Storytelling, tacit knowledge and a leadership Indaba


“If history were taught in the form of stories, it would never be forgotten.”

Rudyard Kipling

Stories matter; everyone seems to be taking on board storytelling – is it a fashion, a fad?

Storytelling bookHuman beings have been telling stories, transferring knowledge, values and history through hundreds of years and generations of tribes. Attention seems to be turning back to our delight in oral histories and stories. Even in electronic forms we see videos and read wonderful blogs that continue the ancient tradition of storytelling through generations, transferring some of our oral traditions to new digital media. It makes me glad – I enjoy stories and they make me laugh and sometimes cry – and I have learnt so much from these stories – they expand my mind.

My personal experiences tell me that stories are a powerful way for me to share my stories, find meaning and knowledge in what I know, that they have a power that charts and sterile traditional business words sometimes miss. My blog has become a place where I try to share stories and in doing so try to unearth some of my tacit knowledge that I wonder if has any value in the world. My stories and reflections are part of my endeavour to share and to move from ‘stuff that is in my head’ to sense making, making it social, transferring and transforming thoughts to a deeper understanding.

Tacit knowledge is deeply personal and hard to extract and measure. It flies in the face of much scientific study and is known to be hard to draw out and share. The spoken and written word, gestures and emotions are in my view part of its transfer and the recipient of it needs to be able to listen, watch and actively participate in the story to sense-make, participate and share.

It is also my view that it is a social activity for many, but perhaps not all; marrying together story tellers and listeners in networks creates a more fertile space for the development of concepts, ideas and taps into our imagination to assess possibilities and create new ‘castles in the air’. I understand that scientific enquiry is vital in our world but I believe that stories allow us to share and interpret experiences in a way that complements our more logical and scientific understanding.

This week I attended a Leadership Indaba.

Indaba is a South African word, with its origins meaning ‘gathering’ or ‘meeting’. More recently they are styled as conferences where there is space for creative thinking and where story telling is likely to have a strong role.

So this week a group of people with an interest in leadership gathered in Leeds as part of an Indaba organised by Centre for Innovation in Health Management in Leeds. The Indaba has an international flavour with colleagues from South Africa and the Netherlands – a great opportunity for story-telling across different cultures and experiences, a chance to collide our experiences and stories together in a way that creates new meaning informed by the people in the groups.

Everyone has a storySo, I went to the day thinking I knew nothing, I knew no theories, and that I may not be able to participate – that I might not be up to the task (Imposter syndrome at its most active). But Indabas are not styled that way…. Story-telling is what I think they are about. I came away bursting with stories and new ideas taken and processed alongside stories from others. It was a social activity, sharing stories, processing meaning and this was just the very first day we had met. I know not everyone was comfortable with the unstructured social nature of the day but I found it liberating. Telling stories links us to emotions that create new ways of thinking and behaving; maybe a creative way to find new and different solutions to complex problems?

So what happened at the Indaba? Storytelling started the process of weaving us together and started us on a new journey. For me it was, and remains, exciting; the chance to hear others talk about their experiences and to weave those stories through mine to create new understanding and meaning. Its early days, we are still building trust and confidence and we also need to work out how we share this learning more widely – I will blog more as our journey unfolds.

Finally, I think that there is a risk in having a single internal story. In this wonderful Tedtalk by Chimamanda Ngozi Adichie she explains about the danger of a single story. If you don’t think that storytelling and sharing is important watch the video – it may just change your mind.

I’ll show you mine, if you show me yours


Many years ago I learnt a very hard lesson. It’s about good intentions but still getting it wrong. We all like to think that our contribution to care is visible and valued by others but do we really take the time to understand the perspective of others who support patients and just as importantly what putting the patient at the centre really means?

NHS Direct

Three of these nurses worked at the site I did! It was a long time ago now!

My lesson is from the time when I worked at NHS Direct. It was a fantastic time we were breaking new boundaries and doing things across the country that hadn’t been done before. We were proud of our nursing assessment process. I was responsible for the technical system we used; not the algorithms, but the system functionality, that is how it works. We regularly referred callers to speak to or see the doctor in out of hours care. We were one of the first sites to integrate these services and we had a great relationship with the clinical leaders in that organisation. Providing seamless care was our aim across both organisations.

I was trying to develop a system whereby in our electronic referral to the doctor we included information about our assessment. The options were limited. We held a history of the full triage, all the questions asked and all the yes and no responses. Of course for a complex assessment this could be many many questions and as far as the nurses were concerned all of those questions were important, they all added weight to their referral. They were proud that they had done a comprehensive assessment, and wanted the doctors to see what they had done.

The doctors decided they didn’t want it- a stand off!

A difficult challenge to us at NHS Direct! I held firm. Surely they needed to understand why we had made the referral?

This went on for a while. We didn’t understand why they were so resistant, how could they refuse clinical information about someone we thought was ill enough for them to need to see them! Finally, in my wisdom, I decided I needed to find out more and persuaded one of the doctors to let me spend some time with them on a night shift. Arguably I should have done this earlier but, as you know, we all live and learn!

In the car in out of hours, in those days, the doctors were receiving referrals from the nurses directly and they only way they could view the referral was to print it off on a tiny portable printer. The doctor showed me what happened if he printed it off – ittoilet roll rolled out like an out of control Andrex* toilet roll….. Clearly not the communication that the nurses or I expected.

I learnt lots of things from this experience; a reminder of the need to listen, that we were not always the most important, that being proud can get in the way sometimes but most of all to stay focused on patients and their families. Fortunately I was able to put it right and improve what we did. We created a system where the nurses could create a short summary to transfer to the doctor; a better solution all round.

I think the lessons that I learnt then may be useful today too……

It is true to say that I really do feel that informatics is finally here to stay. Every meeting I attend everyone is talking about how important it is that everyone can see information about patients/citizens wherever they access services, that we need to reduce duplication and that this will contribute to a better patient experience. Sharing information is discussed as a fundamental enabler for service transformation. Excellent! I at least don’t have to have that debate any more.16571920_s

But then, I am rightly challenged on why do we have to ask for this now, why isn’t it here already? Surely if banking can do it we can? And so it goes on. I have worked with some of the most brilliant technical folk, they are so clever and awesome and I feel so lucky. They tell me that technically what we need, as an enabler for service transformation, can be delivered – so what’s stopping us besides money?

I am starting to wonder if the problem is similar to the one I faced at NHS Direct.

Everyone thinks that their part of any ‘record’ system is the most important, as did those nurses. There are many many conversations that loop round and round about standardisation of records, terms, datasets and about sharing agreements. But no one ever gives anything up. Equally the information governance debates centre on why not, rather than how can we, scaring the living daylights out of staff. And round we go. Although it’s never personal and it’s generally lovely people (most people in informatics are lovely 🙂 )the conversations loop round and round like a merry go round. I think we circle focused on our records and our contribution to care, as we did back at NHS Direct, rather than looking at the whole system and from the patients viewpoint.

I’ve started to wonder if, like I did at NHS Direct, we are looking at it from the wrong perspective. I think what many clinicians mean when they say a patient centred record is ‘my view of a patient centred record’. What’s more, I think portals, the current trend, is merely each group agreeing to share ‘my patient centred record’. Better than not sharing at all but perhaps an ‘I’ll show you mine, if you show me yours’ approach that doesn’t really focus on the patient at all. I’m not so naive as to think that we don’t need some specialty systems – intensive care is intensive care – but I still think we might have got some of the principles wrong!Sharing It leaves me wondering if informatics needs to embrace co-production in its fullest sense; that is getting patients/citizens to describe what they mean by a patient centred record in collaboration with the people who provide care and services and those clever IT folk. Once we start this conversation then perhaps we need to accept that we have to find a way towards this goal in a way that puts aside our existing professional and organisational perspectives. It may be that it’s simpler than we think? Perhaps it throws away the concept of organisational records? Maybe that’s too hard but worth thinking about surely? If we muster all our brains and hearts along with patients perhaps we could co-create a new picture of the future?

Is informatics ready for such radical approaches? So why is it that we haven’t already embraced them? I’m not sure but I suspect it’s cultural and a difficult one to crack! Informatics is more about analytical approaches and logic and not quite so often about hearts and minds. The nearest I have seen is the development of hack days but these tend to retain control in the technical domain.

But as I learnt a long time ago listening and truly hearing are key to better solutions and I wait optimistically for the conversations to change.

*other toilet roll brands are available

Informatics skills – If you always do


‘If you always do what you have always done,

you will always get what you always got’

I see this everywhere, urging us to change; I am a bit bored with it to be honest but it does have an irritating ring of truth about it.

Nurse keyboardI’ve been thinking about the skills that nurses, midwives and health visitors need now and for the future over the last week, as a result of meeting 100s of nurses and talking to them about informatics. What I do know is that technology has already impacted on practice and I feel sure it will continue to do so. These days, as I only spend short rare periods on the ward, I often can’t use a piece of new equipment and have to ask someone to help. Informatics – that is both the use of information resources and technology – have an insidious impact on practice and increasingly are woven into the work we do with patients.

dream jobWhy is it then that we continue to write job descriptions (JDs) that could have been written 2 decades ago when I was a ward sister? They seem old fashioned and if they are trying to describe what nurses need to do they are dull, dull, dull. Nursing is one of the most exciting and diverse jobs I can think of yet if you go and pick up a vacancy on NHS Jobs and open the job description I suspect you might feel underwhelmed. In a competitive labour market surely we need to do better than this? These JDs are like a window into your organisations!

Two years ago I collaborated on a piece of work with Professor Dawn Dowding. We randomly sampled job descriptions taken from NHS Jobs on a single day and analysed them to look for the skills relating to informatics. I was yet again underwhelmed. You can see the full publication here (sorry its pay walled).

In a world where using information and technology are almost routine parts of our lives these JDs were shocking. Few referred to using information in a modern way although there were oblique references to some of these concepts. 16571920_sOne of the most powerful feelings I came away with was the rules driven Information Governance agenda with the focus on ‘thou shall not’ with no focus what-so-ever on how sharing information can improve safety. I am pleased that since then the Caldicott 2 review has corrected this perception but a quick scan on NHS Jobs reveals that this is still not evident in JDs.

Nursing is a modern profession. It is continually reshaping itself to meet the needs of the people we care for. Job Descriptions reflect how we see roles, how we recruit people with the skills to do the job and these in turn inform workforce plans that help us to educate the future workforce. We need modern nurses who are skilled users of information and technology to meet the challenges of the future. But if we always describe nursing in the ways often expressed in JDs, we will always get what we always got!

Here is a my take on a redraft – Nurse Draft JD – as an example of a more modern JD. I am not saying it is right, it was developed with my particular focus and was drafted before the 6Cs Compassion in Practice strategy but I believe it has the informatics skills woven through it, just like the use of information and technology are woven into practice. I just wanted to show how informatics could be described without asking for ‘Computer Skills’!!!!

We need to up our game.

technology future

 

Exploring New Territories


It was a usual morning with an early start at 6 o’clock to get the train from Wakefield to London. It was all pretty much typical, Costa coffee in hand and sat waiting patiently, shivering, on the station platform, as I always arrive early. As is also usual, I’m filling in those pockets of time with my Twitter feed on my beloved iPhone and I notice that the HSJ were announcing their first ’Social Pioneers’. As I do, I flick it open and the first thing I notice is a lovely picture of the lovely Teresa Chinn. Then as I scrolled down, there I was: gobsmacked – me a ‘Social Pioneer’?

I am passionate about how information empowers. Information can bring independence and create changes and shift in social order. So bringing information to nurses can enable them to improve their practice, see things in new ways, revolutionise and encourage improvement as well as spotlighting where things might not be right. For citizens, information can drive real change, be disruptive in creating new paradigms of systems and behaviours; I think that ‘Patients Like Me’ is one of the best examples I can think of that shows this; have a look at this story to see what I mean:

Frustrated ALS Patients Concoct Their Own Drug’ The Wall Street Journal, April 15th 2012

This powerful very short TedTalk from Stanley McChystal is about how having the confidence to open up information can make significant differences to what happens and illustrates my point too.

 

‘Information is only of value if you give it to the people who can do something with it’ Stanley McChrystal 2014

‘Sharing is power’ Stanley McChystal 2014

So what has this got to do with me being a ‘Social Pioneer’?

In around 2010 I discovered social media. I’m naturally curious and experimental so, curiosity prompted, I wander into social media. Wandering is a good description – I had little knowledge beyond being a Facebook user, no skills and little insight = scary!

What I discovered was a space that I think has huge potential for nurses but also those people who have health needs – it has the power to transform some aspects of how we use information.

What I also discovered amongst the nursing community was a reticence, anxiety and resistance and sometimes all of these things are still present. It frustrates me sometimes that I sense a lack of professional confidence about using social media and experimenting with its potential amongst many nurses. I also discovered people who I now realise are social pioneers, people with long term conditions and experiences of the health system that I started to follow and watch – I was amazed.

I saw the huge untapped potential that I believe social media offers us. Yes, it breaks down boundaries and flattens hierarchies, but it also has the real potential to change the very nature of the power based relationship between systems and people. I also believe it still has untapped public health potential but it has to move beyond broadcasting to achieve the possible.

So in 2010 I decided that one of the things that was needed were some role models in nursing that showed what could be achieved and as no one else (other than a few notable exceptions like Teresa @agencynurse and a few other pioneers) were taking that on, I decided that I would. If I was to show the power of social media I needed to ‘show’ it, not just point at it; doing presentations about social media is one thing but living it is another. So my ambition was to be a good role model for nurses in social media. That’s when the real pioneer journey began. My delight on being identified as a social pioneer was partly to do with feeling that it was evidence that I had, at least partly, achieved some of what I had set out to do.

In my journey I also discovered a very eclectic diabetes community and I am proud to say that I have also been part of that, making I hope, a contribution based largely on my 35 years of living with type 1 diabetes but of course combined with my other skills and knowledge. I have written with another social pioneer – @parthakar (whom I have never met in real life but know that I will 🙂  )  about the use of social media in the professional interface between professionals and patients – this would never have happened without Twitter. Here it is:

‘A New Dawn: the Role of Social media in Diabetes Education’

pionee signpost

Famous signpost with directions to world landmarks in Pioneer Courthouse Square, Portland, Oregon

That’s why the word ‘pioneer’ was the part that gave me the most satisfaction when I read the piece in the Nursing Times and Health Service Journal supplement. I was also cited alongside many people I greatly admire – each has made a unique and significant contribution. I was delighted that the write up picked up some of the very things I was trying so hard to do, rather than just my level of frenetic activity! That’s exactly what I set out to do, to start to chart the new territory of social media for patients and nurses and other people who are part of the big NHS and social care extended family and I hope I am a little part of an enduring story.

FlorenceI also came to realise that being called a ‘pioneer’ gave me great satisfaction for other reasons; I have always taken on roles in leading (and sometime ‘bleeding’) edge environments; complaints management in 1990 (listening to complaints then was not what it is now), NHS Direct, the National Programme for IT and informatics is still, in its own way, pioneering. There is also the point that nursing has a strong history of pioneers like Mary Seacole and Florence Nightingale – fantastic role models.

So on Wednesday I celebrated with a very large piece of cake!

Anne Cooper – ‘Social Pioneer’ – who would have thought it! Now where is the next territory to explore?

So that’s enough about me (a very self-indulgent blog this week AnnieCoops!): A very big thank you to everyone who was kind enough to nominate me (you know who you are), the Nursing Times and Health Service Journal and the lovely judges: Jenni, Andrew, Shaun and Emma. But also I couldn’t be social without conversations and it is those people who increasingly have the confidence to share, debate, support and push conversations in social media that I need to thank. Your conversations, blogs, video blogs inspire me, help me to grow and learn, support me and enable me to see new futures – thank you.

Cake

 

 

Guest Blog: Compassion – a MARLARKEY or a CASE FOR CHANGE?


Maxine 2014This is a guest blog from my friend and colleague Maxine Craig who is Head of Organisation Development at South Tees NHS Trust and visiting Professor ( Sunderland University).

Maxine can be found on Twitter on @Maxine_craig and she would welcome conversations about this blog.

Maxine’s blog speaks for itself – so here it is:

This week whilst at a training event in the coffee break a lady approached me and asked me “Was I Maxine Craig who is part of this ‘NHS Compassion Malarkey’? ” – now this has hit a nerve!

Maxine nursing

I have worked in the NHS since I was 17 and this ‘malarkey’ has been my life for 33 years. Ensuring patients get the best we can give and staff are well and healthy is my purpose. It’s no malarkey!

 

This is what a malarkey is:

malarky

I believe there is a compelling case for change in the delivery of care; the latest Panorama programme surely reinforces that? – Yet I sense that a back lash about compassion is building.

For the past year I have been making myself available to help people think about the issues we face, making spaces where people can think more deeply about compassion in our lives. And I am learning that everyone I speak to in the NHS, social care and wider society recognises that something about it needs fixing. Everyone appears to have a perspective on the general lack of compassion in the wider world and that the NHS needs to ‘do’ compassion better.

elderly lady

This is a real puzzle for me. I work in a great organisation and I witness compassion every day, in abundance, and I see situations where compassion in lacking; It’s not as clear cut as the media would have everyone think. I am worried that being compassionate is becoming an industry in our health and social care settings, others also express this view and some are becoming cynical of anything with a compassion label. I would like us to pick out and continue the genuine good work.

In all of my learning I have found that people find talking about compassion rather uncomfortable. Yes, everyone has an opinion, a surface view. Some people have been deeply affected by a positive experience of compassion in their lives and some hurt by a gap in compassion. Everyone who comes to talk about compassion has some interest, and I have noticed that many have some degree of discomfort.

angry womanI think this is because it’s about all of us, not just the bad guys who don’t do it! It has the potential to make us feel guilty, uncomfortable about our personal struggles and challenges.

At a system level the NHS voices that it wishes to improve compassion but it continues to work in a non-compassionate way and I suspect the care sector is the same. This is a paradox. I do not believe this is a ‘problem’ that needs to be solved but see it as more of a societal context, leaving me as an OD practitioner with a complex and sometimes frustrating dynamic to work in. So I am working to explore and practice the ‘HOW’ of increasing compassion in our system – I want to get on and DO something about it not just talk about it!
 

The NHS is deeply evidence based. In some parts this might be more espoused theory than theory in use, but it is an important guiding principle. We also wear the cloak of evidence as a defence. Another important fact is that many professionals and managers (and I include myself in this group), actually were professionally socialised at a point in time when the control of emotions and ‘not getting emotionally involved with the patient’ were prized professional competences. The new world of the psychology of work offers a different view, with burn out, compassion fatigue and emotional labour as key and important phenomenon. It is important we remember the shift which has occurred within one generation. As a result of this shift the current reality of the compassionate intervention is very challenging for some.

the compassionate mindSo I have learned that the very best way into these conversations about compassion and the psychology of work and caring is via the science. The work of Paul Gilbert who established the Compassionate Mind foundation gives us the basis of the neuroscience of emotion (you can read more here) and I have been able to link this to stress in life and wider society.

Tree huggingI have witnessed the relief in people when they come to talk about compassion and are met with the evidence base. It welcomes them in, it is a context they know, it allows them to be open to the practice of compassion. When coming to a talk about compassion people have shared with me that they were worried it would be too soft and fluffy. When I have explored what this means some people say they don’t want ‘new age’ or religious or spiritual. So like all good change agents let’s start where people are at – let’s start with the science!change agent

Compassion is no malarkey; it’s vital and too important to be pushed aside because it makes us uncomfortable.

I am DIGGING IN for the long haul on this one – I want to make sure the NHS and care system is good enough for my dad. Will you join me?

Maxine's Dad

The highs and lows of being a patient


roller coasterI’ve had a very mixed day today, you know, one of those ones where it’s a bit like a roller coaster, up and down and all around – I’ve been to clinic and it wasn’t all good news. To make it worse the good news came first and then the pricking of the bubble 😦 but I guess on balance it was OK in the end.

For those of you who know little about Diabetes I had a clinic appointment and was waiting for a test result called HbA1c. It’s a test that helps you to understand how well you have managed your diabetes over the previous 2-3 months (you can read more about it here). As I had been trying very hard to improve my diabetes management I was looking forward to seeing how well I had achieved this aim. But it wasn’t good news 😦Diabetes

My result was actually higher than I have ever had before and I just don’t understand why. I also have slightly raised blood pressure which has persisted for a year or so. Regarding my BP my lovely consultant, Dr R, wants me to take more tablets but I want to try losing some weight first but we agreed a middle way; a 24 hour BP recording to see what is really going on.

I was despondent. I need to lose weight – for the BP (and also for me) – but that complicates my overall management and I honestly don’t understand why my HbA1c is so high.

This is where the experience turned around – Dr R, is simply a star. Now you need to understand that I suspect I’m not an easy patient, particularly for the nurses, but probably also for the docs. I try so hard to be a ‘good’ patient but I also know that I’m a Yorkshire lass who has a reputation for calling a spade a shovel at times of pressure and clinic = pressure. I also, of course, can smell patronising behaviour from a long distance and my response isn’t always as gracious as it should be, despite my efforts.superstar

I am pleased to report that Dr R handled me and my need for help with skill and aplomb. We have a plan and, more, we are going to manage it using email and technology. It seems that he has heard my pleas for less ‘clinic’ and more remote help and responded with a positive optimistic and helpful outlook. I certainly didn’t feel patronised or told off, he just made to feel like they were going to help me to get to the bottom of my issue. I feel sure with a bit more effort on my part and with his insight and skill we can sort this out. It was the first time I have ever really come away feeling like I had a clear ‘plan’.

But the other thing that happened also made me very happy indeed. Sometimes, as a patient, when you give feedback it’s really hard to see whether anyone is taking you seriously. The place where I receive my care is a struggling Trust. On the recent staff survey only just over half of the staff said they would recommend it as a place for their friends and family to be cared for and they were in the worst 20% scores for all trusts for some of the measures. The diabetes centre is fairly new, build from charitable monies but when I got there today the reception area was closed, shuttered and unmanned for the second time – I suspect a sign of the underlying cracks in the system.Pressure

I also know they have a problem with workload and they need to think about how they can do things differently but I think they feel like they under siege; torn and burdened.

But I discovered that they do listen; Dr R is a gem. I spoke to him last time in clinic about how difficult it is to get an appointment and how I didn’t think I need to physically be with him in the same room and surely we could use different ways to communicate? I also subsequently pointed him at my blog about a ‘Year of Care’ – see here.

Well, well, well; he was bursting to tell me his news as soon as I walked into the room and he brought a massive smile to my face – they are going to start a service improvement initiative to do exactly what I suggested, finding 20 patients from each of the 3 hospitals who would like to try to work with the team in new ways, using email and technology, to see if it works! I couldn’t have been prouder. I just hope of course that it is better for everyone and that includes saving some money but they are going to do this properly, with proper measures to assess the impact – my little heart swelled with pride.Computer stethescope

I also persuaded him (I hope 🙂 to look at how these patients could connect with each other using social media; I offered to run some sessions for those patients who were interested – you never know it might help them to be better connected as it has done for many of the people with diabetes that I chat to on Twitter, using #DOC and #ourD. It seems I have volunteered myself to help and am delighted to do so.

So, today was a day of highs, too high a HbA1c and a great one of feeling good that I might be helping to support making things better even if it’s in a very small way. Dr R promises me that they will write this all up when they are done and I can’t wait to see the outcome.

Are you a patient who has a good idea? Why don’t you try offering it up to see what people make of it? You never know you might have one of the solutions everyone is looking for!idea

On being a ‘hard done to’ bottom


Learning is a funny thing isn’t it? – The things you remember and then those things you don’t. I’ve had my learning muscles tested recently as part of my Organisational Development Practitioner Programme which I chose to do as part of my Florence Nightingale Foundation Burdett Leadership Scholarship. My instinct was right, by the way, there is much useful learning in OD for people interested in leadership. I know that some of the theories passed me by and weren’t retained in my pooh bear sized brain but some things have stuck and some of the systems thinking from this week has definitely stuck; it’s all about tops, bottoms and middles.

organisationsThe theory is quite simple; people in organisations adopt very predictable patterns of behaviour and that breaking out of these is what we need to do before we can really achieve but of course changing behaviours is a real challenge for all of us. Systems thinking is from work by Barry Oshry that explains that organisations are broken down into ‘Tops’, ‘Middles’ and ‘Bottoms’ and that each of these, naturally as part of a system, moves back to unhelpful behaviours that create many of the organisational issues we face. This week we did the organisational workshop to experience the system workings of organisational life in a way designed to magnify these natural and unhelpful behaviours that manifest in the worlds of Tops, Middles and Bottoms; before you say you are never a ‘Top’ etc we all occupy these roles at one time or another, they do not necessarily reflect organisational status (but they might). I had great fun 🙂

The process of allocation to a role in the workshops was random and I was delighted to find myself as a ‘bottom’. That’s where the fun started! I have to say that although in my role I wasn’t unhelpful nor was I as focussed at first as I should have been and I did revert to the behaviours that Oshry would have predicted, for me this was to withdraw to almost a playful space. I was experiencing true ‘bottomness’.

Those of you who have done the organisational workshop will understand significance of this picture :)

Those of you who have done the organisational workshop will understand significance of this picture 🙂

Oshry predicts that people will revert to an unhelpful behaviour and unless we can break from this we will perpetuate the same issues over and over again. Tops at times of pressure suck up responsibility and become ‘burdened’. Middles slide into the middle between tops and bottoms and become weak and ‘torn’. Bottoms hold higher ‘ups’ responsible and become ‘oppressed’. Oshry also explains that Customers also fall into a pattern of unhelpful behaviour where they become ‘righteously done-to’.

Sure enough, as the great workshop panned out, all of these behaviours were exhibited. My bottomness centred on a feeling of no one telling me anything and therefore I didn’t know what I was supposed to be doing so along with my mates we had a grand old time – playfulness as withdrawal.

Oshry goes on to explain that we chose how we behave and that these patterns do not need to persist – we can chose to be different.

Partnership is the key and changing and transforming our relationships can stop these behaviours and stop recreating the organisational patterns.

‘Partnership

A relationship in which we are jointly committed to the success of whatever project, process or endeavour we are in.’

Partnership 2We can chose to be part of what he describes as the ‘side show’ where we make up stories about it and evaluate others as malicious, insensitive and incompetent or we can take the centre ring and have understanding and empathy for others, staying focussed on the best outcome and take a wider view where you take into account the perspective of others. Tops should take a position where they focus on developing responsibility throughout whole organisation. Middles should maintain independence of thought and act in service of the whole system. Bottoms should take responsibility not only for their thing but also for the whole thing.

I think I recognise Oshry’s organisation in many places I have been in my career, where ‘stuff’ happens and I also recognise my own unhelpful behaviours in those he describes. I can also adopt some of the more helpful behaviours that move to a better position of partnership. If you ever get chance to do the organisational workshop I would recommend you jump at it; it certainly fits with my experiential model of learning.

There is no way I will forget being a hard done to bottom and also the need to stop those old behaviours developing, even without thought, and I will try to take a more helpful partnership position.

You can find out more about the organisational workshop and Barry Oshry here and here.

Nursing, research, knowledge and practice


knowledgeI had a really interesting Twitter conversation yesterday.  It was about research and evidence, stemming from a conversation where I said I would be unlikely to attend a research conference. I suspect that I am now also going to appear very stupid although I am not sure I am – I know I can synthesize information and indeed reach robust conclusions from information presented to me – but I often find understanding research papers challenging.

I find the way many research papers are written impenetrable. They use language where I have to look up the research terminology to enable me to understand. And I just don’t get it – surely passing on the knowledge is the single most important thing that you have to do? Research that adds little value as its meaning is lost in complex and obfuscated language is also adding less value than a well written and clear piece of research?  That is, of course, assuming the research is well constructed, undertaken, analysed and presented!

I know I can understand the evidence, after all I scored well at University having done a systematic review and I actually enjoyed my dissertation once I got going but some of the research papers just do not hold my attention if I have to work too hard to find and evaluate the meaning.
There are materials around that can help – I came across this blog by Calvin Moorley, that is clearly written and helpful but understanding these things isn’t necessarily the answer. This assumes research papers are well articulated and clear – but often in my experience they are not!

magazinesAlmost everything we do in nursing should be based on knowledge – that is the critical space between experience and applied evidence. The speed at which new evidence and materials comes available is also a challenge – how can I possibly keep up to date in all the areas of nursing practice that I am interested in, and synthesise it with my existing knowledge?

When I started writing this blog I went to explore some evidence to see what I could find to illustrate points but I found some good stuff, stuff I didn’t know, and I could understand, but I would never have found had I not been writing this blog! It’s impossible to be on top of the whole evidence base and live and work! It would be a full-time job 😦

So what does it all mean? Well, I think this is now about nursing knowledge management; an area of practice that we discuss little in nursing but I believe is increasing in importance. Benner describes the development of skills through novice to expert but in 2014 the ability to practice at expert level taking account of new emerging evidence is challenging.  We need knowledge workers to help us find meaning from new emerging areas of research.

There are some bright spots on the horizon. The recent find of the Evidently Cochrane blog site has encouraged and motivated me to be more engaged with research. The knowledge management part is taken care of, studies assessed and evaluated on my behalf in order that I can assimilate the research evidence quickly and develop knowledge in my practice. For example, I have always been cynical about risk assessment, always feeling that perhaps it wasn’t quite doing what it intended to do, and up pops my friends at Cochrane bringing my attention to this work that was debated on a great @wenurses chat recently – you can see the chat here. Another example of taking evidence and using a twitter chat to increase nursing knowledge.  I also value highly the KCL Policy+ that is published regularly, aimed at current areas of policy focus for nursing.

So what does this all mean? It means that researchers need to write research findings in an accessible way that can be quickly turned into knowledge by practitioners and we need more knowledge brokers like the brilliant Cochrane people who work hard to help everyone access new evidence. Writing in simple accessible language is not dumbing down, in fact I think it’s much harder to write clearly in non-technical jargon so perhaps that’s the real reason research papers are often difficult to understand – writing simply and well is much too hard! The Cochrane site aims to translate evidence in to meaningful understanding for everyone and thank goodness I found it!knowledge 2

Go on, reach out and build your networks!


I’ve always liked to get to know people and stay connected. My Myers Briggs type is ENTJ and my most extreme preference is extroversion – I know I’m a sociable animal. When you have those preferences it’s easy to under play the value of networks, after all connecting, learning and sharing are second nature to me and it’s how I stretch myself too; making sure I have interesting conversations that make me think. It’s also good fun.Myers Briggs

But as leaders in a system where it feels more complex and harder to achieve what we need to do than ever before, networking to share ideas and co-create solutions must be part of the future. Relationships that bridge organisational boundaries and stretch us to acquire new perspectives and look at things in new ways must surely be part of our future?

Networking sometimes has a bad reputation. That funny look people give you when you say you are meeting someone for coffee, a sort of ‘nudge, nudge wink, wink’ and a ‘tapping on the side of the nose’ as if to say – ah you are off for a quick skive or you must be job hunting. That’s not how I see it and how it works for me. I see meeting people and getting to know them part of my knowledge network; it enables me to stop worrying about not knowing so much but knowing others who do, or who think differently, or have different experience to me. My brain sometimes feels full-up and not able to absorb more – I need to share brains through my networks. You know the old AA advert ‘But I know a man who can’. 

Networks are also brilliant for finding people to test my madcap ideas on – it sometimes takes someone to say to me – whoa! Hold that thought right there!

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You need to nurture and grow your networks, they don’t just arrive, and once you have them they need loving care and attention.

 

 

Here are my top 10 tips for developing and growing your networks:

  • Always be genuinely interested in people and what they have to say
  • Find common ground and share what you know too – it’s not a one way street
  • Try to stay connected as much as you can – close connections need more of your energy than loose ones but both need your attention
  • Always try to give as much as you take – generous spirits tend to be good networkers
  • Only promise what you can deliver
  • Build trust and mutual respect and keep at it
  • Never, ever, ask for anything that you know is wrong, however good the relationship
  • Use social media to connect and share
  • Share your connections – you will extend your networks this way
  • Enjoy yourself and relax!

Leeds connected coffeeI recently had the very great pleasure of meeting Phil Jewitt @philjewitt from Leeds City Council as my NHS Change Day pledge for Leeds Connected Coffee. A great example of networking; we both come from very different professional backgrounds but we found much common ground and I feel sure I will be meeting Phil again  and I wouldn’t hesitate to ask his advice on local authority stuff! If we are to connect across systems it is the people who can do this, not sterile organisational structures – so go on, reach out and build your networks!

Finally have a look at this short RSA film about where good ideas come from and spot how networking might play a role here too 🙂 Its a good watch too!

 

What’s in a name?


I recently went to NHS EXPO and noticed something strange; nearly everyone who I networked with called me ‘Annie’. Now most of you all probably know me as Annie and if you were to meet me in real life you would perhaps call me Annie too, so why is this so strange?

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I joined Twitter in July 2012. I remember creating my account and wondering what I would call myself; I instinctively thought it needed to be memorable and reasonably short. I had an ex-boss who used to call me ‘Coops’ so I tried that first but – it’s a common name, Cooper – it had been taken, so as it turned out had AnneCoops. anneYou see my given name is Anne, no middle name, hard to shorten or abbreviate. Everyone who knows me in my family and most of my friends would never call me anything else (unless they were being rude; matron has been known). It was just a flash of, you might say, inspiration – and AnnieCoops was born.

Since then my life lived via social media has been a really fun experience. My career and working life before 2012 was fine but the opportunity to develop my networking skills has allowed me to create a new social ‘me’, I hadn’t really expected Annie to stick in the way that it has. As AnnieCoops I have met many many interesting and incredible people and I hope very much that it won’t stop here.

I never thought of myself as Annie, in fact my paternal Grandmother, who I was not particularly close to, was called Annie. I didn’t think I matched the name but somehow it’s taken a life of its own, so much so that at EXPO I heard my self say (I cringe) to Kate Granger (of all people) ‘Hello, I’m AnnieCoops!’ I have even bought the domain name anniecoops.com for my blog.

It’s become part of me and my persona. I don’t think it was ever a deliberate act but I have completely embraced AnnieCoops and now love being called Annie. It tells me quite often where I know you from and how long we have chatted! Life often creates strange and interesting twists and turns, and I hope AnnieCoops will stick for a long while yet!
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So, what’s your twitter name and what does it say about you?