The Risk Decision-Making Coach

2015 has proved to be the year of business investment and change for Practice Based Evidence, with a focus on a US-based online marketing & coaching programme (EPIC from January – June, and Signature Series from June). The messages of 'Positive Risk-Taking' and a Strengths Approach are in the process of being developed into a webinar and signature programme supported through the purchase of the www.PositiveRiskTaking.com domain as the future home of a membership site.

Keep watching this space, Facebook & LinkedIn ads, as well as clicking on the domain for information on webinar dates. Who knows what the new signature programme could offer you… I will be offering business leaders and senior managers the opportunity to access a simple 5-step method to dissolving those fears associated with high-risk decisions. Get on board in order to change your relationship to risk forever!

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).

Practice Based Evidence for Risk

Surrey and Borders Partnership NHS Foundation Trust recently engaged the Practice Based Evidence consultancy to undertake an organisation-wide programme of Working with Risk training. By identifying a large cohort of senior clinical staff in ‘Leadership’ roles the Trust is establishing a positive commitment to working as constructively as possible within all teams. My role was to devise a training workshop that would reflect the principles and practice issues identified in the initial Leadership workshops. In addition to adopting their locally agreed set of principles and edited filming of Leadership discussions, I used my own materials on ‘Positive Risk-Taking’ and ‘Risk Decision-Making’ to facilitate reflective practice discussions as a main focus of the workshops. With the help of colleagues in ARW Training the cumulative evaluations across 50+ workshops were overwhelmingly positive. See the following two summaries for the numerical ratings of the workshops (the narrative comments cover too many pages to include, but broadly reflect the ratings).

Cumulative summary of workshop responses

Cumulative responses of additional workshops

The summaries represent 1252 and 72 responses respectively. The main lessons to be learned are that practitioners respond best to relevant and practical content that enables them to reflect on and develop their practice. Successful training workshops start with close attention to design and detail.

Real Practice Based Evidence in action

Other posts in this section have outlined my thoughts about what practice based evidence is all about, but here are some of the links to other parts of the site where real practice based evidence has been recorded.

Type of evidence	Link
CMHT practice development feedback	'Take a Picture of This'
Developing assertive outreach teams	‘Strengths Assertive Outreach: A Review of Seven Practice Development Programmes’
Developing practitioners awareness of carers	‘Warwickshire County Council initiative ‘Summary of participant evaluations’
Implementing positive risk-taking in practice	‘Cumbria County Council initiative ‘Cumulative workshop evaluations’
Implementing the DH Principles of Best Practice (Working with Risk)	‘Anonymised Trust cumulative team evaluations‘