In contrast to the picture seen in developing countries, under-nutrition in the developed world is seen predominantly in the elderly. Up to 10% of residents in nursing homes and 50% of older patients discharged from hospital suffer from frank under-nutrition. (1)

When older people lose weight, they double their risk of death even when they are overweight (2,3). The main causes of weight loss are insufficient intake, cachexia, malabsorption and metabolic problems (eg Thyroid diseases). Weight loss puts the elderly at increased risk of falls and fractures, due to weaker bones and also reduced muscle mass. Drug toxicity increases as body fat composition reduces below safe levels (1)

A recent clinical trial (single blind randomised) by Beck et al (4) demonstrated improved outcome over a 6 month period in elderly patients who received home visits from a dietician following discharge from hospital for an acute event. Patients’ mobility and general functional status were improved significantly in the group that received dietician input, versus controls, and utilisation of ‘meal on wheels’ services were reduced. In this short small trial there was not a statistically significant benefit with regards to reduced hospital admissions, although there was a trend towards this.

Good nutrition in the post hospital patient leads to improved mobility and quality of life, and is an important need to be addressed. In this trial each patient in the intervention group received 3 visits to their home from a dietician over three months and outcomes assessed at 6 months. Nutrition is one domain that is heavily neglected in many elderly people. Unfortunately at the current time a comprehensive nutritional service is not available via the social healthcare system here in the UK, however this simple intervention has a demonstrable improvement in quality of life.

If you are losing weight then an assessment by your GP is advised and if no obvious cause found a referral to your local dietician is recommended.

References
(1) Morley, JE, Undernutrition in older adults: April 2012 (Fam Pract. 2012), 29 Suppl 1: i89-i93.
(2) Bales CW, Buhr G, Is obesity bad for older persons? A systematic review of the pros and cons of weight reduction in later life: Jun 2008 (J Am Med Dir Assoc, 2008), 9(5):302-12.
(3) Morley JE, Nutrition and the aging male: May 2010 (Clin Geriatr Med, 2010), 26(2):287-99.
(4) Beck AM, Kjær S, Hansen BS, Storm RL, Thal-Jantzen K, Bitz C, Follow-up home visits with registered dietitians have a positive effect on the functional and nutritional status of geriatric medical patients after discharge: a randomized controlled trial: 20 Dec 2012 (Clin Rehabil, 2012), Epub ahead of print.

Dr. Knight trained as a doctor at the Royal Free Hospital School of Medicine, Hampstead and University College London (UCL). He then undertook his postgraduate training in Internal Medicine, based in north west London, and is currently working full time as a Registrar in Respiratory Medicine, at the Royal Brompton Hospital. His main interests are Asthma and allergy and he is currently studying part time for a Masters degree in Allergy, at Imperial College London.

Recent research released by the Nuffield Trust examining the impact of the Marie Curie home nursing service on hospital use and place of death has thrown further light onto the benefits of care at home. In a study of nearly 60,000 patients it found that the Marie Curie nursing service reduced the number of hospital admission to a quarter of the level seen in the control group and more than halved the number of patients who dies in hospital. Interestingly the Marie Curies service reduced the cost of care by more the £1000 as well (1)

Towards the end of life emergency admission to an acute hospital is common and often undesirable. Palliative care at the end of life aims to maximise quality of life and can be provided in a number of environments, of which a patients own home is one. The Marie-Curie home care service provides support to patients and their families at home or in a hospice setting. This study demonstrates improved care and reduced emergency hospitalisation by use of a dedicated and expert home nursing team from the Marie Curie Cancer Care team.

References
(1) The impact of the Marie Curie Nursing Service on place of death and hospital use at the end of life: Nov 2012 (Nuffield Trust, 2012), available online.

Dr. Knight trained as a doctor at the Royal Free Hospital School of Medicine, Hampstead and University College London (UCL). He then undertook his postgraduate training in Internal Medicine, based in north west London, and is currently working full time as a Registrar in Respiratory Medicine, at the Royal Brompton Hospital. His main interests are Asthma and allergy and he is currently studying part time for a Masters degree in Allergy, at Imperial College London.

Putting care into the actual running of a care provider: Concrete practices to implement
When I wrote about Morriss House and CUN, I want to highlight my mention of the “feel” these organisations spin off when you encounter them.

This may seem somewhat unscientific and an aside from the goals of “keeping someone alive” but if you think from a patient or care recipient’s view, a large part of their experience in a health or social care setting will likely be this “feel”. As emotional human beings, this is so important. If a person is in a hospital and can get well in either, but feels genuinely cared for in one but not in the other, where do you think the person would want to stay? This is not rocket science but unfortunately for England’s health and social care sectors, it is often approached as if it is. Looking at the four model organisations in this article series, I hope the solution is obvious by now: the change, the source of providing excellent care with compassion must start with the management of health and social care organisations.

We must instill care and compassion into the way we run our organisations. We must manage with humility and compassion as this helps stimulate an overall culture of compassion from which staff are better able to provide care with excellence and compassion. No matter how many white papers, laws, and regulations are written to promote dignity in care, they will all have been written in vain if the management of health and social care organisations do not themselves expound care and dignity in the way we conduct ourselves. It is simply untenable to ask your staff to be compassionate if you yourself are not treating your staff with compassion.

Model Practices for Care Organisations
Below are some concrete care organisational practices which are exhibited by the model organisations in this article series that your organisation can implement, as they already are at Penrose Care.

Overall, there is a recurring theme across the “model organisations” covered in this article series: treat your staff with dignity and respect and they in turn will be more likely to put excellence in their work, including treating others with dignity and respect.

Safeguard your employees from temporary organisational setbacks: in a society used to “cyclical redundancies”, how about just avoiding them? As Victorinox has demonstrated, it is fitting and right for the owners of an organisation to absorb the bulk of the pain of temporary setbacks to the extent possible. By doing this, a large amount of stress from your workforce is removed. As what is worse than to go into work everyday not knowing if you will be there tomorrow? In care, a sense of job security among the workforce is so important as we would expect the workforce to be providing a sense of security to patients and care recipients. Although health and social care is generally considered non-cyclical this is not purely true. A cyclical downturn in public tax revenues could result in pressures on health and social care budgets. A weak jobs market could lead to individuals deferring elective procedures. Periods of poor investment returns could impair abilities to privately-procure health and/or social care. In addition, organisational specific events such as the sudden loss of block or other large contracts could be serious short-term setbacks.

If a total transformation is necessary, ensure your organisation is sufficiently conservatively financed to do so in ways which mitigate the negative impacts on staff: As Coloplast has demonstrated, an organisation should limit its usage of debt to give it sufficient breathing room to adjust to difficulties, particularly should they turn out to be structural vs temporary. With such breathing room, staff reductions can be done in ways that limit negative impacts on those losing their jobs through such measures as early retirement, generous redundancy packages, and/or position transfers within the organisation. This is particularly important given the structural challenges facing England’s health and social care system as it struggles with an ageing population. It is further relevant given the high debt levels of some of the larger care organisations in England.

Management and frontline staff compensation divergence should be within reason: At Victorinox, senior management compensation is capped at 5x the pay of an average worker. This to me sounds incredibly sensible, as it is easy to conceive how the culture of an organisation could be engulfed in animosity if workers in are living in poverty while a manager lives in riches. Such a culture is not conducive to providing excellent care with compassion. Recent data from Skills for Care suggests an average care worker in London is paid c £7.10/hour. With c 57.8% (“Time to Care”, Unison, Oct 2012, p19) not being paid their travel time between care recipients’ homes which is c 19% of an average care worker’s work time (“… UK domiciliary care sector”, UKHCA, Sep 2012, p8), this implies many London care workers are effectively paid £5.75/hour which is below the national minimum wage for those 21 and above. The reality that there are certain care organisations that pay their staff such abusive wages while managers/owners live luxuriously is nothing short of outrageous. Local Authorities that commission care work that is priced in ways that force such abusive workforce practices should be reviewed by the Central Government. Firstly, care staff should be paid a decent wage as a minimum and in my view, this is at least the Living Wage. Secondly, care staff must be paid for their travel time between care recipients’ homes – this is just common decency. Thirdly, sensible management compensation caps such as that in force at Victorinox should be encouraged.

Management should manage with humility: Morriss House’s shift manager doing the dishes underlies this model practice. Humility is essential to instilling compassion in an organisation as it is a concrete expression of a belief that we are all humans, equal in dignity and deserving of respect. Staff that feel they are genuinely respected are more likely to have high morale and be in a disposition conducive to providing excellent care with compassion.

Management should to the extent possible, be willing to and be trained in performing the tasks assigned to frontline staff: this is not possible in all settings. Of course, a hospital manager that is not a heart surgeon should by no means try to perform a heart bypass! But this is not necessary, the manager can work alongside the cafeteria staff one day to help prepare the food and tea. Or how about cleaning the toilets from time to time? Why not? Such practices may seem inane but they again, demonstrate humility which helps cultivate a culture of compassion and dignity in an organisation.

Management must remember that each patient or care recipient is an important individual deserving of respect and should be provided the time necessary to receive care with dignity: this is a practice which is incredibly fundamental at CUN and the benefits are evident – patients receive incredible health care in a warm and secure environment. Within social care, a concrete practice is providing sufficient time to a care worker to perform his/her tasks without rushing. As such, personal care appointments in home care allocated at 15 minutes or less should be done away with. In addition, to the extent possible, a care recipient should have stability in their care worker as a care worker that knows a care recipient well is best able to provide care which is comfortable and best customised to the care recipient’s specific needs. In addition, a care recipient should be familiarised with their “back up” care workers ahead of time to avoid unnerving situations where an unfamiliar person shows up at their home.

No detail in care should be overlooked by a manager: At CUN, one can immediately notice the incredible thought and care that goes into cleaning and interior design. Further, CUN has incredibly amazing food – the best food I have ever had at a healthcare organisation. As such, it is an organisation that strives to address the little details in care to help ensure patients receive excellent care. Care organisations should adopt a similar mindset. For instance, reviewing the ingredients of your food and drink? Are there better quality ingredients or drinks you could procure at the same price or could your organisation afford to spend a bit more on food and drink quality? Is your service setting clean? In the case of home care, is your staff sufficiently trained to help ensure a care recipient’s home is properly cleaned and well maintained? These may seem like little details but as CUN demonstrates, when you imbue the little details with excellence, the end result is an overall service which is imbued with incredibly superior quality.

Together, we can transform health and social care in England
Raising the bar in the health and social care sectors is possible and I hope this article series helps inspire other health and social care managers to instill care in the actual running of their organisations. I am under no illusion that every health and social care organisation will be willing to change the status quo, but this is where governments, regulators, patients and care recipients can also help.

Government institutions such as the NHS and Local Authorities and regulators such as the CQC can help by assisting organisations that put in place concrete practices to promote excellence in care with compassion. Patients and care recipients can help by using care organisations dedicated to being centres of excellence and avoiding those not serious about improving the health and social care sectors.

It will be challenging and may take many, many years, but I am hopeful that by working together, organisations and individuals committed to fundamentally transforming the UK’s health and social care sectors for the better can indeed do so, for the benefits of the millions alive today and our posterity that come after us.

Link to Part 4 of the article series

End of article series, Putting care ino the actual running of a care provider

Robert Stephenson-Padron is Penrose Care’s managing director. Prior to founding Penrose Care in 2012 with Dr. Matthew Knight, Mr. Stephenson-Padron was a healthcare equity research analyst at Merrill Lynch in London. Prior to joining Merrill Lynch in in 2010, Mr. Stephenson-Padron was a healthcare equity research analyst at Barclays Capital, also based in London. From 2003-2008, Mr. Stephenson-Padron was a research assistant to epidemiologist Prof. Alison Galvani of Yale University.

CUN – An organisation imbued with a culture of excellence and compassion
In my experiences with numerous healthcare organisations, I have never encountered one remotely as impressive as the Clínica Universidad de Navarra (“CUN”), the teaching hospital of the Universidad de Navarra in Pamplona, Spain. Similar to Morriss House, it is a centre of healthcare excellence which largely goes unnoticed, at least in the English language world. In its over 50 years of operations, CUN has honed a culture that is imbued with compassion for everyone (patients and staff alike), an incredible dedication to excellence, and humble and able management – it is something you feel almost immediately when you walk into the hospital.

I first encountered CUN as a graduate student at the Universidad de Navarra in 2006. As a visitor, I was awed by CUN’s cleanliness and the serenity that its interiors exhume. The staff generally exhibited a joy that one rarely finds to be so common place in a large organisation.

When I later became a healthcare analyst, I became more aware of what a world class healthcare organisation CUN is. I learned how at CUN, delivering personalised care with dignity and striving for excellence throughout the organisation is fundamental. This is what drives the organisation to, along with providing world class frontline patient care, provide impeccable cleaning of its facilities and incredibly delicious food (how often have we complained about hospital food!). It also has a unique innovation, whereby a person is assigned to a patient/patient’s family to personally facilitate their stay at the hospital to ensure the stay is smooth and very importantly, the patient has stability of relationship even if s/he is transferred to different departments.

At the helm of this organisation is a management team which strives to manage with humility and compassion. In 2012, I had the great privilege to meet the managing director of CUN, a brilliant but humble man – the type of manager I have come to learn are commonly behind excellent health and social care organisations.

As I write today, the CUN remains the most impressive healthcare organisation I have ever encountered with respect to delivering excellent care with compassion. I was therefore not surprised in early 2012 when I learned that CUN was named the best private hospital in Spain by Spanish specialist physicians. It is my hope that CUN becomes more well known in the English-speaking world as I have little doubt that if it did, it would quickly stand alongside the likes of the Mayo Clinic as a model healthcare organisation hospitals around the world strive to learn from in delivering world class healthcare with compassion.

Link to Part 3 of the article series.
Link to Part 5 of the article series.

References
CUN 50th anniversary site (CUN), available online.
The University Hospital of Navarra is the highest rated Spanish private hospital by doctors, according to the overall ranking of the OCU [ES]: 19 April 2012. (Clínica Universidad de Navarra, 2012). Available online.

Robert Stephenson-Padron is Penrose Care’s managing director. Prior to founding Penrose Care in 2012 with Dr. Matthew Knight, Mr. Stephenson-Padron was a healthcare equity research analyst at Merrill Lynch in London. Prior to joining Merrill Lynch in in 2010, Mr. Stephenson-Padron was a healthcare equity research analyst at Barclays Capital, also based in London. From 2003-2008, Mr. Stephenson-Padron was a research assistant to epidemiologist Prof. Alison Galvani of Yale University.

Morriss House – Managing with humility and compassion
It’s my firm belief that a manager should be willing to perform the tasks s/he assigns to his/her staff. This creates a more collegial environment, more able management, and a more reliable organisation (as there is one more hand to do frontline work). To this end, in December 2012, I started a healthcare assistant training placement at a north London residential care home, Morriss House, arranged by Stratford-based trainer, Citygate Training. Due to my general experiences with care homes in the UK and US, I did not have very high expectations of my placement. Little did I know that I was placed in what I soon realised is probably the best care home in England – operating with a spirit extremely similar to that of Penrose Care. Morriss House exemplifies the benefits of a humble and compassionate management which drives an operating culture characterised by compassion, patience, and excellence.

I arrived at Morriss House in the very early morning when the night shift was just ending. I was immediately pleasantly surprised by the jovial and upbeat nature of the night staff and had an inclination that I may actually be in a very special care home. As the day progressed, I became increasingly aware of the uniqueness of the organisation.

As I was taken around for get-up duties, the care worker accompanying me performed her duties with joy, compassion, and an incredible amount of patience. Nothing seemed rushed and I noticed this in pretty much every care tasks I saw throughout the day. As breakfast approached, I began to wonder what was driving the unique excellence of this organisation.

It may sound uneventful, but the light bulb moment came after breakfast, when I found the shift manager doing the dishes. Keep in mind that I was in this care home specifically due to my belief that a manager should be willing to do the tasks he/she assigns. So when I saw this I was fairly awes by the irony of the situation. At Morriss House I found an organisation which shared my views.

Soon after breakfast I had the opportunity to meet and discuss care with the home’s incredible registered manager, who I feel so privileged to have met. Here is a leader who has proved Dr. Knight and my strong held beliefs that if you treat staff well and manage them with humility, they will be more apt to provide excellent care with compassion.

In terms of some specifics of the registered manager’s philosophies, the residents and staff eat and drink the same things and from the same venues, creating a family-like atmosphere compared to for instance, having separate resident and staff coffee machines. Staff are given ample breaks and relaxation time during “down periods”. Humility is imbued in the management, and I believe this is core, and it is in part illustrated by the manager’s office being in the basement rather than a “ivory tower” in the top of the house, which instead is where the staff room is located. Although simple things, I am convinced they and other sensible practices are what drive the incredible warmth that you feel when you are at Morriss House.

Without exaggeration, I can say that my discovery of Morriss House was one of the most moving days of my life. It was the first time I have seen the operating culture myself and Dr. Matthew Knight are instilling in Penrose Care, a home care provider, put into practice in a residential care home setting. The results however are what I expected: excellent care delivered by happy and hardworking staff. And when you encounter this – something I have experienced at CUN in Spain (covered in Part 4 of this article series) and at Penrose Care HQ – there is an incredible warmth you feel in the organisation, a warmth that vitally needs to become common place in England’s social care sector. It also further convinced me of the incredible importance of Penrose Care’s mission.

Before I encountered Morriss House, I had very little confidence in the residential care home sector, but now I am confident care homes can be centres of compassion and excellence – Morriss House serves as a model of how this can be done.

In the next section of this article series, I cover the last model organisation in the series: CUN, a private hospital located in Pamplona, Spain which has successfully imbued excellent care and compassion into the entire organisation, from the smallest details through to its overall atmosphere and operating culture.

Link to Part 2 of the article series.
Link to Part 4 of the article series.

References
Inspection Report – Morriss House: 26 Oct 2012 (CQC, 2012), available online
Morriss House website (Abbeyfield), available online

Robert Stephenson-Padron is Penrose Care’s managing director. Prior to founding Penrose Care in 2012 with Dr. Matthew Knight, Mr. Stephenson-Padron was a healthcare equity research analyst at Merrill Lynch in London. Prior to joining Merrill Lynch in in 2010, Mr. Stephenson-Padron was a healthcare equity research analyst at Barclays Capital, also based in London. From 2003-2008, Mr. Stephenson-Padron was a research assistant to epidemiologist Prof. Alison Galvani of Yale University.

Coloplast: One of the world’s most ethical healthcare companies
When I first met the management team of Denmark-based Coloplast in February 2010, I was pleasantly surprised by the honesty and unpretentiousness they exhibited. I knew from that initial meeting, that I had probably just encountered an “exceptional company”, the type of organisation equity research analysts, as I was at the time, often work diligently to discover. I therefore dedicated much of my research time learning about Coloplast, which is the world’s largest manufacturer of ostomy bags and continence care products, and also a leading manufacturer of urology care and wound & skin care products.

Whereas Victorinox’s lessons stem from more periodic transitory pressures, Coloplast offers additional lessons as it has adapted through long-term and ongoing pressures stemming from increasingly strained UK and European health systems. Coloplast has demonstrated that through patience and respect for others, adapting to an ongoing adversity can be done while limiting the pain to individual employees and maintaining excellence in quality.

With publicly-listed companies having to report their earnings to investors every three or six months, it is not difficult to understand why company management teams often wish to take “corporate transformational” measures which are done quickly. Although this may provide a short-term gain, as say for a medical products manufacturer, this may imply the cost of production suddenly plummets if the transformation involves the shifting of production to low cost locations. Time and time again though, as an equity research analyst, I have seen how these quick transformations result in quick, undignified staff firings and rushed transitions which often lead to product quality issues. Not so with Coloplast.

In the early 2000s, recognising the challenges facing the European health care systems where it derives most of its sales, Coloplast set out to transition the majority of its production from higher-cost locations such as Denmark to lower cost locations, namely Hungary, and subsequently, China. It was a transformation that would be difficult as it would indeed include staff redundancies but its necessity was recognised, if Coloplast did not lower its cost it could cease to be a viable organisation (from which no one is employed). However, with a culture that respects the individual dignity of its employees and exceptional commitment to product quality, Coloplast didn’t just set out to carry out this transition in 2 years, or 5 years – the transition only became largely complete over the past two years, something very rare indeed in today’s corporate world. With England’s health and social care system currently facing substantial pressures from fiscal austerity, the lessons offered by Coloplast are very timely. Further, and this is particularly relevant to the social care sector, where some of the larger care providers are heavily indebted, it is my firm belief that Coloplast was able to pursue this corporate transformation with such patience largely due to its focus on maintaing a conservatively financed company (that is, avoiding excessive debt).

What was the end result of this patience? The result is that Coloplast had the opportunity to reduce its staff levels in “high-cost” locations in ways that mitigated the hardship on dislocated staff – through extended consultations, early and normal retirement, role transfers, and other measures. In addition, measured preparations of new factory premises, training of staff, and gradual transition of equipment meant that the quality of Coloplast’s medical products was maintained. Having an incredible admiration and respect for Coloplast, I for one am happy to see Coloplast has successfully adapted to the challenging health care environment in Europe, for the benefits of its numerous end users, many of whom are also the patients and care recipients of England’s health and social care system.

Particularly important to England’s home care sector, there is another lesson to be learned from Coloplast, and that’s regarding the responsible financing of an organisation in which numerous vulnerable individuals are dependent. With the 2011 collapse of Southern Cross, the importance of responsible financing has already been demonstrated. Coloplast was largely able to manage its corporate transition over the 2000s and past few years due to its commitment to being responsibly financed. Responsible finance ensures organisations have the breathing room to adapt to adversity. With the financial accounts of many of the larger care organisations being public, it does not take much research to see that some organisations may have difficulties adjusting to the ongoing austerity England’s health and social care system is experiencing. This is one of the reasons why I am pleased with the Department of Health’s 1 Dec 2012 opening of a 12-month consultation over new measures to protect a care recipient in the case their provider fails.

Link to Part 1 of the article series.
Link to Part 3of the article series.

References
Coloplast named one of the world’s most ethical companies: 16 Mar 2012 (Coloplast, 2012), available online.
Larsen, M. M. & T. Pedersen, Coloplast: Ten years of global operations: 02 Aug 2012 (Richard Ivey School of Business Foundation, 2012), abstract available online.
DH seeks views on new protections if care providers fail: 10 Dec 2012 (Department of Health, 2012), available online.

Robert Stephenson-Padron is Penrose Care’s managing director. Prior to founding Penrose Care in 2012 with Dr. Matthew Knight, Mr. Stephenson-Padron was a healthcare equity research analyst at Merrill Lynch in London. Prior to joining Merrill Lynch in in 2010, Mr. Stephenson-Padron was a healthcare equity research analyst at Barclays Capital, also based in London. From 2003-2008, Mr. Stephenson-Padron was a research assistant to epidemiologist Prof. Alison Galvani of Yale University.

Since the 2009 exposé of failings in England’s home care services sector by BBC Panorama, the pervasiveness of care services lacking in dignity and compassion across the health and social care sectors has become increasingly apparent, to the outrage of many, including myself and Penrose Care’s co-founder, Dr. Matthew Knight. Fortunately, things do not need to remain as they are. The health and social care sectors can change and must change. It is my firm belief that this change should start and be spearheaded by providers, who can act far quicker than public authorities.

Drawing from my experience as a healthcare sector analyst, I draw upon lessons from four exceptional organisations which I believe serve as models for putting care back into the actual running of health and social care services providers:

Victorinox, a Swiss non-healthcare company, that demonstrates that company owners can and should safeguard their employees from transitory challenges to the extent possible, by absorbing the bulk of the negative impacts of such challenges opposed to staff firings;

Coloplast, a Danish medical products company, that demonstrates that an organisation can and should undertake corporate transformations to adapt to long-term and ongoing challenges presented by strained health systems with patience and respect for existing staff and maintain a conservatively financed organisation to facilitate an adaptation that is sufficiently long to mitigate the negative impacts on existing staff;

Morriss House, a north London residential care home, that demonstrates that frontline management that commits to treating its workers well and manages in a humble manner in turn achieves excellence in care quality from its staff; and

CUN, a private Spanish hospital, that demonstrates that an ardent committment to the respect for individual dignity of all patients and all staff can imbue an entire organisation with outstanding quality and excellence, all the way from food quality to frontline patient care.

These organisations show that putting dignity and compassion into health and social care services must start within providers themselves, in the way we treat those both within and outside our organisations. There is a recurring theme across these organisations: treat your staff with dignity and respect and they in turn will be more likely to put excellence in their work, including themselves treating others with dignity and respect.

In the first part of this five-part article, I look at Victorinox.

Victorinox – a model for all organisations
Ibach, Switzerland-based Victorinox is not a health care organisation but it offers unique and valuable lessons to all organisations. You may know them for their quitissential Swiss Army brand. Victorinox is a model of how the burdens of macro-level pressures should be shared. With the UK and Europe facing ageing populations and increasingly strained health systems, this is a fundamental topic for discussion.

Typically in Western society, when times are tough, the employees take the pain. I for one cannot remember the numerous times I have read about cyclical firings at major companies, particularly since the 2008-09 global financial crisis. But not at Victorinox. The Elsener family that runs Victorinox has shown that when the going gets tough, they, the owners, take the bulk of the pain.

Following the horrific attacks on my home country on September 11, 2001, airline regulations changed almost overnight. With the tightening of such regulations, Victorinox saw a substantial decline in sales of its iconic pocket knives and its survival was at stake. However, the Elsener family committed to safeguarding its employees from redundancies.

Following the 9/11 attacks, Victorinox halted hiring and overtime, reduced shift times, subcontracted out employees to other local businesses where possible, improved logistics efficiency, and took other measures which resulted in Victorinox having no redundancies as it adapted to the difficult challenges it faced following 9/11.

These measures by the Elsener family are ultimately, the results of dignity and compassion shown to their employees and the families they support. It does not take a huge amount of common sense to realise that the most appropriate individuals to absorb macro-level burdens are owners, not employees, to the extent possible. When employees see and experience this common decency, you would expect they would be loyal and committed to working to a high standard. Health and social care providers should show the same level of decency to their employees, and in doing so, helping ensure their frontline health and social care professionals are in the mindset conducive to providing care with dignity and compassion.
Link to Part 2 of the article series.

References
Bain, David, “A cut above”: 6 Jul 2011 (campden FB, 2011), available online.
Zonco, Lauriane. “On the cutting edge” (Swiss Style, 2011), available online.
Sims, Josh, “Staying sharp”: May 2012 (CNBC European Business, 2012), available online.

Robert Stephenson-Padron is Penrose Care’s managing director. Prior to founding Penrose Care in 2012 with Dr. Matthew Knight, Mr. Stephenson-Padron was a healthcare equity research analyst at Merrill Lynch in London. Prior to joining Merrill Lynch in in 2010, Mr. Stephenson-Padron was a healthcare equity research analyst at Barclays Capital, also based in London. From 2003-2008, Mr. Stephenson-Padron was a research assistant to epidemiologist Prof. Alison Galvani of Yale University.