Resistance is human (part 3) – Ruth Glassborow

Posted on November 18, 2019

In part three of this blog series, Ruth Glassborow continues to explore resistance to change by looking at what the research says about how to respond to resistance effectively.

Here goes:

Step One – Check your mental model

This goes back to my first blog. If you view resistance as something that an individual is doing because they are being awkward or in some other way demonstrating bad behaviour, then you are much less likely to take the time to openly explore their reasons. Instead you’ll make assumptions, or judge their personal motives. Yet effective responses are often, if not always, dependent on a good understanding of the reason for resistance.

This leads us nicely on to ….

Step Two – Understand the individual’s/group’s reasons for resisting

This goes back to my second blog; if you want people to choose to change they need to be

dissatisfied with the status quo and
believe the change being proposed is a better way of doing things and
have the ability to implement the change and
are supported by an effective leadership context.

When trying to understand why people are resistant, don’t make assumptions without actually talking to them. You might think you know what’s happening but nothing can beat sitting down and openly exploring the issues together. However, the research also identifies the risk that the individual may not know themselves why they are resisting because of what is called “hidden competing commitments”. You can read more about the reasons people resist change.

And remember, we often resist change for more than one reason.

For instance I might be happy with the status quo but alongside this I might also lack the ability to implement the change. You could address the former by getting me to listen to the poor experiences my patients are having or showing me data that says my colleagues are doing so much better than me. However, if you want me to implement the change you also need to tackle the issues around my ability to implement it. So the key message here is consider all possible forms of resistance in play, not just the first one you identify.

Step Three – Decide whether to intervene

I remember many years ago a team member saying to me “why are you paying so much attention to x when the vast majority of the team want this change? We can do this without him so please stop spending all your time on the one person who doesn’t want it and focus a bit more on the rest of us who do”. A very good point well made.

D’Herbemont and Cesar in their book ‘Managing Sensitive Projects’ propose that building a critical mass of allies who support the change is key to the success of any change project. It is not necessary to remove every opponent to change; just to build up enough support so that the positive forces for change are more powerful than the negative ones. They warn against a common mistake made by managers that they refer to as the ‘Magpie Syndrome’, an obsessive focus on opponents to the extent of forgetting one’s allies and their interests.

In my experience, it is all too easy to end up focusing too much energy on the opponents and not enough on the allies, so I’ve found the question “do I need to respond”, a useful one to ask.

In practice, ignoring the resistors and working with the willing is a proven strategy for responding to resistance. It is after all what sits behind concepts such as prototyping with a willing team.

Step Four – If you are intervening, choose an intervention which fits with your diagnosis of the reason/s for resistance

An effective response to resistance will tailor the interventions to the diagnosis. The literature on resistance to change identifies the following key principles which need to underpin this process.

Consider the possibility that the correct response is to amend the change proposal due to the validity of the concerns expressed.

The focus should be on reducing the resistance to change, rather than increasing the force for change. The risk attached to increasing the force for change is that it will result in an equal increase in the forces resisting change. Have you ever noticed yourself becoming more determined not to do something the harder someone tries to force it on you?

Don’t waste time on variables not receptive to change. As an example, trying to change an individual’s deeply held values is unlikely to achieve the desired result.

Remember that resistance is often related to more than one issue and hence your response may also need to be multifactorial to address the different issues.

Timing is important. For example, change can be resisted because of a lack of time to make the change, or an overload of organisational change, or because it is happening at a time when a key individual has a lot of change going on in their personal life. We are often given timescales to work to, which can feel very real and are usually important to work with. Indeed many change initiatives are strengthened by the “drumbeat of the change”. The complete absence of deadlines can be problematic. However, the point here is that timescales are rarely more important than the change itself. Meeting a deadline without effectively bringing about the desired change is rarely advantageous. A short delay and extension of deadline can prove far more valuable if it enables the change to take place. Those of you who, like me, have on occasion asked for extensions to essay deadlines will know this very well!

Specific Methods for Responding to Resistance

Kotter and Schlesinger (1979) developed a summary of methods for responding to resistance to change, providing a systematic way to select approaches. The original paper identifies when each of the approaches is commonly used and the advantage and disadvantages of it. Briefly the methods they highlight are:

Participation and Involvement
Education and Communication
Negotiation and Agreement
Facilitation and Support (Emotional) – providing support for coming to terms with change
Manipulation and co-optation
Explicit and implicit coercion.

Personally, I don’t recommend the last two. Having seen it first hand, whilst they may deliver in the short term, I think they build problems up longer term due to the breakdown in trust that results.

My literature review highlighted a number of other strategies :

Facilitation and Support (Practical) – providing practical support such as advice, coaching, project management resources
Training
Demonstrating how the change aligns with an individuals or groups values
Exposing the need through for instance the use of data, patient experience, process mapping, and/or peer review
Using Subject Matter Experts to highlight the need for the change
Using Small Scale Tests of Change
Making the desired state easier than the status quo
Ignoring it.

This led me to develop a revised version of Kotter and Schlesinger’s analysis .

Step Five – Review and Amend

Finally, when you are implementing change in health and social care it is rarely straightforward. Good change management requires leaders to continuously review progress and adjust as they go. In the words of James Yorke: “The most successful people are those who are good at plan B.” Or in my experience those who have a plan C, D, E, F and G!

This third blog in my series has considered what the literature says about responding effectively to resistance. In my next blog I move on to share some of what I found from interviewing GPs and Practice Managers for their views on resistance to change.

Ruth Glassborow is Director of Improvement at Healthcare Improvement Scotland.

Categories: Resistance to change blog series

Tagged: Resistance to change

Resistance is human (part 2) – Ruth Glassborow

Posted on November 11, 2019

In part 2 of this blog series, Ruth Glassborow takes a more in-depth look at some of the many different reasons why change is resisted.

In 2011, I conducted a literature analysis which identified 63 different reasons why change was resisted. Each reason can be categorised under one of the following four headings:

lack of dissatisfaction with status quo
lack of belief that proposed change is a better way of doing things
lack of ability to action the change, or
poor leadership.

My dissertation was exploring the factors which lead to change being adopted or resisted within the Scottish Primary Care context. So I looked at what the generic management literature said about resistance to change, and considered whether there were any differences in the healthcare literature.

In my analysis I also categorised the reasons why people resist change into three areas: individual reasons, issues associated with being part of a group and issues associated with the organisational set up. You can find a summary table at the end of this blog and access the full analysis.

From this analysis, what struck me was:

There are significantly more reasons associated with a lack of ability to implement change, than with the other categories
Six of the nine reasons for resisting change due to group dynamics only appeared in the healthcare literature. Perhaps group dynamics play a larger role in healthcare due to the emphasis on team working? Maybe the multi-professional nature of teams leads to a greater complexity of group dynamics impacting on resistance to change?
Issues around tangible evidence only came up in the healthcare literature. So perhaps evidence for change plays a bigger role in healthcare change than in other industries? That certainly resonates with my own experiences. It also emerged as a key issue in my interviews with colleagues in primary care. (I will share in a future blog further insights on this issue generated from my interviews with a number of GPs)
The emphasis on senior management resistance in the healthcare literature. One of the common themes I’ve found when delivering training on this topic matter has been middle managers reporting that the problem is not with their teams resisting; it is convincing the senior leadership team to support a change idea that has come forward from their teams. That raises interesting questions for all of us leaders: we are often quick to criticise our staff for their resistance to our ideas, yet how open are we to theirs?

My literature review was limited to 46 papers so it may be that a broader, more contemporary analysis would have different findings. And as I reviewed my findings for this blog, I was reminded of a word of caution from a researcher friend: a lack of evidence of something is not the same as saying there is evidence that it doesn’t exist.

However, over the years of training on the subject of resistance to change, and applying the principles within my own practice, I have found that the key messages in my analysis strongly resonate with others and have usefully helped inform my practical experience of implementing change.

I would love to hear whether these findings resonate with your experiences and also what, if anything, stands out for you. And for anyone interested to find out more, you can find a more detailed analysis of the reasons why change is resisted.

Finally, whilst it is fascinating to consider the multitude of different factors which influence whether change is resisted, I find that often it is enough to stick with the main headings and ask myself whether the group I want to influence are:

dissatisfied with the status quo and
believe the change being proposed is a better way of doing things and
have the ability to implement the change and
are supported by an effective leadership context.

So I’ve shared some of my findings on the nature of resistance, on why people tend to resist change, and how those reasons vary across different social and organisational settings. In the next instalment in this series, I look forward to sharing with you my findings from the research on how to effectively respond to resistance to change.

Ruth Glassborow is Director of Improvement at Healthcare Improvement Scotland.

Categories: Resistance to change blog series

Tagged: Resistance to change

Resistance is human (part 1) – Ruth Glassborow

Posted on November 4, 2019

In the first of a series of blogs about resistance to change, Healthcare Improvement Scotland’s Ruth Glassborow explores the very human nature of resistance. These draw from Ruth’s extensive change management experience and a dissertation she completed back in 2008 entitled ‘Understanding why change is resisted in primary care’.

In a landscape that seems to be continually changing, it is probably not surprising that so much time is spent talking about how we can “overcome resistance”. Yet in my view those two words are both overused and unhelpful.

Why?

Because they communicate a belief that those resisting the change are wrong and that we need to find a way to force them to accept the thing we want them to do. Further, all too often this is underpinned by a pressure on those with lesser power to conform to changes thought up by those with greater power.

Over the years I’ve run many training courses on resistance to change. I wish I’d had the foresight to keep and analyse the outputs of those sessions. By now they would have contained a rich source of evidence that even the phrase “resistance to change” is one that immediately conjures up negative words in the participants’ minds such as “stuck in the muds”, “vested interests” and “hard work”.

“We need individuals working in our health and care system who have the courage to challenge changes that they believe will make care worse. That kind of resistance is to be celebrated and responded to by openly exploring and discussing their concerns.”

Yet when I ask individuals in the room to reflect on the emotions they experience when they think about the resistance movement in World War 2 you can literally feel the atmosphere changing. In this scenario “resisting change” was an act of enormous courage and sacrifice and so clearly the right thing to do.

For me this makes the vital point that not all change is good. And, to individualise it for a moment, that includes some of the ideas that I’ve come up with and, dare I say, some of the ideas that you’ve come up with.

This means we need individuals working in our health and care system who have the courage to challenge changes that they believe will make care worse. That kind of resistance is to be celebrated and responded to by openly exploring and discussing their concerns. After all, if the idea is a good one then it has nothing to fear from such questioning.

Sometimes, when we explore the concerns, we find that the person is resisting because they are placing their own individual needs above the greater good of our populations. Yet, in my experience, more often you will find they have a genuine belief that the change will have negative consequences for those using their services.

They may be right or they may be wrong, but surely the onus is on all of us leading change to explore and better understand the concern. If they are right, wouldn’t you want to know and adjust your change?

Another exercise I undertake in the training is to divide the room in half, and without them knowing, get participants to discuss two different questions. One half looks at reasons why they’ve resisted change in the past and the other looks at reasons why people they’ve worked with have resisted change.

In most cases the discussions demonstrate in practice a phenomenon known as the ‘Actor-Observer Bias’. This is a tendency to overestimate the importance of personal/dispositional factors and underestimate the importance of situational/environmental factors as causes of other’s behaviour. And vice versa when it comes to our own behaviour.

This means we tend to see ourselves as resisting change for good reasons attached to the nature of the change, yet we judge others as resisting it because they are in some way “being bad people”.

What fascinates me about this is that, even though I know this and have spent nearly a decade training on it, I still regularly catch myself making the assumption that someone else is behaving in a particular way because of who they are, not because of the circumstances they find themselves in.

So why does all this matter? In my experience, when we make an assumption that resistance is attached to the person’s disposition rather than a genuine concern about the change, we are much less likely to take the time to find out why the person is resisting.

Yet effective responses are often, if not always, dependent on a good understanding of the reason for resistance. This is why I believe the key message is that we should seek to “understand and respond to resistance” rather than “overcome it”.

“In my experience, when we make an assumption that resistance is attached to the person’s disposition rather than a genuine concern about the change, we are much less likely to take the time to find out why the person is resisting.”

My fascination with resistance to change led me to write a Masters dissertation on it. Even though that was eleven years ago, the findings seem as relevant today. My analysis of the literature identified 63 different reasons why change is resisted, with the majority fitting under one of the following three headings:

lack of dissatisfaction with status quo,
lack of belief that the change proposed is a better way of doing things, and
lack of ability to action the change.

There was a residual set of items that didn’t naturally fit any of these three categories but which did have a common theme. They were all about the way the change was led. Indeed it can be argued that poor leadership is a causal factor of all of the other three factors.

When I used the framework to reflect on my own leadership practice I realised that, on more than one occasion, I had focused my action on supporting people to make change when in practice they weren’t actually dissatisfied with the status quo and/or didn’t believe the changes being proposed would make things better.

In other words I was trying to spread solutions to problems people didn’t know they had or solutions they didn’t believe in. No wonder they were resisting.

In my next blog I will pick up further on the analysis of the 63 reasons, before I then go on in my third blog to consider what the research tells us about techniques for responding effectively to resistance.

Ruth Glassborow is Director of Improvement at Healthcare Improvement Scotland.

Categories: Resistance to change blog series

Tagged: Resistance to change

The heart of the matter: the need for standards around congenital heart disease – Dr Liza Morton

Posted on October 22, 2019

Since I was 11 days old, my every heartbeat has been dependant on a pacemaker. I was born with complete heart block, an abnormal heart rhythm that means the electrical impulses that control my heartbeat are blocked and do not reach the bottom chambers (ventricles) of my heart.

The surgery I received in 1978 at Glasgow’s Yorkhill Hospital was a world first. Since then, while I’ve lived a very full life, it’s one that’s been reliant on pioneering cardiac treatment. Life as a ‘heart child’ involved countless invasive, painful and often frightening cardiac interventions. By the age of seven I had been fitted with five pacemakers, each by thoracotomy – my ribs were split to gain access to my heart. Early pacemakers were set at a fixed rate, making active play, gym and sports day impossible. They were unreliable and often needing reprogramming. I remember lying still and feeling dizzy as a team of men in white coats armed with a magnet, leads, cold gel, stethoscopes, and electrodes made my heart beat faster, then slower as they learned how to interrogate the pacemaker. I was a medical curiosity, although my team always did their very best to support us. I needed open heart surgery at 13 years old to repair a hole in my heart and around this time I was fitted with a more physiologically responsive, variable rate pacemaker. The challenges don’t end, last summer I was fitted with my 11^th pacemaker involving complex surgery to extract and replace pacing leads.

“By the age of seven I had been fitted with five pacemakers, each by thoracotomy – my ribs were split to gain access to my heart.”

Complex congenital heart disease (CHD) cannot be cured, but due to medical advances a growing number of people are living with a lifelong heart condition. Babies born in the 1940s, had a 20% chance of surviving into adulthood. Today, the chances for a baby born with CHD living that long are 90%. Yet the success story of enhanced detection, medical and surgical advances yields new challenges which healthcare services have not developed to meet. Having overcome significant childhood adversity, many ‘medical orphans’, once celebrated as pioneers of medical advancements, are being let down in adulthood. But with adequate, reliable care many of us can live full lives.

Developing standards to improve services

Healthcare standards offer a means to significantly improve care by engendering trust, safety and patient empowerment. That’s why I’m delighted to be involved with Healthcare Improvement Scotland’s development group to create standards for CHD, and work with them to enable people with this condition to live as normal a life as possible.

Standards are statements relating to levels of performance that people should expect from health services. They are based on evidence relating to effective clinical practice, feasibility and service provision that is responsive to patients’ needs and views. They cover the key issues relating to the provision of safe, effective and person-centred care and treatment.

It’s been a long journey to get to this stage, supported by the cardiologists, nurses and surgeons involved in our specialist care, who witness daily what it means to live with CHD. Given my own experience, and my voluntary work as the Scottish Campaign Manager for The Somerville Foundation (a UK charity supporting adults with CHD), in 2012 I sought to raise awareness of CHD, submitting a petition to The Scottish Public Petitions Committee at the Scottish Parliament asking for healthcare standards and improved care provision, joining Cross Party Groups, asking MSPs to submit parliamentary questions and lobbying through social media.

“It’s vital that healthcare provision for CHD is underpinned by a psychologically-informed approach consistent with recent drives for trauma-informed care and to address adverse childhood experiences.”

The challenges for people with CHD

But what exactly are the issues that people with CHD can face that the standards will look to address?

CHD is the most common congenital anomaly, affecting approximately 1% of babies. A quarter of these babies require medical intervention in the first year of life. Around 20,000 people with CHD currently live in Scotland. Approximately half of this estimated adult population are lost to specialist services, often having been discharged before the need for specialist lifelong care was recognised.

It’s vital that healthcare provision for CHD is underpinned by a psychologically-informed approach consistent with recent drives for trauma-informed care and to address adverse childhood experiences. While medical advances have saved many lives, they can involve invasive procedures which can be frightening, painful and overwhelming. Early separation due to medical care may also impact on attachment to parents. Living with CHD can reach far beyond any medical limitations to affect schooling, employment, finances, discrimination, missing out and issues having and raising a family, to name a few. Perhaps not surprisingly, CHD significantly increases vulnerability to neurodevelopmental issues, depression, anxiety and post-traumatic stress disorder (PTSD) while parental psychological wellbeing can also be affected. Yet these outcomes need not be inevitable. By adopting a psychologically-informed approach to care, these risks could be mitigated, improving wellbeing, physical health, recovery and ultimately reduce costs.

Although I am grateful to the NHS for saving my life, I have experienced multiple life-threatening challenges in my care provision and a lack of understanding about the psychological impact of living with a serious lifelong health condition. At times, living with CHD can seem relentless. Having to fight for appropriate medical care, at your most vulnerable, can feel overwhelming. The challenges don’t end. Many of the challenges we face occur at a local level, for example, when we present to our GPs and emergency care. Standards for local care provision are vital to inform safe, equitable and consistent care. I am far from alone experiencing these challenges.

We should be proud of our NHS as testament of our collective humanity. But having experienced it at its best and worst since my first pacemaker all those years ago, I want to help to make it better. I owe that in return.

More information

Take part in the consultation on the scope of our congenital heart disease standards.

Liza is a Chartered Counselling Psychologist working in private practice and at Strathclyde University. She is actively involved in research and advocacy to promote psychologically informed medicine and improved care for people living with a heart condition from birth. Liza represents patients on the Standards Development Group for CHD for Healthcare Improvement Scotland. You can follow her on Twitter @drlizamorton.

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Tagged: impact campaign

How volunteering in NHSScotland can be transformational – Alan Bigham

Posted on October 10, 2019

Volunteering matters. There are an estimated 6,500 directly-engaged volunteers supporting patients, families and communities of NHSScotland, and many thousands more complementing the delivery of health and social care in the third sector. Many roles are centred on interacting with patients on wards; often something as simple as taking some time to have a chat, providing that vital social interaction and company for
people in hospital wards.

There is clear evidence that volunteering has many benefits for patients as well as volunteers themselves. It can improve an individual’s physical and mental health and wellbeing, strengthen social networks and bonds within communities and can also help to create experiences and connections that lead to better lives.

Volunteering roles are extremely varied. From drivers who help to transport visiting relatives or support patients to access support groups, to community volunteers helping with leading ‘healthy walks’, with others providing peer support to new mothers who are breastfeeding. The annual value of volunteering in Scotland is estimated to be £2.26 billion – it is clearly of great social and economic importance to the people and communities of Scotland.

“There is clear evidence that volunteering has many benefits for patients as well as volunteers themselves. It can improve an individual’s physical and mental health and wellbeing, strengthen social networks and bonds within communities and can also help to create experiences and connections that lead to better lives.”

Being able to demonstrate the impact of volunteering throughout NHS Scotland was of central importance to me when I took on the role of leading the Volunteering in NHSScotland Programme in the Scottish Health Council and Healthcare Improvement Scotland. A key objective of my role has been to help NHS Boards to develop their local volunteering into sustainable and robust programmes.

Since the work began in 2011, the impact of the programme has included:

Four NHS Boards creating paid roles to manage and support volunteers and another NHS Board almost doubling its volunteer management staffing from four to eight WTE
Influencing NHS Boards to adopt more sustainable volunteer management models, reducing the ratio of volunteer manager to volunteer to a far more sustainable and reliable level (from one manager to 144 volunteers in 2012 to one manager to 36 volunteers in 2017)
Deploying the Volunteering Information System across 18 of the 22 NHS organisations, increasing information governance and legal compliance, improving the efficiency and accuracy of reporting and reducing the administrative burden on volunteer managers to free up their time for their core work.

The influence and outputs of the Programme help to ensure that leadership for volunteering is embedded at a strategic and operational level across NHSScotland. Our work in developing policies and processes assist volunteering programmes to increase efficiency and compliance.
Additionally, the responsive nature of the Programme helps NHS Boards adapt to meet emerging needs.

“Being able to demonstrate the impact of volunteering throughout NHS Scotland was of central importance to me when I took on the role of leading the Volunteering in NHSScotland Programme in the Scottish Health Council and Healthcare Improvement Scotland. A key objective of my role has been to help NHS Boards to develop their local volunteering into sustainable and robust programmes.”

Within NHS Boards, volunteering can be traced back as far as 1970. The engagement of volunteers in health and social care has shown the impact it can have on volunteers, staff and patients. In collating case studies of volunteering, volunteers and staff told us that:

Volunteers have a positive impact on staff time and morale
Volunteering reduces social isolation for patients and volunteers
Patients look forward to seeing someone who’s not in a uniform
Volunteers have a positive impact on volunteers, providing structure, quality of life and improving confidence and self-esteem.

Over the past two years we have been contributing to the development of ‘Volunteering for All’ a national outcomes framework for Scotland. We’re now in an implementation phase where our contribution will be developing and publishing case studies of volunteering in health and social care that demonstrate progress towards these outcomes.

It’s only by demonstrating the impact of volunteering that we will break down the last remaining institutional barriers and myths on the subject. It can be transformational for the lives of many people, and has been so for myself.

More information

Read the ‘Volunteering for All’ Framework on the Scottish Government website.

View Scottish Health Council’s series of videos showcasing case studies from volunteers.

Alan Bigham is Programme Manager (Volunteering) with Scottish Health Council, part of Healthcare Improvement Scotland.

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Tagged: impact campaign

Screening for swollen aorta is vital to saving lives – Vascular Disease Awareness Month – Dr Zahid Raza

Posted on September 25, 2019

Breast screening. Cervical screening. Bowel screening. These may be familiar to you. You may have even participated in one or more of them. These are three examples of the eight national population screening programmes in Scotland.

Screening for abdominal aortic – more commonly known as AAA screening – is one that many people may not have heard of before.

An AAA is a swelling (aneurysm) of the aorta. The abdominal aorta is the main blood vessel that leads away from the heart, down through the abdomen (stomach) to the rest of the body. Aneurysms are a type of vascular condition. This is the collective term for diseases of the arteries, veins and lymphatics (tissues and organs that help rid the body of toxins, waste and other unwanted materials).

If you live in a town with around 30,000 people – for example, Wishaw in North Lanarkshire – at least 1000 men may be living with an AAA at any given time. Vascular conditions account for 40% of all deaths in the UK. Crucially, many of these deaths are entirely preventable.

“If you live in a town with around 30,000 people – for example, Wishaw in North Lanarkshire – at least 1000 men may be living with an AAA at any given time.”

The importance of screening for AAA

As a vascular surgeon, I regularly see men with large AAAs who have been referred to me from the national AAA screening programme. They are referred to me because at the stage where the aorta is 5.5cm or more, the risk of it rupturing is usually higher than the risks associated with the surgery that my colleagues and I perform to repair it.

AAA screening aims to find aneurysms early and monitor or treat them. You may be unaware that you have an aneurysm as AAAs usually show no symptoms. If you do have an AAA and your aneurysm remains undetected it can grow to a point where it can burst. This is a life-threatening emergency and unfortunately many people (around 50-80%) will die from aneurysm rupture –almost half of them before reaching hospital.

Routine AAA screening is offered to eligible men during the year they turn 65. Women, and men under 65, are not routinely screened for an AAA because most ruptured AAAs occur in older men aged over 65. Men are six times more likely to have an AAA than women. Staggeringly, AAAs are estimated to be present in almost 5% of the male population of Scotland aged 65 to 74.

“Routine AAA screening is offered to eligible men during the year they turn 65. Women, and men under 65, are not routinely screened for an AAA because most ruptured AAAs occur in older men aged over 65. Men are 6 times more likely to have an AAA than women. Staggeringly, AAAs are estimated to be present in almost 5% of the male population of Scotland aged 65 to 74.”

What’s involved in AAA screening

Screening to identify whether you have an AAA involves an ultrasound scan of your abdomen. A technician who specialises in AAA screening will measure the size of your aorta (it’s usually around 2cm wide). Most men have a normal result (an aorta measuring less than 3cm) and are discharged from the screening programme. If you do have an AAA and it measures between 3cm and 5.4cm you’ll be asked to return either annually or every 3 months depending on what size it is. Men who have a large aneurysm of 5.5cm and over will be referred to a hospital vascular department to discuss AAA treatment options with someone like me.

Why standards for AAA screening are important

Along this journey patients will meet numerous healthcare professionals – from the ultrasound technicians, specialist nurses, anaesthetists, ward staff, theatre staff and of course, me.

All of the team that supports the AAA screening programme in Scotland work together to ensure that patients experience a safe and high quality standard of care and support. Healthcare Improvement Scotland has recently initiated a project to revise the AAA screening standards which were originally published in 2011. The standards will specify a minimum level of performance for AAA screening services and will apply to all healthcare organisations and all the people who will assist patients on this journey to potentially save their life.

I’m delighted to be chairing the AAA screening standards development group and look forward to working with colleagues from the AAA screening community including those with lived experience of the programme to ensure high quality care for everyone.

More information

Find out more about Vascular Disease Awareness Month

Read the latest standards for AAA screening

Dr Zahid Raza is Chair of the AAA Screening Standards Development Group and a vascular surgeon with NHS Lothian

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Tagged: impact campaign

Let’s talk about dementia: dementia awareness month – Marina Logan

Posted on September 16, 2019

It’s September which means its World Alzheimer’s Month – the annual international campaign to raise awareness and challenge the stigma that surrounds dementia.

My family’s medical history has largely been characterised by heart attacks and strokes so dementia wasn’t something I had ever particularly worried about. How wrong was I? It transpired that, at various points between late 2013 and early 2014, my mum had a series of mini strokes. There were no obvious physical signs so neither we, nor mum, realised what had happened. These mini strokes interrupted the blood supply to the brain, and this is what caused her to have vascular dementia.

“It was little things the family noticed at first, things we put down to old age forgetfulness. She was in her 80s after all. At that age, anyone could put a pot on the hob and forget about it or not know what day or year it was. It really only became obvious when she couldn’t remember her own address.”

It was little things the family noticed at first, things we put down to old age forgetfulness. She was in her 80s after all. At that age, anyone could put a pot on the hob and forget about it or not know what day or year it was. It really only became obvious when she couldn’t remember her own address – she’d only lived there for 50 years! She laughed that off and said we were ‘being daft’ but it got worse. She became confused. Simple things became a challenge, like turning on the living room fire, she was convinced someone had changed the dials. She thought we were hiding things in the house to confuse her. She got frustrated and this made her quite ‘sweary’ – which could occasionally be funny when it wasn’t mortifying. Although mum had never been shy about speaking her mind, she was inappropriate at times, losing the filter that stops a person saying whatever they fancy about someone loudly in the street (again, mortifying!). Mum had lived alone since my dad died in 1996, so my brother, two sisters and I checked on her every day, visiting and phoning, and we were supported by her GP.

“I’m so proud of the work that Focus on Dementia does, in partnership, to improve the experience and quality of care and support for people living with dementia, carers and staff.”

We were lucky, in a way, that mum only lived like this for maybe 6 months. On 21 April 2014 we were left devastated when she had a major heart attack and stroke. She was in hospital until 17 June, then we were allowed to take her home to care for her, supported by the amazing community nurse team, until she died on 29 June.

I’m so proud of the work that Focus on Dementia does, in partnership, to improve the experience and quality of care and support for people living with dementia, carers and staff. Dementia can touch anyone’s life but with the right support it’s possible to live well and continue to be an active, valued member of society. The more information we have the better, the more we talk about dementia the better. So get involved, become a dementia friend, read more on the Alzheimer Scotland website, or come and talk to the Focus on Dementia team or visit the Focus on Dementia webpage.

Marina Logan is a Project Officer within the Focus on Dementia team of Healthcare Improvement Scotland

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