Tag Archives: Person-centred approach

Do what you say on your tin

Canadian Falls 3Are you taking the risk? It is something we all do, but why do we confuse and complicate it by our lackadaisical use of language? We take risks in order to gain something for ourselves, and occasionally others. We weigh up the options available to us, and make a decision based on what we compute to be the most beneficial course of action. It is called positive risk-taking not because we are trying to find a ‘positive risk’ (whatever that is), but because we are taking the risk in order to achieve a positive outcome (the gain or benefit). So, the word positive is about the outcome not about the risk! I am also not talking about ‘positive risk management’, which sounds too general and like unnecessary window-dressing of a process more often seen as negative or risk-averse. The word positive is being added to risk-taking, in my context, in order to bring some clarity and specific detail to your thinking.

We revere risk-takers in the worlds of sport, entertainment and business, tending to attribute degrees of awe to their decision-making and achievements. Do you think Ayrton Senna planned his route, speed and overtaking manoeuvres around the race-track because he thought the risk would be nice? Does Warren Buffett make his financial decisions based on a spin of his favourite coin? It is more than likely that both of these people employed complex ways of weighing up the pros and cons of choices facing them, sometimes with careful thought and consideration, and sometimes distilling a lifetime of experience into a split second. So do we, in our own personal circumstances.

Risk Decision-MakingSo, next time you are leaning on a bar deciding whether to have that extra Babycham, remember that positive risk-taking is weighing up the pros and cons of your particular set of circumstances at that time. Whereas the positive risk is simply the chance that they might taste better the more you have; and the positive risk management is the hope that those around you will help you home instead of tying you to a lamp-post at the end of the night. These concepts mean different things, so be clear when you use language, only positive risk-taking is thoughtful and considered. But… what do you think?

http://www.pavpub.com/risk-decision-making/

“Words are how people think. When you misuse words, you diminish your ability to think clearly and truthfully.” [Margaret Heffernan].

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Podcast Episode 019: Confidence Tricks [1]

TheStrengthsRevolution_albumart_2-2Risk-taking is part of a healthy way of living, and we make decisions every day. However, just occasionally we are confronted with potential life-changing decisions, such as changing a job, moving our home, expressing feelings for others, marriage, children, divorce, and end of life choices.

How can we face some of these major decisions and make them with greater degrees of confidence? This episode offers a number of common sense tips to help us develop that confidence. Being reflective, checking things out with trusted friends, being aware of consequences, being open to learning not just seeing things as simple as success or failure.

Fir 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/019-confidence-tricks-1/id867043694?i=317489992&mt=2

“But he learned long ago that a life lived without risks pretty much wasn’t worth living. Life rewarded courage, even when that first step was taken neck-deep in fear.” [Tamera Alexander].

Working with Strengths

TheStrengthsRevolution_albumart_1At a strategic level we are continually expanding the language, but essentially using new words and phrases to say the same thing… recovery, personalisation, self-directed support, person-centred planning, re-ablement/re-enablement. Nobody can seriously disagree with the premise that service users should be given a voice in order to say what they need and want, to reflect on how best to meet their wishes and aspirations, to exercise choice and feel supported in their decision-making. However, there is often a gap between what we are saying we are doing as services, and what service users are experiencing on the receiving end. The distance between strategic vision and practical reality rarely conforms to anyone’s idea of close proximity.

This is where the Strengths Approach or Working with Strengths come into their own… call it what you will, but we need some way of translating the big picture into something that is clearly understood and able to be delivered by workers with service users (and carers). We can talk about journeys all day long, but unless you can walk it unaided then we need a vehicle, a route map, a travel guide or companion… a means of travelling that journey. The Strengths Approach sets out a clear statement of values and principles to guide and support good practice; it provides fit-for-purpose tools and the necessary guidance on flexible use of such tools; and it sets out practice-based policy statements that help to tie-in the organisation – team – practitioner levels to an agreement on what we are doing to support people to experience the rhetoric of person-centred services in reality.

The Working with Strengths document represents an overview of how this challenge has been met through a collaborative initiative between Practice Based Evidence and Granta Housing Society between 2007 and 2012.

Playing with numbers

RD-M 2013

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. 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 ifPractice 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 aquality 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…

These are just a few thoughts I am passing on as I reflect on years of connections with so many people who are desperately trying to do good work despite rather than because of their masters. Do feel free to offer your thoughts and ideas (with an accompanying dictionary from those of you who find ordinary language an alien concept… with all due respect to the demands of the Plain Language Association).

Does the whole picture fit together?

AoCC 2009

This question captures the meaning of ‘care coordination’. Are all the elements coming together in a coordinated sequence or pattern? It is a question that we apply to many aspects of our daily lives. We ask it, for example, about the colour schemes and fittings of interior design; the layout of an exhibition or gallery; the clothing we wear in particular situations. Simplicity and straight lines in a map or set of instructions often seem to help us to understand what we are doing, where we are going and how we can get there more easily. Complex pictures and plans might please people who enjoy the challenge of working out puzzles rather than having the solution given to them but, depending on how much time you have and what kind of person you are, high levels of complexity may serve only to frustrate you and turn you off.

The degree of creativity experienced in the smallest to the most complex of mental health tasks will largely be influenced by the attitudes, feelings and personal values that are in play at the time. For example, the simple task of arranging an appointment, and then attending it, might just be part of what a particular person does, and they might do it methodically, with little or no thought. But even a simple task like this can be subject to enormous influences, such as the availability of rooms, effective computer systems, clarity of communication, motivation to attend and transport on the day. Failure to meet the appointment, for whatever reason, has the potential to cause frustrations, fuelling deeper tensions and attributions of blame. But the successful completion of a simple task like this rarely generates the positive feelings that perhaps it deserves. Not all appointments and methods of support are creative, passionate and artful events; but the message is that we need to be more reflective about the smaller details if we are to derive more pleasure from our work routines. This message applies to all practitioners involved in care and support, as the care coordinator occupies a role of supervising the whole picture, not painting the whole picture alone!

Successfully coordinated care and support can be a great source of satisfaction and pleasure for providers and receivers alike. See the ‘Art of Coordinating Care’ manual for a detailed approach to capturing the creativity in the role.