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The Joy of Good Care

Updated: Jul 29, 2022

Laughter can help you lose weight; research shows that laughing for just 10–15 minutes a day can burn up to additional 40 calories. [1]. It also brings a huge number of other benefits that can be used to improve outcomes for people who receive or give care.

Those benefits include, reducing pain and boosting the immune system. Laughter reduces blood sugar levels, increases glucose tolerance in diabetics and non diabetics, improves job performance, and brings people together. [2] It seems incredible that something as simple as making work and places where people receive care fun can bring such benefits. Even more incredible is that laughter and fun can make make leading and managing care cheaper.

I sometimes wonder when the idea that the unwell, the vulnerable and the dependent shouldn't be able to enjoy themselves became the norm. Perhaps its my background in paediatrics and children's services that help me understand that care and treatment need not be all doom and gloom. I trained dancing to Agadoo with toddlers and was taught to waltz by an elderly women called Elizabeth, who had dementia. I have a personal hatred of the contrived, head on one side, gentle touch of arm reaction to anyone with any sort of health problem or sadness. Of course, there is a place for genuine compassion and for empathy, but there is also a place for a good belly laugh that shakes the walls and resonates around a service. I say good laugh because it must be that - something that is shared and recognised by all who are laughing together. It can never be laughing at someone or their distress; I am talking about the laughter that unites and deepens our shared understanding, not bullying or 'othering' by excluding people from 'in-jokes'.

Many doctors, nurses and others working at the frontline of human distress share jokes and discussions over meals that would put others of their meals. They can take some comfort from knowing that that people who laugh at dark jokes have higher IQs and report less-aggressive tendencies. [3] Interestingly couples who laugh together are more likely to have a longer relationship. What is important is not so much finding a partner with a sense of humor, but rather that partners can create humor together.[4]

What's this got to do with outstanding care? I think the answer is that organisations that laugh, that forge genuine relationships founded on mutual understanding provide better care and that improves outcomes for both people using the service and those providing care.

Imagine if you work in a care home and you are five minutes late leaving because a resident is telling you about how they had dozed off and not realised an hour had passed. They were apologetic because they had picked up their cup of tea and taken a huge gulp, but instinctively spat it out as it was stone cold. It had sprayed all over their table and their teeth had shot out. There are several ways you could react including tutting and hurummphing around as you used paper towels to quickly wipe down the table. The resident is left feeling told off', 'naughty', and still hasn't had a drink. Undoubtedly the staff member feels irritated and leaves grudging the additional time spent 'sorting room 7 out'. Not much joy anywhere - just ill feeling, a sense of being an inconvenience and unwanted. Maybe they think its best to not have a drink next time one is offered, or maybe they don't use the call bell as they know staff are busy and get cross if they create extra work, so they try to get to the sink themselves to clear up before anyone sees. A fractured neck of femur isn't nice and brings no joy to anyone.

Now imagine if the same member of staff laughed and asked, "What has happened here, Gladys? Your bed cover looks like it's been raining in here. Can I sort it out before I go home?" They then quickly find a clean bedspread and a cloth to wipe up, asking whether Gladys managed to drink any of her tea. Gladys laughs too and says she must have dozed off for longer than she realised or they had started giving out cold tea. They laugh about how afternoon television after a large portion of fish and chips with a beer at lunch is the ideal way to encourage a nap. Gladys is given a fresh cup of tea and they laugh when the staff member says it's best drunk when you are still awake. They reassure Gladys that it was no trouble at all and made them laugh. Gladys drinks her tea and smiles to herself; she's always liked Jenna as she remembers to speak to her like a friend, a granddaughter, maybe. Jenna has to run for the bus but this makes her puff a bit and she grins widely at the driver. "Good day, Sweetheart?", he asks. "The best", she says, "I love my job. It can be such fun".

A change in attitude and organisational culture that encourages laughter and a shared sense of fun, that truly values humanity, in all its guises, might just prevent that fracture as well as reducing attrition and overall costs.

I was fortunate enough to visit a lovely care home on Friday. It was a service that had asked us to carry out an in-depth improvement review. They knew they were good and wanted to be better still. We took a small team to really understand how services were being provided and to offer recommendations about how they could be better still. It was a thoroughly enjoyable day and I am sorry I am not able to share the name of the service - our report is for the provider's use and for the provider to determine how it is used.

For our team, who so often see care shortfalls, it helped reset our norms, to understand what excellence can, and should, look like. The reviews offered shared learning for the provider and the review team. We laughed a lot and spent some time thinking about what else the provider could do to make improvements: This was hard as all the residents and visitors told us they wouldn't change anything. In fairness, that might have been, in part, due to the Rioja or Pinot Grigio they were offered at lunch or during the afternoon activities. One person being cared for through a Section 117 (of the Mental Health Act 1983) agreement was enjoying a cold beer - but theirs was a non-alcoholic one due to their history of alcohol related illness. Everyone was happy.

We were used to being told about visits to garden centre cafes or to ponds where you can feed the ducks. We were less used to being told about outings to a striptease show and lap dancing club. At the opposite end of the chosen outings and activities was a conversation about how one of the care staff had learned to put on a sari so that they could take one resident to a celebration at a Hindu temple and not feel out of place in western dress or embarrass the resident by wearing their uniform.

We stepped around the young child who was pushing one of the home's trains (James, the green engine, I believe) along the corridor whilst his own father was cutting his great-grandfathers hair with much laughing and teasing from both sides.

We watched someone else feeding far too many dog treats to their daughters (large) dog, giggling happily all the while.

Everywhere we went people laughed. Out loud. Together. Staff. Visitors, Residents. Review Team.

Many people probably think that those of us who work in regulation like finding fault to justify our own existence, or because we are innately bureaucratic. I can honestly say that after twenty or so years in health and social care regulation, I am neither. I know the odd member of staff who is, but most, like me, enjoy seeing good care being provided. Our default setting is that providers should be 'Good'. The standards are, after all, Fundamental Standards. Falling below 'Good' often means that the low bar set in the legislation has not been jumped over and a provider has fallen at a fairly low hurdle. Personally, I am bemused when I see providers on social media saying how proud they are of a 'good' rating with pictures of a beaming team and a large banner. I believe every person deserves good care as a starting point.

Our service reviews can help providers by providing fresh eyes that see the things that have been normalised or where there are barriers to achieving excellence. We look for good practice and recommend ways to build on this. That is not to say that we don't notice areas where there is room for improvement - we are explicit and granular in our feedback to the provider, but do try to focus on what is being done well.

Our reviews are completed by an independent expert team with the team composition adapted to ensure that we bring the right expertise to each service. We accept that one size does not fit all and what is excellent practice in a maternity service might be very different to excellent practice in a care home or private ambulance service. We don't usually bring surgeons to review care homes, nor social workers into an operating theatre.

We can offer reviews of an entire provider group, a single service or a part of a larger service. We work with all health and social care provider types, nationally and internationally.

For more information about our improvement reviews, please contact us to discuss your needs or use the button below to find out more.

References -

[1] Provine, Robert. Laughter: A Scientific Investigation. Auckland, New Zealand: Penguin Books, 2000.

[2] Marano, Hara Estroff. "Laughter: The Best Medicine." Psychology Today, April 5, 2005. Updated: June 9, 2016. Accessed: April 28, 2020.

[3]Specktor, Brandon. "If You Have This Phobia, You Literally Can’t Take a Joke." Reader's Digest. Accessed: April 28, 2020.

[4] Research Proves Couples That Laugh Together Are in It for the Long Haul." Huff Post, February 10, 2017. Accessed: April 28, 2020.

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