My own MSF: Preparing to leave Jordan

Mike is a family doctor (GP) from the UK. He's been working for Médecins Sans Frontières / Doctors Without Borders (MSF) in Irbid, Jordan, helping to provide medical care to Syrian refugees and vulnerable Jordanians. In this final blog before he prepares to head back home, he shares his bittersweet thoughts on the changes he has helped make.

The team celebration

I’m coming to the end of my time in this project.

And, as I’ve been (slightly) obsessed with how we can improve the quality of care we provide during my time here, I was asked by my medical coordinator to write an ongoing quality management plan for the project.

It has been interesting trying to pull together the different strands of work that we have all been doing here, checking what we actually do (as opposed to plan to do).

Focused feedback

Looking at this overview gives you a very different perspective from being the hands-on supervisor going from one meeting with a doctor to another. So, I’ve been clarifying and discovering things that after more than eight months in the project I’d not been clear about before.

I’ve been separating the formative and normally qualitative feedback – which is so important for making sure that each of us learns more about how we could do our jobs better – from methods where there are clear scores and measurable outcomes.

I’ve also tried to check that we have patient feedback available for as many angles as possible. I think we need to be responsive to patient perspectives as well as being evidence-led in our care.

The big picture

It seems to me so important that we know as much as we can about how good we are. Each project, or at least each project type, will need to work out how to measure this for themselves by gathering suitable information.

For me, it is not enough to be part of a movement going to sometimes dangerous places trying to do great things. We also need to look at whether our actions are as great as our intentions, and to ensure that patients are put at the centre of all of this.

Feedback is a gift. Too many people are afraid of giving feedback because they do not want to spoil the good atmosphere, but we all have an obligation to give feedback because it is what develops people."

It’s been reassuring to find that there is a good range of measures that we either already have in place or have agreed to set-up, looking at how our doctors are performing. There are also lots of similar measures set-up to look at our pharmacists’ work from several angles.

Starting my review has generated some interesting discussions on whether we’re able to provide clear feedback on the work of our nurses or health promoters, also. I know that these conversations will carry on once I’ve left, although there are of course some questions that you may never get the right answer to.

My own MSF

“Do not believe in anything simply because you've heard it. Do not believe in traditions because they have been handed down for many generations. Do not believe in anything because it is spoken and rumoured by many. Do not believe in anything simply because it is found in your religious books. Do not believe in anything merely on the authority of your teachers or elders. But after observation and analysis, when you find anything agrees with reason and is conducive to the good and benefit of one and all then accept it and live up to it.”

- Buddha, Anguttara Nikaya III, 65.

It is said that you should always consider taking your own medicine so that you have experienced being on both sides of the table.

So, I’ve also taken this advice on board and have organised to receive anonymous feedback from those I work with. In other organisations, this often goes by the abbreviation of “MSF” or Multi-Source Feedback… although I’ve found using this abbreviation within MSF itself has been much too confusing.

Mike and the Irbid team in December 2017, celebrating three years of the project. Photo: MSF

As my role is a mixture of leadership and management, using a leadership framework to design my questions seemed the logical process. I’m very grateful to the colleagues and friends who have looked at draft versions of this.

For the last couple of weeks, I’ve been trying to remind my colleagues to fill in a form as soon as they can. In an environment where, as far as I can tell, nobody has completed an online and anonymous questionnaire like this, I’m delighted that more than half of the people that I asked have filled it out.

I’m able to see the emerging scores and the comments. Some colleagues have spent a long time giving me some wonderfully detailed and useable feedback. 

Feedback is a gift. Too many people are afraid of giving feedback because they do not want to spoil the good atmosphere, but we all have an obligation to give feedback because it is what develops people.

As I go through this process I am reminded of the GP trainees that I’ve worked with in UK for so many years, desperately trying to get the required number of “360 feedback forms” completed.

I’m hoping for a few more responses, but I’m happy that I can already see comments from a range of people who have worked with me in very different roles. So what I’ve received so far is pretty representative. It has also told me some things that I want to work on to become a better colleague and teammate.

Saying goodbye to Jordan

Leaving also brings other ways to get feedback. Less formal, but wonderful in their own ways…

I’ve just had a great leaving party. In fact, this was two parties.

One in a restaurant that on Mondays gives free Shisha to all women, helping make things more familiar to several of the women in our team. The restaurant also served good eastern Mediterranean/Middle Eastern food.

The second party was later the same evening on our rooftop. A more International staff party with music and lots of chat. I had several conversations in the safety of knowing that we’re unlikely to see each other much more (although I still have one more normal workday), about shared learning and the value we had found from working together.

Some people, though, have preferred the traditional leaving card, which this time has some comments that I’ll treasure.