, the product of personal character rather than mere occupation of managerial positions”.   Bennis and Nanus add to this by described leadership as ‘influencing and guiding’ as having a ‘future focus’, a ‘vision for the future’ while remaining in the present.

The key aspects that interest me in relation to digital and social media leadership is the ‘interpersonal relationship’ and ‘influencing/guiding’ components of these descriptions.  To me they are key in my own engagement with social media, my own role as a leader.

Social Media

So, what is social media – it’s those…

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Healthcare and social media, a shared infographic

August 4, 2013


I’ve been blogging for slightly over a year now.  I started Ayrshirehealth ( on 1st June 2012, the initial plan was to gather a few colleagues together to share opinion, challenges and opportunities.  The opportunity to network has been outstanding, people willing to share their thoughts, people making comments on the blog, as well as a truly international readership.

On a few occasions I’ve been contacted by people asking to re-blog information as well as people asking to submit blogs to be posted.  infographic 1Recently however I was contacted by Aldo Baker regarding the infographic his team were promoting on social media and the healthcare industry – the offer allowed me to use the infographic on Ayrshirehealth blog.  With that blog being subscribed up until November we agreed to post it on my personal (this) site.

The infographic looks at healthcare and social media – who is using it, why they are using it.  It provides an interesting and useful insight, as well as a challenge to each of is to consider how we use social media, personally and professionally.

Infographics are an increasingly popular route to share information for magazines, websites and via social media.  They communicate information (frequently statistical) in an accessible way, which increases their utility for sharing via social media.  They appeal because they engage our audience, they promote an understanding of the information we want to share and they help people to remember (and recall) the information we are sharing or the points we are making.  This infographic ticks those boxes.

 Depth of exploration

One potential pitfall of infographics however can be their ‘thin’ content.  while colourful imagery and clearly displayed figures make it easier to use and digest important information, it lacks the depth of exploration underpinning the statistics.  infographic 2That said however for engaging readers in ‘opinion’ or challenging their preconceptions Infographics work extremely well,  in addition to encouraging readers to consider the message for relevance, more quickly than a block of text.

For me it was certainly true of the infographic presented.  As a ‘picture’ to both inform and challenge it hit the mark head on.  Had you considered how people were using social media in relation to their healthcare information needs, before viewing this?

Infographics can be criticised in several ways – are there facts are accurate  do the graphics obscure inconsistencies and errors in research.  Do the aesthetics make an argument look more persuasive than it actually is.

One way to overcome this is to invite comment (on this site or the source site ).  To my mind challenging thinking, opening up dialogue and our minds to options is certainly a positive step worth taking.

Easily shared

Infographics can allow us to grab the attention of people who are being distracted by other signals (too busy, to much to do etc), it helps us make quick visual connection to what we want them to ‘listen to’.  Of course for those wanting to ensure a wide spread sharing of their message an infographic work well as it can be easily shared across social networks.  infographic 3At the head of the infographic there is a clear introduction to its relevance to us working in healthcare – our ‘populations’ are using social media to seek information, to share information and to explore options.  A health service that truly wants to listen to the people it services needs to engage with social media in a meaningful way.

infographic 4

This part of the infographic shows how some of the ways social media is being used by healthcare professionals as a way to listen, to share opinion, to guide others and provide information effectively across a potentially vast audience.

I recently did two short introductions to social media (mainly Twitter) – this infographic would have helped convey the message perhaps more succinctly than the presentations I actually used.

Leading by example

Those of us not based in the States may be wondering why this infographic is of relevance to use, after all the stats, the examples given are all American.
infographic - MayoHowever when considering this I looked at who was using social media to engage (e.g The Mayo Clinic) and concluded, if they are using it there has to be merit in it, after all we frequently adopt learning, innovation and technology coming out from such centres of excellence, albeit it a few years later.

Adopting and engaging in social media within and across healthcare doesn’t need to be something we come to years later, it’s here now, it’s available and it has the potential to show we are serious about listening, sharing and engaging with our population in a way they want to engage, not simply via the channels we want them to use.

It is undeniable that social media is changing healthcare and communication about healthcare – the question is one of us face personally and professionally, that our organisations face is: where do we want to be in the curve?


I highly recommend that you visit the source site of this infographic to see it in its ‘end to end’ format i.e. the way it is designed to be viewed follow this link

I’d like to thanks Aldo and the team for sharing this infographic and allowing me to use it.

Who would you rather be?

June 25, 2013

Decisions at 16,000′

It’s been a month or so since I’ve blogged, primarily due to workload as I’ve taken on a new, interim role in NHS Orkney, as explained in my last blog. Flight 4 - AberfoyleThere’s been a couple of blog idea bubbling around in my head that I’ve wanted to share, but never quite put ‘pen to paper’ (or should that be fingers to keyboard?). Even as I write this I’m not sure whether to write about an idea I discussed with @docherty_e this morning as we sat in Glasgow Airport, or to write about the ‘difference’ – a blog I’ve already started. The ‘difference’ relates to my role as an executive member of an NHS Board and what is different to the role I perform in my substantive post as an Associate Nurse Director.

As I write this I’m at 16,000 feet looking out of the window at Aberfoyle far below, it’s decision time!

The decision – customer care

This morning I arrived at Glasgow Airport at 09.30hrs for my flight to Kirkwall, 90 minutes early: LoganAir check-in had four operators on duty and approximately 10 – 12 people in the queue (so not overly busy), having reached the front of the queue I moved forward when requested – “where are you flying to”. No good morning, no how are you today – “ID”“have you got any of these items in your hand luggage?” All this while looking down at her screen – efficient and getting through the work! I asked if it was possible to get two seat together, for my colleague and I – we usually use this time to discuss the week ahead, areas that need addressed and basically as an extension of the working day – “your seat’s already allocated” pause “and Mr Docherty has already check in.” Hmm, the text I got from him 20 seconds earlier said he was waiting for his transfer bus at the off-site car park, of course he might be wrong and didn’t know nowhere he was!! I didn’t venture an opinion.

Let me look and see

I compared this to two other events, one last week and another one this morning.

  1. At one of the other desks an older couple were progressing rather slowly with the process of finding their photographic ID, the check-in operator didn’t rush them, however she also processed another passenger, via a side door, who was in the priority queue, while never losing focus on the older couple in from of her. The priority passenger was dealt with quickly and efficiently, he appreciated the extra attention he had received, the older couple were not rushed or made to feel they were a bother.
  2. Last week, arriving at check-in there was a fairly large queue (for LoganAir) of around 30 to 40 people. I arrived at the head of the queue and was called forward “good morning sir, where are you travelling to today”“do you have your photographic ID please”“on the front of the desk there is a chart, do you have any of those items in your hand luggage?” I asked if it would be possible to have a seat beside my colleague – “let me look and see what I can do, is he here at the minute?” “no problem sir, I can give you seat 12C & D, I’ve just allocated that for Mr Docherty when he arrives”.

Not doing wrong might not be enough

Today’s flight is 75% full, last week it was 100% full and check-in was three times busier, which left me wondering – what was the difference? PlaneThese three employees of Loganair each displayed different aspects of customer care. All three of them did their job, they were efficient and effective, they each carried out their duties safely, yet for one the person-centred, caring perspective was missed completely. It made me reflect on how we deliver healthcare on a day to day basis. My current area of responsibility spans nursing, midwifery and allied health professions – as I sat in the airport I wondered how many of our team today would be like last week’s check-in operator or the one on the ‘priority’ desk? How many will get though their workload today in an efficient manner, but never actually look at or consider the person in front of them? Which one do you aspire to be – are you efficient and effective, do you carry out your role as a task, or do you care about making it the best experience the person in front of you can have.

Feeling valued

Flight 4 - OrkneyOrkney 1The check-in person this morning did nothing wrong, however I didn’t leave that check-in desk feeling important or valued – the outcome will still be the same, I’ll get to Orkney just after lunch time …………

………………. but I know which one I hope will be on duty next week when I arrive at the airport.

Will your patient’s look forward to seeing you at their next clinic or home appointment or the next time they are in your ward?

Will it be an experience characterised by care and compassion or will it simply be an efficient experience?

Leading in a new environment

April 23, 2013

Begin with the end in mind

I recently was given the opportunity to work in an other health board area in a senior leadership role.  It was easy to understand this role as a leadership one as the post directly managed only a handful of staff, and yet it’s impact should be felt on the greatest number of staff working in the Board.  Leadership 1What was less easy was to understand what impact I could have in only three months (the length of my secondment); for me the important aspect of this dovetails with my last blog and my re acquaintance with Covey – Begin with the end in mind.

What was the end I had in mind, what did the Chief Executive have in mind and what would the individuals within the teams I would be working with have in mind.

Week one was hectic, there were people keen to meet me (which was nice), meetings that had to be attended, papers that had to be read.  The Chief Executive drafted my objectives for the three months secondment (based on our conversations), and I was all set.  However, my role as a leader demands more than what can be captured in a set of objectives.

If you don’t know where you are ..

In some ways the opportunity I’ve been given is to support others as they travel towards their destination – that’s a privilege and a responsibility.  That said however, this involves individuals and teams knowing where they want to be, the destination, the shared vision.  It involves ‘starting with the end in mind’ – what is the passion of the individual clinicians (as its mainly with clinicians I’ll be working), what do they truly want to deliver every day they come to work?   Are each one of us focussed on the individual in front of us, the next person who will walk through the door.  VisionFor each of us, it’s important to have a vision, to understand our personal/professional values, to understand our impact.

While I am a great believer in having a vision, an understanding of where you want to be, it is also important to know where you are.  If you don’t know where you are, how do you know which way to go?  Think of it as a road map.  You might know the destination but without a starting point you are unable to determine the direction you need to head, where should that first step fall.  Once we have accept where we are, good and bad, we can determine the steps needed to achieve our goal.

Pushing down or pulling up

Booker Washington said “There are two ways of exerting one’s strength: one is pushing down, the other is pulling up”.  Leadership isn’t about pushing others down, it’s about pulling them up.

I recently read a blog by Todd Neilson about Leaders in ‘beta’ being a mixture of ambition with humility (beta refers to the IT term of things being in testing stage).  He noted that it was ok for leaders not to know everything, this reminded me of Hawkins and Smith four stages of leadership  – experimentation, the leader needs to understanding that it is ok not to know everything.  Stage two starts with accepting that as a leader you are always in beta mode, always learning always testing.  Leadership 2As you put that testing, learning and self reflection into action the next stage is evidenced by experience accumulation, you start to gain confidence in putting into actions the things you have learnt.  Full leadership is more difficult to achieve, but people who have moved into this phase are obvious by their actions, they focus less on what they can get out of a situation and more on what they can put in, the outputs are more important than their person accolades.  Their motivation is ‘what is the difference I want to make’, Covey described this as one of his four basic needs- To Live, To Love, To Learn, to Leave a Legacy: not the legacy of  self serving obsession of fame, but rather the difference that the leader supports others to achieve, even when they are no longer there. Hawkins and Smith describe Eldership as the final stage in the development of a leader, many do not get there.  The feature of this leadership stage is a detachment from the difference the leader can make and a focus on what has to be done, creating an environment for others to achieve.  In this respect it follows a similar theme to Greenleaf’s concept of Servant Leadership. The perspective of:

  • – caring for others
  • – being mentor minded
  • – having the passion to develop others
  • – being the compassionate collaborator

There have been few times in my personal leadership journey when I can reflect with any certainty where I am in relation to the stages described.  Leadership 3However I am confident that my role, over the next three months, is not about me, it’s about creating the environment for others, it absolutely isn’t about pushing others down, it’s about pulling them up.

This role I’m in is about Eldership, it about supporting others to ‘be all they can be’, to help set their path for the future.

It’s about finding leaders, but it’s also about finding followers – concepts that are not mutually exclusive, although the wisdom to know when, to be which at what point, can in many circumstances be elusive.

Whatever else, I’m looking forward to working with many new colleagues.

Leaders – where ‘why’ meets understanding

April 9, 2013

Sharpen the saw

A couple of unrelated (in space and time) but interesting things happened last week, firstly my daughter took a feng-shui approach to one of the rooms in her flat – to be honest, I’m sure this was more accurately described as picking things off the floor: however let’s not be unkind. For the purposes of this blog the relevance lies in her discovery.  Covey2As she tidied her academic books and related resources she came across a manual she had been given and used on a course she attended – Covey’s Seven Habits of Highly Effective People.

The opportunity to ‘sharpen the saw’ had presented itself to me and I wasn’t about to pass on it.  Over the next two days I read the handbook, alongside my own copy of Covey’s book, which provided a more in depth explanation.

There was an unmistakable relevance and challenge for me in Covey’s work as I reflected on my impact and influence as a leader :

  • was I always ‘proactive? (habit 1),
  • did I always ‘start with the end in mind’? (habit 2),
  • did I ‘always put first things first’? (habit 3).

After some self review I think I’m pretty good with habit 2, I use this as a guide in my day to day work, it has a synergy with my belief in having a vision and working diligently and enthusiastically towards it.  As a leader having a vision is critical, without it how can you expect anyone to follow you?  Perhaps more accurately how can you truly expect high calibre followers to follow you – people who will challenge you, who will rise to your challenges, who have as their driving principle ‘excellence’?  A leader without followers …..?

Quadrants of activity

Covey quadrants2On the whiteboard in my office I have Covey’s four quadrants of activity as a frequent and ongoing reminder to engage with habits 3 – put first things first.  The diagram has been there for some time, and, rather like the habit itself it would benefit from being rewritten and refreshed – an early task I set myself for Monday (yesterday) morning.

When considering my activities I aim to keep them above the line, when I don’t manage to achieve that I know I’m not always putting first things first and that pro-activity is perhaps slipping a little.

Post Interview feedback

However this blog isn’t simply about a refreshed encounter with Covey, it’s also about the second ‘event’ I referred to in the opening paragraph.  It’s relates to a meeting with a new and emerging leader and one specific aspect of the conversation.  The meeting was focused on post interview feedback – an activity I highly commend to everyone, whether successful or unsuccessful in a job interview.  Indeed those that are successful at job interview quite possibly have as much to gain from this feedback as those that were not, it’s an area we would do well to consider in terms of staff development and supporting people into new posts.  However, I digress.

During the conversation I was asked about one of the questions that I had posed at interview “what would you do on day one, if you were successful today?”.  What was I looking for with that question, what answer was I expecting?

Seek first to understand

The simple answer is I wasn’t looking for a specific answer, it was a people question, I was trying to understand if the candidates had considered a future where they would be in that position, did they have a vision to share.  If a candidate hasn’t consider what success might look and feel like, are they really in a strong position to influence an interview panel that they are right for the job?  I know people will grow into a job, that people take time to develop and mature, but day one is also an important day, it can set your path for the future.

The second thing I was perhaps expecting (but also hoping to avoid) from that question was the rather clichéd ‘I’ll listen to people, hear what they have to say etc etc’. Of course listening is extremely important, we all need to practice it more, however I expect successful candidates to have an understanding of the role they are about to take on, as well as an understanding of what they are going to contribute to the role and, importantly, to be able to share that with their new team.  This brings me to the dichotomy inherent in Covey’s fifth habit ‘seek first to understand, then to be understood”

Golden Circle

Golden Circle

As a new leader people will be looking for an indication of what impact the change is going to have on them, what will this mean for the services they provide.  A new leader simply saying ‘Im going to listen’ is a disappointment for teams.

Day one is an opportunity to share the vision, Sinek in his Tedtalk (and his book) talks about the Golden Circle – Why, How, What – day one is a day to involve teams in the ‘why’, it’s an opportunity for the new leader to share their ‘why’, it’s an opportunity to inspire.

The ‘how’ is where listening comes in, we all need to listen to team members, we all need to feel we’ve been listened to.

As a new leader, or a leader of a new team, Covey isn’t encouraging us to inaction, he’s encouraging us to recognise the value in understanding your team, to get underneath their ‘why’, only then can the team move forward together with ‘how’ to address the ‘what’ that is needing done: remember however they also need to understand your ‘why’.

Strengthening the Commitments – LD nursing in Scotland

April 1, 2013

Strengthening the Commitments

This blog is a reflection on the Modernising Learning Disability Nursing conference held last week (26th March) – it also a celebration of the recent promotion of Sam Abdulla and myself: I’ll explain that in a little more detail in a moment.

Political will

Michael Matheson, Minister for Health for Public Health gave the keynote speech.  He underlined that LD nurses are fundamental to making action plan work for people in Scotland, they need to take ownership of the actions and deliver real outcomes: no-one will do it for them, but others will do it with them.  ‘Others’ in this context include people with learning disability as they are experts in the support they need.

The Minister recognised and noted that preventative and anticipatory care are central roles of LD nurses, roles he recognised from his own previous clinical experience that LD Nurses currently deliver – his challenge was to continue to develop and expand these within and across the new integrated health and social care landscape that Scotland is heading into.

Of note was when the minister said he will be taking personal interest in the action plan being taken forward. As this is the second time he has attended and spoken at events related the the LD Nursing action plan, there’s a reason to believe he may indeed be taking a personal interest.

Experts by experience

Most importantly was the demonstration of clear involvement of people with lived experience in shaping the development agenda – evident in their co-chairing the event and in the role in the programme itself through the “Co-production” steering group.  Ann, lead spokesperson for the steering group stated “we think co-production is just jargon”, the implication being, without action it’s just words.

Everyone has to engage proactively to make it a reality – Ann guided (or should that be instructed) us that whenever co-production was mentioned we all had to make the imaginary quotation mark, in mid air, with the first two fingers.  This was a visual and active physical reminder to us all that “co-production” is only a reality when we act upon it and engage with it.

A more organic approach

In my career I have organised a number of conference, ranging from 50 delegates to 800.  I’m a ‘little’ controlling at these events (ok, that’s probably a massive understatement), I always have presentations preloaded, always have them tested and always have backed up.

On one slightly extended interlude, rather than the chair person filling in with a few general observations or witticisms Ann took the microphone and sang to the audience.  She was never going to win the Voice or the X-Factor (she was far to good for that) her song was heartfelt and just so real, something her dad had taught her many years before.  To me, it underlined that “co-production” meant ownership in all aspects, including filling in a gap in conference proceedings.  I’m glad they had to change the computers, I would have missed Ann’s song otherwise, and would have been the poorer for it.

I can’t promise I’ll be less controlling, but it’s made me reflect on the value of allowing a more organic approach to prevail.


Dr Colette Ferguson from NHS Education for Scotland the launched two important documents which underpin the Action Plan. These documents are the roadmap for education in LD nursing I’ve the next few years.

screen-capture-1The pre-registration framework lays out the knowledge and skills that are required from our undergraduates in order that they progress to registration. The document captures the vision and values of the Learning Disability Nurse, it is the Sat-Nav for future registrants, without which they will not reach their destination armed with the necessary skills, knowledge and attributes.

screen-capture-2The second document, the career and development framework, rather than being a roadmap, is more akin to an architects drawings.  Each aspect is interrelated and each linking together, building on what went before to create the whole building.  It is perhaps a little disappointing that more nurses (not just LD nurses) do not build their careers around the four pillars of practice:

  • Clinical practice
  • Education and teaching
  • Leadership
  • Research and development

These pillars, captured in POST REG DOC are the building blocks that have the potential to guide LD nurses from newly qualified nurses, through first first level clinical practice to advanced practice and on to nurse consultant roles.

A story of new beginnings

The final speaker at the event Professor Angela Wallace (chair of the national action group) reflected on the progress that is already evident in ‘A story of new beginnings’ – moving from foundations into delivering actions for change.  The beginning has ended, now each LD Nurse must take ownership of their own actions, they must deliver individually if they expect to deliver collectively.  The message was very clear, now is a perfect time to deliver change, innovation and quality wrapped around personcentredness.   There are too many stories of getting it wrong, it’s time to address that balance.  Angela’s observations included “LD Nurses can ‘teach’ others in the nursing family about personcentredness as it is the very essence of being an LD Nurse”.  Change and will require leadership and courage, to challenge each other for improvement, indeed to challenge ourselves to ensure personcentredness in every day services.

June Brown closed the morning reemphasising the message previous message that everyone must take ownership of their own actions and deliver individually, to deliver together.

My final thought on the event focuses on the use of Twitter.  From then outset the organisers encouraged delegates to tweet their thoughts, their observations, questions and commitments to action.  On each of the tables there was an upright card placed centrally to encourage delegates to tweet, to explain not just the #tag for the day, but also what a #tag is and how to follow the events tweets using the #tag.  Although it seems that the LD nurses at the event have been slow to pick up on Twitter, the ability to share information widely was clearly demonstrated – perhaps after this they will.

Additionally the twitter feed for the day has been #storified by @ldnursechat and can be accessed here

STCScot 1

Statistics for the event (on Twitter) can be accessed via the healthcare hash tag project, available on Symplur.  An overview of them are shown below.

I did promise to return to celebrate the joint promotion of Sam and I.  The title Heed’o’tweeting is not given out lightly, in fact we were delighted with our new responsibilities: screen-capture-3screen-capture-4

I hope you enjoy the execution of our duties captured in the Storify account above.

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