The view from here: analysis

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Analysis

We were delighted with the wealth of data received from those participating in the project. This, however, made knowing where to start with analysis a little tricky!

After much deliberation, we decided to start our analysis with the ‘reflection points’ (at the end of the recording week, we had asked participants to add a colour coded sticker next to text or diagrams that reflected: one thing they were proud of, one thing that stood out for them (good or bad), one thing they wished they could change and one thing that they wanted to tell their manager). It seemed apt to start with these reflections as these were the points that the participants themselves had identified as being most important after reflecting on their week.

In order to analyse this data, we firstly transcribed each of the indicated quotations and then pulled out relevant themes. We then checked the internal validity of these themes by having another team member sense-check them according to their interpretation. We were then able to discuss any differences of opinion as well as settling on the best ā€˜termā€™ for the themes that we thought were emerging. This analysis was then used as a frame for a sense-checking event we ran directly with participating practitioners (checking external validity) on 11th March.

Sense checking event

Everyone who had taken part in the project was invited to come along to a session to help us make sense of the data received. Those who had participated in the work came from far and wide across Scotland, and so we were pleased that approximately a quarter of participants were able to come along on the day. We encouraged participants to bring any curious managers along with them on the day, although only a few took up this option.

The aims of the day were to:

  • give an overview of the early findings from the project
  • provide the opportunity to talk and share with others who participated in the project
  • get to know each other better
  • work together to sense-check the findings so far
  • generate ideas about what to do with the data
  • generate ideas about what to do next

After giving a broad overview and introduction to the day, we got straight into understanding the themes from the data.

In order to facilitate discussion around this, for each ā€˜reflection pointā€™ we pulled out quotes relating to each of the pre-identified themes and had them available for participants to read and interpret. We discussed these quotes as a group and finally asked participants to:

  1. choose the quote that resonated most with their experience
  2. to write a note about why this was the case
  3. rate on a scale from ā€˜way offā€™ to ā€˜spot onā€™ how much the data resounded with their overall experience of delivering care and support.

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An overview of the conversations that emerged is outlined below.

One thing that you are proud of

Our analysis:

Overwhelmingly we felt that that the data indicated that key pride-inducing moments were centred around working with the people they support and seeing improvement or building relationships.Ā  We broke this down into two key areas (1) seeing service user progression/ surpassing expectations and (2) building relationships (this involved elements such as building trust and open dialogue).

Although it was clear that many practitioners were trying to do their best to support people, and that many were moving towards outcomes, there definitely still seemed to be a focus on tasks (things that practitioners do) and activities (things that people who are supported do), rather than outcomes.Ā  We were interested to tease this out at the event to see if practitioners made the same distinction.

At the event:

All in all, as you might imagine, people really enjoyed talking about this subject!Ā  However, it was continually repeated that practitioners felt like they had to rely on personal pride to know that they are doing a good job. There was discussion that praise is often focused on tasks achieved/ undertaken rather than being focused on relationship building.

Themes that emerged and that corroborated our initial analysis included:

  • Importance of rapport

The issue of building strong relationships was most frequently shared. There was a general consensus that it takes to establish a trusting relationship with a person. Practitioners felt there was a direct relationship between developing a strong rapport with a person and that person’s general well-being, progress and quality of life.

  • ‘Being’ and ‘doing’

In terms of the distinction we’d made in our analysis around ‘outcomes’ and ‘activities’ practitioners at the event highlighted that often there was a disconnect between the outcomes that had been set and the activities that they undertook with the person (this was particularly true for the administration of medication). They felt that this might be due to the fact that often the outcomes are set were negotiated by people other than those who deliver the care.

Practitioners also interpreted the difference between ‘outcomes’ and ‘activities’ differently from us. Instead, they referred to the difference between ‘being’ and ‘doing’ and stated that often they were praised by managers for the activities and concrete actions that they did with people – rather than the simply ‘being’ and establishing connections with people. There was consensus by the group that the ‘being with’ (acting like family member / developing trust / establishing rapport) is harder to achieve, but it is the underpinning work that enables outcomes to be reached.

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One thing you wish you could change

Our analysis:

We felt that there were three key strands emerging from the data on this topic, these included: (1) the emotional impact of the job, (2) concern for circumstances of people supported by services and (3) practical things that would make the job better.

At the event:

Helpfully, the conversation relating to this topic validated the themes we’d initially identified, with some additions and links we possibly hadnā€™t made. The main discussions always came back to emotional impact of the job, and the group in general used emotive language.

  • Emotional impact of the job

This was the strongest theme in this category. Participants added descriptors of emotions including ‘helplessness’, ‘feeling like you could never do enough’ and ‘feeling like you were sinking’. The group always came back to these feelings. They also talked about this being a reflection of caring about people.

  • Concern for circumstances of service users

This was another strong theme. People spoke more widely about policy and changes broader than their organisation and the ways that impacted on their job. This was linked back to emotional impact and feeling personally responsible/guilty. People also talked in the groups about relationships – knowing the person really well and that being an asset, but also a challenge as they maybe werenā€™t heard in their role, or because they had become ā€˜indispensableā€™ (a reliance they werenā€™t comfortable with).

  • Practical things that would make the job easier/better

The group didnā€™t actually speak about terms and conditions (a code that we’d used) – but did discuss working hours a lot. People generally felt ā€˜staffingā€™ was a key issue, more than it appeared in the original data. In fact, they felt that staffing was often the route of other issues – like excessive working hours, excessive paperwork.

Another issue that emerged was the challenging relationship with GPs and health professionals, who the practitioners at the event felt had different value bases, and didnā€™t listen or respect their views. Issues around collaboration appeared more strongly at the event than in the data.

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One thing you would like to tell your manager

Our analysis:

This data was difficult to synthesise due to the very personal nature of issues that people wanted to address with their managers. It was also clear from the data that people had varied relationships with management. That said, key themes included: (1) the emotional impact of the job (which were almost equally balanced between negative/positive emotions that they wanted to talk about) (2) wider systems issues that need to be addressed (including very small practical changes that need to be addressed) (3) feeling undervalued by colleagues and managers.

At the event:

It was clear that the themes identified in the pre-analysis were relevant to the group with almost all practitioners thinking that they were ‘spot on’. It was clear from the discussion that the relationship the practitioners have with their managers is one of the defining features of whether or not they are happy in their work. These practitioners thought that the theme that came out most strongly was that of ‘value’ and ‘communication’.

  • Value/ communication

Practitioners felt that ‘not feeling listened to’ or ‘valued’ was a theme that seemed to cross-cut many of the quotes that were provided. In three of the four discussions, practitioners highlighted an awareness of how hard everyone in the sector works, but they felt that managers seemed to forget what it is like to be on the frontline and the type of pressure this work provokes.

Similarly, those who were in attendance frequently sited the disconnect between the pay and conditions that they are offered and how valued they feel. There was an articulated gap between what it is expected that frontline staff will deliver and how they are recompensed for this work. It was felt that frontline workers in social care are generally lower paid than those in other sectors, with terms and conditions that are rarely as good.

  • Sector challenges

More than any other ‘station’ the wider issues affecting health and social care were highlighted here through discussion. Many of the practitioners picked on a particular theme around the sector needing an ‘overhaul’ and highlighting that issues such as funding ( a ‘race to the bottom’) and capacity being at the root of many of the issues that staff present to managers. Again communication was clearly an issue here with the majority of practitioners stating that a lack of communication and honesty around cuts, changes to services, policies make it particularly difficult for them to support people to deliver outcomes. There was the feeling that as there is so much change in the sector it could often be difficult to be clear and consistent with people who are supported.

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One thing that stood out the most for you

Our analysis:

Positive reflections

The majority of reflections centred around having quality time with people supported by services and working with them to work towards outcomes. Respondents noted how rewarding this particular element of their work is. Another key positive reflection coming through strongly was the personal achievements of practitioners ā€“ this could be anything from seeing progress, to setting up a new service to supporting colleagues well.

Negative reflections

The majority of negative reflections centred around worry or concern for service users. Key to note here that there were quite a few participants (9) who highlighted serious incidents that had happened during the week (such as death or illness). Another significant negative reflection was the amount of paperwork that has to be completed. This seemed to stand out particularly for participants.

Overall, we felt that there was another common theme which focused on ‘attachment’ and ‘professional and personal boundaries’. The data showed many instances of practitioners becoming connected to the people they support, not wanting to ‘hand a case over’, and forming friendships. This, to us, was interpreted as being about how personally invested practitioners were in people’s lives.

At the event:

The most frequently selected quote and recurring theme was that of relationships. Most people felt that they have a relationship with the people they support but that it is one-sided. It was clear that everyone really cared about the people they supported, however, many talked about how they often feel like a ā€˜fraudā€™ who pretends to be someoneā€™s friend but doesnā€™t share the connection. The need for professional boundaries wasnā€™t discussed, the focus was instead on how it feels to act like someoneā€™s friend but then tell them you arenā€™t their friend when they cross an invisible boundary. The frustration and emotion around this was clear in the groups.

Most people said that they had experienced death in their role. There was a general feeling that there is little time to be person-centred at the end of someones life, due to the fact that practitioners often had to juggle the person’s emotions, the families’ emotions as well as their own emotions. Practitioners often felt that although necessarily their own emotions often came last, that this could be hard to deal with particularly when they have a deep connection with the people they care for.

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The Process

As well as supporting us to make sense of the data, the event was used as an opportunity to check-out how practitioners had felt about taking part in the project, so that we could better understand its impact on them. Overwhelmingly, practitioners felt that it had been a useful exercise to support them to reflect on their work and although most people generally found it hard to fit doing this work into their day, they did so because they were motivated to share their voice/views.

Here are some of the thoughts from those who attended:

Reflecting on self: “You forget about yourself in this job, this project provided me with time to reflect about myself”, “Feedback about your work stops after your probationary period, you donā€™t get a chance to reflect on your work anymore. This project gave me the chance to do this again.”

Reflecting on the amount and type of work that they do: “my god, what do I do in a day”, “itā€™s full on”, “difficult to get a break”, “great job, the day goes so quick”

Reflecting on what they value: “Made me appreciate, I like my job and I have autonomy and a passion for it”, “Highlighted my time management: where I am wasting timeā€™ and ā€˜how much I travel compared to face to face time”

Overall, the majority of people said that their experience of this project was cathartic. In terms of the impact of the project on personal practice, practitioners were generally positive. The majority felt that this should be the sort of reflective process that all practitioners should undertake – two people said they were continuing to use a diary to reflect on their practice – one person said that the prompt cards had prompted reflection on their career trajectory (something they hadn’t thought of before), many others said that they’d generally learned a lot about themselves.

At the sense-making event some practitioners gave us theirĀ reflections on The View from Here project.

Ā What next?

For the last part of the session (before nibbles and networking) we asked practitioners what they’d like to see us do with the wealth of data that we’ve collected and how they’d like the data to be displayed.

There were loads of ideas shared on the day, but a key few were flagged up by the majority:

  1. develop a reflective practice tool
  2. use the data from the diary entries to create something (perhaps a storybook) that tells the tale of frontline practice – (audience: other frontline practitioners)
  3. create a report with infographics to highlight the data visually/accessibiliy. This should enable practitioners and managers, and people more broadly, to understand the experiences of those working closest with those supported by services. (audience: national, managers, policy).

We’ll be taking forward these actions in 2015. Keep in touch for progress!

Update October 2015

The View from Here website is now available.

The View from Here – overview of respondents

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About the project

At IRISS, we want to better understand the experiences of staff working closest with people supported by services ā€“ those who are supporting people everyday in their homes, in a homely context or in the community.

This project asked people, over one week, to record their experiences of delivering care and support using qualitative, creative methods (sometimes these methods are called ‘cultural probes‘).

Cultural Probe pack

We chose this method because:

  1. Ā we know that frontline practitioners won’t be at a computer all of the time (and are more likely to be in and out of people’s houses or in the community) so electronic surveys and observation wonā€™t work as well.
  2. Ā we know that frontline practitioners do a lot of travelling from place to place, so talking to them on the phone was likely to be tough.
  3. we wanted to understand experiences, so qualitative methods are better than quantitative
  4. we wanted to take a ā€˜deep diveā€™ into a select number ofĀ  cases, rather than take a broad brush overview of a larger sample
  5. this technique allows people to self-report and allows for an element of creativity not possible in standard surveys or interviews.

Overall, 120 people applied to participate and packs were distributed. We received 74 packs back. Here is an overview of the makeup of the group of people who were involved.

sectorgender

Top 5 jobsclient groups

We were really pleased to have almost equal representation from the private, voluntary and public sector – and the spread of the types of support that these practitioners provide is also quite evenly spaced.

The wealth of rich data we received has been overwhelming. We had no idea that participants would warm so well to their task and be able to provide quite as much detail as they did in their diaries and timesheets – for which we are truly grateful.

The data includes:

  • 9 x 74 pieces of information from ā€˜prompt cardsā€™ – designed to elicit responses on specific topics ranging from ā€˜work/life balanceā€™ to ā€˜Support and Supervisionā€™.
  • 74 diaries – designed to give people the luxury of recording anything that they wished
  • 74 timesheets – hourly data on the types of activities that people undertook each day
  • 74 x 24 photographs (and associated ā€˜tagsā€™ to explain the photographs) designed to encourage people to creatively record the story of their experience
  • 74 x 4 reflection points – in each pack we asked participants to reflect back on their week and to use a sticker to identify: one thing that they were proud of, one thing that stood out for them (good or bad), one thing that they wished they could change, and one thing that they wanted to tell their manager.

We are currently in the early stages of analysis which will involve comparison between responses from each of the sectors, as well as across the different themes that are emerging. After an initial eyeball of the data, weā€™ve been particularly struck by the complexity of the long-term challenges facing frontline practitioners, as well as their knowledge, tenacity and resilience.

At IRISS, we aspire to being as participatory as possible which is why we have chosen to begin analysis with the reflection points submitted by each of the participants themselves. In essence, we felt that this was using their own identification of important factors from their week as a starting point. We worked together with participants to make sense of this data at an event in March – more coming on this very soon.

Update October 2015

The View from Here website is now available.

Let Them Eat Cake

On 16th July 2013 the Guardian raised the important question:

ā€œIs food the future of philanthropy?ā€

This was as part of their report on Free Cakes UK – a service that matches keen amateur bakers with families struggling to provide their child with a birthday cake – delivering its 1,000th cake. Proving that perhaps, in this case anyway, cake is the answer to big questions.


Meanwhile, somewhere else in the world (Glasgow), on the same day, I (Fiona Wood) was starting my journey as a new IRISS employee.

I came to IRISS from a series of academic research posts in collaboration with various Scottish Higher Education Institutes and NHS Boards but I donā€™t have a healthcare background. In fact my background is as an academic researcher specialising in designing programs of activity for childrenā€™s outdoor play and learning.

So whatā€™s it like for an academic/designer suddenly finding they work in the field of social services after years of working in education and health care? Well, let me tell youā€¦.

IRISS is different from any other place Iā€™ve ever worked before. The office is large and open with all staff (including our director) sitting in the same space. At one end there are three sofas used for meetings, chatting, eating, reading and so on.

At the other end there is a bright pink wall with the words ā€œlearning, partnership, creativityā€ embossed in white across it. Below this phrases like ā€œyou are what you shareā€, ā€œan essential aspect of creativity is not being afraid to failā€ and ā€œIf you canā€™t explain it simply, you donā€™t understand it well enoughā€ inspire the organisation.

There is bunting on the ceiling and always a fresh supply of chocolates, biscuits, lots of fruit and, of course, cake!

But, does this style of working work I hear you ask? Well, a colleague, also new to IRISS, summed it up pretty well I think when they said:

ā€œHappier workers are more productive. Get the environment right and everyone functions properly and you produce some nice workā€.

So yes, I think it works.

Now, how does this compare to other organisations Iā€™ve worked for? Well, before IRISS I worked as a researcher in a hospital. There were not open offices, there were not sofas or relaxed spaces for staff to interact with one other and there certainly werenā€™t any pink walls with inspirational quotes. But there was cake.

However, in the hospital the cake wasnā€™t shared across hierarchies because there were doors in the way. The doctors had their cake; the nurses had their cake; the researchers hadā€¦.well we would steal everyone elseā€™s cake. The point is, everyone had a specific role and they stuck to it. They didnā€™t share ideas, they didnā€™t listen to one another, and they didnā€™t know what was going on with each otherā€™s work. Instead, day in, day out, they came in and did their work and didnā€™t stop and think and question one another. This is not co-production.

At IRISS, there is a lot of listening and asking colleagues what they are working on; there is a lot of sharing ideas; and a lot of engaging with one another and openly questioning each other in a friendly way. Each of the staff members have a broad range of skills that they creatively feed into the organisation. This supports the wide variety of projects currently taking place within IRISS, allowing a spectrum of social service issues to be addressed and considered from a wide perspective.

The resulting difference is that in IRISS there is no room for egos or hierarchies.

I am reminded of the striking difference between these two approaches when I attend meetings with external partners. Iā€™ve observed Health and Social Care professionals pointing the finger at one another and complaining about the ā€˜arranged marriageā€™ they are facing at the start of 2014. There is no conversation, no listening, no questioning, no engaging ā€“ instead I see more closed doors, more talking, more blaming.

It is clear more needs to be done to create a happy and collaborative relationship between these groups.

Perhaps they could learn from IRISS.

But what is the solution I hear you ask? Well, itā€™s been 9 weeks so far and Iā€™m not yet sure, but as a starting point I suggest that if we really are going to work together to make a difference for people in Scotland receiving care through Social Services then we have to be willing to listen to one another and actually hear what the other parties are saying.

In short, if youā€™re going to have your cake and eat it, at least share it with your colleagues too [and that includes your external colleagues and those from other sectors].