<\/p>\n
Taking time to have shared conversations about what you want to achieve; resisting the urge to rush to action before\u00a0knowing why, is important. Slowing down to speed up! Maybe it’s also about resisting the urge\u00a0to offer the same well-trodden responses or solutions from a familiar menu without exploring new solutions together. Give yourself time and jack the traditional format of 1.5 hour meetings with agendas and plans set by few and offered for ratification as a supposed inclusive approach. Our days lasted from 10am \u2013 3.30pm, with lunch and plenty of breaks.<\/p>\n
Building trust and relationships takes time, but time well-spent to build a community<\/strong> of learners and do-ers.\u00a0This relates to my thoughts on ‘the importance of beginnings.’ (For the record, ‘trust relates to being able to trust yourself to contribute as well as trusting others. This is\u00a0about confidence and good respectful listening. It’s also trusting that power-sharing is better than not! This is what we hoped to show!<\/p>\n Time and commitment\/readiness to trying out new ways of working is key. It will remain a challenge, however, especially after the end of projects which bring these together.<\/p>\n Thinking about time and timings, we also had to consider WHEN it was going to work to bring people together. There may be tensions between when it is best for practitioners a when it is best for people with lived experience- and how long and how frequently your sessions should happen. It’s best to ASK people and be prepared to adapt this – but you may need to come to the best compromise you can find. Interestingly, some group members were unhappy with being asked to do ‘homework’ in between sessions (individually and with others in the group) while others weren’t. This related to both capacity and ‘boundaries.’ It may be that asking people to volunteer or offer is a better approach?<\/p>\n <\/p>\n At any first meeting, people usually feel a bit apprehensive, shy and we’d like to think hopeful or excited about what they might achieve together. The importance of beginnings should never be underestimated in my view, which is why an ice-breaker is so important. \u00a0It’s a tool to\u00a0build a community of learners and improvers who will start to get to know and trust one\u00a0other. From this we anticipate they will support and help one\u00a0other, helping to break down any ‘them and us’ mentality. Consequently, I would suggest that ice breakers in sessions are\u00a0never skipped due to feeling short of time unless people already know each other well. I believe that ice-breaker activities are vital for creating the conditions for effective co-production and for person-centred practice. At a practical level, it’s also about helping people ‘arrive’ in a session, it can support people to find ways to leave the stress of parking cars or thinking about emails and connect to the moment.<\/p>\n <\/p>\n Your place or mine? It can be tempting to hold meetings at a partner’s workplace. It\u2019s cost-effective, easy to arrange and convenient – especially if it\u2019s your own place. However, a neutral space may be more conducive to sharing and shifting perspectives for mutually beneficial outcomes. This isn\u2019t about one side winning or losing or protecting territory; conversations should be entered into as an opportunity and not a threat. The environment in which these conversations take place, a\u00a0\u2018neutral\u2019 venue, has a part to play in setting the scene. Other important aspects include: good natural light and ventilation, flexible space (including furniture to re-arrange as needed), easy access and good parking or transport links. Phew! So after all of that we needed to ask our partners if they knew of venues which fitted these criteria.<\/p>\n In North Lanarkshire we worked in the GLO Centre<\/a><\/span> and the South Dalziel Studios<\/a><\/span>. We had initially booked the GLO Centre for all of the sessions, however, we had to move on because the space needed to be used for an inquiry.<\/p>\n The space we used at GLO was upstairs and this caused issues for some of the people with lived experience. The stairs were too steep, so the move to South Dalziel proved a positive one in terms of our ability to ensure that people were as physically comfortable as possible.<\/p>\n The room we used later on in the process was also a lot cosier (GLO was very large) and people noted that this helped the group bond.<\/p>\n In North West Glasgow we worked in Partick in the Whiteinch Community Cent<\/a>re. <\/span>The space worked for us, but presented different challenges in that there was less space than we\u2019d have liked. For this reason we hired a \u00a0conference style room and a\u00a0small room for break out sessions or when people needed a break.\u00a0However,\u00a0we tried to cut back on moving around too much, due to the potentially confusing\/distressing nature of \u00a0continued change of location for people who have dementia. People in the\u00a0group also requested\u00a0to not be split up too much as they liked working in a large group.<\/p>\n We had to think carefully about noise levels in\u00a0small spaces as people with dementia can find certain\u00a0noise levels<\/a><\/span>\u00a0distressing, distracting and disorientating. I like to remember that the words noise and annoyance have similar origins! This is pointed out by John Picker in his book \u2018Victorian Soundscapes (2003): \u201c\u2026[noise] annoys because it doesn\u2019t fit: it jars, disrupts, upsets. And it upsets because it can’t be understood\u2026.\u201d One doesn\u2019t need to have dementia to appreciate this point. Therefore we had a number of small group discussions that optimise sharing, reduce noise levels and make best use of the space.<\/p>\n <\/p>\n At IRISS we have a policy about paying people who collaborate with us<\/a><\/span>\u00a0in recognition of their time and contributions. For this reason we paid people with lived experience and who were supporting people with lived experience.\u00a0We pay people \u00a3150 per day, pro rata. As the KiP sessions are not a full day, \u00a0this meant that people were paid \u00a3100 for a 10am-3.30pm session, plus any travel expenses that they had incurred. So, just as professionals are paid for their time, so too in this project, are people with dementia, heart failure and their unpaid carers.<\/p>\n <\/p>\n All participants were provided with information sheets about KiP and the projects’ aims and objectives (KiP: dementia personal information sheet<\/a><\/span> \/ KiP: heart failure personal information sheet<\/a><\/span>). We talked through the information on the sheet before asking people to complete a consent form. \u00a0In cases where people had\u00a0difficulty reading or making sense of the information, we took time to sit down with the individual or couple and go through the form. It was important to ensure that everyone understood what would be involved and was happy about being part of the project.<\/p>\n All participants were asked to sign a\u00a0consent form<\/a><\/span> stating that they understood their involvement in the project and allowing us to use, including posting online, photographs and video we may take during the project.<\/p>\n Traditional project management approaches often START with an end output or product, and works back from this to devise an action plan. This does not happen in co-production. Co-production gives the group members or partners the power to drive forward and agree what improvements or initiatives will happen AFTER conversations have happened. This means individual group members (and facilitators) can’t predict WHAT outputs and impacts they wish to achieve as a priority at the outset. It might not be the ideas that individual group members came into the project with.<\/p>\n This level of uncertainty can make some people very uncomfortable and wonder what they are going to get out if it? They need to hang on in there and not push people to action too soon. I guess the challenge is trying to keep people motivated through this uncertainty and when they are still forming as a group. It’s helping them trust the process and judging when, as a facilitator, you need to move the group beyond from sharing experiences and perspectives to implications for services, supports and action.<\/p>\n The project is as much about developing peoples’ capacities – and giving them the opportunity to try out new ways of working- as it is to achieve specific local improvements.<\/p>\n <\/p>\n We worked with the organisation\/s who had applied to be part of KiP to identify and recruit should join the group. We purposefully tried to balance the number of people with lived experience and professionals in the group. This was to help balance the power. We also wanted people at different job levels, including those in key roles who could help make things happen or make connections to others who could. If you read the Evaluation Report<\/a>\u00a0(3.2.5) you’ll see the difficulties we ran into with the heart failure group. We were unable to recruit a GP, largely to do with the fact that their time would need to be back filled. We therefore had to find ways to go to them which was not as effective. Certainly it slowed down progress and didn’t involve them as equal partners.<\/p>\n While co-production encourages everyone to show leadership in terms of making contributions and sharing their assets, it’s also good to have people up for taking the lead on certain things to galvanise a group. We need both leaders and followers and individuals might be both at different times.<\/p>\n <\/p>\n We tried really hard to avoid jargon throughout the project as best we could. We had ‘red cards’ for these (although seldom used) and a ‘parking lot’ to highlight any words we felt were problematic and ‘didn’t like.’ This included co-production, person-centred care and positive risk taking! We also asked our groups what kind of communication they preferred between sessions – for some it was email; others letters, postcards and phone calls.<\/p>\n There were added complexities around communication, however.<\/p>\n We build reflection and assessment into each session and did this as a group. Again, on reflection, we may have missed an opportunity to get more individual feedback between sessions to ‘out’ any uncertainty and discomfort on anything, especially in the initial sessions before people felt more purposeful.<\/p>\n <\/p>\n We began by wondering if improvement methodology was the \u2018best fit\u2019 for this project in the context of person-centred care and co-production?<\/p>\n It seemed that the focus of improvement methodology in health service has been on the point of care eg when a patient and health professional meet\/interact and on \u2018quick wins\u2019 that the practitioner can deliver \u2018tomorrow\u2019 (or next day or day after). It fits within dialogues about \u2018leadership at ever level\u2019 \u2013 so what you can do (not what you can\u2019t) and practitioners, wherever they are in the system, identifying improvements ad taking the initiative on this.<\/p>\n In this scenario, tests of change are easy\/easier for practitioners to trial with one person, and repeat the next and next again day with different patients say. You can do 5 tests in a week! \u00a0Most emphasis (as highlighted at the National Learning events) has been on changes to the behaviour of practitioners \u2013 something as simple as introducing yourself by name, sitting alongside or asking key questions about what matters to someone as part of a reliable procedure.<\/p>\n The other thing that\u2019s been emphasised is patient experience feedback and\/or big data\/real-time feedback with systems to support this to drive improvement and change forward. But again, this seems to be about measuring something at a point in time, a snapshot.<\/p>\n Applying this to more collective responses\/ peer-supported action to providing person-centred care such as setting up carers groups or peer support groups needs a slightly different approach. An appreciation of the following through our experiences of Keeping it Personal might help:<\/p>\n These reflections are really about how the improvement model works with our ambitions and philosophy of working in Keeping it Personal. Other co-production projects, may well bring other perspectives?<\/p>\n See others thoughts about this here.<\/a><\/p>\n","protected":false},"excerpt":{"rendered":" Kerry (Project Lead) reflects here about issues in the design of KiP. Time and trust Taking time to have shared conversations about what you want to achieve; resisting the urge to rush to action before\u00a0knowing why, is important. Slowing down to speed up! Maybe it’s also about resisting the urge\u00a0to offer the same well-trodden… Read More »Reflections on project design<\/span><\/a><\/p>\n","protected":false},"author":19,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"open","ping_status":"closed","template":"","meta":{"_coblocks_attr":"","_coblocks_dimensions":"","_coblocks_responsive_height":"","_coblocks_accordion_ie_support":"","neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"","neve_meta_content_width":0,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":""},"_links":{"self":[{"href":"https:\/\/blogs.iriss.org.uk\/keepingitpersonal\/wp-json\/wp\/v2\/pages\/620"}],"collection":[{"href":"https:\/\/blogs.iriss.org.uk\/keepingitpersonal\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/blogs.iriss.org.uk\/keepingitpersonal\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.iriss.org.uk\/keepingitpersonal\/wp-json\/wp\/v2\/users\/19"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.iriss.org.uk\/keepingitpersonal\/wp-json\/wp\/v2\/comments?post=620"}],"version-history":[{"count":0,"href":"https:\/\/blogs.iriss.org.uk\/keepingitpersonal\/wp-json\/wp\/v2\/pages\/620\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.iriss.org.uk\/keepingitpersonal\/wp-json\/wp\/v2\/media?parent=620"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
\nThe importance of beginnings<\/h2>\n
\nNeutral space<\/h2>\n
North Lanarkshire<\/h3>\n
North West Glasgow<\/h3>\n
\nPaying participants, recognising contribution
\n<\/strong><\/h2>\n
\nGaining informed consent<\/h2>\n
\nLetting things happen…<\/h2>\n
\nWHO to involve?<\/h2>\n
\nCommunication<\/h2>\n
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\nImprovement methodology and co-production?<\/h2>\n
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