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Tension 3 – starting with problems vs starting with strengths

This blog is part of a series of reflections by the Re-imagining Healthcare SIG. Here Matthew Bell shares his thoughts about the third of six 'tensions' that surfaced during his efforts to create organisational change.

I started with a survey that identified gaps. This was implicitly negative. It focussed on what was missing, not what was there. The survey also identified purpose as being a significant positive, but naturally the eye is drawn to the biggest gap. By defining the start by a negative, there is a greater chance that it can be seen as a criticism before building the necessary relationships for holding areas of improvement productively.

Reversing the approach, I started with positives when speaking to carers. I asked them to speak about stories of success. We drew out the sentences that described why they were so successful. And quite unplanned, but the sessions became even more powerful when we acknowledged that it’s difficult to know why you are so good, and asked carers to tell one another why they thought the other carer was great. The purpose statement that was going to be tested looked pretty great:

We create a secure home that is Safe and Stable
We become trusted family & friends with relationships that are Warm, Caring, Consistent, Nurturing, Valuing, Whole
We give outstanding support by demonstrating Perseverance, Patience, Determination, Listening
We learn together by Growing, Living life to the full with Joy, Fun, Curiosity
The other difference was the process. With staff we went from a survey to a group exercise, whereas with carers with started with group exercises. So there is a good comparison between both focus and process. On reflection, focusing on identifying strengths, working face to face and building out from there is a much more positive start point.  And it starts to answer the tension pace vs patience.

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