Wednesday 23 March 2016

And Finally.......


Letter from Pluto 




When I set out to paint a picture I never give it a title as I then immediately limit my scope - I must paint that image or scene. Rather I have a general idea in my mind and I let the brush take me where it might.

Similarly, when I have finished the work I never name it lest it confine the viewer to seeing what I have said I have painted OR look for it. Better the viewer decide what I have painted based on all she or he brings to the viewing, inspired by her or his own space and place and state of mind: that is part of the mission of the artist, to free, empower and enrich the viewer.

"The Kiss" by Caravaggio
Take Caravaggio’s ‘The Kiss’, which hangs in the National Gallery of Ireland, having been ‘lost’ for 200 years (it was in fact hanging in various places but thought to be a copy).

I would have called this ‘Illumination’ because although the artist needed the light coming from an unknown out of picture source on the left, it is the lamp holder who is in fact ‘illuminating’ the scene; a metaphor for the artist’s role and purpose, inviting light into dark places in order to help the viewer to see and perhaps understand the world from a different perspective. This is particularly so in this painting as Caravaggio painted his own face for St Peter holding the lamp; we do not see the artist’s face as St John, or Judas, or Jesus, or one of the soldiers but as the holder of the lamp, illuminating the scene.

To further my point, I do love the Dutch Masters, although I have some sympathy with van Gogh’s view that:

 “Those Dutchmen had hardly any imagination or fantasy, but their good taste and their scientific knowledge of composition were enormous.”

This pair of paintings by *Metsu are called ‘Man Writing a Letter’ and ‘Woman Reading a Letter’.
This leaves nothing at all to the imagination, but what technically superb works.
"Man Writing a Letter" by Metsu
"Woman Reading a Letter" by Metsu

And, another example is *Eva Gonzales's 'Brother and Sister at Grandcamps'. Could we not be left to imagine this, thereby transporting us to a place of our choosing with a person of our choice?
"Brother and Sister at Grandcamps" by Eva Gonzales

*Picasso on the other hand, in most of his work, empowered the viewer and although he did name his works it was an interesting journey for the viewer deciding what he or she saw before him or her and wondering about what the artist believed he was painting! And Picasso did not mind what we took away from his work.


So, where am I going with this? Perhaps to suggest that in all we do in our lives, including in our professions, we should not seek to compel or persuade those with whom we come into contact that there is only one way to approach what we do and what we see (my way?). 

With education I am inclined to the view of Doris Lessing:

"You are in the process of being indoctrinated. We have not yet evolved a system of education that is not a system of indoctrination. We are sorry, but it is the best we can do. What you are being taught here is an amalgam of current prejudice and the choices of this particular culture. The slightest look at history will show how impermanent these must be. You are being taught by people who have been able to accommodate themselves to a regime of thought laid down by their predecessors. It is a self-perpetuating system. Those of you who are more robust and individual than others will be encouraged to leave and find ways of educating yourself—educating your own judgements. Those that stay must remember, always, and all the time, that they are being moulded and patterned to fit into the narrow and particular needs of this particular society."

And I am reminded that in the teaching of surgery, which one would think is all about science, the trainee is constantly reminded that surgery is an art as well as a science.

Thomas Schlich writes:

‘The proponents (of surgery as science) claimed to manage the uncertainties of innovation through making surgery more scientific, drawing on the ideals of control, rationality, objectivity, and predictability. The critics (of surgery as science) mobilized another discursive pattern. They considered surgery an art and emphasized the individuality, contingency, and situatedness of medical practice’.

So what about what we do professionally, you and I? Is there room for personal interpretation, is there room for art in what we do, or is it all about being told what we see before us, is it all about ‘science’?

ISQua has embraced the patient as partner in all we do and in doing this we expect also to be working with the patient’s network; family, friends, colleagues. At ISQua we commence face to face Board meetings with a patient story, to ground us…to remind us why we strive for what we strive for. Each of us around the table takes something different out of this and applies it in our own way to our work and our lives – I like that, not much science there. And I know a leading surgeon (and you know or know of him too) who when asked by a patient when he has done his science, ‘Will you stay with me for a while?’ will always say ‘Yes’ bringing a special personal dimension to his work.

And referring back to Doris Lessing, I like the fact that our Education Programme is ‘learner led’, that it is flexible and relevant and that it values the contributions of the participants. And the popularity of the programme suggests our participants like this too. Add to this that the research of our Head of Education, Yulianna, has found that while forcing people to undertake professional development education (through legislation or other means) may result in more being done and done more regularly, critically and much more important is that mandating CPD reduces effectiveness; in other words if I decide to undertake CPD it will be much more effective than if somebody else decides that I must do it. I believe this means we are on the right track.

So there is much to be said for allowing ourselves and others the freedom to dream, to express ourselves and not to label our paintings.

This is my last BLOG as CEO and I have chosen LETTER FROM PLUTO as its title – here I go, ignoring my own advice and naming my BLOG. But you have to admit the name could mean anything. I will let you decide what it means for you but for me it reflects my willingness as CEO to embrace new ideas and ventures however ‘from left field’ they may seem and from whomever they might come. I have to admit many of the most outlandish ideas were mine and were often labelled by my staff as ‘coming from Pluto’. So what else was I to call my final BLOG!?

Peter Carter
Chief Executive Officer
March 25 2016

*Metsu and Gonzales died in their mid 30s, and Vermeer, who inspired Metsu, at around 40 – what precocious talent! Picasso on the other hand lived to see 91 and died happily at lunch in the South of France with his wife, family and friends! There has to be a message in that!



Monday 8 February 2016

I have an Idea....

"I can't understand why people are frightened of new ideas. I'm frightened of the old ones."
John Cage

I have 52,768 items in my mail.

I also have a file with the title: ‘IDEAS’. When I click on ‘IDEAS’ the following message appears:
 ‘We didn’t find anything to show here’.

Now before you conclude that I have never had an idea in my life, sadly, many of my ideas are scattered amongst the 52,768 items in my mail; the remainder are orbiting Pluto just waiting to touch down. 

I hasten to add that my ideas that have touched down are in the SENT section, not the IN BOX, so they are my ideas. They reside in SENT because I have a habit of testing them on others before maturing them into a discussion paper or something a little less ephemeral than an email (or discarding them!).

I really must get organised, especially as I do not want my successor as CEO to discover how I ‘managed’ my mail!

 There are good ideas and bad ideas.

What is an ‘idea’?

John Locke said an idea is:  "that term which, I think, serves best to stand for whatsoever is the object of the understanding when a man thinks, I have used it to express whatever is meant by phantasm, notion, species, or whatever it is which the mind can be employed about in thinking; and I could not avoid frequently using it."  

There you go….now you know! 

‘’The capacity to create and understand the meaning of ideas is considered to be an essential and defining feature of human beings. In a popular sense, an idea arises in a reflexive, spontaneous manner, even without thinking or serious reflection, for example, when we talk about the idea of a person or a place.’’

In his book, 100 Mistakes that Changed History: Backfires and Blunders That Collapsed Empires, Crashed Economies, and Altered the Course of Our World  Bill Fawcett talks about bad ideas:
‘’From the Maginot Line to the Cuban Missile Crisis, history is filled with bad moves and not-so-bright ideas that snowballed into disasters and unintended consequences. 
Japan bombs Pearl Harbour. The Caliphs of Baghdad spend themselves into bankruptcy. The Aztecs greet the Conquistadors with open arms. Mexico invites the Americans to Texas - and the Americans never leave. ‘’

The Slinky: Inventor: Richard Jones, a naval engineer
Then there are the ideas that didn’t work but which succeeded as something else, including penicillin, the pacemaker, X-rays, post it notes, popsicles, potato chips, silly putty, the Slinky and Velcro.


Typically scientists, including those who deliver healthcare, share their ideas. That is what publishing in journals and presenting at conferences is all about. We stand on the shoulders of those who went before us in order to make progress. I remember well when CEO of the Royal Australasian College of Surgeons mounting a legal challenge to an attempt by a surgeon to patent a particular variation on a long standing surgical procedure…we won!

Festivals of Ideas
A Festival of Ideas is a space where an intelligent public can engage with some of the best thinkers across a wide range of intellectual endeavour. 

I like this idea (oops). We have music, book, flower, comedy and other Festivals so why not one for ideas. In fact there are scores of these Ideas Festivals held around the world and they come up with a whole heap of thought provoking stuff AND….they can lead to positive change.

Take the 2015 Battle of Ideas at the Barbican, London. It explored a range of issues in which we as healthcare professionals have a keen interest including a topic I have been writing and presenting on a lot lately and one which occupies the minds of the ISQua Innovations Group – Ageing.

Topics such as these were tossed around:

‘Can technology solve the ageing timebomb?

From scandals over the quality of elder care to predictions about the burden that greying baby-
boomers will place on future generations, it is easy to lose sight of the success story of individuals living longer and healthier lives. And amid the discussion of how we pay for an ageing society, there is much less debate over what that care looks like. Policy-makers stress the importance of preventative medicine to reduce the need for care, as increases in life expectancy provoke angst about the loss of autonomy as our bodies age. As Oliver Sacks has argued, however, there is a growing perception that ‘we have come to medicalise aging, frailty and death’, rather than focus on how to provide ‘a life with meaning, as rich and full as possible under the circumstances’.

Research in this field has tended to be high-tech, focusing on such things as designing robots to provide nursing care or ‘smart’ homes in which embedded technologies monitor people’s physiological state. Such advances offer significant opportunities for semi-independent care. In theory at least, technology also offers the prospect of more than just physical support, with experimental ‘robot seals’ providing emotional support for dementia-sufferers alongside a variety of tools that help retain mental agility and provide a connection to the outside world. But there are surely ethical questions about outsourcing compassionate care to gadgets. What kind of society is it that has neither the time nor the interest to provide care to its elderly? More prosaically, much of the care needed by older people with chronic degenerative illness is ‘high touch’ – of the kind provided by incontinence teams and district nurses – not ‘high tech’.

Do assisted-living technologies offer a radical transformation in quality of life for the elderly or merely a distraction from the unglamorous challenges of adequate care? Can such advancements challenge our pessimistic view of ageing in society? Will society – or the market - inevitably produce the right solutions to cater for an ageing population, or do we need a shift in cultural outlook? What should be the focus of assisted-living technology if we are to help the elderly to enjoy as full and active a life as possible for as long as possible?’

RECOMMENDED READINGS

With the world's elderly population growing rapidly, scientists are suggesting that robots could take on some of the burden of providing care, support and - most surprisingly - companionship.
                Alex Hudson, BBC, 16 November 2013

With the proportion of over-65s on the increase, Britain is facing a crisis when it comes to care of the elderly. Is technology the answer?
Andrew Griffiths, Telegraph, 13 April 2013

Sensors installed in nursing homes and even individual residences are helping nurses monitor seniors' health, but questions remain about cost, and privacy.
Michael L Millenson, Atlantic, 11 January 2013

Soon there will be three pensioners for every child under 15. Now, Patrick Collinson reports, the Land of the Rising Sun is going back to the future …
Patrick Collinson, Guardian, 20 March 2010’


Then there are Commissions for the Future.

These have tended to be subject specific, such as one on the future of Hospice care in the UK, but Australia established a generic body in 1985 with a wide and open remit. It turns out this Commission did not have much of a future itself and it closed in 1998. The Aussie Commission of the Future attracted much criticism during its life but it published commentaries on the future of many things and one general text: 

Melbourne: Commission for the Future and Australian Bicentennial Authority 1989

Despite its critics, it did some good. The offices of the Commission were just around the corner from my offices in Melbourne and I used often take my lunch there and enjoy the company of these ‘futurists’. 

SO, do not fear to think outside the box, even if our ideas emerge because we are standing on the shoulders of those who went before us….we are where we are because those who went before us did that too!





Peter Carter
Chief Executive Officer
February 2016

Mistakes That Worked – May 1, 1994 by Charlotte Jones (Author), John OBrien (Illustrator)