The modern medical conundrum

Posted by Shane Carmichael in Change, Medical Regulation on September 29, 2011

“The observation that the provision of dignified care is ‘not rocket science’ is one that is frequently made and at the level of individual interactions or personal care this may well be true…However, the reasons why this does not always happen are complex and multi-layered and they cannot be addressed by imploring one occupational group, to care more. Instead, it requires action at all levels of the NHS and by every member of staff, from the chief executive to the porter. Another set of guidelines or ‘dos and don’ts’ will do little to rectify the situation as these already exist in abundance”

Dignity in Practice: An exploration of the care of older adults in acute NHS Trusts (June 2011)

“Here then is our situation at the start of the 21st Century: We have accumulated stupendous know how. We have put it in the hands of some of the most highly trained, highly skilled and hardworking people in our society. And with it, they have have indeed accomplished extraordinary things. Nonetheless, that know-how is often unmanageable. Avoidable failures are common and persistent, not to mention demoralizing and frustrating, across many fields – from medicine to finance, business to government. And the reason is increasingly evident: the volume and complexity of what we know has exceeded our individual ability to deliver its benefits correctly, safely or reliably. Knowledge has both saved us and burdened us”.

The Checklist Manifesto: How to get things right (Atul Gawande, 2010)

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A street. Celebrating a multitude of stories

Posted by Shane Carmichael in Lambeth, Life, Northern Ireland on September 20, 2011

Last Sunday, we held our third annual Sudbourne Road Street Party. As ever it was a personal, neighbourly and community affirmation of the simple power of human connection (http://www.shanepcarmichael.com/2010/07/the-big-lunch-2010-and-the-importance-of-social-capital).

Place and our association with it is a funny thing. The two places I tend to speak of most often are Belfast and Brixton. I’m always interested in how others respond to my stories of these two extraordinary places and how they (among others) shaped and continue to shape me.  The stereotype is of course of two troubled places; gritty, associated far too often (and always sadly) in the minds of others with division and decay (social, economic, political, economic). And yet, for those of us lucky enough to call either of these places home, that is just one story from among a multitude. And one which denies both them and us the glory of their true, complex, gritty, divided and yes, in parts decaying, selves. And in doing so the stereotype prevails, grows stronger, pushes out the possibility of another reality, an alternative narrative.

The danger, the limitations, the challenge of these “single stories” is articulated in this wonderful talk by Chimamanda Adichie: http://www.ted.com/talks/chimamanda_adichie_the_danger_of_a_single_story.html 

And last Sunday as I watched neighbours and friends come together in a simple celebration of shared place I was struck by the limitations and distorted reality of Brixton’s oft told “single story” and the possibility in the alternative story we – in a simple act of gathering to celebrate our physical communion in SW2 – were (and are) writing. As I watched friends and neighbours come and go I wondered at the multitude of stories that made last Sunday what it was and our street what it is and Brixton what it really is more often than it is not……and in doing so we too regain(ed) a kind of paradise.

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A “bucketlist” and the last of human freedoms

Posted by Shane Carmichael in Change, Life on June 10, 2011

To-do list book.

I’m conscious the last few posts have been focussed on human mortality – though I prefer to think of them as a celebration of life if you read more closely. But at the risk of distressing still further…..

You may have heard of Alice Payne. And if not then you need to: http://www.alicepyne.blogspot.com/

I tweeted (a little tearily I admit) about Alice’s inspiring (if a little heartbreaking) blog on the morning of 8th June and then again that afternoon.

And so, it transpires was everyone else. And so by this morning Alice was tweeting about how the twittersphere was making a series of wishes come true….while newspapers as far aways as Sydney were running her incredible story.

There are a few lessons in Alice’s story. One being the power of the Internet to spread news/share stories/inspire action among many. Another being of course the power of connected consciousness – when harnessed - in the service of good. But the most important is a very human one….

The most important lesson perhaps that Alice has taught us all is that we should never underestimate the ability of one person – even in the face of the most insurmountable of all human obstacles – to affect many for the greater greater good.

I doubt Alice has heard of Victor Frankl, the celebrated psychiatrist and of course, holocaust survivor. And why should she. But in his famous book: “Man’s Search for Meaning”, Frankl wrote something that I recalled as I read Alice’s blog the other morning.

Frankl wrote of the lesson he learned from simple acts of courage and humanity he observed among the devastation of the internment camps,  in the face of the most insurmountable of all human obstacles, death itself:

“Everything can be taken from a man or a woman but one thing: the last of human freedoms to choose one’s attitude in any given set of circumstances, to choose one’s own way”

In Alice, Frankl finds the modern embodiment of that sentiment. She is choosing her own way, her own – incredible – attitude in the face of her given set of circumstances.

I hope Alice completes her buckletlist. I hope she outlives her diagnosis. I hope. But whatever transpires she has served many of us in a more profound way than she might ever imagine….a 15 year old girl, writing with such gentle sadness and wonder reminding us and perhaps challenging us to ask the question….do we truly appreciate and exercise that last (and maybe the greatest) of all human freedoms….the ability to choose how we might live. Even in dying.

Alice. Thank you.

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Gil Scott-Heron (1949 – 2011)

Posted by Shane Carmichael in Change, Life, Mindfulness on June 2, 2011

Gil Scott Heron smiles while on stage in front...

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On 27th May, the celebrated ”bluesologist” Gil Scott-Heron sadly passed away, aged 62 years old, to what he might allow us to refer to – in a nod to one of his most notable works - ”The Other Side”.

Gil Scott-Heron was many things to many people: writer, composer, poet, recording artist, long time drug-addict, son of Chicago (and an ex-Celtic footballer!), resident of Harlem, father, convict, cultural critic, “voice of Black protest culture”, husband, anti-apartheid activist, friend, inspiration….to quote Chuck D, the leader of Public Enemy, speaking in The New Yorker in 2010, “You can go into Ginsberg and the Beat poets and Dylan, but Gil Scott-Heron is the manifestation of the modern word”.

I came late to Gil Scott-Heron. While aware of his early work and influence on the music and social culture of the 1970′s, I hadn’t engaged at any real level with his music. I picked up his last album, “I’m New Here” in early 2010 just after it’s release. It was a crucially important time for me personally and perhaps as a consequence of that, something in him and this album, at this moment deeply affected me. In particular the title track struck a deep chord. When you understand Gil Scott-Heron’s own life story, what he achieved and lost; what he succumbed to, suffered and ultimately overcame (however briefly in the end), the lyrics take on a genuine power and for me, at that time, a deep and important resonance. From opening with a searingly honest two line admission of personal responsibility (or at least complicity) for what we may each become,  it plays out ultimately as a celebration of and a testament to the ability to change; to redeem oneself; to renew and redefine a life, however late, in the face of any adversity; in spite of any past.

Gil Scott-Heron has come full circle in this life. And wherever he is now, I’m sure he’ll find someone to show him around. But I’ll always feel sorry that I never got a chance to express to him that while our respective challenges were, of course, very very different, he reminded a fellow seeker in this life that whatever we face, however daunting the road ahead, whatever we carry with us from the past – in an echo of the great Invictus - we can always, always, turnaround.

And so thanks, at least in part to Gil Scott-Heron, as the first hour of my 36th birthday rolls past, I truly feel that after a long long time….with a voice of reason….I am new here again. 

Gil, RIP.

I’m New Here lyrics
I did not become someone different
That I did not want to be
But I’m new here
Will you show me around

No matter how far wrong you’ve gone
You can always turn around
Met a woman in a bar
Told her I was hard to get to know
And near impossible to forget
She said i had an ego on me
The size of Texas

Well I’m new here and I forget
Does that mean big or small

No matter how far wrong you’ve gone
You can always turn around

And I’m shedding plates like a snake
And it may be crazy but I’m
the closest thing I have
To a voice of reason

Turnaround turnaround turnaround
And you may come full circle
and be new here again

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Is iníon, deirfiúr agus máthair mé

Posted by Shane Carmichael in Life on April 1, 2011

For my Mother.

On this date….still hidden among the stars.

I depart as air, I shake my white locks at the runaway sun,
I effuse my flesh in eddies, and drift it in lacy jags.
I bequeath myself to the dirt to grow from the grass I love,
If you want me again look for me under your boot-soles.
You will hardly know who I am or what I mean,
But I shall be good health to you nevertheless,
And filter and fibre your blood.
Failing to fetch me at first keep encouraged,
Missing me one place search another,
I stop somewhere waiting for you.

~ Song of Myself, LII by Walt Whitman

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Scars healed

Posted by Shane Carmichael in Life on March 13, 2011

The signature of Haruki Murakami

Image via Wikipedia

Last night I saw the much anticipated film version of Haruki Murakami‘s famous novel, “Norwegian Wood“.

Anyone familiar with the novel will probably suggest it isn’t the most obvious choice for Saturday night “entertainment” and true to the original work, while beautifully shot, it undoubtedly makes for bleak viewing. However, while watching it I was most particularly struck that it comes to cinema’s here precisely as a larger, albeit also very human, tragedy unfolds in Japan where the book and film play out and the parallels one might draw between two apparently very different stories.

For while the novel and film are dominated by the themes of unfulfilled promise, love, loss, death, regret and displacement it seemed to me that at it’s heart it is really a story of survival, of human endurance, embodied in the experience of and ultimate commitment to living of the protaganist, Watanabe.

And while the loss of so much life, in such shocking circumstances, can never be measured nor made right, it is the struggles of those left behind in today’s post earthquake Japan that I kept thinking of last night; people who’s lives, loved ones and therein very meaning for (and proof of) being has been stripped from them. The same people who are now faced with the task of recovering, rebuilding, reclaiming, reinventing, remembering, regretting, restoring….

I’ve often felt those who are left behind suffer as much – if not more – than those who have departed. And yet what is there to be said? What words can ameliorate such pain associated with the loss of one loved one, or the loss of thousands?  And as I watched the film last night and thought of those coming to terms with what has happened in Japan today, I kept running the words of F. Scott Fitzgerald over in my mind:

“One writes of scars healed, a loose parallel to the pathology of the skin, but there is no such thing in the life of an individual. There are open wounds, shrunk sometimes to the size of a pin-prick but wounds still. The marks of suffering are more comparable to the loss of a finger, or the sight of an eye. We may not miss them, either, for one minute in a year, but if we should there is nothing to be done about it”.

It seems a rather cold and unsettling contemplation and it doubtless offers little comfort to those suffering in the towns and cities of NE coastal Japan today but it goes to the very heart of what it means to be human and to inevitably experience the suffering that entails. Most importantly it reminds us that “to forget” or “try to forget” is futile and indeed to remember is exactly what we must do.

Some scars run deeper than others but they are scars nonetheless. And it is these which enable us to understand – at some level – what others experience in the face of loss and tragedy; it is what helps us to empathise; it is what reminds us to reach out, to offer ourselves in whatever way we can to those whose time it is to suffer and it is what propels us forward as individuals, as families, as communities, as countries, as a population….helps us to evolve, to learn from (and not forget) what has gone before so that we might look to and prepare for the future with greater understanding, readiness, hope and indeed, as we are reminded of the fragility of life itself: humility.

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#BigSociety Squiggles & Behaviour Change

Posted by Shane Carmichael in Change, Government on December 9, 2010

THE BIG SOCIETY letters
Image by Leo Reynoldsvia Flickr

Just over a month ago, the very excellent @davidwilcox posted another excellent piece on “Mapping the Big Society Territory” here. I recommend it to you.

So taken was I by it that I scribbled a humble response which I’ve copied below. It touches on similar points as my response to Elizabeth Moss Kanter’s blog post on “Leading Change” back in May this year.

I really need to commit to doing what I said I would and build out this model I have in my head showing a map of considerations (anchored in empirical evidence) when designing and leading a change effort. 

Anyway – thanks to David Wilcox for his piece and the chance to articulate this. It’s a bit more generalised than I’m entirely comfortable with but it was late and Mrs C was digging me in the ribs to “turn that bloody iPhone off!!”…

@davidwilcox Interesting post, squiggles and all.

Three points only and humbly submitted. 

First, although some will argue it’s “only semantics”, the point on naming convention is interesting. Any behavioural economist worth their salt will tell you that the very phrase “Big Society” is enough to disengage (or at least barely raise the inherently self interested/motivated pulse of) the general populace.  We know from years of research that even when our own very personal (e.g. Health, wealth) interests are at risk we often remain unroused to act appropriately (rationally) in the short or long term. So, when the long term aim is as impersonal, intangible and thematically vast as a “Big Society” then people won’t be roused. They’ll feel it’s “too overwhelming”, “too big for them to meaningfully contribute to”, “clearly not a pressing priority specifically for me to act on” (the latter is oft referred to as ‘the bystander effect’ in behavioural psychology) etc. It’s a similar challenge for Global Warming…So, although “Our Society” is still a little wooly (what do we think those we’d like to see more involved interpret “society” to mean do you think? I doubt many would respond positively on instinct alone..) it at least calls to the (shared) ownership instinct in each of us via “our”. Shame you didn’t mention our very own “Co-operative Society” here in Lambeth….It’s like the Big Society but re-labeled for Red Rose Authorities. Room for one of those on the diagram?  

In it’s effort to address this behavioural challenge – in part by setting up it’s own “Nudge nerve centre” (aka The Behavioural Decisions Unit) at No 10 and trying  to encourage behaviour change among the general populace from there, the Coalition appear to be overlooking the key principle of any effective change (diffusion) initiative: those in the “Early Adopter” and IN PARTICULAR those in the “Early & Late Majority” categories adopt the desired behaviours/engage fully not simply because of WHAT they see to the left of them on the diffusion model but WHO they see. And I’d suggest that those who the Government hope to engage in the Big Society (who currently aren’t) are least likely to respond to diffusion from Government/Civic Orgs and most likely to respond to diffusion from peers and role models from the “Our Society” bubble of your diagram. I hold out most hope for the Social Enterprise community but I’m not convinced alone that we’ll get to (and sustain) those hard to reach places where society of any sort – big or small – could do with a little pick-me-up.  Hence my second point – the role of the existing “Our Society” is most fundamental to this effort and why the work the RSA piloted in New Cross to understand and leverage existing social networks and influence is vital. If Tipping Point and the myriad of behavioural economic/psychology books that followed in the last decade have taught us anything, it’s that influence is not distributed evenly. And rarely are authority or establishment gifted with the large quota they might like to believe is the case.  Should all roads on your pic therefore start from “Our Society”? I’m not sure just yet but a more considered understanding of how to harness and embolden existing activists with genuine and breadth of influence across into your “BS” bubble seems like the best bet for Gov. I’ve seen little to reflect they grasp this and the meeting you describe (the inside/out or top/down model) confirms this. The call for a more “emergent” approach is a good one – and could ultimately prevail (though do we even have high level desired outcomes?) but it need not be entirely free form as I infer above if we target resources where the greatest return in diffusion can be earned.

Finally, if there is one thing that we know works more powerfully than peer pressure to encourage behaviour change, it’s loss aversion. The final, actual reality of withdrawal of local services and the gains that were previously derived from those services may ultimately be necessary to create the incentive to engage the hereto disengaged. But I’m not convinced. Given the discussion on Big Soc has largely focused on community services such as libraries, parks, leisure facilities and some non (or lightly) regulated local authority functions, I’d hazard a guess that those most likely to feel the greatest loss aversion to their withdrawal are those who are already reasonably socially active in the “Our Society” bubble. So back to point two I guess.

Longfellow once wrote: “I shot an arrow in the air, it fell to earth I know not where”. We Irish have a more optimistic take on that. As I’m often reminded: “if you don’t know where you are going, that’s where you’re sure to end up”.

I sense Cameron would prefer to locate his arrow (age of austerity etc) and I don’t think he’s a wandering Irish troubadour at heart. But without some future vision expressed in somewhat tangible outcomes for people to organise themselves around that may be his fate. At the very least the current vacuum on meaning and process was sure to open and much energy dissipated in the ensuing mudfight.

Part of me hopes for the best. Part of me fears the horse has bolted, unhoved, unsaddled and with no direction. Part of me thinks that the true discussion can only commence when we understand the gaps the big society has/will need to fill when the CSR dust settles. I know that’s not the ultimate point but it may be it’s ultimate test.

And part of me thinks he should have just published one of those “Change the World for a Fiver” books with 50 no cost ideas for contributing to the local community with a foreword which explains that research from the past fifty years suggests that levels of social connection and philanthropy are better predictors of life expectancy and mental health than most any other measure (incl alcohol and tobacco consumption). Long life and happiness you say?! Sign me up. I’ll start soon, honestly….

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What it means to live. And Die.

Posted by Shane Carmichael in Life, Mindfulness on December 7, 2010

WASHINGTON - JULY 28: Elizabeth Edwards, a se...
Image by Getty Images via @daylife

Earlier this week I tweeted a link to this piece by Joan Bakewell entitled: “Do you really want to live forever?”. I thought it was a beautiful reflection not just on the aging process, or our human mortality, but on what it really means to live; to be alive.

Sadly, I was offered another reminder of just that question this week with the untimely passing of the indomitable Elizabeth Edwards. I never met her directly but, like many, I always admired her from afar. Here was a woman who has known real pain, loss, hurt – much of it experienced in the public glare – but refused to be bowed or defined by it. A woman who kept her head held high and focused her energies, however diminished in the end, on making a positive contribution to others. Who saw her own mortality not as something to rail angrily against but as something to shape how she chose to live in the time – the finite time – granted to her; something she ultimately was grateful for.

Her final Facebook post read:

“The days of our lives, for all of us, are numbered. We know that. And yes, there are certainly times when we aren’t able to muster as much strength and patience as we would like. It’s called being human. But I have found that in the simple act of living with hope, and in the daily effort to have a positive impact in the world, the days I do have are made all the more meaningful and precious. And for that I am grateful.”

As a reflection on mortality, human imperfection, aspiration and mindfulness it is as powerful as I have read. It is a reminder and a challenge to each of us. 

And for that, we should all be grateful. 

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Dante, Frank O’Hara & this human journey

Posted by Shane Carmichael in Life, Literature & Quotations on November 10, 2010

To the Harbormaster

BY FRANK O’HARA

I wanted to be sure to reach you
though my ship was on the way it got caught
in some moorings. I am always tying up
and then deciding to depart. In storms and
at sunset, with the metallic coils of the tide
around my fathomless arms, I am unable
to understand the forms of my vanity
or I am hard alee with my Polish rudder
in my hand and the sun sinking. To
you I offer my hull and the tattered cordage
of my will. The terrible channels where
the wind drives me against the brown lips
of the reeds are not all behind me. Yet
I trust the sanity of my vessel; and
if it sinks it may well be in answer
to the reasoning of the eternal voices,
the waves which have kept me from reaching you.

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David Cameron – in the footsteps of Marco Polo

Posted by Shane Carmichael in Government, Life on November 8, 2010

Statue of Marco Polo in Hangzhou, China, near ...

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As David Cameron prepares for his two day visit to China (commencing tomorrow, Tuesday 9th November) at the head of the largest-ever official UK delegation to the country, I thought this might be a timely post.

See below for a short insight into how the 24 year travels around China by Marco Polo (as well as his lesser reported father and uncle) changed the very nature of life itself in Europe.

I wonder if DC (or we) dare expect his visit to prove just as seminal?! I’d personally doubt it though given his Bullingdon Club background, the odds on him too returning with a Mongol servant called “Peter” are probably quite short. Could make an interesting addition to the historical catalogue of PM gifts. Certainly better than a box set of 25 American films and certainly more useful around the house.

Anyway, hǎo yùn Mr Cameron.

“[Upon their return from China], the three Polos received respect from their fellow citizens, with Marco singled out for special attention. ‘All the young men went every day continuously to visit and converse with Messer Marco,’ Giambattista Ramusio claimed. ‘who was most charming and gracious, and to ask of him matters concerning Cathay (China) and the Great Khan, and he responded with so much kindness that all felt themselves to be in a certain manner indebted to him.’

“It is easy to understand why Marco attracted notice. The significance of the inventions that he brought back from China, or which he later described in hisTravels, cannot be overstated. At first, Europeans regarded these technological marvels with disbelief, but eventually they adopted them.

“Paper money, virtually unknown in the West until Marco’s return, revolutionized finance and commerce throughout the West.

“Coal, another item that had caught Marco’s attention in China, provided a new and relatively efficient source of heat to an energy-starved Europe.

“Eyeglasses (in the form of ground lenses), which some accounts say he brought back with him, became accepted as a remedy for failing eyesight. In addition, lenses gave rise to the telescope – which in turn revolutionized naval battles, since it allowed combatants to view ships at a great distance – and the microscope. Two hundred years later, Galileo used the telescope – based on the same technology – to revolutionize science and cosmology by supporting and disseminating the Copernican theory that Earth and other planets revolved around the Sun.

“Gunpowder, which the Chinese had employed for at least three centuries, revolutionized European warfare as armies exchanged their lances, swords, and crossbows for cannon, portable harquebuses, and pistols.

“Marco brought back gifts of a more personal nature as well. The golden paiza, or passport, given to him by Kublai Khan had seen him through years of travel, war, and hardship. Marco kept it still, and would to the end of his days. He also brought back a Mongol servant, whom he named Peter, a living reminder of the status he had once enjoyed in a far-off land.

“In all, it is difficult to imagine the Renaissance – or, for that matter, the modern world – without the benefit of Marco Polo’s example of cultural transmission between East and West.”

Extract taken from Laurence Bergreen‘s excellent book ”Marco Polo” (2007)

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