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Laura Proctor's activity

In group: Philosophy and ethics for health care improvement

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  • Laura Proctor posted an update in the group Philosophy and ethics for health care improvement 4 months, 1 week ago

    Hello and happy new year all!

    I have been pondering today the question why can’t humans co-operate on a large scale? On the face of it you might say different beliefs, values, interests, politics which I’d agree with…

    What I’m really interested in is do we all need to co-operate for improvement to happen? What would it take to improve human co-operation in terms of our health service? e.g. frontline, middle managers, senior managers, government working together sharing visions, objectives. Is this a complete illusion? Or can we tap into this?

    Thoughts please 🙂

    • Hi Laura

      Your question is one I have been seeking the answer to for some time and prompted the development of the Jigsaw Lid concept and toolkit, which we have since went on to apply in various situations. Here is a link for more info. https://www.cope-scotland.org/wellbeing-tips/entry/finding-common-priorities-matter (Its a hit and a miss when the links work, if not please paste in your browser) The basic idea is a tool to see others vision and then find areas in common to collaborate on, recognising we will not agree on everything and it may be we work with different groups at different times. For meaningful change to happen it evolves, as opposed to happens overnight, as often change requires a paradigm shift which takes time and the patience and willingness to view things from a different perspective and not only our own. Well that is my view 🙂

      Collaboration and connectedness is something I am keen to explore further with colleagues in 2024 as while we do not all need to agree, we do need to find ways to work together when we do share a common concern/challenge/goal as opposed to working in silos and missing the creativity of thinking which can come when we do work together across non traditional boundaries.

      Keen on hearing others thoughts on this too 🙂

      • This sounds like a very positive venture Hilda! What a great ethos and principle to work by. I love the notion of collaboration and connectedness and I would love to consider ways in which I can encourage this in my work and attitude. Is there a way of accessing the jigsaw lids resource? Should others wish to use it?

        Best wishes, Laura 🙂

    • Hi Laura

      The materials are on our site, we are currently looking to update the site and our downloads and are in the process of doing a podcast about the lids. What may be easier if you want, is to schedule in a catch up online, I can show you how its been used in different circumstances and give you an editable PDF which you can then use in your own work. If you would find that helpful, please send me some dates and times work for you

      its a really simple concept but is so powerful for helping plan actions built on diverse viewpoints, we are happy for others to use it so long as we are credited with the concept.

      Hilda 🙂

      • Good morning Hilda,

        Sounds great, thank you! I have time today, tomorrow or next Monday? Can be pretty flexible at the moment too.

        Bw,

        Laura.

    • Hi Laura

      Do you have time before 11.30am on 9th or before 11.45am on 11th Jan? my direct email is hilda@cope-scotland.org I can send a zoom invite if that works for you, just let me know if any of the times on the 9th or 11th suit you

      Hilda 🙂

    • Employees in many very large International organisations manage to cooperate on a large scale and of course our armed services. I have experience of both particularly on a very fast production line where, for example, a new car comes off the line every minute. In can making, where I also have experience it’s 100 or more times faster. A great deal of cooperation is required throughout the organisations. Also in my experience (I’m old so have lots of experience) we do need to cooperate for improvement to happen. People need to know how work is done, that is all work. How do we achieve that in the NHS?

      • Yes that’s very true Thomas and you are quite right, some large companies do manage to co-operate successfully. Thank you for this reminder! I wonder what we can take from how they do it? Also does the fact they are dealing with inanimate objects make a difference? It shouldn’t should it? Thanks for your thoughts.

      • Talking of inanimate objects have a look at: https://q.health.org.uk/document/nhs-products-chatgpt/
        and I’m not sure that it should make a lot of difference if inanimate or not.

      • I do think dealing with ‘animate subjects’ rather than inanimate objects odes make a difference. First, because the subject has preferences, values, experiences, knowledge and their own goals and interests which will shape how care and healthcare services should be delivered to them (the differences may be more exaggerated in some areas of care like psychotherapy and primary care, and perhaps less in more technical and less patient-facing areas like radiography and pathology services).

        Secondly, subjects are agents, and so they can also push back and refuse or resist certain kinds of treatment. Cooperation is required not only between healthcare professionals/institutions but also *with* patients and healthcare service users in order to provide healthcare services. So this potentially complicates the cooperative picture quite a bit!

    • Love this question Laura! I’ve pondered it myself a lot too. I think a lot of our perceived disagreements and conflicting values/beliefs are exaggerated by a polarised political system. And if we focused more on our actual needs and our dreams for the future we’d find we are more alike than we think. In particular at a local scale, where it can become more practical. I also think we can disagree on things and still successfully co-operate.

      I think we need to come together more to explore/share our needs and dreams for the future. I think tools and practices such as what Hilda suggests are important as they can help us move beyond our disagreements. I think we also need to have more fun and play more and tell new stories.

    • Thanks for this stimulating comment Laura 🙂

      You’re also absolutely right that there are some big obstructions to certain kinds of cooperation–the COP climate summits and their consistently underwhelming negotiations and declarations are a great example, and organisational failures in the NHS and other social institutions can reflect failures of cooperation too. But I do think it’s important to recognise that these take place against a backdrop of lots of very effective cooperation.

      On some ways of looking at it, humans are brilliant at cooperating at a large scale. Think about the cooperation that is needed for trade agreements, time zones, international travel, democratic elections, and so on. The state and public institutions do also use threats of force/punishment and personal incentives and disincentives, but they wouldn’t function without very consistent cooperation, So I think there is reason to be optimistic!

      One thing this got me thinking about, and this ties into Hilda and Maria’s points too, is about how cooperation doesn’t require disagreements to be resolved — often there are good practical compromise solutions which can sit alongside deeper disagreement about what matters and why. A greater appreciation of and understanding of disagreements might in fact be good for cooperation because it can help us make predictions about when and why some solutions might not work in practice even though they seem good on paper.

      One issue is that there can be a tendency to think that everyone needs to share the same vision and work has to be standardised for cooperation to occur. And this can lead to declarations and systems that don’t work very well for many, or any, parties. Another way of thinking about cooperation is that it is a way of securing mutual benefit (win-win outcomes) for different people and organisations despite them having different values and objectives. So cooperation requires people to understand each others differences rather than try to resolve them or get completely aligned.

      • I do not disagree with you but their must be a degree of work standardisation for improvement to be sustainable. It’s the degree of standardisation that is important to ensure that work is not being restrictive. I’m now using the terms NHS Lean and NHS Standard Process To identify how to document ‘work’ to enable improvement and safety assessment and innovation but also not be restrictive. Unfortunately most of my work is unread or ignored. I was told the other day that my views would only be regarded as that of a patient or family member. I’m not so sure about cooperation!

      • Laura Proctor replied a minute ago
        Thanks everyone for your thoughts and responses to this question. I agree co-operation isn’t dependent on agreement, people of different backgrounds, values, beliefs can work very well together. I also think about the early covid pandemic days when NHS teams pulled together even more to co-operate and this was seen across hierarchies. So it is possible, I suppose in a crisis people often don’t have an alternative choice, the urgency of the situation makes it pressing. I also like the point about Hilda’s work the Jigsaw lid approach (from what I know of it) allows different visions to come together to enable co-operation. I would love to know more about this approach (which I will after meeting with Hilda I will). I think there is great merits in considering the purpose and vision behind work, I know NHS Organisations come up with vision statements but these don’t compel me to work differently. Involving people in this process on a local level seems to me the key, but it’s not as simple as it should be…. Humans are motivated by purpose and yet this can easily get lost and it’s something that needs revisiting and refreshing in peoples minds. I agree working with animate objects doesn’t add a greater degree of complexity and consideration. Thanks for listening to my thoughts 🙂

    • Perhaps the desire to cooperate (act together for the good) is never simple to implement and in real-politik standards are minimally-satisfiers for democratically achievable aims. Sometimes experts disagree, but sometimes they would choose policies deemed too expensive.
      ” For surgery alone, there are some 222 different procedures across the 13 major site specific cancers
      that need to be organised and quality assured. Yet patients also need combinations of treatments
      including radiotherapy and systemic therapy in both curative and non-curative settings. These too are
      highly specialised services, with a broad geographic distribution aiming to provide greater accessibility
      on the one hand but to centralise expertise to drive improvements in quality on the other.” [ Proposal to scrap England’s long term plan for cancer; A catastrophic decision that will cost lives; Richard Sullivan, Ajay Aggarwal ] [ BMJ 2023;380:p326 / http://dx.doi.org/10.1136/bmj.p326 / Published: 15 February 2023]

    • * I agree working with animate objects does add a greater degree of complexity and consideration. My original sentence contained a typo as it said doesn’t.

      I wonder if co-operation needs to come at a higher level in terms of values which support specific decisions.