In this interview Anne Clilverd talks about the important therapeutic value that pets provide for their owners and for others. They offer a remarkable range of functions that can help people across all age groups. She also talks briefly about her work with the Pets as Therapy charity.
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In health and social care services we have a long tradition of adopting a scatter-gun approach to staff training. Perhaps this is why staff members often feel negative about mandatory training initiatives, or feel that provision is often made as a knee-jerk response to something going wrong. More generous feedback emerges from events that individual’s have personally chosen to attend, but these often have little positive ripple effect out into the team they are part of… if you weren’t there you simply aren’t going to know much about it.
The Practice Based Evidence initiative has long tried to establish a strengths approach to training, as well as to working with service users. The essence is to get all team members to provide a baseline evaluation of the good and not so good practice in their team, against a series of positive statements of best practice that should be relevant to the way they work. Hence, several Practice Based Evidence tools were devised to address different types of teams and different person-centred approaches to working.
In the case of one of the Newham Community Mental Health Teams in 2006 an honest anonymised evaluation of team practice helped to identify the priorities for a subsequent 5-day programme tailored to their needs. This example illustrates how a practice development approach to training initiatives can respond to the needs identified by practitioners themselves, impact on the practice of a whole team, and engage people more in the process of change. This is how a strengths approach can apply as much to team development as it should do for working with service users.
More recently, in 2014/15, a programme of work with North East London NHS Foundation Trust acute care services focused on the place of positive risk-taking in relation to the work of crisis assessment and home treatment teams, including the teams for adult and older adults services. The programme commenced with team-based training workshops in order to focus in on relevant current clinical material and practices. It was followed up some 6-9 months later with in-service conversational semi-structured interviews of 28 staff, and a further number of Practice Based Evidence designed for purpose evaluation tools. The final reporting is a means of identifying positive practice, as well as giving staff a means for identifying what they can and need to change in order to improve the implementation of best practice.
“Practice is the hardest part of learning, and training is the essence of transformation.” [Ann Voskamp].
We shouldn’t be happy just being critics; do so with constructive responses, so you are always being helpful in your role of criticising others. I have been a critic of the management culture in general in recent episodes of this show, but also need to stand up and be counted in my response alongside my criticism.
I have chosen a process of transformation of my own recent work, particularly positive risk-taking and risk decision-making, to align it more with the needs of more senior managers and business leaders. These are people who are continually making high risk decisions, but in my experience in health and social care they commission me to work with their practitioners and teams, but don’t take part in any of the work. It is my intention to refocus my work through the EPIC Program of online marketing and coaching, into a transformation statement directed to my new ideal client avatar through a new webinar that can lead some people through strategy sessions into my signature programme.
It is my intention to offer a high degree of transformation for senior people experiencing difficulties or fears in relation to their decision-making. Michelle Mone is a lingerie tycoon who has recently publicly spoken about her daily fears about these decisions, despite being a very successful entrepreneur, so Michelle helps me to identify the type of people I would ideally want to be working with.
Steve realised he misread the idea of a Google Hangout when nobody turned up to the venue he booked!
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In this episode a couple of recent newspaper articles reflect on the malaise of the management culture in two UK world class institutions… the NHS and BBC.
Damning reports into the culture of management in the NHS are being withheld until after the imminent general election, where the description of the sturcture is described as ‘totally shocking’ and ‘not fit for purpose’. Could this be the very structure that was re-structured against previous manifesto promises by the Tory led government initiative?
Meanwhile, over at the BBC it would appear that investigative journalists who blow the whistle on previous BBC celebs for child abuse scandals, are themselves demoted and sidelined, while the bullies are promoted! Great institutions are created from lofty principles and values, but it would appear that by a process of evolution the management function gradually grows into a misguided sense of its own self-importance.
Bureaucracy becomes top heavy, unmanageable, and filled with overpaid people who have little understanding or connection with the true heart of the enterprise. There is no simple solution to a malignacy decades in the incubation; but we must continue to respect our world class institutions for their founding principles and uphold their core values as theur main purpose.
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I am often mindful of the need to criticize the quality of leadership and management in health and social care services; particularly the obsession with numbers, the tick-box mentality, and the blind faith placed in targets for driving change and daily practice across services. I am surely not a lone voice in this critique, but is it valid or just a reaction against the sound of the pips squeaking?
I do believe that an absence of targets or defined outcomes, and a failure to establish high standards for provision of services only leads to inconsistencies between practitioners and teams… what is often referred to as a postcode lottery. Service users don’t deserve to be on the receiving end of either stressed out practitioners fearful of constant criticism, or laid-back practitioners doing their own thing. Audit and regulation have a place, but surely they need to be clearly joined up to practice, not existing in a vacuum somewhat disconnected from the realities within which good practice has to operate.
The ever-growing chasm between person-centred practice and business-focused managerialism does little to promote a culture of organizational collaboration that may encourage a more engaging form of audit and regulation across services. My solution would be to eliminate most of the current audit requirements imposed on practitioners and teams, particularly that which they experience as wholly time-consuming and unhelpful. So far so good, say the practitioners amongst you; please do share your thoughts, but read on before you do…
Over the last 12 years, through the Practice Based Evidence initiative, I have been developing tools designed specifically for use by practitioners and teams. These tools have flexible uses: personal reflection, individual supervision, team development and team evaluation. Used diligently they should be able to provide a host of qualitative and quantitative data, which in turn should offer useful feedback to practitioners and teams for practice development purposes.
Updated Risk Resource (2013)
The Risk Decision-Making publication includes examples of these tools, and a specific example of data emerging from their use in a specific organization to help identify good practice and priorities for further development.
So, the sting in this tail is that practitioners and teams need to own the processes of audit and regulation if they are to reflect and develop good practice. For those auditors and managers fearful of losing their jobs if Practice Based Evidence emerged as the norm, you could always make use of the data to tick your boxes; better still, you could prioritise your time more effectively by getting in and alongside practitioners and teams to support a quality revolution. You might then be in a stronger position to challenge and inform the thinking of the inter-galactic warlords from distant planets a.k.a. commissioners, Department of Health, Care Quality Commission.
It can be argued that over several decades the function of management has morphed from the role of supporting the essential development of a business into a role of managers running the business for their own primary gain.
Recognised management academic gurus have identified the dangers of management for management sake, and the way it can block the functioning of the frontline workers. This has been my experience throughout many structured interviews with frontline clinicians in health and social care services in the UK. Managers need to reconnect with the primary business of its business. The excellent managers contribute significantly to developing staff to identify and make best use of their strengths. Good management is a talent in its own right, but the majority of what constitutes management can frustrate and block creativity, and largely ignore the vital strengths.
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An interview with Anne Clilverd as she reflects back on three specific teams to identify what elements contribute to good team-working.
An acute admissions ward where, despite being based on a hierarchy, a strong sense of belonging was fostered. The environment was supportive through all staff being encouraged to contribute their observations in a way that was respected by multidisciplinary colleagues.
Compass as a walk-in advice and mental health centre also offering a degree of outreach work as a new initiative at a time when long-stay hospitals were beginning to be closed down. This initiative was joint funded and managed by health and social care, operating as a small multidisciplinary team of four people committed to a strong set of values and principles. As a group the workers need to feel confident to have their ideas openly and constructively critiqued; and they were supported by an advisory group that included several service users and representatives of local voluntary sector services.
As team manager Anne worked in the Kings cross Community Mental Health Team. This type of team functions as a group of individuals who come together for a common purpose, but belonging may be more to the team name than a sense of full collective working. The team manager carries the specific responsibility to stamp a personality on the team through a vision for common goals and purpose, and the quality of supervision as a means for encouraging reflection and professional/personal development.
Anne also briefly reflects on the optimal size of good functioning teams. For the full content of this episode click on the links to iTunes and Sound Cloud (or go to Stitcher Radio):
In this interview Anne Clilverd talks about the important therapeutic value that pets provide for their owners and for others. They offer a remarkable range of functions that can help people across all age groups. She also talks briefly about her work with the Pets as Therapy charity.
The Strengths Revolution 