Growing up in an age where the England cricket team was routinely beaten by opponents Down Under I have always had a grudging respect for the Australian people. Their attitude to work, and play, seemed to strike a chord and the 18 months I spent working in an ED in Sydney merely reinforced this.
Therefore, it came as no surprise to me when I first saw this video, showing the head of the Australian Army, Lt. General David Morrison, talking directly and bluntly about his attitude to those who did not uphold the values of the organisation he leads.
This speech was in response to the actions of some soldiers allegedly producing and distributing highly inappropriate material demeaning women, across both Defence computer systems and the internet and he chose to tackle the issue head on, declaring to those he commanded that
“If you’re not up to it, find something else to do with your life.”
Although the reason for him speaking out was not something I experience in my workplace, much of what he said rang true and I realised that by replacing the word “Army” with the words “Health Service” much of it applied to us all.
There is no doubt that, perhaps despite the efforts of some in the media, the NHS and those of us privileged to work within it are still valued highly by the British people. We are a proud nation and there is nothing we can be more proud of than a health service that is free at the point of delivery, 24 hours a day, 365 days a year, treating patients regardless of socioeconomic background or ability to pay and those of us working in EM are at the forefront of this. We share a common set of values that the patient comes first and I know that we hold this close to our hearts regardless of the difficulties put in our way. To paraphrase the General,
“Our health service has been engaged in continuous operations since 1948, and in all operations, all have proven themselves worthy of the best traditions of the NHS.”
This is undoubtedly true for most, although events such as the Mid Staffs crisis prove that this is not universal and the largest challenge that this speech presents to us all is summed up in a single phrase,
“The standard that you walk past, is the standard you accept”
I know that there are times when I have not lived up to this maxim, when there is more I could have done. This can be from the very simple, ignoring litter in the hospital corridor, to the more serious. In fact, the more you think about it the harder it is to achieve. I am sure not a day goes by where I fail to uphold this in some way, but this does not stop me trying. We need to put ourselves in the place of our patients and their relatives and ask what would we expect? Idle chat about social outings and the planning of lunch breaks may help us get through the tricky times, but I am sure do not inspire confidence in those we care for.
I have even witnessed, and not done anything about, due to my own professional fear, what the General describes as the humiliation of others. Despite huge advances in recent years, I know, as I am sure you do, that there are still places where the culture is not one of inclusiveness and support, but an atmosphere of fear prevails and if I ever witness this again I know my approach will be different.
“The same goes for those who think that toughness is built on humiliating others. Every one of us is responsible for the culture and reputation of our health service and the environment in which we work. If you’ve become aware of every individual degrading another then show moral courage and take a stand against it.”
As a senior doctor in our Emergency Department I now refuse to walk by. I hold my values, and those of my ED, dear, and refuse to allow anything to threaten them. The NHS is a great institution and we are the custodians of its legacy. We too are a band of brothers and sisters. I challenge you to know the values that are important to you and more than that, I challenge you to not walk past.