A little bit (of care) goes a long way – Cost effective means to improve patient recovery.

I have recently been on the other side of the delivery of medical capability as part of my own rehabilitation. I spent a lot of time with service personnel across all ranks who are at various stages of this patient recovery process.  During that time it became clear that, for very many of them, a feeling of being of no value to their chain of command and “forgotten” was very strong. It also seemed clear this has an impact on their recovery and whether they would return to “soldier on” or end up being medically discharged.  From these experiences I have identified some simple, inexpensive ways we, as leaders of these people, can make the patient experience better and support the rehabilitation being delivered by the Defence Medical Services to potentially reduce the medical outflow and make our personnel feel more valued.

So what has changed?

The withdrawal of large numbers of personnel from Afghanistan in 2014 meant a significant reduction in numbers of combat related, complex trauma cases.  Although we still have ground forces deployed there, and in Iraq, the numbers of casualties returning and the types of injuries they are returning with are less “front page of tabloids” compared to the peak of operational activity.  We all became very familiar with headline news about the care received at both the Queen Elizabeth Hospital in Birmingham and Defence Medical Rehabilitation Centre, Headley Court. It was ground-breaking, and, in some cases, patients survived previously un-survivable injuries. The support our service personnel received, both from their own units and the wider public and charities was unprecedented in recent times. During that period, we still had service personnel with non-combat related life changing injuries whether from Road Traffic Collisions, medical causes such as strokes or from incidents on exercise.  All these individuals continued to be treated alongside the more high-profile cases, they were all provided the same high standard of care by the Defence Medical Services, but they appeared in the minority compared to those with complex trauma.  

“Peace in our time” – but the broken still need fixing…

We have now entered a period of relative peace on our current operations; this means units are seeing more non-combat related injuries amongst their personnel.  Individuals with non-complex trauma or medical conditions resulting from sports injuries, workplace injuries or just from unfortunate life events.  Many of these conditions lead to chronic pain conditions and other accompanying disorders which can include depression and anxiety.  A significant amount of work has been done to recognise and manage PTSD amongst the service population and veterans. It is high profile, but it may not be the most common mental health condition and we must caution against ignoring or missing those in our command who are wounded, injured or sick.  It is not uncommon for any person who has an injury that is causing chronic uncontrolled pain to go on to develop low mood, anxiety, anger management, depression or alcohol dependency issues. All of these are detrimental to the recovery pathway and can prevent a patient engaging in their recovery.  How we look after those individuals whilst they are still in our chain of command and when they are managed through the patient recovery pathway is key in our ability to return these individuals to full fitness and retain them in service.

The Defence Medical Services, operating under JFC and the single services, provide a diverse spectrum of medical capabilities from front line emergency operational medical response through to secondary care and rehabilitation facilities.  These services provide a very high standard of care and, as seen frequently on operations, often ground-breaking clinical work.  If our injured service personnel can access that care in a timely manner and attend planned appointments that allow them to fully engage with the recovery process, then we have an excellent chance to return them to duty and retain them in service.  If, for whatever reason, they cannot or do not engage with that process then recovery is delayed or even prevented, and we risk losing potentially recoverable personnel.

World class facilities …

The new rehabilitation facility at DMRC Stanford Hall is unique to the MOD in the UK.  The value of the service it provides to our personnel is undeniable.  It is a purpose-built facility with teams of specialist staff and support personnel whose one goal is to provide a holistic rehabilitation capability.  I recently spent time there as a patient, previously having been a patient at Headley Court 8 years ago.  From this personal experience I can attest to the high standard of care and the commitment of the staff to the recovery of personnel.  This experience also exposed me to many individuals who felt let down by their chain of command and “the system”.  Their complaints were about their own units and regiments and how they hadn’t felt supported by their direct line managers and chain of command.  This was not specific to a service; one of the great things about rehabilitation is it is a great leveller – mixed courses of patients all wearing civilian sports rig who work together during the day and eat together means there is little indication of rank or service which allows for a more honest conversation.  It was during many of these conversations that it became clear that individuals felt as if their own units had forgotten about them or no longer saw any value in them.  Once they become part of the formal recovery process either through a Patient Recovery Group (PRG) or the Wounded Injured Sick Management Information System (WISMIS) then they see a change and feel better supported.  Many comments of how great an individual’s Patient Recovery Officer was being were common to hear. 

… But forgotten people?

What can units do for these individuals before they are fully enmeshed in the Patient Recovery Pathway.  Most just wanted someone to care enough to keep in touch, they wanted to feel as if their absence was felt.   They want to be remembered.  One young man who ended up on ITU for 2 weeks following an incident one weekend wasn’t visited by anyone from his unit. His girlfriend had actively engaged with the chain of command to say any of the unit and his friends would be welcomed as visitors. When he had recovered enough to speak to his friends the message had not been passed to them and, when they had asked, their chain of command told them they couldn’t because visiting hours had changed.  Others I spoke to had been ignored or actively disengaged from their departments.  When they were able to work reduced hours, they felt they were not brining value and there was little point in them trying as they weren’t really wanted. If we are to keep these individuals engaged in their recovery we need to take a little time to ensure that they still feel part of their units or departments until such a point as they enter the Patient Recovery Pathway and even, then keeping in touch is key.  Those in a position of responsibility also have an obligation to understand what the Defence Medical Services provides as part of this rehabilitation especially for newly opened units such as DMRC Stanford Hall – it is often a long way from a parent unit and the support they can provide.  Understanding how the rehabilitation process can work Is essential to be able to encourage those individuals to engage with their own recovery.  If they are engaged with their recovery, they are more likely to benefit from it and it may also help prevent some of the negative impact on an individual’s mental health. Many in the recovery process have had some impact on their mental health, not PTSD type diagnosis, but issues with living with chronic pain, loss of ability to manage normal daily living activities or their job. 

The challenge for leaders

So what can we do as leaders at all levels for our people? We are good at process, making sure we have systems in place to monitor and progress our personnel through a pathway, they fill in the forms, they tick the boxes and go on the recovery courses but for many of our service personnel it is the direct, personal touch that makes the difference to them.  A simple telephone call or home visit, someone reaching out to check on their progress, a boss that understands that because they are in chronic pain it may make them frustrated, angry, tired, emotional.  They want to still bring value even though they are downgraded. The chef with the NFCI to his foot doesn’t’ want to be put on a task where he has to stand in the cold store; the leading hand with chronic pain and fatigue issue may need some adaptations to the workspace and a space to have proper breaks in the workplace; the private who suddenly becomes sullen and aggressive may be struggling to manage every day with little sleep and unrelieved pain from his shoulder injury.  A little extra value added to our care and welfare of our personnel, understanding the impact of a condition on someone, compassion and empathy – all these things can be done with little cost except time and the right attitude. This is not about the welfare officer being tasked to visit once a week, this about all of us, as individuals, caring a little more for those under our chain of command.  We need to show our service personnel that they are valued and bring meaning to keep them engaged in their recovery pathway at what can be an exceptionally hard time.