Author's Posts

“Out beyond ideas of wrongdoing and right doing, there is a field, I will meet you there”  ~ Rumi

I met Neil last year, as part of our Future Leaders course. I immediately sensed that here was someone who I could learn from and with, and who would challenge my thinking around co-production. A few months ago I asked Neil to be one of my Co-Production Partners around families and young people, and was delighted that he agreed. Here is his first blog with us, and you can see why I am excited to learn together.

Since being involved in Co-production, I have come across two types of ‘elephants’ that occupy meeting rooms. The small ones that run around causing havoc-  these ‘elephants’ are easy to identify and each participant in the meeting,  if they had a mind, could call them out. The larger ‘elephants’ on the other hand, require the vantage point of everyone in the room to describe them. 

The little ‘elephants’, figuratively speaking, are the tokenistic acts of people that use Co-production meetings for their own agenda, or to tick a box on their job description. In both cases, such people seem to operate without really understanding, or perhaps deeply caring about the purpose of Co-production. Sometimes, people in Co-production meetings have competing priorities that simply outweigh the virtues of collaboration. 

Due to the stature of the bigger ‘elephants’, it requires everyone in the room to give their unique perspective, and for the sake of accuracy, these descriptions need to be from an equitable position. It is critical that common ground is established in Co-production meetings, wherein Health and Social Care ‘Professionals’ are able to meet and talk to those with ‘Lived Experience’ on an equal footing. Only then are we able to see what good Co-production looks like.

However, there is an inherent division of power that means that whilst people with Lived Experience are treated equally, there are not treated with equity. People with Lived Experience, by necessity, have to continuously reveal aspects  of their private lives in order to make Co-production happen. Parent carers have to talk about the indignity of changing their disabled child on the floor of public toilets- wheelchair users have to share with the room what sitting in a wheelchair over several hours does to their body.  When do the ‘professionals’ in the room display this kind of vulnerability?

If we were to sincerely answer this question, we would have to say rarely, and yet  you cannot Co-produce when there is inequity in the room. This means that if genuine Co-production is to happen, then Health and Social Care professionals are going to have to figure out how to be vulnerable and to stop, albeit unconsciously, using their ‘professional boundaries’ as a shield. 

It feels as if the Self Management approach developed by the Wellbeing Teams addresses this issue and is the key reason I accepted Helen’s offer to be Coproduction Partner for families.  Wellbeing Team members are empowered to bring their whole selves to work and to share aspects of their personal lives with those they have the privilege to support. 

As Helen remarked at a recent presentation on Wellbeing Teams “…we also talk a lot about love”. If I had one aspiration for this partnership, it would be to join that conversation, because I feel that it is only through love can we are genuinely vulnerable and only then can we authentically Co-produce.

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Last week I posted on Linked In that I was re-reading Bernadette Jiwa’s excellent book ‘Story Driven’ and was planning to using this framework with Wellbeing Teams. This is the bit that I found the most difficult because it is personal and vulnerable. So I have taken a deep breath and posted here to ask for your comments about how I could improve it. Thank you, in advance, for any suggestions and comments. 

It was two books, and on on-line programme called the Seth Godin’s AltMBA which led to Wellbeing Teams.  

My Dad died when he was 53. As I approached my 50th year I started to ask myself,

“If, like my Dad, I only had three years left to live, would I still want to do the work that I am doing now?

My career started with Occupational Therapy,  and then Learning Disability services in social care. For the last twenty years I have worked as a trainer and consultant. Twenty years of projects, courses, conferences, a masters, a PhD, advising the Department of Health, writing DH guidance and sharing what I have been trying and learning through twenty books. I have been immersed in a world of person-centred practices,  personalised care and support planning, personal budgets and personalisation (I am clearly attracted to work that begins with ‘P’). I have supported different ways of thinking and working, and helped to show what these could look like in practice through. I hope I have had a positive influence in some way, but if I only had three years left would I do more of the same?

One of the two books I read around that time was Atul Gawande’s ‘Being Mortal’. This powerful book challenges the way we support older people and think about end of life. As a consultant I had worked in home care, care homes and hospices and his words resonated with my experience. I wanted to contribute to better ways to care and support older people at home. How could I do that?

The second book had part of the answer. This was a book recommendation from a fellow student on the AltMBA, Susan Basterfield. It was  Reinventing Organisations by Frederic Laloux. It introduced me to how organisations are evolving, and that the leading organisations of the future, called teal organisations, will have 3 things in common – bringing the whole self to work,  focus on purpose, and self-management. Immediatley I wanted to make that change, and for us to evolve as a team. I was CEO of a H S A, a small, international, health and care consultancy team, and the book led us to become a self-managed team. I stepped down from being CEO and over the next two years we learned how to self-manage. 

One of the examples in LaLoux’s book is the self-managed organisation of nurses called Buurtzorg, in the Netherlands. It employs over 12,000 nurses, who all work in self-managing teams of now more than 12 people, supported by a coach. There are no managers. They have with a small HQ of around 40 people with no director of finance, no HR director, no marketing team. Against all measures of success they are highly successful. 

Atul Gawande’s book helped me focus on the change that I wanted to be part of, supporting older people. LaLoux’s book, and the story of Buurzorg helped me see another way to organising support, through self-managed teams.

The AltMBA helped me have the courage to ‘get skin in the game’. This is a phrase attributed to Nassim Taleb who berates how most academics and consultants (me being one of them) did not have anything to lose for the ideas they propagated. This is a controversial view, but it struck a cord with me. In my time as a consultant I have learned that when it is someone else’s organisation, where I am not responsible for their finances, their registration with CQC or reputation, naturally, there is only so far you can go. I have learned that to go to the edges of what I want to test and learn, the risks that I want to take, it could not happen within someone else’s organisation. So I needed to start my own, and this is how Wellbeing Teams started, to answer these two questions:

Could we actually do what we had taught people as trainers and consultants in H S A? Could we implement the person-centred practices and deliver person-centred care to supported older people to live well and be part of their communities?

Could we be part of demonstrating a new way to support older people through self-managed teams?

My purpose, my ‘why’ evolved to be “ to innovate, demonstrate and inspire change in health, care and community, where everyone’s wellbeing matters”. Wellbeing Teams is how I am trying to do this

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We were delighted to hear that Nesta, the global innovation foundation, had chosen us as one of their New Radicals. But what does it mean to be radical?

The Oxford English Dictionary defines radical as “affecting the fundamental nature of something”. We think that social care needs fundamental change, which is why we have taken an intentionally radical approach to designing Wellbeing Teams.

Here are 10 ways that we think what we are doing might be considered radical.

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How can Wellbeing Teams live their values everyday, in every interaction? This is the question I am looking at with our Advisor Jackie Le Fevre, and this is the first of a series of blogs to explore this.

What is the road to hell paved with?

According to one well known saying it is paved with ‘good intentions’: we set out on a path with noble aspirations steeped in genuine intent to be and do better and yet it does not always turn out that way. I find this to be particularly true of organisational core values programmes.

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Jackie sits on my shoulder – she is my challenge and support around values. Jackie is our Advisor on values, and is helping us ensure they are living through all of our work. She helped us to develop our value-based recruitment process, and over the next few months, we will be developing and sharing practical ways to stay focussed on bringing our values to life. I asked Jackie to introduce herself here.

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“Optimistic and naive of a utopian future”, these were the words used to describe me at a meeting I attended recently. It wasn’t said in a positive frame, but as I have reflected on this over the last number of weeks I have come to see this as actually a compliment, let me tell you why.

My name is Dominic Cushnan, and in this short blog, I would like to share with you why I am excited about joining Helen Sanderson and the Wellbeing Teams as one of their advisors.

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I have Garry to thank for connecting with Perry. I follow Garry on Twitter and he mentioned his blog on his favourite books, so I followed the link to find that the first one was Transformational HR by Perry Timms. I ordered it, read it over two days, and through some synchronicity, had dinner with Perry this week. I am delighted that he has agreed to be the Advisor to Wellbeing Teams on all things related to H.R. I asked Perry to write a blog to introduce himself, and here it is. Something that he does not mention in this blog, is his amazing shoes!

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I have been obsessing about outcomes. In the Individual Service Fund work I am doing with Martin Walker and Wigan Council, we need to be able to identify and deliver to outcomes. I asked our Wellbeing Teams Advisor in improvement, Andy Brogan, to help me explore this. What are the issues we need to consider here? Over to Andy.

Driving a focus on outcomes has become something of a hot topic, perhaps especially in health and care services but elsewhere too. Just start looking and it’s easy to find people working on how to do Outcomes Based Commissioning (OBC) and on what it means to manage for outcomes. It’s all plausible, well intentioned stuff; after all, how could we not want good outcomes?

My impression of the folk doing this work is positive too. It’s not easy and those doing it are working earnestly and intelligently against the momentum of how things have always been done. Credit is due for being prepared to work hard for a better way.

I worry though, that focusing on outcomes is at risk of becoming a case of the Emperor’s New Clothes, finding itself beaten back into a preoccupation with changing the score when the real opportunity and need is to change the game.

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How did we do? You can answer this question with the list of metrics that Neil suggests in our earlier blog and his book. As we are looking at Value Based recruitment there is another question – did we live our values in recruitment? What was peoples experience like and how can we improve?

After our recruitment workshop for Coaches and Community Circle Connectors, I asked everyone five questions based on the ‘touch points’ in their experience of recruitment. I did this by email, after they had been told whether they had been successful or not, and since then we have used the same questions as a survey monkey.

For each question, I asked people to give us  a score out of 10 for how well we did (10 was amazing and 1 was very poor) and I asked people to describe what worked well and how we could  improve. This gives us our first base line scores for our recruitment practice, as well as specific ideas about how we can get better. We have introduced some of these ideas already, and they also become the experiements that we test with out next recruitment.

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