Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

School for Health and Care Radicals 2016: Programme Guide

2,730 views

Published on

Welcome to the School for Health and Care Radicals. This Programme Guide will help you make the most of your studies and your time. We will try to anticipate – and answer – some of your questions, and offer some tools and suggestions that will help you translate your learning into action.

The 2016 School starts on 4th February at 14:30-16:00 and runs for 5 weeks.

You can find out more about the School and register for our 2016 programme by copying and pasting this link into your browser: http://www.theedge.nhsiq.nhs.uk/school/

Follow the School on Twitter @School4Radicals and using the hashtag #SHCR

Published in: Health & Medicine

School for Health and Care Radicals 2016: Programme Guide

  1. 1. PROGRAMME STUDY GUIDE ‘Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has.’ Margaret Meade http://www.theedge.nhsiq.nhs.uk/school/ @School4Radicals #SHCR
  2. 2. School for Health and Care Radicals Programme Study Guide http://www.theedge.nhsiq.nhs.uk/school/ 2 SHCR III 2016 Contents The School for Health and Care Radicals ...................................................................................................3 Introduction ...............................................................................................................................................4 A short history of the School..................................................................................................................4 Who is it for?..........................................................................................................................................6 What’s in it for me? ...............................................................................................................................6 How does it work? .................................................................................................................................8 Programme outline................................................................................................................................8 After School….to The Edge and beyond...............................................................................................10 Is there any formal recognition or qualification? ................................................................................11 Introducing some Health and Care Radicals............................................................................................11 Getting the most from the School ...........................................................................................................13 Social learning..........................................................................................................................................13 Communities of practice......................................................................................................................14 School Learning Groups .......................................................................................................................15 Case study: New Zealand class of the School for Health and Care Radicals........................................17 Sharing your experiences.....................................................................................................................18 Finding support........................................................................................................................................20 Keeping a learning journal .......................................................................................................................21 Drawing up a learning plan......................................................................................................................23 Getting to know yourself: the Johari Window.........................................................................................25 Becoming a reflective practitioner ..........................................................................................................27 Theories and models of reflection...........................................................................................................30 Kolb’s experiential learning cycle.........................................................................................................30 Critical incident analysis.......................................................................................................................31 Johns’ model of structured reflection..................................................................................................31 Tripp’s model of structured reflection.................................................................................................32 Stories and transformation......................................................................................................................33 Glossary....................................................................................................................................................36 Resources.................................................................................................................................................38
  3. 3. School for Health and Care Radicals Programme Study Guide http://www.theedge.nhsiq.nhs.uk/school/ 3 SHCR III 2016 The School for Health and Care Radicals 'If you want to build a ship do not gather men together and assign tasks. Instead teach them the longing for the wide endless sea.’ Antoine de St Exupery Core team Helen Bevan @HelenBevan Jodi Brown @JodiOlden Kate Pound @KateSlater2 Pip Hardy @PilgrimPip Paul Woodley @Paulwoodley4 Joanna Hemming @joannahemming Faculty advisory group We have had the great good fortune to be ably assisted by a number of graduates of the School. Their input and support have been invaluable in shaping the 2016 School. Grateful thanks to: Debra Barrath, Julie Beard, Jon Bryant, Maxine Craig, Mark Davis, Ann Fewtrell, Colette Hawkins, Wendy McIntosh, Jim Rawson, and Stephen Webb. The School for Health and Care Radicals is an initiative of the Sustainable Improvement Team (formerly NHS Improving Quality), NHS England. This Programme Study Guide was prepared for the School for Health and Care Radicals by Pip Hardy, Pilgrim Projects Limited.
  4. 4. School for Health and Care Radicals Programme Study Guide http://www.theedge.nhsiq.nhs.uk/school/ 4 SHCR III 2016 WELCOME! Introduction ‘Be the change you want to see in the world.’ MK Gandhi Welcome to the School for Health and Care Radicals. This Programme Study Guide will help you make the most of your studies and your time. We will try to anticipate – and answer – some of your questions, and offer some tools and suggestions that will help you translate your learning into action. We can imagine how busy you are, but we are pretty sure that you will find it helpful to skim through this study guide before beginning your work on the first module you have chosen. As well as explaining a bit more about the programme, we will introduce you to some other Radicals and share with you some of their stories of change. We will also encourage you to engage with the School and the learning in a number of different ways. A short history of the School The School for Health and Care Radicals is not just another new initiative. The first seeds of the School were sown back in 2002 and took the form of a one-day school for organisational Radicals – that is, people who wanted to bring about constructive change in their own organisations. Over the years, these ideas have taken root in the world of healthcare quality improvement, have been nourished by the application of social movement thinking and have spread by means of community organising principles and the use of public narrative. The first School for Healthcare Radicals was held in 2012, partly in preparation for, and in support of, the first NHS Change Day in March 2013. NHS Change Day has been hailed as ‘the largest simultaneous improvement initiative in the history of the NHS’, resulting in nearly 200,000 pledges from people throughout the NHS and beyond, from people of all ages, at all levels, doing a wide variety of jobs and extending to patients, families and carers. It has demonstrated yet again that grassroots movements really can make a difference and, in this case, improve care for all of us. http://changeday.nhs.uk/ In 2014, the School was renamed The School for Health and Care Radicals to acknowledge the close relationship between health and social care and to reinforce the idea that anyone, whoever they are, can participate in the School and contribute to bringing about positive changes in care. Once again, the School ran during the lead-up to Change Day 2014 and participants were encouraged to link their work in the School with their Change Day pledges. In 2015, the School ran again for the five weeks leading up to Change Day and welcomed even more participants from around the globe. Social learning came to the fore with School learning groups springing up all over the place. An external evaluation of the School was carried with the 2015 cohort
  5. 5. School for Health and Care Radicals Programme Study Guide http://www.theedge.nhsiq.nhs.uk/school/ 5 SHCR III 2016 and it was no surprise to discover that the School really does help to give people the skills, knowledge and confidence they need to bring about transformational and sustainable change. If you are interested, you can read the evaluation report here: http://theedge.nhsiq.nhs.uk/school/school- evaluation/ In keeping with the founding principles of the NHS, the School for Health and Care Radicals is also free at the point of access, non-hierarchical and open to all. Staff working at every level in the NHS, together with patients and carers, have been joined by people from around the world, united by their common goals to improve the quality of care for everyone, to share learning and to support one another in their efforts to bring about positive change. The overarching aims of the School are to equip people across the health and care system with the core skills to become effective change agents. Through the effective use of social media as a means to connect, communicate, shape and share, the School works to:  equip people across the health and care system with the core skills to become change agents  ignite people’s passion to improve services  promote a grassroots change movement  provide a robust underpinning in new ways of thinking about improvement  operate to help people implement and sustain change  promote connection and communication via many different channels  create a national and international community of practice share leading-edge change methodology and thinking. So, by joining the School, you will become part of its history and its future. If you want to know more about the history of the School, you might like to read a light-hearted blog about the early days of the SHCR, here: https://www.linkedin.com/pulse/reflections- reluctant-radical-short-history-school-health- pip-hardy We hope that you will join the growing number of people who are committed to making changes –large and small – and that you will also find support and encouragement from this community of practice and learning. ‘Beauty and the sense of belonging it evokes introduces us to a new standard of care--a quality of attending-- which we may extend to our sense of stewardship in creating communities of care. Perhaps in the future a well- lived life will involve the shift from a focus on utility to the combined search for signs of the beautiful.’ Michael Jones, 2004
  6. 6. School for Health and Care Radicals Programme Study Guide http://www.theedge.nhsiq.nhs.uk/school/ 6 SHCR III 2016 Who is it for? ‘Dialogue is the encounter between men, mediated by the world, in order to name the world.’ Paulo Freire The School for Health and Care Radicals is for anyone and everyone who wants to improve the safety and quality of health and social care. You may hold a senior post in the NHS or in another health or social care organisation; you may be a doctor or a nurse, or a student doctor or student nurse Professional; you may work on the frontline or behind the scenes; you may be a commissioner, an administrator or a manager; you may be a healthcare assistant or an allied health professional, a carer, a patient, a service user or a citizen. Health and care affects everyone, everywhere and The School for Health and Care Radicals is an opportunity for all of us to come together to pool our ideas and our resources with the intention of making sure that care will be as good as it can possibly be for us, our parents and families, and for the generations that follow us. ‘I’ve cared for my husband, who has dementia, for eight years. The number of people we have to deal with can sometimes be overwhelming – it’s certainly confusing, especially as they often don’t know what the others have been doing. My Change Day pledge is about finding a way to co-ordinate all those different people and different activities so that there is one person carers can call who actually knows what’s going on – like a case manager. In order to make that happen, I am hoping to learn more about how to make change happen so that many other carers can be saved from going through what I’ve had to go through.’ Carer In 2014, around 1900 people from 66 countries took part in the School. Around 10% of those people went on to graduate and become Certificated Change Agents, proudly displaying their badges in many different ways! They connected with each other via the weekly webinars and Tweet chats and many have remained in contact, sharing ideas and experiences, offering support and building a strong sense of community and connection. Since then, the number of people who have participated in The School has grown to over 7000 people, and 300 of those because Certificated Change Agents in 2015 – and the numbers are still growing! What’s in it for me? If you’ve ever thought to yourself ‘I could do that better’ or ‘I would want to be cared for like that’ or even ‘I’m so glad that’s not my gran in that bed’, then you probably have some great ideas for how health and social care could be improved. But, if you are like many other people, you may then think to yourself ‘Nobody will pay attention to me’ or ‘I wouldn’t know where to begin …’. If you have ever wanted to make a difference to patient/service user and staff experience, and improve the outcomes of care, then the School for Health and Care Radicals is for you.
  7. 7. School for Health and Care Radicals Programme Study Guide http://www.theedge.nhsiq.nhs.uk/school/ 7 SHCR III 2016 The School for Health and Care Radicals will provide you with information and tools to help you identify the kinds of changes you can make for the better and give you the knowledge to go ahead and make them. You will gain skills and confidence that will enable you to act as an effective change agent – you’ll learn how to rock the boat but stay in it! ‘The moral test of government is how that government treats those who are in the dawn of life, the children; those who are in the twilight of life, the elderly; and those who are in the shadows of life - the sick, the needy and the handicapped.’ Hubert Horatio Humphrey, US Vice President You will also have the opportunity to meet other people, not only from around the UK but around the world – other people who are trying to make health and social care better. Some of your fellow learners will be experts in bringing about change and some will be people just like you – wanting to make things better for yourself, your families and friends and for future generations. You will join a Community of Practice – other people who are as passionate as you are about making the world a better place – so you will have plenty of encouragement and support to carry out your plans and accomplish your dreams. Along the way, the School will also:  offer relevant and rewarding skills and learning opportunities  encourage learners to gain knowledge, skills, abilities and confidence  provide opportunities for active learning  offer appropriate coaching and mentoring support  provide opportunities to relate learning directly to the workplace in order increase personal and organisational potential  acknowledge and value learners’ achievements  offer opportunities to shape and participate in the School  encourage learners to form a network of like-minded people (a community of practitioners) and remain involved with the School as it grows. ‘There are a lot of possibilities for medical students and junior doctors to influence the NHS and the health and social care system that we work within. We’re often not taught to think about those things but actually we all have a voice and I think that we are very powerful change agents. We move around the wards, we meet people in a lot of different areas, we have a way of talking to patients which sometimes consultants don’t have time or the inclination to do and because of that we can sometimes understand their perspectives better. That can be really powerful about how to get more compassion back into the NHS.’ Medical student
  8. 8. School for Health and Care Radicals Programme Study Guide http://www.theedge.nhsiq.nhs.uk/school/ 8 SHCR III 2016 How does it work? The School consists of the following components:  this Programme Study Guide  five weekly webinars  five module study guides  weekly Tweet chats  online discussions via Facebook and Google+  School Learning Groups  an international community of learning and practice. Programme outline The Programme consists of five modules: these are outlined below. Module 1: Being a Health and Care Radical: change starts with me The first module invites you to continue or embark on your journey as a change agent and offers some new ways of thinking about how you work to bring about change. The module highlights learning from some of the most effective change agents across the globe, explores the differences between troublemakers and rebels and helps us to understand how to 'rock the boat and stay in it'. Module 1 will help you to:  understand the history of change agents and of The School  recognise your own values and passions and connect them with your transformation work  recognise the difference between transactional and transformational learning  consider the emerging direction for transformation and change  reflect on what it means to be a change agent  explore some of the challenges for Health and Care Radicals  learn how to rock the boat and stay in it  build self-efficacy  recognise the importance of community  clarify your vision and your purpose.
  9. 9. School for Health and Care Radicals Programme Study Guide http://www.theedge.nhsiq.nhs.uk/school/ 9 SHCR III 2016 Module 2: From me to we: creating connections and building communities The golden rule for change activists is: ‘You can’t be a radical on your own’. This module gives us an understanding of the power of working together by exploring communities of practice and social movements. We identify techniques for connecting with our own and others’ values and emotions to create a call for action. Module 2 will help you to:  build your own alliances and create communities for change  identify the characteristics of effective social movements  learn from the leaders of social movements  give some thought to what co-production really means in your own context  recognise the power of storytelling  use stories to connect with others through emotions and values  reflect on your existing networks  establish and build new networks  bridge disconnected groups utilising strong and weak ties. Module 3: Rolling with resistance It is natural to resist change. Rather than seeing resistance as something negative, here we shift our perspective so that we see dissent, diversity and disruption as essential components of effective change. However, we need to build resilience in order to work effectively with resistance. This module offers some tools and techniques to ensure that we remain strong, adaptable and able to continue our work as change agents. Module 3 will help you to:  recognise the challenge of resistance  understand some of the reasons for resistance  embrace diversity  recognise the crucial difference between impact and intent  use the Stages of Change model to help people through change  build resilience in yourself and others. Module 4: Making change happen This module will help us create and sustain the energy we need to make change happen. We will look at a number of practical ideas, tools and resources to help us change the way we do change. Module 4 will help you to:  recognise the power of politics  understand why change efforts often fail to achieve their objectives  examine the need for both extrinsic and intrinsic motivators and balance the tension between them
  10. 10. School for Health and Care Radicals Programme Study Guide http://www.theedge.nhsiq.nhs.uk/school/ 10 SHCR III 2016  create shared purpose  build energy for change  plan for success  share stories of success  prepare for the Change Challenge by recognising the need for bottom-up change  move from testing your ideas to embedding them. Module 5: Moving beyond the edge Change always starts at the edge and always starts with activists. This module will help you move closer to the edge and towards sustainable change; it will help you take your learning from the School for Health and Care Radicals forward, think about what you might do next and where else you might get support/resources. Module 5 will help you to:  review what we have learned so far about the characteristic of a transformational change agent  examine Peter Fuda’s Transformation Change Agent framework: Being, Seeing, Doing  consider emerging directions for change and change agents ‘from the edge’  recognise some of the change methods suitable for a new era  reflect on some of the key messages from the School  plan for the future. After School….to The Edge and beyond After the five School webinars have finished, you will probably want to visit The Edge http://theedge.nhsiq.nhs.uk where you’ll find plenty of up-to-date information about change, including a series of recorded webinars called Edge Talks http://theedge.nhsiq.nhs.uk/?s=Edge+Talks These talks are presented by experts in their fields on topics of particular interest to anyone wanting to bring about change.
  11. 11. School for Health and Care Radicals Programme Study Guide http://www.theedge.nhsiq.nhs.uk/school/ 11 SHCR III 2016 Is there any formal recognition or qualification? We hope that you will engage with the School and enjoy learning for learning’s sake. If you do want to engage more deeply with the opportunities provided by the School, there are various ways in which your work can be recognised, although at the moment there is no formal qualification. If you engage with all five modules and submit a reflective statement about your work, you will be eligible to become a Certificated Change Agent. You can meet some people who gradated from the School and became Certificated Change Agents below. It may be possible to gain CPD (Continuing Professional Development) accreditation from your own professional body and UK nurses may be able to use their work on the School to support revalidation. Introducing some Health and Care Radicals We would like to introduce you to a few Health and Care Radicals – hopefully their stories will give you a flavour of the great diversity of people who can be Health and Care Radicals and inspire you to join them! Molla Imaduddin Ahmed, Specialist Registrar in Paediatrics, University Hospitals of Leicester ‘The School for Health and Care Radicals course has been an eye opener for me and has encouraged me to work towards improving patient care and encouraging others to do so as well. I have learnt the importance of networking with like-minded people and the power of a community to change things. As a part of the community, I have been able to share experiences and support others and this course gave ample networking opportunities to liaise with other change agents. The course was extremely well conducted with excellent study materials enabling me to learn about various aspects of being a change agent.’ Jon Bryant, Video director and software developer of disruptive technologies, UK ‘Going back to school after 45 years was a personal challenge, so when I started to engage with the SHCR team, it came with a lot of preconceptions and a strong sense that I would be an outsider as a “citizen radical/rebel”. How wrong I was! From the very first contact with SHCR, I was welcomed by all, and I very soon felt part of something important and valuable. A lovely surprise was to discover we were all there for the same reason: “we care” and want to challenge the conventional wisdom in positive and innovative ways to improve health and care at all levels.’ Rebecca Lacey The School for Health and Care Radicals has a lot to answer for: I spent a lot of 2015 out of my comfort zone! It was challenging and exciting; taking part in the School gave me the confidence and inspiration to achieve some very small changes in me and also to be part of much bigger change events. Participating in the School was a breath of fresh air and the energy and positivity gained last January is still with me now. The School has inspired me to put creative thinking
  12. 12. School for Health and Care Radicals Programme Study Guide http://www.theedge.nhsiq.nhs.uk/school/ 12 SHCR III 2016 into practice. It’s the best thing I have done in education, ever!’ CJ Graham, Project Manager, Imperial College Healthcare NHS Trust ‘SHCR started off as a way to build a bit of confidence as I embarked on a new job, but it became a lot more. I met like-minded, inspirational change agents from all over the world and learnt a huge amount about being the best change agent I could be. The energy of the School sessions was electrifying and sustained well beyond the end of term. Now, two years and three jobs later, I owe a huge amount of my self- efficacy to SHCR, which taught me that I am in charge of my comfort zone, I am in charge of my limitations, and I am in charge of overcoming both!’ Dr Sabira Mohammad, Project Manager, Urgent Care, Herts Valleys Clinical Commissioning Group ‘I found being a part of the School for Health and Care Radicals completely life- changing. The process sent me on a journey of self-discovery and empowerment. It was liberating to spend time learning and sharing with like-minded people, to know that I am not alone in refusing to settle for the status quo. Since the SHCR, my entire approach to my role within the NHS has changed. I get it now: if change is going to happen, it’s up to me. So I have started to speak up, sit at the table where decisions are being made, question when things are being done that are not in patients’ best interests. I found a voice through the process and the confidence to undergo a career change that has taken me from the frontline of healthcare delivery to the centre of redesigning out-of-hours services!’ Dr Maxine Craig, Visiting Professor ( Sunderland University ) and Independent OD practitioner ‘I think the greatest impact for me was being in the community during the School. I found it enlightening and heartening to work with so many enthusiastic learners from all over the world. It made me proud of our NHS. It helped me think about how we could create The Great North School of Health and Care Radicals! It gave me energy.’ Wendy McIntosh, Acting Director Safety and Quality, WA (Western Australian) Country Health Service ‘The SHCR has really enriched my work. I've realised that to engage and influence others, I needed to change. I've listened more. Been braver about making new connections. Stepped outside my comfort zone: set up an SHCR learning group; promoted Change Day Australia within our organisation and published my first blog and YouTube! Participating in the SHCR has changed my approach and behaviours more than any other course.’ The rest of this Study Guide will suggest ways in which you might get the most from the School – some of these suggestions might be particularly helpful if you haven’t done any studying or learning for awhile.
  13. 13. School for Health and Care Radicals Programme Study Guide http://www.theedge.nhsiq.nhs.uk/school/ 13 SHCR III 2016 Getting the most from the School As with most things in life, the more effort you put in, the more you are likely to benefit from your efforts. Having said that, the School has been designed to be flexible and we invite you to engage with it in whatever way works best for you. You might decide to:  dip in and out of the weekly webinars  enlist the support of a coach or mentor to support your learning  work through the reflective and other activities in the programme and module study guides  keep a learning journal  set up an Action Learning Set or a School Learning Group in your organisation to spread the learning more widely  share your own experience of change with others, perhaps by becoming a mentor  any combination of the above. However you engage, we encourage you to:  ask your own questions  set your own goals  plan your own time  decide what you want to learn, and how you want to learn it  become a reflective practitioner  assess your own progress  share your learning – and put it into practice – with others. Social learning ‘All change starts when people get together and talk about the things they care about. We move in the direction of the questions we ask.’ Margaret Wheatley It is difficult to find your way in the darkness if you have only one candle; but many candles will illuminate even the darkest of paths. Similarly, sustainable change comes about when groups or teams of people work together to bring about the desired change. So, while the desire for change may begin with you, The School for Health and Care Radicals is founded on the principle that large-scale, sustainable change happens when many people share the desire for change; this collective energy can then be harnessed to bring about the changes you want to see in the world. By creating a resource that can be used flexibly but that also encourages a social approach to learning, we hope to increase the potential for real change and improvement. Learning is changing as people become busier and virtual learning replaces face-to-face learning. We are connected in myriad ways, communicating via email, Facebook, Twitter, Google+, LinkedIn; we
  14. 14. School for Health and Care Radicals Programme Study Guide http://www.theedge.nhsiq.nhs.uk/school/ 14 SHCR III 2016 blog and vlog, sharing photos, hopes, ideas, experiences, aspirations and knowledge more widely and more rapidly than ever before. Certain characteristics of learning in the 21st century can be thought of as ‘social learning’. One of the people who has clearly articulated the characteristics of social learning is Jane Hart. Here is how she describes ‘Guided social learning’:  It is social – you are learning – not simply with others but from the shared experiences and ideas of others – in the professional learning networks of trusted connections that you have developed.  It is continuous – you are benefiting from a constant drip-feed or flow of information or resources, or conversations with colleagues, all of which over time builds up into a large amount of knowledge and shared experiences  It happens in short bursts – you tend to have short interactions with others and read bite-sized pieces of content  It is autonomous – you are in control of what you do, the relationships you build, and how much time you spend time on any activity – based on what value it gives you and to what extent it meets a personal interest or professional need.  It is often serendipitous – although some of what you learn is planned, you are also learning just by hanging out in social networks, gradually assimilating new ideas and experiences, in many instances without even realising it (Hart 2014). You can find a number of resources about guided social learning on Jane Hart’s website: http://c4lpt.co.uk/ Communities of practice Most people have a deep desire to be part of a community. This longing was recognised by Etienne Wenger when he coined the term ‘Community of Practice’ to describe a group of people who wish to be connected in order to share learning and skills as a way of deepening, improving and expanding their practice. In fact, Wenger, and his colleague, Jean Lave, made a rather radical proposal in the 1990s, suggesting that learning actually takes place as a result of a engaging in a community of practice. As radicals and change agents, it is common to feel isolated. There may be a lack of peers with whom we can talk, or a lack of opportunity to get together to share experiences or there may be what Habermas (1972) describes as technical rather than emancipatory interests – in other words, a reluctance to discuss anything that is not directly and practically related to the task at hand. But our work as change agents is emancipatory – intending to free us from the constraints of old power structures and facilitate movement and change for the better.
  15. 15. School for Health and Care Radicals Programme Study Guide http://www.theedge.nhsiq.nhs.uk/school/ 15 SHCR III 2016 So it is vitally important for our work as change agents to make connections, have conversations, explore ideas and feelings and share common purpose. This is one of the reasons that we are encouraging you to join a School Group. A very succinct introduction to the concept of communities of practice is here: http://infed.org/mobi/jean-lave-etienne-wenger-and-communities-of-practice/ The theory is borne out in practice in the SHCR, as one of the things that people value most about the School is the opportunity to connect with like-minded people. But the journey to School can be long and arduous, as Kate Pound describes: In 1993 I qualified as a nurse, I had to work hard for 6 years to find what I believed to be the best job in the world, however it wasn’t long before I became disillusioned. I felt overwhelmed by the pressures, such as time and health inequalities. I had gone into nursing with my core values of always doing my best for patients and making a difference to improve their lives. I felt I was becoming disconnected from what was important to me, but I refused to let go. In 1999, I qualified as an advanced nurse; this was a changing point for me in my life. I got a job at Nottingham University Hospitals and I started to connect with others who also had the same values and beliefs about wanting to make a difference. I had found hope! My managers were supportive and inspired me, their leadership approach was relational, not power-based. I had found a place where I could make a difference. The big learning for me was the School for Health and Care Radicals, where I was able to connect across the world with people with the same core values. This gave me energy and hope to keep on going. Please click on the Word Cloud below to watch Kate’s digital story: Finding my niche. Kate Pound 2015 School Learning Groups The design and delivery of the The School for Health and Care Radicals aims to nurture the conditions that support both planned and serendipitous opportunities for learning. In seeking to establish a community of learning and practice, the School promotes the sharing of knowledge by all those who engage with the School. We would like to encourage you to set up or join your own local School Learning Group where you can reflect on the ideas put forward in the School Webinars, engage your colleagues with your hopes for change and engage in activities designed to be thoughtful, thought-
  16. 16. School for Health and Care Radicals Programme Study Guide http://www.theedge.nhsiq.nhs.uk/school/ 16 SHCR III 2016 provoking and relevant to people’s jobs. We will support your efforts by providing content that is generated by experts, practitioners and users. The philosophy of the School encourages you to become more autonomous by providing some choices around when you learn and how you apply your learning at work while also providing guidance and support for individual and collective learning journeys. The School will provide plenty of opportunities for you to connect with others from around the world. We also encourage you to establish your own local School Learning Group, where you can connect with other change agents from your own organisation. If you’d like some suggestions or help with setting up your own School group, please get in touch with us: radicals@nhsiq.nhs.uk ACTIVITY: SHARING YOUR PASSION FOR CHANGE It can be a daunting prospect to think about setting up a learning group, so we would like to encourage you to adopt a slightly more radical approach – one that has been successfully used by the Star Wards Programme http://www.starwards.org.uk/ Star Wards has brought about great changes in mental health care, partly by appealing to people’s passion, and harnessing the energy that prompts people to do the things they love doing. 1 Begin by thinking about something you really like to do – it doesn’t have to be work-related. Make a note or two here. 2 Now think about how you could share your passion – whether it is for cooking, reading, running, listening to music, repairing motorcycles, making quilts, gardening, walking dogs – whatever it is – with others. Try to visualize how you could bring your passion to work. Make a few notes. 3 If you are feeling really brave, make a poster, send an email, let people know that you will be meeting at a particular time in a particular place and see what happens! You may be surprised to find others where you work sharing your passion – whatever it is.
  17. 17. School for Health and Care Radicals Programme Study Guide http://www.theedge.nhsiq.nhs.uk/school/ 17 SHCR III 2016 Some great examples include:  setting up a weekly running club  establishing a reading group  promoting healthy eating through ‘Come Dine with Me’ activities  founding a gardening group  preparing a cookery book  organising a singing group. When people have the opportunity to share their passions, unexpected things may happen. Undoubtedly something will change. Trust is built up, attitudes shift, the energy of resistance can be harnessed, diversity can be embraced and conversations can move towards other kinds of changes that may have a more direct result on the way care is designed and delivered. You can find some great examples of changes in care delivery on the Star Wards website: http://www.starwards.org.uk/ And, if that is not enough to inspire you, please read about how one group of committed, enthusiastic, excited and eager group of Health and Care Radicals shared and deepened their learning from the 2014 School. Case study: New Zealand class of the School for Health and Care Radicals Dr. Lynne Maher, Director for Innovation, Ko Awatea & Associate Honorary Professor of Nursing, The University of Auckland Alex Nicholas Project Coordinator Community Organising, Ko Awatea Alex Twigg Campaign Manager, Ko Awatea Excited, enthusiastic, committed and eager. This is how ‘we’, Alex, Alex and Lynne, felt as we joined the School for Health and Care Radicals in 2014. We are all change agents and were keen to extend our knowledge and ability to become more effective in our roles. New Zealand is around 11, 7682 miles (18,800 km) away from England and it is ahead in time zones by around 12-13 hours depending on the time of year. We worked out that most of the Web Based Learning sessions would take place on Friday evenings our time which initially posed a challenge in our ability to join the sessions ‘live’ without disruption to family lives. We added the word ‘determined’ to our vocabulary and worked out a slightly different way of participating; the ability to be autonomous in our method of joining the School was highly successful. We were able to access recordings and a transcription of the discussions held during the web sessions in addition to the slide deck used, these tools provided all of the basic learning material we needed.
  18. 18. School for Health and Care Radicals Programme Study Guide http://www.theedge.nhsiq.nhs.uk/school/ 18 SHCR III 2016 By arranging to meet after each of the web teaching sessions we set a pace for our learning which was in step with the programme and incorporated time to reflect. At our meeting one of us would lead a review of the learning session and each of us committed to feedback on our individual interpretation and to provide examples and additional learning from our own practice. This was fascinating; we had all committed to ‘do’ something and the diversity of our discussion brought a richness that vastly increased our understanding and knowledge. After each session we developed a short update to share with others in our organisation, this started to create much interest. As the weeks progressed we turned our attention to how we might more deeply share our learning with others, we wanted many people to have the opportunity that we had. The three of us pledged to bring 400 other passionate change agents together and enable them to also learn. Through eleven half-day foundation workshops we have achieved our pledge. We know that a fundamental principle of being a Health and Care Radical means that change starts with ‘me’. Through participating in the learning modules we have achieved the knowing. This has now lead to doing a number of things including raising awareness through five articles shared on our organisations newsletter (The Daily Dose) and putting into action a plan to achieve our pledge. This has enabled others to experience our learning and has resulted in a new community of 400 change agents. We are living the principles of being effective boat rockers through our conviction that this will make a difference, and creating a sense of hope as we go. Excited, enthusiastic, committed and eager. We, together with our 400 colleagues are now part of ‘us’ a global learning community of change agents. Together we can radically improve health and care around the globe; ‘we’ are starting in Auckland, New Zealand. Sharing your experiences Whatever you decide to do and however you decide to do it, we would love to hear from you about what you’ve done, how you’ve done it and what’s happened as a result. ‘I think the School for Health and Care Radicals is for everyone who wants to make a difference and hasn’t known how to. I think it will give you the tools to really engage with the NHS, to really impact and do those things that you’ve always dreamt of doing.’ ‘If you feel that the system is too big, too confusing, that you’re alone, I think if you get involved with the School for Health and Care Radicals you’ll find other people who feel like that too, but also people who have already made change happen in whatever area you’re looking at and by networking together and forming that community, coupled with the resources that the School will provide, then we will be able to make some real change.’ Learner, School for Health and Care Radicals
  19. 19. School for Health and Care Radicals Programme Study Guide http://www.theedge.nhsiq.nhs.uk/school/ 19 SHCR III 2016 REFLECTION: THE ONCE AND FUTURE STORY Before going on, you might like to give a few moments’ thought to the future story you might like to tell about your involvement in the School. What would you like to be saying to your colleagues/friends/family by the time you have graduated from the School? 1 It might help you to think about what made you decide to register with the School in the first place. Note your thoughts here. If you have a particular problem or issue that you are hoping to change or solve, write that down too. 2 Next, consider what you hope to gain from the programme? Consider, for example, how you would know whether you have solved your problem or answered your question. 3 Finally, what would you be doing differently in say, six months – one year’s time, to indicate to yourself and others that the School has been successful? 4 Now write your own ‘quotation’ summarising what you hope to gain from the School. If you find it difficult to visualise your own future story, you might be inspired by this digital story, created by Helen Bevan, anticipating the change agents of the future: https://www.youtube.com/watch?v=9WFcWgO9D5M Helen’s story looks at The Five Enablers, which are explained in the recently published White Paper: The new era of thinking and practice in change and transformation. The Five Enablers are: 1. Activate disruptors, heretics, radicals and mavericks 2. Lead transformation from ‘The Edge’ 3. Change your story 4. Curate rather than create knowledge 5. Build bridges to connect the disconnected You can read more about the five enablers in the White Paper here: http://www.nhsiq.nhs.uk/resource-search/publications/white-paper.aspx
  20. 20. School for Health and Care Radicals Programme Study Guide http://www.theedge.nhsiq.nhs.uk/school/ 20 SHCR III 2016 Finding support ‘Learning and teaching should not stand on opposite banks and just watch the river flow by; instead, they should embark together on a journey down the water. Through an active, reciprocal exchange, teaching can strengthen learning how to learn.’ Loris Malaguzzi (1920-1994) Now that you are part of the School for Health and Care Radicals, you never need to feel isolated. We have suggested the possibility of setting up or joining a local School Learning Group, but there are many other opportunities for support , including people involved with the School want to work with you and support you. Consider your needs for:  personal support  professional support  coaching support  mentoring support  practical support. ACTIVITY: FINDING SUPPORT You might like to note down here the names of people who may be able to support you – and the type of support they could offer others. Be as specific as you can.
  21. 21. School for Health and Care Radicals Programme Study Guide http://www.theedge.nhsiq.nhs.uk/school/ 21 SHCR III 2016 In terms of personal support, friends and family can be good sounding boards for new ideas. Tell them about your involvement with the School and share your experiences with them – they can encourage you and support your efforts. Professional support comes in many forms. There will be people from your past or present who can help you, by talking over ideas, reading your work, helping solve day-to-day problems at work. It’s good to have the support of your manager and immediate team members. Let as many people as possible know that you are learning with the School. Ideally your colleagues will work with you to provide peer support and perhaps even some peer assessment. It is helpful to gain the views of your colleagues as to what’s changing at work – they may even notice changes in you! We also encourage you to involve your colleagues in some of the activities and to draw on their thoughts and reflections. Practical support can also take a variety of forms. In addition to the weekly webinars and this Programme Study Guide, there will also be a Study Guide for each module. These will contain lists of additional resources that you can use to deepen your learning: books, articles, papers, films, blogs, videos and so on. And, of course, you can always ask for suggestions from other learners. Remember that you are now part of an international community of practice, where everyone is encouraged to contribute, and everyone can learn from everyone else. Working with a mentor You may like to formalise this support by arranging to work with a mentor on a regular basis. You might connect with other learners in the School or be inspired by a former Graduate of the School – many of these people will be very happy to support you in your change efforts. On the other hand, if you can’t, or do not wish to, have a mentor, that is absolutely fine. Whatever you decide it is important, when studying at a distance, not to become isolated. There are many ways of keeping in touch with other people and sharing some of what you are learning. You will find others engaged in the School a great source of support and inspiration. Keeping a learning journal ‘By three methods we may learn wisdom: First, by reflection, which is noblest; Second, by imitation, which is easiest; and third by experience, which is the bitterest.’ Confucius As one of the best ways to learn is to reflect on your experience, we strongly suggest that you keep a learning journal to help you keep track of your work – it can also form the basis for useful discussions between you and your mentor or colleagues. Research by Dr Neil Conway and Dr Rob Briner (2001) at Birkbeck University found that keeping a journal or diary at work can help you survive and thrive. Not only can learning journals be used to keep track of your time, they can also:  keep track of both negative and positive feelings  provide insights into how people relate to one another  provide a release for things which are bothering you  encourage reflection
  22. 22. School for Health and Care Radicals Programme Study Guide http://www.theedge.nhsiq.nhs.uk/school/ 22 SHCR III 2016  help you recognise changes in yourself and others  identify patterns  make you more efficient by helping with time management  offer a ‘reality check’ amidst of the mysteries of organisational culture and politics. Source: ‘Why keeping a diary at work can help your career’ by Tola Awogbamiye in The Guardian Saturday July 28, 2001 Your learning journal will give you the opportunity to keep notes on:  what you are learning  how you are learning it  how new skills and knowledge may be interacting with your work  your thoughts and ideas for the future  questions and concerns. In addition, you can use your learning journal as a:  critical incident or reflective diary – recording significant learning and work experiences  record of written work – published or unpublished, as well as letters, memos, reports, etc.  private diary for examining personal issues  log for future learning/training needs. You may also like to use your learning journal like a scrap book, keeping track of letters, memos, minutes of meetings, articles, etc. which may stimulate your thoughts and ideas about projects you want to undertake and how you might like to undertake them. Some people like to keep a journal in a beautiful (or handsome!) book, while others prefer to keep an electronic journal. Whatever you do, try to get into the habit of writing in it regularly. If you are interested in journaling, you may like to look at some of the following resources: Progoff, I (1982) At a Journal Workshop Dialogue House Price, D (1999) How to Make a Journal of Your Life Ten Speed Press Senn, L (2001) The Many Faces of Journaling Pen Central Press
  23. 23. School for Health and Care Radicals Programme Study Guide http://www.theedge.nhsiq.nhs.uk/school/ 23 SHCR III 2016 Drawing up a learning plan ‘To know how other people behave takes intelligence, but to know myself takes wisdom. To manage other people’s lives takes strength, but to manage my own life takes true power.’ Lao Tzu Now that you have begun thinking about what you would like to get from the School, it may be helpful for you to draw up a learning plan. If you have a mentor, a learning contract is a useful basis for your relationship. If you are working with other colleagues or people in your team, you may like to share and review each other’s plans. Or you may just decide that you will make an agreement with yourself. Your learning journal may be the ideal place to keep your learning plan. A learning plan is really just a way of clarifying your expectations, especially in relation to:  what you hope to gain from the School  what you expect from yourself, your colleagues, your mentor  what others expect from you. You don’t have to complete the plan all at once – it can change over time but it does put a peg in the ground as you begin your work with the School and will help you to organise your work and your learning in the way that is most helpful to you in your particular circumstances. Your learning plan should start with where you are now and a realistic assessment of the things you already know and the things you are good at. ACTIVITY: WHERE ARE YOU NOW? 1 Give some thought to your own strengths and weaknesses. Be as honest as you can – especially in relation to your strengths! 2 Looking back at the programme outline, you may know something about some (or many!) of the topics already. Jot down some notes relating to the content headings and learning outcomes. Many of us find it challenging to talk about our strengths so you may find it helpful to talk to a friend or colleague and try to see yourself through his or her eyes. And remember that you don’t have to do everything at once: taking the first step can sometimes be the most daunting but it is always the most important, as this poem by David Whyte reminds us:
  24. 24. School for Health and Care Radicals Programme Study Guide http://www.theedge.nhsiq.nhs.uk/school/ 24 SHCR III 2016 START CLOSE IN Start close in, don't take the second step or the third, start with the first thing close in, the step you don't want to take. Start with the ground you know, the pale ground beneath your feet, your own way of starting the conversation. Start with your own question, give up on other people's questions, don't let them smother something simple. To find another's voice, follow your own voice, wait until that voice becomes a private ear listening to another. Start right now take a small step you can call your own don't follow someone else's heroics, be humble and focused, start close in, don't mistake that other for your own. Start close in, don't take the second step or the third, start with the first thing close in, the step you don't want to take. David Whyte (2012) River Flow: New and selected poems In the rest of this Programme Study Guide, we will offer some ideas, theories, tools and techniques that may help to deepen your learning and make your time spent on the School more fruitful. You can pick and choose what you like and leave the rest but we hope that you will find something that resonates with you and your particular approach to learning.
  25. 25. School for Health and Care Radicals Programme Study Guide http://www.theedge.nhsiq.nhs.uk/school/ 25 SHCR III 2016 Getting to know yourself: the Johari Window The Johari Window is a technique designed to improve your self-awareness and your understanding of others in your group or team; it’s particularly useful for personal development, self-awareness, improving communications and interpersonal relationships, understanding group dynamics and inter- group relationships. in relation to behaviour, empathy, cooperation, inter-group development and interpersonal development. The model consists of a grid made up of four squares (like a window with four panes). http://en.wikipedia.org/wiki/Johari_window The arena The upper left quadrant, usually labelled open self/area; free area; public area or arena, represents those behaviours, attitudes, feelings, emotions, knowledge, skills, experience, views, etc. that are known to the person and to others. This is the most productive area for individuals and groups, where there is good communication, co-operation and trust. This is obviously the area that most teams should concentrate on developing.
  26. 26. School for Health and Care Radicals Programme Study Guide http://www.theedge.nhsiq.nhs.uk/school/ 26 SHCR III 2016 The blind spot The upper right quadrant, known as ‘blind self’, ‘blind spot’ or ‘blind area’ represents what is known by others by unknown to the individual. The person may lack self-awareness or be deluded or may be deliberately hiding things from others. It is helpful to gain sensitive and non-judgemental feedback from others to reduce the size of the blind spot and increase the open area. The façade The lower left quadrant is known as ‘the façade’, ‘hidden self’, ‘hidden area’ or ‘avoided area’ – these are the things that are known to an individual but are kept hidden from others. This area may include fears, insecurities, sensitivities, hidden agendas, secrets – anything that a person does not want others to know about. Obviously there are personal things that are private and not relevant to work, but there are other things that could more usefully be brought into the open area for the benefit of the individual and the team. The unknown The lower right quadrant, or ‘unknown self’, area of unknown activity’ or ‘unknown area’ relates to information, feelings, abilities, aptitudes, experience, etc. that are unknown to the individual and to the group. This area tends to be larger in younger people with less experience, but can also cover abilities that are underestimated, perhaps through lack of confidence or training. Using the Johari window There are many opportunities for using the Johari window and it is an excellent tool for developing skills in delivering constructive feedback as well as promoting trust in teams. All team members, but especially leaders, should try to increase their open areas and reduce hidden and unknown areas. Give some thought to ways you could use the Johari Window to increase understanding and self- knowledge within your team or between teams in your organisation. You can find more on how to use the Johari Window here: http://www.businessballs.com/johariwindowmodel.htm
  27. 27. School for Health and Care Radicals Programme Study Guide http://www.theedge.nhsiq.nhs.uk/school/ 27 SHCR III 2016 Becoming a reflective practitioner ‘We learn not from experience but by reflecting on experience.’ John Dewey, 1939 There is a great deal of emphasis within the NHS and other health and care systems on becoming a reflective practitioner…. but it is not always clear what this means. We hope that, by joining the School for Health and Care Radicals, you will take the opportunity to learn from reflecting on your experience. Some people regard the ability to reflect as the hallmark of a professional, as opposed to someone who simply does their job. Academics and theorists have written a great deal about reflection and reflective practice and we will summarise some of these below. In essence, the practice of reflection is not difficult, and it is quite likely that you are already doing it in your work and in your everyday life. The fact that you have registered with the School indicates that you have given some thought to what you do well – or at least to what you don’t do so well – and this is the basis of reflection. ACTIVITY: PRACTISING REFLECTION Think of an incident which has occurred during the last few days. It doesn’t really matter whether it was at home or at work – the main thing is to take some time to reflect on what happened. Briefly describe the incident: what happened? How did you feel? What did you do in response to the incident?
  28. 28. School for Health and Care Radicals Programme Study Guide http://www.theedge.nhsiq.nhs.uk/school/ 28 SHCR III 2016 What was the outcome? If it was successful, what did you do to contribute to the success? If not, what would you do differently next time? Here is an example that might help to illustrate the process of reflection. Case study: How are you? A medical student is working with his clinical partner doing psychiatric triage. The patient is depressed, confused, disengaged, barely responding to questions, however hard they try to engage with him. When the assessment is finished the patient goes out to the waiting room. After a few minutes, they hear him announce that he wants to leave. The doctors are remonstrating with him, fearing that he is at risk of self-harming or even suicide. He makes no eye contact, gives no response to their questions. After many minutes of fruitless attempts to engage with him, or even to get him to speak, they threaten to detain him under the Mental Health Act. Just then he looks up and asks ‘How much is the treatment going to cost?’ The man was an NHS patient, and there would be no cost. Our medical student reflects on the conduct of the assessment. ‘If we hadn’t been so engrossed with getting all the clinical details, we might have paid more attention to his concerns, his anxieties, especially as money worries were a huge contributing factor to his depression.’ ‘I would like to think that the next time I am assessing someone, I would ask a simple question like “Is there anything you are concerned about?” Or even, simply “How are you?” That would save so much anxiety for the patients and so much time for the clinical staff.’ You can watch the reflective digital story made by the medical student by clicking on the word cloud:
  29. 29. School for Health and Care Radicals Programme Study Guide http://www.theedge.nhsiq.nhs.uk/school/ 29 SHCR III 2016 David Gill, 2014 There are a number of other reflective digital stories created by medical students, which might help you to think more deeply about the value of reflection: http://www.patientvoices.org.uk/pkt.htm Most of us go through this process many times each day, both at work and at home, and it is one of the ways we learn best. The key stages of the process are: 1. Identify the incident or problem. (The experience) 2. Think about what happened: who was involved, what each person did, what the outcome was and how you felt about it. (The description and its effect on you) 3. Now consider what might have been differently to produce a different outcome. (Your reflection and analysis of the situation – can also include your thoughts and feelings about the knock-on effects, what led to the situation arising in the first place and what is really going on?) You can also use this process to help you keep track of what you are learning: 1. What have you learned? 2. How do you know you have learned it (i.e. what are you doing differently now to indicate that there has been a change in your skills, knowledge or attitude? 3. How is this affecting your work and what might be the implications for the future? This process is one that you can use throughout the School and beyond and it will stand you in good stead throughout your life and career. ‘Mere activity does not constitute experience…. To learn from experience is to make a backward and forward connection between what we do to things and what we enjoy or suffer from things in consequence. Under such conditions, doing because a trying: an experiment with the world to find out what it is like: the undergoing becomes instruction – discovery of the connection of things.’ Dewey 1916
  30. 30. School for Health and Care Radicals Programme Study Guide http://www.theedge.nhsiq.nhs.uk/school/ 30 SHCR III 2016 Theories and models of reflection Many models and techniques have been developed to assist the reflective process. They all have a similar aim: to provide a way of thinking about and recording experience so that it becomes possible to learn from that experience. Three of these models are set out below. They are not intended to constrain you but to help you begin to structure your thinking in the most effective way. All the models described here share crucial similarities. Feel free to mix and adapt them to your own situation or learning style – the important thing is that you take time to reflect upon your work and your learning and learn from your experience. Kolb’s experiential learning cycle David Kolb (1983) identified four key stages in learning: 1. Concrete experience – learning begins when something happens – there must be active involvement and felt experience. So here is where you identify the problem, situation or incident. 2. Reflective observation – standing back and observing ore reviewing the incident. Has it happened before? How was this time different? How did it make you feel? Why is this aspect of your work particularly important or particularly troublesome? It can be helpful to involve others here. 3. Abstract conceptualisation – this is when you make sense of what has happened and involves your deeper analysis and interpretation of events. What caused a problem or what made it work well? What are the knock-on effects? How did it arise in the first place? What is really going on here? 4. Active experimentation – engaging in this process helps us learn from experience in a very effective way by considering how to translate new learning into planning and doing. This is where we set out the possibilities for change and better practice. Kolb’s learning cycle from: http://www2.le.ac.uk/departments/gradschool/training/eresources/teaching/theories/kolb
  31. 31. School for Health and Care Radicals Programme Study Guide http://www.theedge.nhsiq.nhs.uk/school/ 31 SHCR III 2016 Critical incident analysis Critical incident analysis is another well-known way of establishing a structure for your reflections. Critical incident analysis as a technique originated during World War II, when the US Army Air Force needed to select and train air crews quickly. Instructors were asked to answer four questions about their trainees in an attempt to discover why pilots failed the training programme.  When was the last time you saw a trainee pilot do something effective or ineffective?  What led up to this situation?  Exactly what did the trainee do?  Why was it effective or ineffective? The questions demanded factual answers – not intuitions or unfocused feelings about particular individuals. Today, critical incident analysis is used by professionals in many fields, particularly as part of the reflective process. It can help identify the areas which professionals themselves recognise as critical. Critical incident analysis should take into account questions like the following: Where did the event occur: what were the relevance of the place and its impact on the situation? When did it happen: was this an important factor? Who was involved? A detailed description of what happened. Why the incident was critical or significant to you? What you were thinking about as it was taking place? What was most satisfying or dissatisfying? What you might have done differently? Why you might have done this differently? What action, if any, you will take as a result of this learning? Johns’ model of structured reflection Christopher Johns (1994) devised his model of reflection for use by nurses and other health care professionals. With slight adaptation, it is as suitable for any professional – or anyone at all – who wishes to learn from experience. 1 Description - Describe the incident or problem or issue. - What are the key issues within this description which you need to pay attention to?
  32. 32. School for Health and Care Radicals Programme Study Guide http://www.theedge.nhsiq.nhs.uk/school/ 32 SHCR III 2016 2 Reflection - What was I trying to achieve? - Why did I act as I did? - What were the consequences of my actions? - How did I feel about this experience when it was happening? - How did others involved feel about it? - How do I know how they felt about it? 3 Influencing factors - What internal factors influenced my decision-making and actions? - What external factors influenced my decision-making and actions? - What sources of knowledge did or should have influenced my decision-making and actions? - Could I have dealt better with the situation? - What other choices did I have? - What would be the consequences of those other choices? 4 Learning - How can I make sense of this experience in the light of past experience and future practice? - How do I now feel about this experience? - Have I taken effective action to support myself and others as a result of this experience? Source: Johns, C. (1994) ‘Nuances of reflection’ IN Journal of Clinical Nursing 3: 71-75 Tripp’s model of structured reflection Finally, here is Tripp’s model of structured reflection. Questions used to examine a critical incident Kind of judgement Information required Questions asked People involved Practical Procedural What should I do? How? When? Where For and/or with whom? Diagnostic Descriptive Causal Effectual Affectual Semantic Explanatory What happened? What made it happen? What does it do? What does it feel like? What does it mean? Why did (does) it occur? Who was involved? Who acted? For whom? For whom? To whom? With whom? Reflective Personal Evaluative Do I like it? Is it a good thing? Do others like it? For whom? Based on Tripp, D. (1993) Critical Incidents in Teaching. London: Routledge
  33. 33. School for Health and Care Radicals Programme Study Guide http://www.theedge.nhsiq.nhs.uk/school/ 33 SHCR III 2016 Despite the many different models of reflection, it is not always clear that what we are really seeking to do in the process of reflection is to develop a felt understanding of an experience. This is particularly important when working in the context of care, when those with whom we come into contact are often ill, vulnerable and needy. We need to understand their situation, their life experiences, as well as our own, in order to provide care that is kind and humane as well as clinically effective. The creative arts offer opportunities to explore meaning, to see light and shadows and to use our imagination, especially when trying to understand others. This kind of reflection can also deepen our capacity for empathy and compassion. ‘The culture of the mind must be subservient to the culture of the heart.’ Mahatma Gandhi We would like to end this section by drawing your attention to the power of stories and storytelling as a way of engaging hearts as well as minds, and reflecting on others’ experiences as well as our own. Stories and transformation ‘Storytelling is the mode of description best suited to transformation in new situations of action.’ Schön, 1988 Storytelling is one of the oldest – and most pervasive – of human activities. Stories help us make sense of experiences – our own and those of others. It is through stories that we learn to be part of a family, a group, a society, an organisation or a culture. Stories convey tacit knowledge – the things we know but don’t necessarily know we know. Stories can be educational and instructive as well as entertaining. A story is so much more than just a list of events: stories carry our values and our passions, allowing us to encourage, motivate, inspire, celebrate, enthuse and engage – all vital when we are trying to effect change. ‘How can I help people if I don’t know the right stories to tell them?’ Jack Cash in Walk the line However, as Schön warns us, ‘Stories are products of reflection, but we do not usually hold on to them long enough to make them objects of reflection in their own right.’ (Schön, 1988) So, if we want to use stories to carry our dreams and aspirations into reality, it’s necessary to find a way of preserving them. There are many, many different ways of sharing stories and you may be more adept at some than others. Some people love to tell stories, some write poetry, some draw or paint pictures, some take photos, some make films, some write plays, some act in them, some throw pots, some compose music (or play it), some make quilts, knit scarves, work with wood, decorate cakes, arrange flowers, while still others dance…
  34. 34. School for Health and Care Radicals Programme Study Guide http://www.theedge.nhsiq.nhs.uk/school/ 34 SHCR III 2016 All these activities are ways of expressing and sharing our common human experience. So, it’s helpful not only to the think of the stories you want to tell, but how you will tell them. You may be thinking that you are not very creative; most of us, however, are more creative than we think. ACTIVITY: THINKING ABOUT STORIES AND CREATIVITY 1 How do you express your own creativity? 2 How would others – friends, family and colleagues – describe your creative gifts? If you are able to bring your creativity into your work in such a way as to engage with others, you are likely not only to find greater satisfaction in your work, but also to be a more effective change agent. ‘Telling this story has reminded me of how our creativity connects with part of our soul - how wonderful it is to be part of something that does not have measurable targets or hard matrices.’ Patient Voices storyteller ACTIVITY: CELEBRATION 1 Think of something you have done that you are really proud of. Jot down a few notes. 2 Now turn that experience into a story – one that will engage, entertain and possibly even inspire or motivate your audience. You might find it interesting to watch some stories of celebration made by colleagues in the health and care sector – they may inspire you to share your own stories of success and transformation! The chief officer of the NHS Heart Improvement Programme wants to make a difference and with a little help from his friends he does so. http://www.patientvoices.org.uk/flv/0050pv384.htm
  35. 35. School for Health and Care Radicals Programme Study Guide http://www.theedge.nhsiq.nhs.uk/school/ 35 SHCR III 2016 A small voluntary organisation that provides free counselling for those who would not otherwise have access to such a service is struggling to survive in the face of funding cuts. If the prevailing attitude does indeed prevail what future is there for voluntary organisations in the co-production of care? http://www.patientvoices.org.uk/flv/0123pv384.htm A brief history of the Heart Improvement Programme celebrates the real improvements in services to patients that are the result of working collaboratively and building networks of doctors nurses and patients. http://www.patientvoices.org.uk/flv/0026pv384.htm Val Leggett, Infection Control Nurse for Norfolk and Waveney Mental Health NHS Foundation Trust, describes how lateral thinking, teamwork and use of colleagues' expertise achieved an award-winning facility. http://www.patientvoices.org.uk/flv/0266pv384.htm A chance remark made Katie determined to return to the nursing job she loved. But it wasn't until she was sent on a Montessori for dementia patients training course that she realised the direction she now wanted to take. Today she is really making a difference to people's lives. http://www.patientvoices.org.uk/flv/0633pv384.htm As you progress through the School, you may find it helpful to pay particular attention to the different ways in which people tell stories and how you respond to them. If you haven’t already done so, begin to develop your own storytelling style – and you can see from the examples above that it is possible to say a great deal in a very short space of time! ‘Narrative is radical, creating us at the very moment it is being created.’ Toni Morrison, 1994
  36. 36. School for Health and Care Radicals Programme Study Guide http://www.theedge.nhsiq.nhs.uk/school/ 36 SHCR III 2016 Glossary Every field of endeavor creates its own language or jargon to describe the people, activities, tools and skills that are particular to that field. The field of change, transformation and improvement is no different and we know that there are some words and terms that may be a little unfamiliar. By the end of School, we are confident that you will be bandying around terms like ‘self-efficacy’ with confidence but, to begin, it might be helpful to have a bit of guidance as to how these terms will be used in the School. Advocate Someone who speaks or writes in support of another person or cause. As a radical, you may be advocating for positive change, or you may be advocating, for example, for people with dementia. Apathetic When you are feeling apathetic, you have no interest or enthusiasm for anything. This can happen when you are exhausted, overworked,, unwell or feel taken for granted. Autonomy If you have autonomy, you have the power to make decisions and to act on those decisions. Disparate When things are disparate, they are completely different, separate and distinct. Diversity Diversity refers to the unique difference that we all bring into the world. Diversity is essential for growth, development and survival, in nature as in society. The concept of diversity relies on accepting the value of each individual, whatever their race, ethnicity, gender, sexual orientation, socio-economic status, age, physical or mental abilities, religious beliefs or political stance. Here are a couple of short videos that might bring the concept of diversity to life. https://www.youtube.com/watch?v=8taWGfkVvTg https://www.youtube.com/watch?v=C1lxTJyrCls Extrinsic When something is outside or external, it is extrinsic. We use the term to describe the kind of motivation that comes from outside, in the form of targets, KPIs or even salaries….
  37. 37. School for Health and Care Radicals Programme Study Guide http://www.theedge.nhsiq.nhs.uk/school/ 37 SHCR III 2016 Heretic A heretic is someone who does not believe in the prevailing system of belief; he is she may be referred to as a dissident, a non-believer a non-conformist, a renegade, a rebel – or perhaps even a radical! In the past, people who did not comply with the rules established by the Christian Church were considered to be heretics and were often burned at the stake. Hierarchy and hierarchical In a hierarchy or hierarchical system, people or things are ranked according to their importance (or perceived importance) or their status. ‘Old power’ relied on the notion of hierarchy where the people at the top of the hierarchy have power over the people beneath them. Inherent When something is inherent, it is an essential characteristic or aspect. So, inherent in the School for Health and Care Radicals is the goal of giving people confidence to bring about transformational change. Innovative When something or someone is innovative, they are involved in new and original thoughts, ideas or designs. Many of the initiatives that emerge from the School for Health and Care Radicals are innovative approaches to improving health and care. Interprofessional Interprofessional working and learning refers to activities that take place when people from one or more professions work together. It is the opposite of working in silos and is, actually, essential for 21st century healthcare. The School for Health and Care Radicals is a good example of interprofessional learning, where people learn from, with and about each other. (See www.caipe.org.uk) Intrinsic Intrinsic is the opposite of extrinsic and refers to the essential nature of something. We talk about intrinsic motivation as being something that comes from within you and relates to your core values or aspirations. Maverick A maverick is a bit like a rebel – mavericks are unorthodox or independently- minded person determined to do their own things in their own ways. Non-conformists Non-conformists don’t do what society expects of them; they think and possibly live in a way that is quite different from other people. in the middle ages, people who did not agree with the established church were referred to as non-conformists.
  38. 38. School for Health and Care Radicals Programme Study Guide http://www.theedge.nhsiq.nhs.uk/school/ 38 SHCR III 2016 Radical Radical has a number of meanings: it can refer to the root of something or, in chemistry, to a particular kind of chemical reaction. People who are referred to as radicals want to bring about radical (or extreme) change from the traditional ways of doing things; in the School for Health and Care Radicals, we use the term to describe those of us who are passionate about bringing about significant change in health and care and recognise that we need to do things differently in order to achieve the changes we want to see. https://www.youtube.com/watch?v=XKeilf1Fp5c&spfreload=10 Self-efficacy If you have self-efficacy, you believe in your own capacity to influence your situation; you have control over your motivation, your behaviour and your ability to influence your environment. Silos In the world of health and care, silos refer to systems, processes, departments, etc. that operate in isolation. This tends to be a traditional way of working and makes it difficult to bring about change across organisations. Part of the work of the SHCR is to reduce the number of silos and encourage people to work across professional boundaries. Status quo Status quo is Latin for ‘the state in which’, in other words, the existing state of affairs, especially regarding social or political issues. The School for Health and Care Radicals offers opportunities and skills to enable people to challenge the status quo in constructive ways that will result in sustainable change. Resources Each module will contain a list of resources that are particularly relevant to that module. You will also find a collection of resources at www.theedge.nhsiq.nhs.uk/school/ This collection will grow as we update it so please do check back often and, if you have a favourite resource, please do share it with us all! Email: radicals@nhsiq.nhs.uk Telephone: +44 2476 627543 Facebook: School for health and care radicals Twitter: @School4Radicals #SHCR

×