Matt was asked by the Kings Fund to write a blog on his reflections of partnership working. The following is based on our experience in a deprived area of the city where there is a lot of discontent and frustration with an over stretched surgery.
The practice cannot see everyone in the time they would wish to nor get there quick enough to stop people going elsewhere in the health system e.g. the Emergency Department (casualty/A&E). Many of the issues they see, as with most practices across the UK are not fully medical in nature, or even at all. This practice sits in a ‘deprived’ neighbourhood within Plymouth where many initiatives have been tried; and better access to general practice is what is being asked for.
We find this issue is central to anything else succeeding. However, there are multiple barriers: * The general practice find it hard to attend meetings and, as we hear it, find it hard to askfor help. * Community leaders are disillusioned after many years of trying to create change. * As mentioned, many issues turning up in the general practice are not medical, and don’t require a medical solution. * At another end of the cost spectrum, setting up a new practice closer to the community is challenged by cost and finding a building. This will just be a small sample of the barriers that this issue faces. We’ll discover more as we go on.
Working in conical spirals
One of the ways Belong in Plymouth is learning to work is iteratively. This applies to both what we do, how we do it and who is doing it. Change is a social process, so we recognise the need to build slowly. Spirals are starting to be a recurring form that describes this. And thinking in 3D our work moves in conical spirals, starting small and building outwards all the time. The reason a 3D spiral is helpful is that it explicitly describes the movement outwards, involving more people AND the movement forwards, through time.
Back to the beginning
How we got involved in the neighbourhood above is a good example of working in conical spirals. A very small group started the whole programme and won the funding. Once up and running, rather than establish a large team with pre-established roles described by a predefined programme, our starting point was to speak to people about social isolation and loneliness. This spiral widened as we developed the conversations. At the point it came into contact with services we asked ‘the system’ to identify a service areas we could test the translation of stories about whole lives into a narrow service focus. The Emergency Department was identified as that service area.
A range of new relationships was needed so a new, small group formed and a new spiral started. We started small, recruiting people to speak to through general practice. Further people joined. We learnt and developed and through this and some data analysis we decided to work in the neighbourhood.
At this point, yet another spiral was initiated because we needed to start afresh, starting small in the neighbourhood. By listening, we realised we had to put aside the previous conversations and plans so we could begin with ‘how can we help?’. This starting point allows collaboration, we don’t have any fixed points that prevent collaborative action. It doesn’t stop us bringing in what we know, but it will be in service of the neighbourhood, not the other way around. It allows us to weave into other pieces of work already happening. It allows a coherent, not fragmented conversation to develop. And in time it will reduce Emergency Department attendances.
How does working in spirals create more impact?
Another King’s Fund blog Partnering is a verb quoted one of Myron’s Maxims
“The process you use to get to the future is the future you get”.
It is therefore quite a simple logic statement:
IF we know collaboration & listening will create greater impact, AND we absolutely know through feedback from across the system- whether it’s from within teams, between the VCSE and statutory sector, between communities or as a patient to service provider, the story of no listening, of poor collaboration is prevalent AND we know our ways of working lead to the ends THEN we have to change the ways we are working.
This triggers another logic statement:
IF we are not using the ways of working that reaches our desired ends THEN we must change our ways of working. This change is hard because new ways of working are non standard by definition, create ambiguity and uncertainty and therefore heighten our emotions (which is never comfortable!).
So the challenge that faces us is how do we do this when people hardly have time to do their day jobs?