Helen: I am insatiably curious with a wonderlust for exploration – okay, so it’s got me into a few scrapes and interesting positions, but on the whole it has led to personal growth and a few tales of adventure to regale and amuse people with over dinner.
What I have noticed though is that I am often counselled to; stay put, experience a bit more ‘lingerlust’ perhaps…. be content with the way things are, be less disruptive and ‘settle down’ to an easy life, and don’t leap you may fail. I recognise that some of this counsel is external from well meaning people who don’t want to see me get hurt or a perhaps a little tired of all of my ‘adventures’ but I have come to recognise that the ones that are most damaging to my progress are the ULP’s.
Gay Hendricks in his book ‘The Big Leap’ introduces us to the concept of the ‘Upper Limit Problem’ or ULP and after much consideration, I’d like to offer a ‘P’ swap from Problem to Perception, because to my mind, it’s all about how we perceive things and that many things that are seen as problems are also opportunities; opportunities to grow, change, improve, unleash and transform.
This is a perfect example of a man-made ULP in action; one that jumps (no pun intended) the species divide and has lasting generational limits for the flea community. Humans really can limit our own growth and the limit of others.
Blimey! so what can we do about it? How can we prevent any perceived lid that either others or we place on our own limits being our future reality? How can we as individuals, teams or organisations recognise our very own ULP’s and identify them as the artificial limiters to a life fulfilled that they are; limiters that are barriers erected to keep us safe and limit our failures and hurt, physical, financial, emotional or ego related. When we ULP though, we miss the opportunity to change things for the better; we miss the opportunity to test our real capabilities and step into our very own genius space.
At Changeunlocked.today we see ULP’s as being cULPable in holding back so much progress and desirable transformation and offer the following as steps forward to scULPt the future you choose:
S= Spot it by making a conscious effort to notice.
C= Conspirator. Find a trusted someone and others who will conspire with you and be your critical friend – someone who will nudge you when you are ULP’ing
U= Unleash your true potential.
L= Listen to the language you use and what your body is telling you when you ‘ULP’.
P = Positive action to move forward
T= Test yourself by reframing your ULP.
We’d love to hear your thoughts of where you ULP and if you do break through, how you achieve that?
For those of you who, like me, experience the internal wonderlust drive not just to change things for change sake but have an underlying purpose towards the growth of humankind possibility, you may like to read the blogpost from Garret LoPorto -P.S. it clearly explains why I have hairy toes 😉
I never in a million years expected that Helen and I would have been co-hosting an ‘’unconference’ at an event hosted by Prerana Issar, the NHS chief people officer for England and Samantha Allen, chief executive of Sussex Partnership NHS Foundation Trust and chair of the Health and Care Womens Leaders Network. The globally known Helen Bevan, chief transformation Officer was the ‘MC’ for the event – what an inspirational line-up! In fact, when Helen DC suggested it I very casually replied “yes, that would good, that will push us out of our comfort zone” without giving it too much thought. It was only when we realised over 3000 people had signed up to the event that the ‘oh what have we done?’ began to kick in. The event ended with over 5000 people signing up – what incredible achievement.
As part of a presenter WhatsApp group, the nervous excitement began to grow a few days before the event. Fellow presenters were beginning to connect with each other sharing their apprehension about the forthcoming day. As I watched from the sidelines (it takes me a while to build up the confidence to join in) I could see what was beginning to form was a ‘sisterhood’, a community of incredibly supportive women all sending words of encouragement (and emoji’s – who doesn’t love an emoji?) to each other. Albeit on the sidelines, I still felt very much part of the group, the growing community. I thought to myself, how was this possible when I don’t even know these people and yet I feel I belong? What I noticed was that it didn’t matter what your contribution to the chat might be, it was welcomed and you were suddenly part of the fold. I eventually plucked up the courage to contribute and found I instantly got swept along with the enthusiasm – such a wonderful, empowering feeling.
Even after everyone had presented and the event began to draw to a close the WhatsApp group were still encouraging, supporting and respecting one another. Who knows, some may have started the day as supportive strangers but ended the day as friends.
Let me take you back to the ‘unconference’ Helen and I hosted. It was entitled “Forging Our Own Path Whatever our Footwear of Choice”. I’ve always found it quite fascinating how clothes and shoes (shoes in particular in my case) can give us the sense of “girl-power” and anything is possible. In fact it has been known and commented on over the years with groups of male colleagues “she’s wearing heels chaps, she means business!” We touched on this during our group conversation and it seems I wasn’t alone. Interestingly though, during lockdown, slippers seemed to be the footwear of choice and girl power is still thriving – there is a message in this for us I think!
Helen and I shared our experience of being women pioneering in health and care – in particular the introduction of the HOPE (Help to Overcome Problems Effectively) Programme in a medical world of predominantly male clinicians. You can read further about our experience in our previous blogs on this site.https://changeunlockedtoday.wordpress.com/2019/10/25/trial-and-much-error/
In the spirit of learning from one another, sharing our experiences maybe helpful but we were keen to take our personal learning deeper. We offered the group a couple of tools that might help us better understand our marginalisation as women together with our positional power and privilege.
The first tool, the wheel of power and privilege was kindly shared by Sylvia Duckworth on Twitter (thank you Sylvia!) and it can be seen above. We found this wheel to be so engaging and enlightening that we decided to convert it into a short questionnaire and share with our group. The results of the group can be seen in the radar diagram below and was a great conversation starter into a topic that can sometimes feel uncomfortable. In my personal view, the more we can talk about power and privilege the more we learn and hopefully less judgements are made – a small step towards appreciating each other for who we are, not what we are. After-all, embracing diversity and seeing the world through different lenses helps us build on our rich fabric of society. As women, it is our responsibility to recognise where we hold more powerful positions on the wheel than others and commit to supporting them to achieve their ambitions rather than holding them back.
Such tools encourage conversations that start providing us with invaluable information and knowledge that might give context to and explain why we are in the positions we are in. Importantly, if we are open and listen well, we are given clues as to how we might approach situations by being more curious and understanding and jumping less to conclusions and assumptions.
Thanks to Becky Margiotta who founded the Billions Institute we also shared a set of 5 reflective questions (as seen below). Helen and I have used these in different situations, usually when we are undecided about something. In fact, my personal reflections upon these questions and newfound realisation enabled me to let go of my worries and gave me the courage to write this blog. I’ve held back before, as I now realise, down to the fear of being judged – not being good enough. I recognise as women that many of us carry such a burden. We sometimes hold ourselves back hindered by believing what we have been called or told by others during our lives. Being labelled ‘academically weak’ by a male consultant left me scarred for many years but with the help of the journal questions I have found my worth and risen above the critic. I am proud to be me, a woman who has much to offer the world even though I don’t have much in the way of qualifications. However, without sounding too corny I’d like to think I have plenty experience from the university of life.
Finally, as I draw this blog to a close in the week of International Womens Day 2021 I have a couple of things left to say.
Firstly, thank you so much to our group who were spontaneously open in sharing their experiences – #EverydayCourage was in abundance.
Secondly, I came across a very poignant tweet “never let us forget those who came before us” with this picture below.
A thank you to those women that have gone before us just doesn’t feel sufficient and as we know, actions speak louder than words. Therefore, I pledge to create a wave of positive change enabling people to feel that they belong, whatever their footwear of choice, and in turn create their own waves of positivity in the world. I’ll leave you with two questions to ponder. What’s your pledge and what’s your footwear of choice?
This post is a little different from our previous ones as we are inviting you to join us live on 8th March at a free online event to celebrate this years International’s Women’s day https://www.everydaycourageiwd21.co.uk
We are excited to be facilitating a discussion on the subject of ‘Pioneering’ a subject very close to our hearts. The name of our session is “Forging our own path whatever our footwear of choice” and it is being held between 11.25 – 12.10 UK time.
During the session we will discuss and identify things that may hold women back from pioneering and will consider some helpful techniques and tools to support us; giving us the courage to strive to deliver the change we wish to see in the world.
We are hugely grateful to the awesome Becky Margiotta: founder of the Billions Institute https://www.billionsinstitute.com/ for the use of a number of her resources. To learn more about, or to develop your own skills as a social change leader, check the Billions Institute out, their courses are highly recommended and truly transformational.
We hope to see you on the 8th March 2021 at https://www.everydaycourageiwd21.co.uk/ Come and meet us between 11.25 – 12.10 UK time, we’d be delighted to share time, conversation and a giggle with you.
See you there – much love and courage Helen and Chris X
Specific challenges that our local system is experiencing with delivering responsive and valued outpatient services are:
Increasing first appointment to follow-up rates.
Delay = reduced outcomes and poor experience.
Challenges achieving the 18/52 week ‘Referral to Treatment’ times
Workforce burn-out, evidenced by increased sickness/absence, challenges in recruiting into some specialities. Increasing locum and agency spend to address the unavailability of our own workforce capacity to support the required out-patient clinics
Limited space to hold traditional clinics
Financial challenges to deliver safe and effective services
Added to these pressures NHS England’s Long Term Plan states an expectation that face to face out-patient follow-up is reduced by a third in the next five years
Participatory co-design with patients is not a new concept, however most are carried out for single health conditions. We recognised that there were more people in our local populating living with two or more long-term health conditions than single health conditions and that secondary care services in particular traditionally silo their offers. We boldly (some may say) decided to work with four secondary care specialities (that we as a project team referred to as the Fantastic Four): Rheumatology, Diabetes, Respiratory and Neurology to hold a participatory co-design event inviting up to 200 patients (50 per speciality) and 25 specialist team staff (5 per speciality team). Why this Fantastic Four? you may ask, when we had a whole suite of secondary care specialist teams to chose from…….. we simply went where the energy was. (See a previous blog explaining why following the right energy is important https://wordpress.com/block-editor/post/changeunlockedtoday.wordpress.com/211 )
Everett Rogers developed his now famous ‘diffusion of innovation’ curve in 1962. His model has been built on over the years by several thinkers. The version depicted in the accompanying graphic demonstrates that depending on where people are in terms of their comfort with the innovation, the messaging required to engage them will be different. We considered that our particular ‘Fantastic Four’ (by and large) were on the far left of the change curve and were keen to test out new ways of working and it was their support and evidence from the work that would best persuade others in the system to adopt the learning.
Starting from a position that ‘Quality and Value are only ever viewed through the lens of the customer’ we, the small project group, had always planned to engage those people with lived-experience of our outpatient follow-up to co-design a better way, but as so often experienced in the NHS, funding to be able to do this was a barrier. We were challenged with identifying a defined saving that would be generated and delivered as a direct response to the co-design. Now this was a difficult thing to do! We could easily pluck random pound signs out of the air with some reasonably accurate numbers aligned to the mass of patient data that the NHS captures, professing to be able to save £X as a result of any proposed intervention/outcome from the co-design, but wasn’t that assuming that we already knew and had decided on what we were going to do even before we asked people? Oh hang on…………. yeah, now that sounds familiar. So no, we decided against that. Here is where the wonderful South West Academic Health Science Network (AHSN) https://www.swahsn.com stepped into the equation by offering to work with us and fund an initial co-design day. The South West AHSN works to improve the health and patient experience of people in the South West by supporting and accelerating innovation and quality improvement, so our project was a perfect collaboration partnership. This sponsorship enabled us to apply for Health Foundation Q Exchange funding to support the teams testing the outputs of the day, meaning that we did not have to spend precious energy and time writing a spurious business case to seek permission from a series of groups and assurance panels. You can look at our winning Q Exchange proposal here: https://q.health.org.uk/idea/2019/redesigning-outpatients-through-inclusive-participatory-co-design/
We used a validated tool to identify the level of knowledge, skills and confidence to self-manage their conditions (The Patient Activation Measure also known as PAM) and stratified the timings of the attendance on the day to those who had high levels of activation in the morning and those with lower levels in the afternoon, with a shared lunchtime get together for all. The day was a triumph, interspersed with a few grumbles about the dodgy, creaking toilets at the venue and a lack of parking.
A variety of different ideas, suggestions and proposals were made by those who attended and the outputs were shared with all who were interested. Two major pieces of work were then embarked upon in the first instance, both being a different supported self-management offer, designed to improve individual’s health and care outcomes and enabling unnecessary face to face clinical contacts to be reduced.
Firstly, people told us that it is all very well having apps and websites etc to support them in better managing their health conditions, but if you were living with several different conditions (some of the people who attended were living with 6 or more), having several different apps that didn’t ‘talk to each other’ was a burden not a help. So the first piece of work was a single app that connects up all of their relevant health conditions for people living with a number of Long-Term Health Conditions. The resulting CONNECTPlus Multiple Conditions App is a collaboration between those who attended the co-design event, clinical teams and the talented digital folk who work in Health & Care Innovations (HCI). https://hci.digital/products/connectplus-app/
If you are interested in learning more about how CONNECTPlus can help you to support those you work with to better self-manage their multiple long-term conditions in a single place while enabling you to remove unnecessary appointments, have a chat with Dr Matt Halkes (he is very approachable) email: firstname.lastname@example.org
The second exciting piece of work is just about to be launched in January 2021. Prior to the co-design event we undertook several literature searches and reviews with the view to identify the best evidence based interventions or activities that can support people to better self manage their health condition (optimising their levels of activation). We did this for each of the four specialties and also identified generic interventions and actions. We know from the evidence that those people living with lower levels of activation have poorer health outcomes and cost the local health and care economy significantly more each year than their more activated peers; so we were keen to explore how we could better support those who have lower levels of knowledge, skills and confidence to self-care. Those impactful actions/interventions identified from the literature searches were written on cards and placed on the tables, as discussion prompts, should the conversation run dry.
One of the interventions that the evidence identified was that a peer health coach offer was valuable for some people (the literature mainly identified this being helpful for people living with Chronic Obstructive Pulmonary Disease and also those with Mental Health concerns). We were surprised when both the morning and afternoon groups thought that this was an idea worth developing locally with a number of people in the morning suggesting that they would like to volunteer their time for this purpose and those in the afternoon saying that they would really value having a structured conversation with a peer who could offer them more time and at a slower pace than their current health care teams could. So that got us thinking and beavering away in the background (interrupted slightly by the Covid-19 pandemic) to develop a skeleton framework that was of value, measurable and safe from the perspective of all involved; the clinical teams, the system, the volunteer peer health and wellbeing coach and the person who was receiving the offer (oh and lets not forget the bean counters!).
We are recruiting a co-ordinator role in January 2021. It turns out that there is little to no published evidence in the literature that looks to improve people’s holistic levels of activation (across multiple Long-Term health conditions) through peer to peer health coaching and so we are excited to be working with the Torbay Medical Research Fund and Plymouth University to undertake a feasibility, randomised control trial, from which we shall be able to synthesise and share the learning. So just to whet your appetite for things to come, here is a short recruitment video for Volunteer Peer Health and Wellbeing Coaches that we have been developing, just to give you a taster.
The value of undertaking a participatory co-design event across multiple specialties, has been multifaceted, not least the powerful recognition from the clinical teams that different approaches and different paces of change are needed for people living with different levels of activation.
The atmosphere was palpably different between the morning and the afternoon, with many of the clinical teams being shocked at the difference. For those participants who attended in the afternoon, the mood was much flatter, with a sense of being overwhelmed and struggling with their lives…….. however after about an hour of off-loading a remarkable change occurred. The conversations naturally without prompting changed in their focus from what was the matter with them to what matters to them, both at the time and into the future. The phrases most commonly heard were of relief that “I feel listened to”, “I have a voice“, “today, I have met others who ‘get it” and “I no longer feel alone with all of this” and the ideas generated for a better future started to flow.
If we are truly going to create a health and care service fit for the future we need to co-design and co-produce it with those who use our services. Sometimes the outcomes will not be what we want to hear and will force us to think differently and sometimes the ideas generated will be potentially transformational as in the CONNECTPlus app and the volunteer health and wellbeing coach role but whatever the outcomes, quality and value are only ever defined by the customer, so lets create future services, full of quality and value in collaboration with them, who knows where that will take us.
Curiosity and a sense on incredulity occurred when I first read the statistics that essentially said that it takes on average 17 years before evidence of what works makes it into practice and that those that do are merely a slither from the tip of the iceberg – so many great things, things with potential to deliver positive change get lost down the abyss between knowing and doing. Why is that?
But hang on ‘Helen’, this isn’t just about the translation of academia into health and care practice, oh no, no, no…… this goes much deeper into the human psyche. Public health and government campaigns across the globe exhort the virtues and long-term benefits of ‘healthy living’ whether that relates to healthy eating, safe sex, increases in exercise, not smoking or taking recreational substances and limiting alcohol intake etc, however in many cases their words fall on deaf ears with people making a conscious choice to behave in the ways that they do, those behaviours seemingly being far more rewarding, at least in the short term, than the effort of making the required change – even when the pay off is much greater in the long term. What is this all about and what can we do about it?
I was assessing a new HOPE facilitator https://www.torbayandsouthdevon.nhs.uk/services/hope-programme/ the other day on their maiden-voyage , sitting quietly at the back of the room, witnessing the delivery and experiencing first hand the impact that the programme was having on real people, when I was struck by the group discussion the developed in front of me.
It was started off from a seemingly simple statement made by one individual, innocently setting the scene for others to chip in. “We are all familiar with the words, we all know what we should do………. but it’s only since starting this course that I’ve been able to start to do these things“.
The person was right of course, all of the people in the room had been through the ‘NHS sheep dip’ of investigations, diagnosis, treatment etc and had all been given the same or similar information in the form of ‘professional advice’, leaflets and video’s etc, but clearly the messages that the NHS is so keen to relay to the public, with the belief that they should soak these messages up, somehow combining them with their DNA, to enact a permanent change in behaviour clearly simply does not work for many people.
The Everett Rogers model of attributes of a successful innovation demonstrates 5 key components to consider if you want the odds of your innovation or behaviour change sticking to be in your favour.
So what is it about the HOPE programme that helps people who for far too long feel that they have been stuck on an inescapable hamster wheel of struggling to overcome physical or mental health challenges, but never really getting anywhere? I suspect that the lesson’s shared by Roger’s can shed much light on the difference that this particular programme offers.
The programme works particularly well when you bring people who share similar experiences together, whether that be health conditions or symptoms, such as chronic pain, fatigue, anxiety etc = Compatability (tick)
It is simple and gentle in its format, scooping people up from week one when they embark on their own personal journey, but one that is shared with others treading the same path. The power of the programme is in its simplicity. = Complexity (tick)
The programme is offered free across the community and although we actively target those people who describe themselves as having lower levels of knowledge, skills and confidence in managing their current health and wellbeing concerns, the programme is inclusive – all who desire HOPE are very welcome to give it a go. We have found that in the main when people join on week one, they stay the whole 6 week course. We have even had a small number of people come back for second helpings! = Triability (tick)
The last of Roger’s attributes for innovation is slightly more difficult to evidence for HOPE. People who attend the programmes are not ‘observable’ – we do not encourage onlookers to peep, reminiscent of a bygone era in Victorian entertainment, however we do offer HOPE to the workforce members of our system wide health, care and wider partners: after all those who care for others often require that same compassionate care, time and understanding for themselves – it is what makes us human. We also share the programmes reported outcomes, letters of HOPE and in the near future plan on recording podcasts where we can hear from participants directly, while maintaining their anonymity. = Observability (oh go on then, let’s have a final tick)
One of the 6 components of Personalised Care is “Building my knowledge, skills and confidence“. On its own it seems barely enough to turn the tide of poor health outcomes that are plaguing many in our society. Across the western world we may be blessed with increasing life expectancy, but without the accompanying health expectancy those extended years of life can be miserable and frustrating for all concerned.
Add “working in partnership with care team” and “connecting with help and support in my community” into the mix and we start to witness phenomenal positive changes, based on building relationships, human to human, where individuals believe that they can create a future that is meaningful to them.
From what I have witnessed in person, the strength in the HOPE programme, where people build knowledge, skills and confidence around their own health and well-being alongside others in similar situations, is in its ability to bridge that gap between knowing and doing while developing long lasting human connections.
A final couple of questions for you to consider as we end this blog;
How many of Roger’s attributes does your change work encompass and what can you do to build more of these into your work?
If this seems daunting don’t fret, we are here to help……. if you need to mull over any of the above, feel free to get in touch and we will assist where we can; after all when we combine forces, anything is possible..
If I asked you to walk on fire how many of you would actually go ‘hell yeah?” Not many, in fact most people would (did and still do) say are you mad?.
What is it that stops most of us from wanting to take that first step? Of course the obvious answer is that people are afraid they will get hurt (understandably with a firewalk it’s a visible risk) most people believe it can’t be done and more importantly believe they can’t do it, they don’t trust themselves or indeed understand how it can be done?
That was me as I embarked on a truly life changing long weekend run by Mr Tony Robbins called Unleash the Power Within.
Mr Robbins is a giant of a man, with a great heart to share all his learning from 30years plus experience in the world of personal development. His events are long days over 4 to 7 days and attended by thousands of people at a time.
So traveling up from Devon to London and preparing for 4 long days, rising at 7am to queue to get a good spot and not getting back to the hotel until gone midnight on several days, I was thinking how on earth am I going to have the energy to do this when I get so shattered after 9.5 hours. Well I smashed that limiting belief to smithereens.
You see in order to walk on fire, you need to understand that fear is the number one reason for most people stopping taking action. Sometimes fear is useful and necessary. Fear triggers the fight, flight or freeze (stress) response in our bodies. However, our brains were wired over 2 million years ago, and whilst parts have further developed there are still parts of it that believe we are being chased by sabre tooth tigers when in actual fact we are sat watching a horror movie.
What we can develop is our ability to understand, change our minds and take control of our emotions and bodily responses, Mr Robbins describes this as changing our state. On the first day, it’s very much about learning how to change your state in preparation for taking that first step on to the Firewalk.
You can change your state in an instant. Think about it, have you ever woken up in the morning dreading going into work because you are thinking about that meeting with your manager, the list of tasks you’ve got to do or that difficult conversation you have to have. You can feel the pressure building inside you (stress anxiety frustration even anger). You become more likely to grab some junk food or nothing at all, hit the caffeine, sugar, looking to feel better, and forget to say goodbye to your loved ones (in fact you don’t remember that you have loved ones at that point).
You get to work, your manager has cancelled the meeting, you’ve received a compliment in your inbox and that difficult conversation isn’t as bad as first thought. How quickly do you feel lighter happier and less stressed?
There is a way you can change that state before you get to work. You can start your day by deciding what you are going to focus on, changing your physiological state and looking at the language you are using both out loud and in your head.
So for that first half an hour in the morning ( don’t tell me you can’t put half an hour aside for yourself!) here are some examples where you can change your state before work:
Focus – read something in a book written by someone you admire, watch something funny, write a list of 3-5 achievable goals you will focus on today or check out the priming exercise on tonyrobbins.com.
Physiological – do some exercise (doesn’t need to be strenuous just a 5 min workout video) deep diaphragm breathing for at least one minute or more (this helps your body to get into its parasympathetic system which is the relaxed system), meditation.
Language – listen to what your thoughts are saying (write them down) or how you are speaking to your loved ones and change it if it’s negative. Negative thoughts/language will trigger your sympathetic system (fight or flight stress) unnecessarily.
Let me take you back to that difficult conversation you are due to have. How do you know it’s going to be difficult? It will be difficult if you focus on it being difficult. However, if you think to yourself my intention is to have an open and honest conversation as I want to get the best out of the situation? Then you have reframed it by changing your language and hence your focus.
The most important piece of learning is to practice practice practice. Success comes from failing, learning from those failures and keeping focussed on the reason you started on this path in the first place. Success is very rarely a straight line.
So back to the firewalk, yes I did it, no burns on my feet, a few black marks to remind me I did it (which washed off) How did I feel and what did I learn… I felt freaking awesome. I learnt what great things we can achieve , by taking a few simple steps to change our state and smash those limiting beliefs that aren’t serving us well.
So I’d love to know what first step you are going to take today in making some permanent changes in your life?
Emma Bewes has over 25 years experience within the Health and Social Care sector, beginning life as a mental health nurse. Over the last 5 years Emma has gained qualifications in strategic intervention coaching and become a workplace coach and mentor as well as leading health and social care teams in South Devon. Emma will be launching her own private practice in 2020
In this blog post we are starting to share with you the lessons that we learnt around the flexible use of communication styles, dialogue and messages utilised, through trial and much error, to engage multi-disciplinary, multi-organisational and multi-community groups of people to buy into our vision and commit to join us in our social movement journey. The ride was by no means smooth, so strap in, as the road was certainly bumpy!
At the risk of being accused of trying to teach you to suck eggs, firstly we are going to reflect on what we believe it is about change that makes it seem so difficult, but is essential to achieve for those who are in the sustainability game.
Creating a climate of positive engagement for initiating a social movement for health was never going to be a gentle walk in the park, for a start it’s not what the NHS was initially set up to do. It was set up in 1948 to ‘fix things’ within the framework of a hierarchy, command and control that can now be referred to as ‘old power’. Indeed the seemingly but necessary chaotic essence of a social movement flies directly in the face of the highly controlled and precise, scientific nature of how business is usually done in the NHS and points to the need for ‘new power’, a different, collaborative way of doing things. That said we shouldn’t throw the baby out with the bathwater rather, instead we should be looking to blend the elements of the two, learning how to nimbly respond, improvise and transition, just as if we were playing in a jazz band.
In 1991 William Bridges declared that “It isn’t the changes that do you in, it’s the transitions. Change is situational: new policy, new boss, new site. Transition is the psychological process people go through to come to terms with the new situation. Change is external; transition is internal“. What Bridges described in 1991 was the ‘dis-ease’ resulting in fear that many people experience when change is first suggested or upon them. Brightman (2001) suggests that it is based on perceived threats to a person’s sense of mastery. Asking someone to make a change can call into question the value placed on a their skills and contribution, often challenging their work identity and their sense of purpose. The change that we were suggesting went even further, it encouraged the sharing of power and at times the standing to one side and letting go, enabling another to step into the ‘powerful position’, ie a loosening of the ‘control reigns’, moving from an inward to an outward mindset and to take a leap of faith into a form of social prescription.
Henry Timms & Jeremy Heimans describes the differences between Old and New power, the parts that they play and how best to blend these in the modern world. This is exactly the strategy that we needed to take with HOPE.
Many people working within the NHS are shackled to ‘Old Power’ rules, the way that our services, systems, processes and long cherished hierarchies have been set up. In order to shift the balance of power we needed to blend and adapt our messages and approaches; giving the appropriate amount of expected deference, while managing to introduce a challenge to their ‘world view’ about what is possible and achievable when there is a prepared willingness to try a different way.
Perhaps on paper that doesn’t seem too difficult a task but in reality shifting the balance towards new power takes time, patience and is underpinned by high levels of trust. The NHS doesn’t have the luxury of time to wait before it transforms into the new world, this is something that needs to be acted upon now! However as we all know ‘now’ in the NHS can take an extraordinary length of time.
If only we had spent time from the outset, identifying the team’s and individuals adoption profiles before we entered the ‘colosseum’ of delivering presentations, we would have saved ourselves much time, anguish and frustration. The graphic below will give you a better idea of what we are talking about, however essentially, many working in the health and care arena sit on the right side of ‘THE CHASM’
This is something to celebrate when what you need is a safe pair of hands, who are rarely distracted and are highly skilled in their specialist fields. Having been a patient in the hands of such a skilled professionals it is of paramount value to feel confidence in their profound competence.
This said when you are looking to disturb the status quo and introduce uncertainty into their world, the people comfortably sitting on the right hand side of the graph are not the place to start conversations leading to transformational change – a painful error that we made on several occasions, forcing us to question what on earth we were trying to achieve and retreat to a quiet corner in order to lick our wounds and regroup.
There is a great saying in the world of Organisational Development (OD) “Go where the energy is“, when you are trying to bring about change. On reflection we kicked ourselves that although we knew this, why did we not pay enough attention to this from the outset, and instead repeatedly made same mistake over and over again?
What we found was that those individuals and groups who sit on the right hand side of the diffusion of innovation curve, would readily invite and welcome us to their group meetings, where they would be present in force. They would politely listen to what we had to say and thank us for our time, then ‘politely’ turning us down, before pointing us in the direction of another area who may be interested in our offer. On the other hand, those people who reside on the left-hand side of the curve sought us out for initial conversations, to explore possibilities and we very quickly recognised that they were our local innovators, visionaries and creators who were able to share our vision and passion for the new and join us on our amazonian journey.
On reflection we mistook and misunderstood the apparently open welcome of the teams sitting on the right hand side as the energy that we were seeking to follow. As the jungle drums began to beat, more and more of the same tribe invited us to their meetings, only to respond in similar ways, disappointing to us. Which brings to mind the The Spider and the Fly poem by Mary Howitt published in 1828 where the opening lines are: ‘Will you walk into my parlour?’ said the Spider to the Fly.“
(Note to selves – be mindful of the innovation profiles of those people you seek to engage with)
The energy contained in ‘new power’ has ability to reach and unnerve us all. Why? you might ask. In order for a true shift in power to occur, to be seen and felt as authentic by the receiver, the language that we use needs to be followed through by congruent actions. Whilst this it would seem is not a new concept, the ability to put ones ‘ego’ and self interest to one side isn’t often easy to achieve, particularly in turbulent and frequently chaotic environments that stir the beast of fear in the most level headed and professionally competent of us.
Moving to a position of true partnership between all parties and away from where one person or group holds the perceived power is Utopia in the land of true personalised care https://www.england.nhs.uk/personalisedcare/ however in our experience the Amazon jungle path is fraught with vines, creepy crawlies and ferocious beasts, all sent to floor our well-intentioned attempts.
If you’d like to learn more about old and new power and how you can utilise these to best effect in your situation, NHS Horizons School for Change Agents 2019, is a great place to start. If you missed the formal 6 week online ‘school’ you can still access the live recorded video sessions here: https://www.youtube.com/channel/UC1s_kDDit3FJgxR_QtawhLg/videos
We tantalised you in our last blog about sharing some chucklesome remarks and terminology that people used in an apparent attempt to deflect our efforts so here you go! (forgive us for being human – we have tamed our typed thought responses so as not to cause offence;)
Next time we meet, Chris will be sharing with you her musings and learning around the power of developing relationships and conversations to help us more easily navigate through the jungle undergrowth.
If you haven’t seen the short film “Your Very Good Health” that introduced the NHS to the population in 1948, it is well worth a watch and shows us how far we have come already – it appears that the NHS has always brought about large scale change after all – who would have thought! https://www.youtube.com/watch?v=VFhEB3gG8HA
Starting from the assertion that “The NHS belongs to the people” https://www.gov.uk/government/publications/the-nhs-constitution-for-england/the-nhs-constitution-for-england I was intrigued as to how we could harness the deeply ingrained and valued principles of the NHS Constitution into the ‘health as a social movement’ reality espoused by Simon Stevens in 2014. Clearly some understanding about human psychology was needed to bring onto play as well as a whole heap of convincing and influencing of the ‘great and the good’ to let us give it a try. We had little to lose and a lot to gain, yet even then, we were expected to leap through fiery hoops of financial assurance, and provide evidence of a realistic ‘route to cash’, after all we were making the bold and audacious request to allocate £7,500 to cover the set-up and implementation of the project in 2018/19. Clearly our superabundant budget request sent the financial risk worry beads hurtling into orbit
Therein started a series of seemingly endless briefing papers project plans, business cases and presentations to boards and groups of siloed people. As an aside, we are more than happy to share any of these documents to those of you who may wish to emulate our model and intend to load as many as possible onto the portfolio page on this site, but please be mindful that even when armed with countless eloquently written documents, you are still likely to have a challenge convincing those with ‘the power to permit’, to put aside their incredulity and hysterical laughter for a moment and hear what you have to say. One piece of advice for you find your allies, you’ll need them to help maintain your resilience, and as Helen Bevan says “Go for no!” (https://twitter.com/helenbevan ). You have to be tenacious and be prepared for many closed doors and rejections if you want to succeed and join the well trodden path of the people in the graphic below.
Committed individuals who are drawn to working to improve the lives of others are found in their masses in the UK ‘caring industry’, however regulatory and financial targets have increasingly become key focusses for organisational leaders, severing in the minds of some, the connection between what makes the NHS the ‘National Treasure’ that it is and the constant struggle and demands to deliver commissioner driven targets.
Integration is the way forward, we are told, however in the minds of many commissioners, regulators and leaders, provider organisations need to be directed and commissioned by way of hard negotiated contracts to deliver services. This has a tendency to create and reinforce the silo working that we are told to disassemble and in a way works against the very essence of integration that we strive towards – after all contracts = £’s, which therefore introduces competition and rivalry into the equation.
The social movement that started in South Devon in 2017, pushed back against the usual way of developing services, refusing to capitulate to the ‘way we do things around here’ mentality and yet still has a governance structure (albeit a loose one), quality assurance frameworks, is building a qualitative and quantitative evidence base and most of all an energy built on passion, a desire to give something back, a drive to improve the lives of others and a drive to maximise our purpose. Dan Pink beautifully illustrates what drives human being to be purpose maximisers here: https://youtu.be/u6XAPnuFjJc . This 11 minute video at the time of writing has had over 17,124,458 views, if you haven’t watched it yet don’t be the one who misses out because grasping the knowledge that Dan Pink shares will ease your journey into orchestrating your own social movement for health and wellbeing.
We built a collaborative partnership between primary, secondary, community and social care; mental and, physical health the voluntary sector and most importantly people with lived-experience. Our work was and is still not formally contractually ‘commissioned’ but was supported in bucket loads by our organisations Chief Executive. We believe that the movement has been possible in part by it’s lack of contractural commissioning. Without contracts we were able to engage with, collaborate and work flexibly and creatively together as an ever growing community of people with a shared purpose, maximising it’s impact across our geography.
Oh and by the way, that hard won budget of £7,500 for 2018 …………. ended being underspent by £5,000. The £2,500 that was spent, mainly went on:
Funding of community venues (we were very keen to focus this away from the acute hospital as the vast majority of health and wellbeing occurs in the community that a person lives in),
Training resources for facilitators (the model that we use is each HOPE programme ideally being co-facilitated by two facilitators, a member of the ‘workforce’ and a facilitator with ‘lived-experience’)
out of pocket expenses for volunteers
and a very small amount went on volunteer drivers who transported the few in number who were unable to get to the courses on their own.
The first part of this series set the scene for our journey https://changeunlockedtoday.wordpress.com/2019/08/01/passing-a-movement-forward/ , go back and have a quick read, if this is the first of our blogs you have read – it will give you the context. Next time, Chris and I will focus on the different messages that we utilised through trial and much error, when presenting our idea to differing groups of people, including the chucklesome nuances of communicating with some male doctors in senior consultant positions.
Please sign up to follow this blog by entering your email at the bottom of the home page here: https://changeunlockedtoday.wordpress.com/ . Share with us your thoughts about what you have read, in the pages comment box. We want this blog to be interactive and welcome comments and questions from readers as we believe that as a community we can all learn from each other.
In order to be of service to you, we need to understand what you’d like us to describe and share with you to help you make sense of the opportunities that you have in your local system. Interventions are rarely ‘lift and shiftable’ in facsimile form. According the the Health Foundation (2018) https://www.health.org.uk/publications/the-spread-challenge For things to be spreadable and scaled we will need to codify how and what we have done so that you may take the bits that are relevant to you, enabling you to then emulate and improve on our current model, in your local system – by making it your own you can avoid the ‘Not invented around here’ syndrome of non-engagement by stakeholders.
Things take longer than we usually expect, here is a basic outline to give you an idea of how long it has taken to date. The below timeline was created for you on advice from a twitter follower- Thanks, ‘Alison Waters’!
Until next time take care and embrace your inner possibility architect, you won’t know what you are capable until you try.
P.S. Huge thanks to Lyn and Jonathan Ward for the gorgeous photo of Fistral Beach Cornwall.
It was back in 2014 that I first came across an interview with the then new Chief Executive of NHS England ‘Simon Steven’s’. When asked about the challenges ahead for the health of the population and how the NHS needs to respond, he referred to the need to create a “social movement for health’“
This was both a curious and intriguing concept for my ‘NHS brain’ to consider, having had 29 years’ experience on the job. Surely the NHS, ‘our National Treasure’, an institution held in international envy and esteem, an organism with its own set of peculiar cultures, sub-cultures and training, a monolith of gigantic proportions, couldn’t design and create a social movement. For a start, the NHS is recognised as being risk averse and social movements by their very nature are uncontrollable, flexible and adaptable with few governance structures, the very opposite of how the NHS has been designed and developed. How on earth could the NHS become a social movement, generating social change from the ground?
The challenge therein certainly got me thinking and at first it felt like an impossible ask, yet here I am today orchestrating a personalised care social movement based around peer-support, self-management education and health coaching. A social movement that appears so incredible and amazing that people from all walks of life, near and far afield want to understand and emulate what we have done. It is worth emphasising here, the most important two letter word in the last sentence you have just read ‘we’, it may seem a small point, however if you indulge me with your attention it will soon become apparent that although I am seen locally to be leading this programme, in fact it is the many, the people of Devon and increasingly the people of South West of England who are the ‘we’, I refer to, without whom our social movement ‘HOPE’ would merely be a figment of my possibility architect brain.
We are only too aware; having been an NHS England ‘Demonstrator site’ for Integrated Personal Commissioning and now an ‘Exemplar site’ for Personalised Care it can bring many demands and tribulations in the form of reporting and ‘feeding the beast’. However what it also brought was an opportunity to draw down funded support from the Voluntary, Community and Social Enterprise (VCSE) sector. One of the offers available in 2016/2017 was to work with Coventry University’s professor Andy Turner https://www.linkedin.com/in/andy-turner-ba6b395/. Andy Turner is an innovator who created the HOPE programme. Andy’s work at Coventry included evaluating several successful and popular self-management programs. By taking the best bits of these programs and synthesising them together within a positive psychology framework, he and his colleagues have created a program which they call Help to Overcome Problems Effectively or ‘HOPE’. https://www.h4c.org.uk HOPE is a six week programme that runs for 2 ½ hours a week and blends peer-support, self-management education and health coaching into a seemingly magical combination. It has become the catalyst that is bringing personalised care approaches to life across Devon and is now spreading further afield into the wider South West Region and gathering interest from across England.
Let me take you back a few steps…..”HOPE, why call it HOPE Andy?” I asked (Andy Turner’s following response is paraphrased). “When we first developed the program we tested it out on several groups. At weeks one and five, we ask the participants to each identify and write down three emotions that they are feeling. We then create a word-cloud. At week six we show them the before and after word-clouds to demonstrate how far they have come. The one word that stood out time and time again in the second word cloud was ‘Hope’, so we decided to make an acronym out of it, Help to Overcome Problems Effectively. But it also simply means ‘Hope’ – the program seems to bring a real sense hope to people!” Trust academics to turn it into an acronym!
The possibility architect in me then started thinking………………… the system in which I was working, like many other systems, was experiencing significant pressures in terms of capacity and available finances. This environment brings about challenges and also opportunities; after all it is often when our backs are to the wall as a species, that we are our most creative and innovative. What if supported self-management in the guise of HOPE could be the thing that helps us to cement personalised care approaches across our system? Integrating primary, secondary, community and social care; mental and, physical health the voluntary sector and most importantly people with lived-experience, a truly holistic approach to creating the social movement for health that Simon Stevens challenged us to create in 2014?
If this is something that interests you; and you wish to orchestrate your own local or even national social movement for health, utilising personalised care as the chassis of choice, in the weeks to come we shall share with you our journey, the hill climbs, the pot-holes, the dead ends and the high speed stretches of road where there are no ‘National speed-limits’, only clear roads ahead and the wind in your hair, after all who doesn’t love to go topless!
This our first foray into the blogging world, where we intend to describe and demonstrate what it takes to architect and deliver change that makes a real difference to people, organisations, communities and most importantly you.
The blogs will be mainly written by us, Helen or Chris, but we will occasionally publish guest blogs from people whose work or life stories we admire and who share our closely held values of inclusivity, compassion, honesty and insatiable curiosity for the possible in making this world and our health and care services, the very best that they can be.
Join us on this exciting journey, interact, comment, share your views, insights and ideas, after all ‘It takes a village to raise a child’ or in this case ‘a whole bunch of possibility architects and change agents to change the world’.