Over the mountain to the edge of the Sahara…

…Environmental quotes, learning and service improvement.

Screenshot 2019-11-01 at 22.44.41By Katie Elliot, Occupational Therapist, NHS Forth Valley

Twitter: @KatieElOT  Email: katie.elliott@nhs.net

Who doesn’t love a good inspirational quote? Why do some quotes resonate?  Certainly, I am not alone at having reached saturation point with cute kittens and their slogans on social media but there has to be a place for intelligent and inspirational quotes.  This year I have conducted focus groups and interviews for my AHP career fellowship project with patients and staff on the stroke wards about their experiences with setting goals. Transcribing and analysing the data has unearthed some quotes which took my breath away.  The participants have shown such spirit and allowed me into their motivations for what they do everyday.  You can’t help but be uplifted by the determination and kindness demonstrated.

I have realised that there is a direct connection between these powerful quotes and how to improve our services and our patients’ experiences; but are we always truly listening?  On the subject of setting goals at an early stage of the stroke journey, one patient told us,

“initially the goal is surviving.” 

This idea was echoed by many other patients and staff.  Our team has reflected on the fact that ‘one size doesn’t fit all’ and have acknowledged that there are times where it will be more helpful for staff to gain consent to prescribe goals.

The opening discussion point in the patient focus groups was about success.  Patients were asked, what does success look like?  A drawing similar to this by the cartoonist and comedian Demetri Martin was used as a visual cue.

Screenshot 2019-11-01 at 22.50.08

One patient commented,

that is exactly what my brain feels like – a big squiggly blur, it’s not as straightforward as straight up and down.  It’s a real struggle, not straightforward.”

The process of transcribing the staff interviews and focus groups is complete. During the process I could sometimes remember the patient or the staff member saying the words, but I didn’t always hear the true meaning until I really slowed down and took the time to properly listen. It makes me wonder, how much I am missing day to day with patients, families, colleagues, friends and family?

One of the themes that emerged from the analysis was the role of “will and ability” in goal setting after a stroke.  This was summarised by one patient:

“if you can find your will, determination, that’s a huge part of it, that will help you get through.  You have to get to that point where you find it again.”

By being more ‘present’ and exploring the deeper meaning behind words and statements like this, I intend to improve my attention.  The prize will be to gain more insight into what is being said and understanding  about how to improve what we do every day.

Another key point of learning from my fellowship experience, is that this year is not only about the the service improvements but equally it is about our learning.  I stopped and properly listened to this advice and it changed my path and my focus.

“Mountains should be climbed with as little effort as possible and without desire…. If you become restless, speed up.  If you become winded, slow down.  You climb the mountain in an equilibrium between restlessness and exhaustion.  Then, when you’re no longer thinking ahead, each footstep isn’t just a means to an end but a unique event in itself.  To live only for some future goal is shallow.  It’s the sides of the mountains which sustain life, not the top.”  “ Sometimes it is better to travel than arrive”  Robert Pirsig (1974).

An additional element of my project has been to review and improve the use of the patient-held “My Stroke Folder.” This provides patients with individualised information, goals and plans. It was originally developed in 2008, following patient and carer focus groups.  This included the use of talking mats, a communication system using symbols for patients with aphasia. One gentleman was commenting about the lack of information provided immediately following his stroke.

I felt that I had been dumped on the edge of the Sahara, away from human beings.”

I found this very powerful and interesting that it uses nature as it’s analogy.

Have you ever noticed that quotes often use on the forces of nature to make comparisons?  Mountains, deserts, oceans….why?  This makes me think about vastness, timelessness and something that is inhospitable, or dangerous for mankind.  Something that will exist after us and existed before us.  It lets us know we are mortal.  When we make an analogy we think of something that is different but has similarities.  Natural forces are permanent and enormous and the humans are temporary and small by comparison.

Finally, the learning from the Fellowship has helped me with evaluating individual and team efficiency.  Through my learning and my improved listening to patient experiences,  I aim to guide how we shape our stroke service moving forward. One quote that captures this for me,

“ I don’t have time to sharpen the saw…I’m too busy sawing” said by the man exhausted from using a blunt saw.  Stephen Covey (1989).


Covey, S: The 7 Habits of Highly Effective People: Simon and Schuster: 1989www.georgecouros.ca  Demetri Martin success: what it really looks like: 2016

Pirsig, R Zen and the Art of Motorcycle Maintenance: An enquiry into Values: William Morrow and Co. 1974


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