Tag Archives: NHS

Risk Aversion or Risk-Taking?

Positive Risk-Taking logo

We all work with risk; we all have to make risk decisions, and sometimes those decisions involve the challenge of taking risks. Part of overcoming the challenges resides in our awareness of our own mindset in relation to risk. I have a simple 5-step approach to helping me make the challenging decisions… in work as well as in life.

Click on the following link to access a free webinar that provides 40+ minutes of training in the challenges risk can present, and an introduction to my 5-step approach:

https://app.webinarjam.net/register/21360/99e6026a97

This webinar condenses 30+ years of my experience working in and alongside health and social care services, and 60+ publications around the subject. Risk is something we should embrace from a positive perspective, and this webinar develops this mindset.

Positive Risk-Taking & Dementia-Friendly Communities

JRF screenshotThe increasing incidence of dementia, and profile it is gaining in the public imagination, means that this is a condition that none of us can ignore. What role might a strengths approach have to play in the way we view people living with dementia? It is all too easy to see the negatives and deficits around someone living with dementia, and to remain oblivious to their capabilities and potential, as well as the supportive resources they have around them. Just because you have a particular label doesn’t mean you have lost all capacity to dream and desire a reasonable quality of life for yourself, as determined by you, not imposed on you by others. However, the so-called ‘community’ can become a progressively challenging place as cognitive capabilities decline.

‘Positive risk-taking’ is a concept well established by the Practice Based Evidence consultancy, and it applies equally to the risks a person living with dementia may wish to take, and to all of us who live in, work in and develop communities. The Joseph Rowntree Foundation commissioned a piece of work from a collaboration of Practice Based Evidence and the Mental Health Foundation to investigate how the concept of positive risk-taking may apply to the government initiative of developing dementia-friendly communities. The think piece is explored in the published ‘Viewpoint’ at the following link:

http://www.jrf.org.uk/publications/how-can-positive-risk-taking-help-build-dementia-friendly-communities

“Those with dementia are still people and they still have stories and they still have character and they’re all individuals and they’re all unique. And they just need to be interacted with on a human level.” [Carey Mulligan].

Check out ‘Still Alice’ as a great portrayal of the tragic descent into dementia, and the impact on a wider family as well as the person living with the condition.

 

Assertive Outreach: Examples of Great Teams

IMAG2227_1‘Strengths’ Assertive Outreach: A Review of Seven Practice Development Programmes.

The Practice Based Evidence consultancy made special efforts to get involved in going beyond simple training; focusing on developing teams with a positive impact on practice. It is one thing to claim to support best practice, but another thing entirely to provide evidence for such claims. Assertive Outreach teams in the UK were a particular passion from the original establishment of the consultancy in October 2001. The following article was first published in the Mental Health Review Journal (June 2008) and is reproduced with their kind permission; it is an evaluation of the support provided, from a strengths perspective, for seven such teams.

ABSTRACT

Assertive outreach is based on extensive international research and has been promoted in the UK in 1999 as a key area of the National Service Framework for Mental Health. Its primary aim is to provide a specialist service for people disengaged from traditional approaches of mental health services, but very little attention has been paid to how such services can be developed. Practice Based Evidence, a practice development consultancy, has engaged seven assertive outreach teams to focus on development first, and follow-up evaluation of the impact of reflective practice on team functioning. This has prompted a number of strengths-based recommendations for changing the way we think about developing services before we engage in research and evaluation.

PDF: ‘Strengths’ Assertive Outreach: A Review of Seven Practice Development Programmes

Podcast Episode 079: How can we ‘do’ recovery?

TheStrengthsRevolution_albumart_2-2In recent episodes I have explored the meaning of recovery and concluded that I fully support the original intentions of its service user creators, but despair at the corporate take-over and misappropriation of a good idea. I have also explored how the ‘can do’ strengths approach lends practical reality to the conceptual language of recovery. But how does recovery happen in practice?

In this episode I explore some of the resistance that it, and most new concepts, confront alongside the challenges within a deep-rooted culture that need to change in order to provide the conditions for these good ideas to flourish. I also explore the tools that have been created to implement recovery, but argue in favour of choice if we are to inhabit the service user’s life with the trappings of bureaucracy. Finally, I identify recovery as yet another concept where family/carers express concerns at feeling like they are an afterthought in the discussion of what happens in the delivery of a service.

For the full content of this episode click on the links to iTunes or Sound Cloud (or go to Stitcher Radio):

https://itunes.apple.com/gb/podcast/strengths-revolution-steve/id867043694

https://itunes.apple.com/gb/podcast/079-how-can-we-do-recovery/id867043694?i=355718152&mt=2

“Recovery is something you have to work on every single day, and it’s something that doesn’t get a day off.” [Demi Lovato].

 

Podcast Episode 078: Making sense of recovery

TheStrengthsRevolution_albumart_2-2Having explored the concept of recovery in the previous episode I concluded that I fully support the original service users’ intentions but despair at the corporate take-over of manifestly good ideas in order to decorate their own complex and confused way of going about things.

As a realist I have to accept that recovery has become a leading mantra headlining the development of 21st century mental health services, but I struggle with the degree of confusion expressed by so many practitioners who would rather not be asked to describe what it actually means. What does the Strengths Approach lend to this set of circumstances?

In this episode I compare the language of the principles of recovery with the practical ‘doing it’ approach offered by the strengths movement. We can sit around and talk about conceptualisations as long as we like, but at some point someone has to do something, and that is where the strengths approach comes into its own.

For the full content of this episode click on the links to iTunes or Sound Cloud (or go to Stitcher Radio):

https://itunes.apple.com/gb/podcast/strengths-revolution-steve/id867043694

https://itunes.apple.com/gb/podcast/078-making-sense-of-recovery/id867043694?i=353576161&mt=2

“I know now that we never get over great losses; we absorb them, and they carve us into different, often kinder, creatures.” [Gail Caldwell].

Podcast Episode 077: What is recovery?

TheStrengthsRevolution_albumart_2-2‘Recovery’ can simply be described as to regain, get back or restore something which has been lost, but in health and social care services we don’t tend to go for the simple and straight forward, particularly when confused and complicated are on offer.

I fully support the concept of recovery, as it was originally identified by service users, but I despair at how easily those in power feel able to misappropriate good ideas to dress up their otherwise complex demands. Now I tend to see recovery as something designed by service users, hijacked by commissioners, managers and politicians, and crashed by practitioners.

In this episode I explore how a uniquely personal and individual concept of great merit and purpose has become subsumed into the corporate world of strategic direction, and subsequently lost in translation. The original pioneers foretold in warnings of how the concept will lose its power when it becomes systematised, but the world of bureaucracy is not known for heeding warnings, particularly if they don’t appeal to the perpetual need to homogenise the individual experience.

For the full content of this episode click on the links to iTunes and Sound Cloud (or go to Stitcher Radio):

https://itunes.apple.com/gb/podcast/strengths-revolution-steve/id867043694

https://itunes.apple.com/gb/podcast/077-what-is-recovery/id867043694?i=353576160&mt=2

“You can get the monkey off your back, but the circus never leaves town.” [Anne Lamott].

Podcast Episode 063: Truly meeting the need

Person-centred (2009)
Person-centred (2009)

Within the context of service-centred working can a meeting ever be person-centred?

In this episode I outline experiences of ward rounds and community reviews that are frequently presented by the services as being person-centred, but are clearly service-centred.

Our use and misuse of language is more often than not a reflection of our values and ultimately a reflection of what we deliver as a service, so it needs careful attention.

Attendance at meetings does not equate to involvement in meetings. So what will it take to make service meetings, particularly client reviews more genuinely person-centred? I present four messages to guide us towards this aim.

For the full content of this episode click the links to iTunes and Sound Cloud (or go to Stitcher Radio):

https://itunes.apple.com/gb/podcast/strengths-revolution-steve/id867043694

https://itunes.apple.com/gb/podcast/063-truly-meeting-the-need/id867043694?i=344569092&mt=2

“If you had to identify, in one word, the reason why the human race has not achieved, and never will achieve, its full potential, that word would be ‘meetings’.” [Dave Barry].

The Art of Co-ordinating Care

Person-centred (2009)
Person-centred (2009)

Care co-ordination, the role of the care co-ordinator, has become a challenging function of our care and support services, attracting more than its fair share of negative connotations. A genuine tension exists between the passion and artfulness of human relationships on the one hand, and the pursuit of a scientific basis for interventions on the other. The science of research seeks to impose a sense of reassurance by means of consistent results when defined sets of circumstances are observed or applied.

By contrast, the quality of an artful endeavour may be measured more by its emotional characteristics and the feelings it engenders in those involved or observing. In reality, the experience and practice of mental health and learning disability services is primarily a study of people’s emotional experiences, feelings and behaviour patterns. So we should be wary of any attempts to understate the elements of artfulness and passion; and we should recognise the potential impact this may have on our enjoyment of the work, as well as our motivation for doing it.

Arguably, one of the most crucial effects of the evidence-based practice focus of research is that it undermines the art of relationship-building. The pursuit of a rigorous scientific rationale places a clear priority on the cult of numbers. ‘How many?’ and ‘How frequently?’ and ‘How quickly?’ become the valued quantitative outcomes of an efficient service. But what is the cost of this, in terms of an effective, good quality experience for the individual service user within this wider research picture? Or, indeed, what is the cost of its impact on the qualitative experience of the work that, for many practitioners, is their motivation? Ideally, we need to strike a careful balance between art and science in the delivery of good quality care and support.

Check out my 2009 publication The Art of Co-ordinating Care, written with Andrew & Roberta Wetherell, for the best practice to achieve person-centred working and delivery of care and support.

Podcast Episode 051: World Class institutions

TheStrengthsRevolution_albumart_2-2In 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.

For the full content of this episode click on the links to iTunes and Sound Cloud (or go to Stitcher Radio):

https://itunes.apple.com/gb/podcast/strengths-revolution-steve/id867043694

https://itunes.apple.com/gb/podcast/051-world-class-institutions/id867043694?i=338033889&mt=2

“Bureaucracy is a giant mechanism operated by pygmies.” [Honore de Balzac].

Podcast Episode 050: Who is management for?

TheStrengthsRevolution_albumart_2-2It 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.

To hear the full content of this episode click on the links to iTunes and Sound Cloud (or go to Stitcher Radio):

https://itunes.apple.com/gb/podcast/strengths-revolution-steve/id867043694

https://itunes.apple.com/gb/podcast/050-who-is-management-for/id867043694?i=337535026&mt=2

“Most of what we call management consists in making it difficult for people to get their work done.” [Peter F Drucker].

“There is nothing so useless as that doing efficiently that which does not need doing at all.” [Peter F Drucker].