by Wendy Lansdown. On Twitter @wendylansdown
Appreciative Enquiry in action – Ely Market Square
I recently learned that a dear friend who I have lost touch with sadly died last year. Roger and I had worked together back in the early 90’s at a hospital for people with learning disabilities. We were both baffled by why people in good physical health were in a hospital, on the outskirts of a village, separated from the world, even more so in the ward we worked on, with its locked doors due to ‘challenging behaviour’. I was fresh out of uni at the time and Roger tacitly became my mentor, helping me to understand how to work within a system, to build a new way of doing things.
Roger taught me to listen, really listen, including to people who didn’t use words to communicate. He recognised people as human beings, discovering what made them tick, uncovering long hidden personalities, finding voices, seeing skills, where others only saw problems, challenges and need. Our team supported people who had rarely left the hospital to go on holidays where they – free from the restrictive ward environment – emerged from their shells. One literally finding his voice, speaking for the first time, having been electively mute for decades.
The changes wouldn’t have been possible without Ruth, an amazing nurse who started at a similar time and facilitated us as a team to set a strong joint vision. She created the space for good stuff to happen and gathered energy around the emerging positive culture. People who didn’t want to work this way, chose to leave, often for another more traditional ward. New team members were recruited who shared our values, and creativity flowed, together we brought in what we might now describe as early versions of Circles of Support.
Remembering Roger, I started seeing parallels with where I find myself today and with Neighbourhood Cares. Since the pilot ended, our team have moved on to an array of different roles inside and outside the council. We are in regular contact (still using our Out of Hours What’s App group!). Each of us continue to passionately hold our Buurtzorg learning as our compass, bring it to our daily life, hugging our vision of a stronger future, one which is community-led, where everyone has agency, built on strong relationships.
Then and now, listening is at the heart of everything we do.
Gary Wallace has extensive experience of using Appreciative Enquiry in the world of Public Health in Plymouth and he kindly shared his wealth of learning with us. Almost 50 of us from across the East Cambs system are now trained in this listening technique; community and faith leaders, residents, policemen, social workers and Integrated Neighbourhood colleagues. We’re focusing on what helps people be happy and healthy at home for as long as possible. We’ve heard a lot about the importance of being valued, connected and having agency. Here’s our write up of our first attempt at using our new found skills.
Now, in our deeper dive, we’re out and about having conversations at Warm Hubs. I love these rich conversations (although, perhaps unsurprisingly, we’re finding many people don’t love the ‘Warm Hub’ name). Something that struck me is how important it is for people, especially those who are more introverted, to be personally invited to join in. One gentleman shared how he’d been asked to bring his war medals. ‘It gave me a reason to come through the door’.
Rich conversations are also happening across the system, the process of having the conversations has brought us together and our insights are sparking new potential. One of the Clinical Lead GPs for our Integrated Neighbourhood got in touch to ask if her new GP registrars could join in the next training session. An opportunity that wouldn’t have come to light a few years ago.
Our Appreciative Enquiry work is firmly-footed in our Integrated Neighbourhood team. Ashling (who manages the Integrated Neighbourhood Programme) has deftly weaved an Appreciative Enquiry approach into numerous strands of work from Winter Wellness to Population Health management. Others are using the technique for their work on vaccinations, community transport and one-to-one support.
I’d describe our work as ‘inspired by’ Appreciative Enquiry, we’re not purists. It’s still relatively early days, we’re fledglings… although as Gary says, it’s less about learning something new, more about unlearning being a formal, straight faced professional, and remembering how to have a normal conversation.
Something else which has followed from listening to our communities is a small jointly run initiative which we’ve developed with our Integrated Neighbourhood. Volunteers are matched with Carers and their loved ones to make friends and for the Carer to have some time for themselves. We’ve seen some great outcomes, we’ve learned a lot, and can see how an evolution of the project will take it to a new level by incorporating the coordination role in a more systemic way. Simon, the PCN Manager’s has a brilliant approach. He suggested using the Care Coordinator role which is within the gift of the PCN’s as the ‘chassis’ for something more bespoke to our local need. The role is due to be advertised soon. And that feels core to what we’re all about, responding to what we hear by being creative with what we have.
With each of these examples there’s something about us as a system ‘getting each other’, seeing how we’re aiming for the same thing, using our shared values and approach to shape the way forward together. I love how Ashling describes it, ‘a relational way of neighbourhood working’
It feels as though we have done the work we need to now, to create the pattern for our joint system team. We’ve cut out the pattern and mocked up our first attempts to see how system working fits our organisations. For our council the stepping stones have included Transforming Lives, Neighborhood Cares and Think Communities, with each step our paths more seamlessly intertwined with our partners.
We’ve expended a lot of time and energy doing pilots, projects, and programmes…it’s been worth it to get us to this point. Now we have a good fit and it’s time to proudly wear our new clothes.It is time for this to become ‘the way we work round here’.
We are starting to think differently with Care Together, our newest initiative. As a ‘programme’ our team have struggled with measures and all the gamification and reporting they bring. I think this is particularly tricky for us as a Community Team. Despite many attempts, our work just doesn’t fit into predictable linear boxes where we can say what will happen if we do well. However, together we are finding our way through, for example, 50 people have now been trained in Appreciative Enquiry and this measurable “output” is a foundation for positively impacting people’s lives in a way which will evolve organically. We aim to retrospectively measure what happens as a result. I see Care Together as a bridge – straddling the tricky waters between traditional ways of working and a more nuanced approach which recognises the complexities of the real world. With it, we have the potential to tread the delicate path between our current necessarily hierarchical structure, reassuring colleagues that we’re doing what we said we would do, whilst simultaneously generating space for creativity and the ability to work alongside our communities, sharing power, respect, ideas… based on where we are, what we see and iteratively shaping the future together.
We’re currently taking inspiration from Frome as we develop a Community Makers experiment (more about that soon) and I find it really interesting that in Frome, when they are thinking about the difference they make it’s in terms of real system change over multiple years e.g. 21% reduction in healthcare costs versus 21% rise across the country. 81% experience a wellbeing increase. And, 17% fewer emergency hospital visits versus 28.5% increase across the county.
Perhaps we are on the path to become more Frome. It would be wonderful if we have comparable shared achievements when we have the luxury of looking back at what has emerged through whole system change, rather than trying to predict what will happen through single workstreams.
Thinking back 30 years to when I had the fortune to work with Roger, we were working for the NHS in what were seen as health-related roles. The positive winds were already driving change on a national scale with the Community Care Act, and within a couple of years we were delighted to be supporting the ‘patients’ to become residents of their local communities.
And thinking back just three years to Neighbourhood Cares, there may be some parallels. Funded by the County Council, we were seen to be in council roles. In reality my roles both three decades, and three years ago didn’t fit into the health, council or any other siloed box. Done well, the aim of most public and community sector roles is about supporting people to have a good life. A good life as whole people, with all the complex, often wonderful, messiness that that entails. In East Cambs many of us in preventative roles come together informally as a Healthy and Wellbeing team – and we’re beginning to think how we can use our joint capacity to respond to what we hear.
It feels as though, within the existing system, we have begun to build a new way of doing things for our place, and that’s now ready to emerge bold and bright.
Is the Integrated Care System (ICS) our opportunity for system change today? And could our Integrated Neighbourhood be a starting point?
Yes, I think so, albeit less clear cut than the Community Care Act, but perhaps more fitting for that very reason. The ICS gives the structure for building relationships and the canvas for us to jointly create something local, East Cambs shaped, with our communities… the chassis for our Neighbourhood to build whatever vehicle best suits our communities.
Neighbourhood Cares Soham 