Skip to content

Q logo

What is the challenge your project is going to address and how does it connect to your chosen theme?

 

Q: “What matters to you?”

A: “Authentic, helpful relationships with service users.”

I get a similar answer from most colleagues during this conversation, based on the Institute for Healthcare Improvement’s “Joy at Work” paper. Authenticity is a key component of therapeutic relationships so it works both ways.  It’s this seeing of one another that can help health professionals and patients to learn from each other and overcome challenges.

Yet we rarely get to focus on relationships in our busy, task driven working days. This disparity can lead to lack of fulfilment and burnout (School for Change Agents). NHS staff sickness is 27% higher than other public sector organisations, so a focus on staff wellbeing has potential for significant gains and better care. (Nuffield Trust)

With the development of integrated care systems locally, staff can suffer ‘change fatigue’. This programme is seeking to harness the power of hopeful relationships to create an opportunity to work across barriers.

What does your project aim to achieve?

 

To reconnect with who we are and why we choose to do the work we do. To explore and test the conditions for an effective sharing of our humanness. It’s this seeing of one another as people that can help health professionals and service users to learn from each other and overcome challenges.

We will design a wellbeing collaborative to improve the quality of our relationships with a) colleagues and b) service users, considering the similarities and differences between the two. Those involved will create or choose a verified quality of relationships measure.

To reduce the financial loss associated with absence and poor staff retention.

Collaborative format:

– Getting clear picture from stakeholders on what creates healthy relationships
– A theatre workshop: what is authenticity?
– Ongoing workshops to explore the themes raised to create a dramatic piece to provoke discussion and action
– Harness the interest to develop QI projects that test these changes

How will the project be delivered?

 

Improved staff wellbeing calls for a collaborative between our colleagues in education, the emergency services, commissioning, health and social care. Camden and Islington’s Community Division Director will invite the Integrated Care System working group so we can shape future care based on authentic relationships.

Peer coaches are the experts in sharing personal history to help others, so they will be a vital partner. Cerdic Hall, Nurse Consultant, co-produced Islington’s peer coaching programme and will bring his experience of developing community-wide improvement.

We have invited an expert in the Theory of Change to join us for learning sessions on how to facilitate a workshop. (Weiss, 1950) This will be based on the IHI’s Joy at Work framework.

The theatre work will be facilitated by Playing ON, who have experience in using theatre to practice conversations without the risks associated with clinical practice.

 

What and how is your project going to share learning throughout?

 

By using theatre, this collaborative will encourage people to be creative with their ideas about improving our joy at work. Attendees will take ideas back to their workplaces in local authorities, schools and hospitals for testing. For those who can’t attend, there will be opportunities to contribute ideas for improvement online.

Hexitime members will be invited to attend the learning sessions for Theory of Change facilitation. This is a method that could be used to design improvements far beyond this collaborative.

We will share the impact of everyone’s change ideas as they are tested throughout the collaborative. The process and outcomes will be evaluated and published for Q members and the wider community to discuss. We hope this could be used during the development of Integrated Care Systems across the country.

We have connected with the team proposing Q Exchange joy at work in North Cumbria and will each invite the other to attend their program to share learning across the country.

How you can contribute

  • What makes for a good quality relationship for you with a colleague or service user?
  • How do you bring your authentic self to work and everyday actions?
  • Please help us to refine our idea
  • Shared knowledge on the Theory of Change
  • Join us for the Theory of Change learning sessions
  • Join the Theory of Change and/or the whole collaborative. Bring your personal skills, whether that may be a hidden talent for singing or the secret of how to grow strawberries
  • Please share our idea with others who may be interested in taking part
  • Help us to evaluate the collaborative
  • Let us know if you might be interested in replicating the collaborative in the future
  • Watch the video below to hear more about the expertise of our peer coaches.
  • Thank you for all of your input! We will continue to share ideas and opportunities with Helen Smith's team in the South West.

Plan timeline

15 Jan 2020 Theory of Change Workshop Getting clear picture from stakeho
4 Feb 2020 One day theatre workshop
18 Feb 2020 Testing changes and improving relationships using theatre
18 May 2020 Testing and improving relationships in clinical practice

Comments

  1. There are a lot of great comments and ,it's inspiring to see how this platform is helping to evolve the idea further. I think in terms of a Comms strategy that Laura mentioned earlier we should research some other national joy at work programs too and see what they did? Dubai have a minister for Happiness from which they launched a number of Happiness and Positivity programs which would be interesting to look at.

    Also love the idea of a tribe of us boat rocking with vulnerabilities and open conversations about our own experiences (reminds me of that Friends episode with the blue blazers and white coats).

    1. Here's the episode

      The whole domain of happiness/joy at work is so massive and exciting.  I'm really excited to think that this could be an area where we can learn directly from people who have overcome mental health issues to foster joy and contentment.  I also wonder about informal carers and how they occupy a grey ground that is both professional and intimately connected to family members.

  2. HI Nicola

    A great idea and wonderful to see the arts being used to positively support patients and staff in this way. I think the conversations that you will generate could really help people in wider sense that just the work space and so you may wish to think about relationship as a whole and not just center on the work place. I would point you toward some great work on civitlity in the NHS have a look at this Ted-Ex and see if you could add this aspect to your work.

    https://www.ted.com/talks/chris_turner_when_rudeness_in_teams_turns_deadly

    Good luck with it all, Jono

  3. Hi Nicola,

     

    Reading these comments is making me aware that we need to think about how to engage the wider audience so that we can get as many staff and service users involved from all sectors including social services, NHS, charities etc. I wonder what our branding should be and our comms strategy?

    I know that when we first describe this idea staff can often feel threatened by the idea of opening up about their vulnerabilities. So how can we manage this to get as many people involved as possible?

     

     

    1. I was thinking too that the beauty of using drama approaches is that there is room for polarised perspectives (certainly its in the air in so much of the political discourse these days) and that the methods themselves encourage taking other perspective and challenging your own.  Having a theatrical piece as an outcome that can challenge, encourage, question the whole area of sharing of your vulnerabilities within a professional context may drive QI processes going forward.....  another play by Playing on Theatre called 'Hearing Things' explores the dilemmas in psychiatry and has been performed in many places including the Wellcome Trust and speaks to a larger audience.

    2. Hi Laura,

      Good thinking; shall we use our Theory of Change run through on 4th August to start planning communications? There are joy collaborative proposals from North Cumbria and the South West, so if we come together I think we can offer something nationwide.

      I previously removed the mention of professionals sharing their vulnerabilities because it seems to split us into two camps: “for” and “against”. But our peer coaches constantly remind us that sharing life experience is what makes their involvement so effective. Since posting this idea, I have met so many of people in the “for it” camp that I think we should do what the School for Change teaches us – find your tribe and rock the boat! We don’t need everyone on board to try it out!

      Let’s discuss at Monday’s meeting 😊

  4. We had a service user conference last week and presented some of the thinking and underpinnings of this programme.  Whether or not to share your vulnerabilities whilst in a professional role is a great talking point (with lots of differing views) and provides encouragement that a theatre methods exploration of the topic will help those involved streeeetch  our thinking and experiences in the service of good care and a joyful working life.

  5. Hi Nicola

    I have been doing some great learning with the Billions institute and wondered if some of this might help your thinking.

    Are you looking at how people bring their authentic selves to work and use this in their everyday actions. getting people to reconnect with who they are and why they choose to do the work they do.

    But love your idea....I am looking to do something similar in the south west so would value your feedback into this!

    Kind regards

    1. Yes, Helen, that is exactly what we are thinking – you put it so well I’ve just added it to our idea!

      Team, have a look at Helen’s Q Exchange idea – another joy collaborative! https://q.health.org.uk/idea/2019/create-conditions-for-staff-to-thriveculturecompassion-joy-at-work/  Helen is this the idea you’re referring to or are you planning something separately about sharing our authentic selves?

      We have taken slightly different approaches with our two ideas; do you think we could merge them? I’ve suggested the same to a team in North Cumbria: https://q.health.org.uk/idea/2019/increasing-joy-in-work/

      07990 755753

    2. Helen, hi, I'm working with Nicola on this programme.  The Billion's Institute looks fascinating when thinking of large scale change (did you do a course of type with them?).  Certainly there is a resonance with our framework and the 'going deep' they mention.  Feels like mental health services really need the unleashing of the transformative potential of coproduction and lived experience in the professional domain (rather than bolting on peer working and the like as task driven only).  I'd love to know more about the context of what you are planning in the SW.  I wonder if there is scope to be thinking about our drama piece (that gets created and performed as part of the programme) being performed in your area to further interest your participants? Interesting that there are several of us approaching this general area and wonder about finding ways to work in support of each other.  Perhaps the Joy in Work SIG?

  6. It looks like you should check out this one from the Joy in Work SIG, and discuss how you can work together - I've met most of you and you're all fantastic so I think between us we can make something special!

    https://q.health.org.uk/idea/2019/increasing-joy-in-work/

    1. Wow it sounds like they want to do something very similar indeed - well spotted John, thanks! We are in touch with Julia now so let’s see what we can do together.

    2. Thanks for the tip....have started to check it out....

  7. I really like the sentiment behind this and would like to help you make it work. We can mobilise Hexitime.com to support this for you and bring in additional resource/participation.

  8. Great idea and worthy of further exploration as even directing staff to discover what brings them joy at work generates more joyfulness. It is also timely as NHS Staff sickness in the context of the workforce crisis is a problem with urgent need for solutions.

    It is nice that you've included Hexitime, as my experience with developing the platform has been that bringing people together to do meaningful activities has been motivating for both donors and recipients.

    With regards to refining your project, your stated Primary Aim is not actually an aim, but a measure of success. I also suspect the "Have you had a good day?" measure will not be sensitive enough to pick up the consequence of your interventions as there are so many other factors that will affect the result. Perhaps pick up and adapt one of the many validated culture questionnaires.

    I would also suggest delineating in your planning between relationships with colleagues and with service users as I think they are different drivers of intrinsic motivation. One is about membership and sense of team, the second derives meaning or purpose from activities.

    1. Your ideas have helped us to clarify what is most important and unique about this idea. Having refined it, we will make time to explore and test the similarities and differences in relationships with the people who use our services and with colleagues.

      Perhaps our aim is the comment Cerdic made below, “To explore and test the conditions for an effective sharing of our humanness.”

      Cerdic for now I have avoided “creating a culture of exploration” because colleagues have said they do not feel safe exploring this in clinical practice. I hope the collaborative will provide an opportunity for people to try something new using theatre as a safe space.

      I took the question, “How was your day” from some brilliantly successful projects running in our IAPT services. It works for them but perhaps we should instead use (or simplify) one of the validated questionnaires for quality of relationships. Does this mean we should really change the name of our idea?

    2. Hi Hesham, really appreciative of your comments.  The process that we are shaping involves building a clear idea of what type of relationships in the health setting facilitate joy and satisfaction at work (using Theory of Change which also will help identify levers to change, assumptions, outcomes and hence measures).  The drama methods will then help us dive deeper into key areas of challenge and opportunity and with the creation of a performance piece, get people talking about and generating their own change ideas.

      Around the primary aim, it does feel like this needs further consideration....one aspect I've been chewing on is the notion of whether joy is a worthy goal for this.  I'm conscious that on some clinically based days, I come away feeling distressed by the exposure to the lives of my clients ...so not feeling joy as its often considered... but on another level feeling deeply satisfied that I can bear witness, offer help, kindness and some assistance on their journey (and then there are other days!).  I fear that under the health and social care pressures, we get some faux joy enforcement at a front line level whilst societal factors continue to brutalise the populations we often work with.  Is joy the quality to aim for?  Perhaps primary aim is about creating a culture of exploration, interest, testing and expertise about effective relationships at work.

      I'm curious about your note about staff staff relationships and staff client relationships.  I wonder about whether that is an avenue for exploration within the process.  What's different? What's the same?  Coproduction work means my colleagues are also clients of services.  How do we move through different versions of effective relationships?

      Thanks for the stimulating comments.

  9. This looks like a great idea.   I be interested to see how this progresses and whether there is an opportunity to roll-out across other parts of North Central London.

    1. Hi Claire,

      We would welcome partners from across North London right from the start. We have 90 spaces at the initial theatre workshop so do let me know if you know anyone who would like to join us.

  10. HI Nicola

     

    Thanks so much for getting in touch. I think this is a really great idea. I would love to hear more and if possible get involved in this

     

    Amanda

    07597880616

    1. Fantastic Amanda, you are very welcome! I know you have expertise in teaching performance art; would you be interested in being part of the delivery of our drama workshops?

      I will definitely let you know when we have a date for our first Theory of Change workshop.

  11. This sounds really great.  thinking about this in relation to outpatients - do you think this approach results in more productive / beneficial / meaningful outpatient consultations for both patients and staff?    Clearly many benefits for staff as well.

     

     

    1. Hi Robin,

      This came up at our service user conference last week – here’s what Rona from Camden and Islington has to say:

      https://photos.app.goo.gl/fyALUNkUYAoJ5Je78

      “The best "therapy" I ever had was from someone who had gone through what I had gone through about twenty years earier and had that empathy."

      So yes, we THINK this approach can result in more meaningful contacts, but we want to test and measure this in a safe space.

      Thank you for suggesting the collaboration with Jenni in West London – I have suggested this to her so watch this space!

    2. Hi Robin ... Its interesting.... we have noticed in working with Peer Coaches, that rather than feeling depleted by their work, they are energised and honoured by the work.  They come with a high degree of joy and emotional engagement based, at least partly, on  a foundation of having permission to bring their vulnerability and challenges into their work (they use their story as a tool to engage and explore managing health conditions).  I wonder whether, as health professionals, we waste our energy providing a too strong facade of coping/expertise/solution bearing?  If this methodology can help staff to explore and understand the conditions for an effective sharing of our humanness, it could improve how readily we collaborate, how fully we can empathise and hear the client narrative and need, and promote more honest and realistic planning once people leave the room.

  12. i really like this topic and see it working well in the department i work in and in my own team. i did a presentation on the joy in work paper and it got a good response. People said it made them think and start to think about what they enjoy about coming to work as most people in the department do like their job.

    we encourage people to acknowledge emotional pain is as real as physical pain e.g. if your parent has passed away you will need time off work, make sure you are well when you return so you can focus and do your job

    i think about the type of questions and statements that help me and use them with my team e.g. "what do you need from me?"  "how are you doing today?" "tell me more about that"

    we have a team whatsapp group where you can post anything you want to share with the group - having a bad day, got lost going to an appointment, a patient said thank you, want to meet up after work, recently a team member had to go abroad to look after a relative and she updated us by the group and we could send her supportive messages

     

    We are getting lots of feedback that we are an incredibly supportive workplace but we arent sure we are getting the balance right and are we being too supportive and this is becoming a barrier to getting work done?

     

    i have done a lot of work with my team to explain the importance of inter team relationships and have tried to make my team meetings have an element of fun and joy about them

    id love to be in one of your groups

    i have also done a project on the change model, i did it in regards to speech sound therapy,but it is a model i use for all sorts of things

     

    Good luck, i think health care really needs more this type of approach :)

    1. I’m really excited to see how much of the peer coaches approach we can adopt as this work progresses. I hope the collaborative can offer informal social support removed from the immediate work environment.

    2. Really interested to hear about your fabulous work Jenny.  Left me reflecting on the impact on me of working with Peer Coaches (so people with a lived experience of mental health problems who are trained to deliver a supportive coaching experience to people with long term physical and mental health conditions).  They put such a premium on support and go out of their way to check in with each other.  They go over and above in this regard ...  And as the manager, they also call on me to recognise the impact of work and be responsive .... perhaps because their everyday working lives involve using their own recovery as a tool, they are more tuned into fostering wellbeing and avoiding burnout..... that said, I also really get what you are saying about the balance with getting the work done..... interestingly, as their clients know they have long term conditions they are very understanding about when plans change to accommodate difficult days/patches .... I'm hoping we can come up with a process that can help us strike a good balance more often.

    3. Hi Jenny,

      Yours sounds like a lovely team to work in, and it's an interesting point you make about how much work time should be spent "supporting" each other. I've heard people saying "in the good old days" people would socialise more outside of work, and in other industries this is still the norm.

      Do you have anything you could send me from the project where you used the Theory of Change? Would you be interested in joining our Theory of Change learning sessions?

      I will definitely invite you to the collaborative if we get the funding.

      Thanks,

      Nicola

Comments are now closed for this post.