Analogue man goes digital

On 22^nd April 2014 ‘The Strengths Revolution’ podcast show launched… without any fanfares, major venues, or even a fireworks display. It is just great content brought to you for free from Practice Based Evidence productions, in association with Inspired Marketing productions, Libsyn Hosting, and to be found in the podcast section of the iTunes Store.

The intention is to offer approximately 15-minute weekly episodes (recognizing that your time is precious), usually on a Thursday (to coincide with that brighter end-of-week feeling), on all subjects ‘Strengths’ related, and reflecting much of the type of content you will find on this site.

So, what are you waiting for? Head over to the iTunes Store now, click the podcast section, search for ‘The Strengths Revolution’, and enjoy. Then, please do me a favour by subscribing, downloading, and even reviewing particular shows. It will cost you very little time, and nothing financially! If you are a glass-half-full can-do sort of person, what could be better?

10th Birthday!

This website 'practicebasedevidence.com' reaches its 10^th birthday on 5^th February 2014, and in celebration I hand the main message over to a colleague from a blogging course in London last year, Peter Galvin (with his permission to use his thoughts). Peter is a recently retired Educational Psychologist, and his blog 'The Summerhouse Years' is an entertaining reflection on the first year of retirement. However, he does occasionally reflect back on his work, and a recent post of his pretty much sums up the philosophy of many messages here in Practice Based Evidence. I couldn’t put it better, so it’s over to Peter, where he uses the ADHD label to discuss the issues raised by the links between labels, drugs and profits in mental health… you can access the post on his blog at http://thesummerhouseyears.com/mental-health-adhd/

A 10^th anniversary is as good a time as any to reflect on the messages that Practice Based Evidence was established to promote, and in particular the way those messages are communicated. This site has changed from a traditional website to more of a blog in structure during its 10 years, and many people connect with messages through different media, so keep an eye on this space for further evolution as Practice Based Evidence moves into its second decade.

Best wishes to all who land on this site and find something that educates or entertains,

Steve Morgan.

Values-Based Practice

In 2013 Oxleas NHS Foundation Trust commissioned a piece of work from Practice Based Evidence and the Mental Health Foundation to explore ways in which ‘values-based practice’ can be practiced and evidenced more in the day-to-day work with service users and carers within the Adult Mental Health Directorate. So far, the programme has engaged with six pilot teams and produced a set of draft guidelines. In 2014 the programme will seek to explore innovative ways of implementing the ideas, and spreading ideas to staff in other directorates. Any page references will be referring to the draft guidelines document produced for the Trust, and as such will not be available in full here.

Why focus on Values-Based Practice?

They influence everything we think, decide and do in day-to-day practice, though often in a more sub-conscious way rather than overt statements and discussions. Good practice is not about adhering to one set of right values, we should respect and embrace values diversity. Values can be very personal, professional or organisational statements, but the focus here is on the values that underpin the day-to-day language of focusing on the needs and priorities of the individual service user. Practitioners need to be supported to be able to work where values of the service user, organisation, or professional may differ or conflict, See p.3 for a guide to the process of good values-based practice. A recent high profile report highlights the need to put this approach to values-based practice into context:

Francis Report into Stafford Hospital “People must always come before numbers. Individual patients and their treatment are what really matters. Statistics, benchmarks and action plans are tools not ends in themselves. They should not come before patients and their experiences. This is what must be remembered by all those who design and implement policy for the NHS.” Excerpt from press release statement by Robert Francis QC in Stafford (5/2/13)

Click here for the introduction to the guidelines document.

Click here for the report to Trust Managers.

Targeted training

In health and social care services we have a long tradition of adopting a scatter-gun approach to staff training. Perhaps this is why staff members often feel negative about mandatory training initiatives, or feel that provision is often made as a knee-jerk response to something going wrong. More generous feedback emerges from events that individual's have personally chosen to attend, but these often have little positive ripple effect out into the team they are part of... if you weren't there you simply aren't going to know much about it.

The Practice Based Evidence initiative has long tried to establish a strengths approach to training, as well as to working with service users. The essence is to get all team members to provide a baseline evaluation of the good and not so good practice in their team, against a series of positive statements of best practice that should be relevant to the way they work. Hence, several Practice Based Evidence tools were devised to address different types of teams and different person-centred approaches to working.

In the case of one of the Newham Community Mental Health Teams in 2006 an honest anonymised evaluation of team practice helped to identify the priorities for a subsequent 5-day programme tailored to their needs. This example illustrates how a practice development approach to training initiatives can respond to the needs identified by practitioners themselves, impact on the practice of a whole team, and engage people more in the process of change. This is how a strengths approach can apply as much to team development as it should do for working with service users. See also Take a picture of this for a larger initiative following a similar approach but capturing the evidence of positive change.

Playing with numbers

I am often mindful of the need to criticize the quality of leadership and management in health and social care services; particularly the obsession with numbers, the tick-box mentality, and the blind faith placed in targets for driving change and daily practice across services. I am surely not a lone voice in this critique, but is it valid or just a reaction against the sound of the pips squeaking?

I do believe that an absence of targets or defined outcomes, and a failure to establish high standards for provision of services only leads to inconsistencies between practitioners and teams… what is often referred to as a postcode lottery. Service users don’t deserve to be on the receiving end of either stressed out practitioners fearful of constant criticism, or laid-back practitioners doing their own thing. Audit and regulation have a place, but surely they need to be clearly joined up to practice, not existing in a vacuum somewhat disconnected from the realities within which good practice has to operate.

The ever-growing chasm between person-centred practice and business-focused managerialism does little to promote a culture of organizational collaboration that may encourage a more engaging form of audit and regulation across services. My solution would be to eliminate most of the current audit requirements imposed on practitioners and teams, particularly that which they experience as wholly time-consuming and unhelpful. So far so good, say the practitioners amongst you; please do share your thoughts, but read on before you do…

Over the last 12 years, through the Practice Based Evidence initiative, I have been developing tools designed specifically for use by practitioners and teams. These tools have flexible uses: personal reflection, individual supervision, team development and team evaluation. Used diligently they should be able to provide a host of qualitative and quantitative data, which in turn should offer useful feedback to practitioners and teams for practice development purposes. The Risk Decision-Making publication includes examples of these tools, and a specific example of data emerging from their use in a specific organization to help identify good practice and priorities for further development.

So, the sting in this tail is that practitioners and teams need to own the processes of audit and regulation if they are to reflect and develop good practice. For those auditors and managers fearful of losing their jobs if Practice Based Evidence emerged as the norm, you could always make use of the data to tick your boxes; better still, you could prioritise your time more effectively by getting in and alongside practitioners and teams to support a quality revolution. You might then be in a stronger position to challenge and inform the thinking of the inter-galactic warlords from distant planets a.k.a. commissioners, Department of Health, Care Quality Commission…

These are just a few thoughts I am passing on as I reflect on years of connections with so many people who are desperately trying to do good work despite rather than because of their masters. Do feel free to offer your thoughts and ideas (with an accompanying dictionary from those of you who find ordinary language an alien concept… with all due respect to the demands of the Plain Language Association).