Buber: All real living is meeting

I love this quote from Buber, that "All real living is meeting". I don't think he's talking about the typical meetings we all too often hold in our workplaces, rather those precious, positive and productive times when humans genuinely meet, when ideas and feelings are voiced, horizons touch and people change and grow.


I also love this quote from Buber

"I knew nothing of books when I came forth from the womb of my mother, and I shall die without books, with another human hand in my own. I do, indeed, close my door at times and surrender myself to a book, but only because I can open the door again and see a human being looking at me."

I'm not even going to attempt to explain all the complexities of Buber's ideas here. Just to salute his core idea: the distinction between "I - it" understandings, and "I - thou". This encapsulates the difference between seeing the person or the world in terms of it's properties and functions, as organisms rather than as individuals, and his argument that  we become  more fully human through our accepting "I - Thou" interactions with other human beings and the world when we put ourselves fully into the relationship, being fully open to dialogue, unconditional and authentic, embracing the risk that this could result in real change in ourselves.

His ideas were revolutionary because they refocus us on the importance of our relationships with each other and our world: How we connect, how we take notice, how we learn, how we give, how we move toward our potential as human beings.

Much of the best thinking about good listening, good meetings, coproduction, community and wellbeing that's around today owes a great debt to the concepts expounded by Martin Buber. His fingerprints are in the silences wherever people intentionally think together. His thinking was utterly person-centred:

"Every person born into the world represents something new, something that never existed before, something original and unique....If there had been someone like her in the world, there would have been no need for her to be born"

There's a very nice slideshow introduction to Buber and his ideas here: http://courses.washington.edu/spcmu/buber/index.htm

In an interesting piece of synchronicity, this video narrated by Gill Bailey was posted today. It's an explanation of how the 'Relationship Circle' person-centred thinking tool is used to improve people's lives and supports.

The relationship circle honours the important relationships in people's lives, and ensures they are recorded and respected. Understanding how a person is part of a network of important human relationships is so very different from regarding them in terms of  a set of deficiencies or a set of care tasks.

"What's important to people always includes relationships" says Gill: I think Buber would warmly approve.

Is there a way forward for the Winterbourne Concordat?

 The 1st June 2014 is an important date. It was the date that was set for significant improvements in the lives of people housed in Assessment and Treatment Units by the Winterbourne Concordat. For most this was meant to have been resettlement back into places in their own communities, for the rest, clear plans for resettlement were meant to have been written. The statistics coming out however show that in fact the reverse has happened. People are still staying in ATUs for long periods, the numbers in ATUs are increasing. Most people do not have resettlement plans.

What follows is not in my usual blogging style. It was written as an essay for the Management Unit of my Masters degree, so it's in an academic style packed with references. It's also full of management theories which I had to include to demonstrate knowledge. I'm quite sceptical about a lot of management theories - sometimes they are blindingly obvious, sometimes they are gnomic, occasionally they provide brilliant insights. As I point out in the essay, knowing these theories has not helped the people who signed the concordat to actually deliver its promises, something extra is needed.

I thought about taking a lot of the academic stuff out before I blogged it, but I couldn't find a way of doing this without fundamentally changing the meaning of what I've written, so I have to apologise in advance for the inaccessible style.

The case of Connor Sparrowhawk is mentioned in the essay, because I felt it was directly relevant to the Winterbourne Concordat. I shared the essay a few days ago with Connor's Mum, and she is OK with me sharing it.

Is there a way forward for the Winterbourne Concordat?

One of the most problematic recent issues for government and local authorities has been around their response to the Winterbourne View Scandal. In May 2011, the BBC’s Panorama programme broadcast shocking undercover footage of serious abuse at an Assessment and Treatment Unit (ATU) (BBC 2011), this was followed over a year later by another programme showing that the same serious failings still existed (BBC 2012).

The furore around Winterbourne (and also Mid-Staffordshire) also led to the resignation of several CQC leaders following criticisms of their ‘light touch’ approach to regulation, and alleged unwillingness to be critical of the NHS (Ramesh and Muir 2013).

In response to the outrage around Winterbourne, Care and Support Minister Norman Lamb vowed that by June 2014, people would be placed in small local community based facilities, rather than being sent hundreds of miles to inappropriate placements (Samuel 2013). This policy was a key feature of the Winterbourne View Concordat (DOH 2012), the headline commitment being “Health and care commissioners will review all current hospital placements and support everyone inappropriately placed in hospital to move to community-based support as quickly as possible and no later than 1 June 2014”.

This concordat was signed by directors of Adult Social Care and NHS Clinical Commissioners along with many other leading bodies: over 50 in total.

Impacts on people with learning disabilities and their families:

The key impacts on people with learning disabilities and their families of the successful implementation of the concordat would have been that people with learning disabilities and challenging behaviour would find locally available services to meet their needs, staffed by well trained people. Those still on ATUs would all have discharge plans, and the changes would “lead to a rapid reduction in hospital placements for this group of people by 1 June 2014” (DOH 2012 p5). Long stays in hospital would not be tolerated as “a hospital is not a home” (ibid p5), and there would be “zero tolerance for abuse and neglect” (p5).

This contrasts markedly with the current situation revealed by the Learning disability census which shows that two thirds of the 3250 people on Assessment and Treatment Units are being given large doses of anti-psychotic drugs, and over half being subject to restraint, seclusion, physical abuse or self harm (HSCIC 2104). 74% do not have a plan to return home (FPLD 2014), and the number housed in ATUs have actually INCREASED since the signing of the Concordat.

The report also revealed the extremely high cost of living in such miserable conditions; between £1500 and £4500 a week, with 10% costing even more than this (Parton 2014). Chris Hatton of CEDR estimates that the total cost per annum of housing 3250 people at these rates is over 1/3 of a £billion, and an incalculable cost to the wellbeing of the individuals concerned and their families (Hatton 2014a).

The stark reality of what this means to people and their families was revealed by the report into the preventable death of Connor Sparrowhawk, who drowned while unsupervised in a bath in an ATU. (Hussein and Hyde-Bales 2014) This report found that staff at the unit did not understand person centred planning, and that despite the high cost and high number of staff, the risk around his epilepsy was not properly assessed and the procedures in place were not adequate (ibid). Connor’s family report that they were made to feel unwelcome on the unit, as if they were interfering, and that their concerns about his level of activity and his epilepsy were not properly listened to. (BBC Radio 4 2014)

Impacts for Managers Commissioners and Providers:

Other key changes committed to in the concordat include:
• A strategy to reform the current arrangements for the assessment of special educational needs
• Joint commissioning between the NHS and Social Services locally
• Transition planning starting in childhood and continuing up to the age of 25
• Improvements in training and support for staff
• Unannounced CQC inspections
• Six monthly healthchecks
• Involving families and people with challenging behaviour in the commissioning of services and gathering feedback on their experience

Changes for organisations implied by the concordat obviously imply the strategic redirecting of that £1/3bn from funding places at ATUs to funding local community based facilities. This requires a very different approach from those commissioning these places, and may involve upfront investment in developing these new facilities. Similarly, the new approach to transition requires fundamental changes in the culture and practices of local organisations, breaking down barriers between children’s and adult services. Transition is a perennial issue, with very similar ideas for change included in Valuing People (2001), the difficulty in overcoming these barriers is evidenced by the repetitiveness of calls to break them down.

 Managers at ATU’s would need to begin to ensure that every resident has a discharge plan, and actively work to reduce the numbers resident in ATUs. This is problematic, as there is no rational incentive for these institutions to shrink themselves.

Managers and commissioners at local authorities and in the NHS will need to improve the way they involve and engage families. This could be achieved through coproduction approaches similar to ‘Working Together for Change’ where people that use services and their families work together with providers and commissioners to design and implement strategic change (Bennett and Sanderson 2009).

Implementing such engagement programmes and other ‘localism’ measures is made more difficult when government austerity measures have impacted significantly on local government finances (Lowndes and Pratchett 2012), not least because such engagement is likely to require time and money investing into it, both into engagement workers in local commissioning bodies, and into carers and self-advocacy groups in the voluntary sector, as well as buy in from leadership for it to be more than tokenistic (McCabe 2010).

Local authority and NHS Managers are also instructed by the Concordat, and other government policies, that they need to be working in a much more integrated way, with pooled budgets and local collaboration through Health and Wellbeing Boards (Lamb 2013). There is a long history of attempts to integrate Health and Social Care, and results up to recently have been disappointing, Wistow (2012) argues that this is because the NHS has a culture that tends toward national uniformity, while local authorities exist in situations of local diversity. Any integration has occurred in peripheral functions, rather than core provision. Changing this requires deep cultural change in both sectors.

Applying Management and Leadership Theories to the Changes Advocated by the Concordat
One big obstacle to the implementation of the Winterbourne Concordat may be that it has coincided with a major restructuring of the NHS, and in the context of increasing complexity of commissioning within it (Goodwin 2011). Bruce Tuckman describes the stages of team effectiveness as ‘forming, norming, storming and performing’ (Tuckman and Jensen 1977). In the case of the NHS it has been formed and reformed by successive governments, and the current reforms have been particularly drastic, and while it was hoped the new Clinical Commissioning Groups (CCGs) would have geographical boundaries contiguous with those of local authorities, in many places it has not worked out like that on the ground. (Coleman et al 2014). Reorganisation has led to a period of instability during the forming and norming period, while people work out who is who in the system, and who is responsible for what.

It may be now that the new system has “bedded in” that progress on the Concordat becomes easier, McCafferty et al (2013) believe that the new organisations are likely to be receptive to implementing policies, providing they are clear, coherent, achievable and there is buy in from stakeholders. Kotter’s approach (1996) to change may be useful here. He argues that 70% of attempts to implement significant change in organisations fail, and puts forward eight stages. The first three are to establish a sense of urgency, to create a coalition to guide progress and to create a vision. On paper this was there in the Concordat with that ambitious target to achieve significant changes in numbers incarcerated in ATUs by June 2014, and with the signatures of leaders of all the most powerful institutions in Health and Social Care.  The abject failure to progress implies that these commitments were not taken as seriously by the signatories as the wording of the Concordat suggests, with Lamb admitting “it’s business as usual in too many places” (Wiggins 2014).

The next steps are communicating the vision, and empowering broad based action, however the disruption caused by austerity measures and significant reorganisation in the field seem to have cut across this empowerment to find the funding to create new local community based provision. Bill Mumford, new director of the Winterbourne Joint Improvement Programme pointed out the lack of clarity in the vision: “Nobody defined what ‘appropriate’ was, and nobody quite understood what the numbers were.” (ibid) There also seems to be a paucity of ‘short term wins’, the sixth of Kotter’s stages leading to the programme being branded “hopeless” (ibid). Lamb has vowed that he is “more determined to see this through” which corresponds to stage 7: ‘never let up’, but the total lack of progress means that there are no changes to be incorporated into the culture.

The sheer number of stakeholders named in the Concordat (over 50) creates a “diffusion of responsibility” (Wallach and Kogan 1964, Leary and Forsyth 1987) where individuals are less likely to feel accountable for an action or inaction due to the presence of a number of others and due to the lack of clearly assigned responsibility, this effect, similar to the ‘bystander effect’ (Darley and Latane 1968) noticed when people fail to come to someone else’s aid increases in conditions where the victim is unknown to members of the group. The social and emotional distance between people with learning disabilities and their families and carers, and the powerful people charged with leading health and social care could thus be a key factor in accounting for this lack of action. Chris Hatton (2014b) suggests that similar bystander apathy was a factor in the death of Connor Sparrowhawk on a well-staffed ATU. It could be argued that overcoming this apathy therefore requires the finding of ways of reducing this social and emotional distance, so that powerful leaders feel some personal connection to people in the ATUs and their families, as well as assigning to them a clearer personal responsibility to address the situation.

Narratives and storytelling are one way of bringing about organisational change (Boyce 1996, Hurwitz, Greenhalgh and Skultan 2008, Maas 2012). Well told stories that bring home the personality and individuality of people in the ATU, like the story of Connor Sparrowhawk being told by his mother and a coalition of his allies (Ryan 2014, #107Days 2014) could serve to begin to bring home some of this understanding if they are shared throughout the sector. A serious approach to coproduction is therefore needed, that brings together people that use services, their families and carers and key local decision makers (Durose et al 2013) so that they can share their narratives in a way similar to that suggested by Downing (2005) where entrepreneurs and stakeholders tell stories together and make sense together is another way of beginning to address this distance.

  Figure 1. shows a ‘Forcefield Analysis’ (Lewin 1943) of some of the factors promoting towards the desired goals in the Winterbourne Concordat, and of the factors that are creating resistance to this change. Leaders use the forcefield analysis to think about how they can enhance the factors promoting change, and weaken those resisting change. In this case the factors resisting change seem mighty. However there is also a deeper cultural shift occurring: expectations are very different today from what they were 30 years ago, and it is the contrast between community based provision, self-directed support and the lives people are achieving through person centred approaches and the lifestyle endured by people on ATUs that throws this situation into sharp relief.

To paraphrase Thompson (1967):The environment is changing, and therefore so should the company. The cultural change in wider society, towards people insisting on more choice and control in their own lives and away from deference to authorities and experts that are rapidly discrediting themselves needs be reflected deeply in the culture of services. “Culture eats strategy for breakfast” (Drucker cited by Braun 2013). However the 3000+ people in ATUs and their families are unlikely to wish to wait for small iterative accretions of cultural change to reach a ‘tipping point’ (Gladwell 2000), where the ATU and its current practices are simply no longer acceptable in our society.

Bringing about the change envisaged by the Concordat given it’s poor performance so far requires the increased use of cultural and change catalysts in Health and Social Care organisations. For the concordat to succeed, a fundamental shift in power relations in Health and Social care needs to occur, and so far the attempts to dismantle the Master’s house with the master’s tools (Lorde 1984) have failed abjectly.

Approaches for Personal and Strategic Change:

A strategy to bring about change then needs to begin by looking at the strategies attempted by families like Connor Sparrowhawk’s themselves. They attempted to hold a person centred review around Connor at the ATU, which at the time the professionals there found confusing and alien to their practice (Hussein and Hyde-Bales 2014). Holding a series of person centred reviews is part of the first stage of ‘Working Together for Change’ (WTfC) (Bennett and Sanderson 2009) a coproductive change process that brings each element of the system together, including people, families, providers and commissioners to think about how to achieve strategic change. This effect of bringing elements of the ‘whole system’ around a single person is deeply powerful as it reveals so starkly the change that needs to happen. The rich discussions held at such a review help turn grey statistics into colourful stories about real personalities.

Given that the average cost of a week in an ATU is £3000 - £4000 (FPLD 2014) the resources are there for each person in an ATU to have a person centred review. This could involve the people who commissioned their place at the ATU, along with family, friends, advocates and others who know the person well.

A person centred review has 7 questions, including “Questions to Answer, Issues to Resolve” (Sanderson and Mathieson 2004) the key issue to consider here would be “what would it take for this person to live in their own community”, and the answers to this question used to devise the resettlement plan demanded by the Concordat. For some people, a ‘Community Circle’/Circle of Support (Sanderson, Carr and Neill 2013) approach might well be an appropriate way of mobilising the thinking and action necessary for a resettlement. A person centred review could be the starting point for the formation of such a circle. Where leaving the ATU immediately seems impossible, the other questions in the person centred review: what’s important to me now? What’s important to me in the future? What helps keep me healthy and safe? What’s Working, and What’s Not Working? can be used to involve families and allies in improving the day to day support of their loved ones.

To overcome the effects of diffusion of responsibility, each person in an ATU should have a named person with the necessary authority from the commissioning agency who is personally responsible and accountable for ensuring this happens. This may require some upfront allocation of resources, but this is justified by the potential improvements in the life of the person, not to mention potential savings on the high cost of ATU treatment.

Similar work needs to be done with people currently living in the community who are at risk of being moved to an ATU, particularly with young people in transition. Each authority could then bring together the rich person centred information gathered at these Person Centred Reviews for the next stage of the WTfC process; a coproduction session which brings together self-advocates, families, providers and commissioners to think together about the issues raised.

Doing this around the question “What would it take for us to bring these people back home?” could focus local people and agencies on the task of creating adequate local provision. Processes like the ‘5 whys’ devised by Sakichi Toyota as a method of root-cause analysis (NHSIII 2008) which are used in WTfC will help these local coproduction efforts get to the deep rooted reasons why adequate local provision and skills mix for the people housed in out of area ATUs is either not present or has not been used, and make action plans to address these reasons.

Another key outcome of such coproductive work would be the development and deepening of productive relationships and partnerships, as local commissioners, providers, self advocates and families work together on delivering good lives individually through person centred approaches, and more strategic level 2 and 3 change through person centred coproduction techniques such as WTfC.

Conclusions:
Kotter (1995) has told us that the majority of big organisational change efforts fail. The Winterbourne Concordat’s first 18 months makes it appear likely to be one of these failures. Leadership and Management Theories give us clues about how to address this, but I think it likely that 90% of those powerful people who put their signatures to that concordat are well-versed in leadership theory; learning to be articulate in such management and leadership discourses will have been a requirement for attaining their current senior positions. This knowledge has not however enabled them or their organisations to deliver on the targets they signed up to.

Bennis (1989) argues that leaders tend to reflect and defend the culture that put them into their positions of leadership, while real innovation requires people to dissent and “thumb their noses” at the “way we do things round here”. The experience of the survivors of Winterbourne, and of Connor Sparrowhawk, along with the backward movement on the Winterbourne Concordat suggest that current structures and leaders in health and social care in this area are still failing to involve and engage people in their own support, and to become partners in the strategic direction of services. Radical person-centred action is needed to involve those who wish to deliver change, particularly those with a personal stake, who understand it is vital for their lives, in the strategic direction and change processes of the services intended to support them.

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The plight of the systematiser

Can humanity assert itself in the face of the systematising power of markets and bureaucracy?

Can our human services organisations genuinely personalise the supports they offer in a way that makes sense to the people they serve?

Will person centredness always be struggling in the spaces it makes in small cracks and corners of the system, always in peril of being abolished by the swipe of some bureaucratic pen?

The inimitable John O'Brien recently released a new paper: "The trouble with person centred planning". In it he explores the tension between "lifeworld rationality" and 'system rationality'.

Lifeworld rationality being those ways of thinking that lead to lives that make sense for individual people, whose subject matter is building and enjoying relationships, dialogue between subjective individuals aimed at mutual understanding and change, the everyday components that go to building good days and good lives and characterised by appreciation of individual gifts and contribution and a celebration of the person's unique identity.

'System rationality' being the ways of thinking encouraged by the driving forces of market and bureaucracy that coordinate, standardise, regulate the ways we work, aiming for efficiency, and characterised by indifference to individuals and uniformity in approach.

It's a tension that everyone who has tried to implement person centred change, in the life of an individual, the work of a whole service or the culture of a whole sector has experienced. Part of person centred work is to 'part the veil of indifference' that John describes, showing how a system's standard practises, policies, structures and assumptions are underestimating and limiting the people they support.

Sometimes I feel John sounds quite pessimistic in his article, he describes the society we live in as the most completely systematised in the history of humankind, with tendrils of the market and bureaucracy insinuating themselves into everyday life, commodifying and regulating every aspect of our existence. He says that the plight of those advocating and practicing person centred approaches is that they can never fully overcome "the colonising forces of system rationality" though he does celebrate the space that person centred approaches have managed to carve despite these forces and seeks ways to defend and extend these spaces where people can be present to each other and search together for the conditions that create a good life.

In response to this hint of pessimism I'd suggest that it is not just the personalisers and humanisers, the 'lifeworld rationalists' who face a 'plight':

The systematisers face an equal and opposite plight.

At the heart of the plight of the systematiser, is that their systems are made of human beings. Systems designed on paper are held together by our habits, reinforced by our assumptions. Human beings have powerful minds and hearts, they are able, (sometimes with the help of a few good questions) to think outside of the systems that contain them, to sense the changes that need to happen.

There's something about humanity in that it resists regulation, commodification and standardisation, especially when it is provided with the tools to do something different, allowing what Michael Smull calls 'positive discontent' to manifest itself as change.

The most ironic plight of the systematiser is that their systems usually don't work UNLESS human beings find other ways of acting and connecting with each other beyond those prescribed in the policy and procedure manuals.

It's clear that oftentimes this resistance to systematisation manifests itself very negatively, especially when it takes the form of  'cynical discontent'. The most regulated and systematised environments are the ones where the darkest abuse tends to occur. Locked doors, walls, protocols and procedures do not keep people safe. The human relationships that all those things are preventing are what keep people safe.

When people are given positive tools and approaches that help part that veil of indifference, even for a moment, it's surprising how easily and joyfully humanity can break through. I loved this little vignette from a hospital ward posted just yesterday on facebook by Jo Harvey:

"Last week I spent two days working at London Road Community Hospital in Derby on our personalisation programme. We are working to introduce one page profiles for patients and staff, more inclusive MDT meetings and working together for change. One of the simple but effective things we are introducing to improve the patient experience is to ask each patient each day what would make a good day for them. This week when we were reviewing how the start of the programme has gone, one ward sister shared a story of how a patient had said that it it would make a good day for him if he could see the staff dance. So they did! Lots of smiles on that day. Simple but effective!"

This story reminded me of Emma Goldman's quote "If I can't dance to it, it's not my revolution".

Person centred thinking tools aim to find big and small ways to part the veil of system indifference - using a one page profile to seek to learn and list everything that people appreciate about a person, everything that really matters to that person is an attempt to do this.

Being willing to share your own one page profile with others creates opportunities to create relationships that are based on more than transactions, offering insights into what may be shared common interests and other ways of connecting.

Matching up people with staff with the right personality characteristics and shared common interests creates new ways of working and being. Linking people into their communities and finding ways with them that they can contribute to the community creates new opportunities for relationship. Creating organisational cultures that value intentional listening, listening to understand, and demonstrably value it when people act on that listening creates whole new possibilities for change.

 

I love this photograph of a temple from Thailand; just as humanity, given the opportunity bursts through systematisation, this tree has somehow both destroyed and preserved the temple it has grown around. It's taken a dry, abstract and formal structure and turned it into a living, breathing entity, rooted in nature. I wonder whether we can change organisations and systems in the same way, by allowing humanity, and the power of human relationships to really take root, in those little cracks in the system we open up every time we use person centred approaches to appreciate and listen well to people?

Michael Smull on One Page Profiles

Michael Smull speaking in Texas

Michael Smull sent out the following message to people on the Learning Community for Person Centred Practices general mailing list today, he's given permission for us to share it.

"In our efforts to support people in have lives of their own choosing within their communities we have developed an array of practices, skills, and tools. Notable among them are 1 page profiles.  They are both powerful and remarkably useful.  They have made significant differences in the lives of people and have been a critical part of making positive changes in practices.  One page profiles are not meant to be a complete picture of a person, rather they are a snapshot that introduces the reader to the person, outlines what matters most to that person and gives the top tips for support.  Part of their power is in their brevity and that, done well, they are visually attractive.  They are a powerful “tool” in changing how people are perceived and supported.  But they are not powerful simply because they exist but because of their impact.  People who use services, their families, and those who support them have given us story after story about how they have helped in their efforts.  For some people part of what was powerful was the learning that that takes place in development.  For many others it is how effective they are in introducing someone and advocating for them. 

 

A test for something being person centered is that it works for humans.  If it just works for disability it is clinical.  When we apply this test for 1 page profiles we see that can be helpful in a variety of human circumstances.  My 1 page profile as a trainer (on the learning community’s website) is very helpful for those asking me to do training.  With teams, I have facilitated a process for them to develop 1 page profiles on each other and team members find that they are then more effective in working together.

 

There are so many stories about the efficacy of 1 page profiles from so many places that I find it difficult that anyone paying attention can criticize them as ineffective. This is not to say that they cannot be poorly done or badly used.  They are a means not an end. They are not a “magic bullet”, they are not the only thing that needs to be done to change practices, but they are key part of what I teach and coach.   Criticism of those done badly or done just to be “trendy” is justified and useful.  Broad criticism flies in the face of the reality of their impact.  But that criticism has occurred. The criticism I have seen suggests that we are promoting  one page profiles as an end.  Yet if you read the stories associated with the profiles you see that it is how it was used not just that it exists.

 

Because 1 page profiles are being criticized we need more stories.  If you could take a few moments and share your learning it would be very helpful.  Clearly we want stories that illustrate the breadth and power of their use.  But, because we are learning community, we also want stories that illustrate your learning in what was required to make them useful.

 

Thank you.

 

Michael"

One Page Profiles: Just Garnish?

One page profiles are a simple person centred thinking tool that sum up what people like and admire about a person, what's important to that person, and the best ways to support that person on a single sheet of paper. Their simplicity and practicality means that they are becoming very popular, they are an easy first step in the person-centred journey. The growing uptake of these tools however  has inevitably meant that they have also invited criticism, criticism which gives us an opportunity to think more deeply about the best ways to use one page profiles, their benefits and their limits.

Last week Simon Duffy tweeted what looks like a quote from Peter Kinsella at a big everyday living conference "One Page Profiles are just garnish, they make no difference".

This is a 'black swan' statement. Find one black swan and you prove that the statement 'there is no such thing as a black swan' is pretty unfounded.

As a black swan statement, all that's required to prove that particular tweet wrong is one example of a One Page Profile that has made a difference for somebody. And of course there are many more than just one example, all kinds of examples and stories of one page profiles that made a difference are posted on the '100 One Page Profiles' blog. Stories are statistics with souls, and the list of stories on that blog is only growing longer and richer.

Sweeping statements that dismiss One Page Profiles and other pieces of person centred thinking as 'just garnish' are therefore pretty unhelpful and easily disproved, though to be fair to Simon and Peter, maybe the statement would have been phrased better if it was not constrained by the 140 character limit set by twitter.

 A more helpful statement would have been 'some one page profiles are just garnish and make no difference'. We could then investigate what makes the difference between one page profiles that achieve change in people's lives, and those that don't, so that we can work to create the conditions where more of the first kind are produced. This is the purpose of the Learning Community for Person Centred Practices, which develops person centred thinking tools, shares them and then gathers learning about the best ways to use them to ensure that people win more choice and control in their lives. You can also find TLCPCP on facebook and twitter.

There are however some more thoughtful criticisms of One Page Profiles out there that we need to consider seriously because they will help us work better at increasing choice and control in people's lives. Below I'm listing some of these criticisms, and giving what I hope are some  equally thoughtful and constructive responses, the beginning of a respectful learning conversation:

1.    "One Page Profiles are only for disabled people, so having one labels you as disabled"

We would argue that one page profiles have many many uses, with applications for many diverse people, including non-disabled people and situations that are nothing to do with health or social care.

 

On the 100 One Page Profiles website, there are examples of one page profiles used in mainstream schools, in a couple's birthing plan, to find a nursery, to help people know how to speak to a recently bereaved woman, as a way of applying for a job, as a method that an employer can support their staff. People are inventing new ways to use one page profiles in almost every aspect of their lives.

 

We also use one page profiles in our own work as trainers and planners, we share our own profiles with the people we serve, and their families before we ask them to share anything with us. We see one page profiles as being useful in many different people's lives and work, and not as something exclusively for disabled people.

 

Because they increase the amount of choice and control in people's lives however, we're do find one page profiles particularly useful in the lives of people who have less choice and control in their lives as a consequence of society's attitude to the presence of ill health or disability.

2.    We shouldn't use any predetermined tools or scripts. If we properly listen to people we can improvise and adapt our approaches in a way that suits that person.

 

There are a few, absolutely brilliant and charismatic facilitators out there who have the ability to facilitate person centred thinking and practice 'on the hoof'.

The rest of us however don't share this level of confidence in our abilities, many of us may be new, inexperienced and nervous, and therefore find tools that prompt and structure our discussions in a direction that inquires into a person's gifts and skills and that seeks out what really matters to them very useful.

 Having such simple tools means many more people can practice and experience person centred thinking. They democratise the practice rather than leaving it in the hands of a small and gifted elite, and mean that many more people get to benefit from more person-centred support in their lives.

 We also hope One Page Profiles will replace those much more complex and negative tools that services traditionally (and many still currently) use. Assessments and approaches that focus on what a person can't do, that inquire into people's incapacities rather than their capacities, that consider health and safety without also considering what really matters to a person and which implicitly regard the person as a problem to be solved are doing great damage to people, saddle them with negative reputations, and lead us to support them in paternalistic and overprotective ways.

 

Replacing such segregating deficit model tools with simple tools that focus on gifts and capacities and on connecting a person into the community is part of shifting the whole culture of health and social care toward a different way of regarding people.

 Of course we must endeavour when we use one page profiles, to do so in a way that respects the person's preferred methods of communication to be sensitive to what really matters to that person. We need to keep learning about what helps this work best.

 

3.    Sometimes One Page Profiles are just superficial lists of likes and dislikes.

 

Like any tool, there are useful ways of using them and ways that are less useful. I don't prove that my screwdriver is useless just because my shelves fall down, I prove that I need some help and advice to use my tools better.

 Using a one page profile well, to structure a meaningful conversation and to delvier change, requires a real intention to discover what's strong and valuable about the person, and a determination to find ways to support that person that make sense for the person, as well as a genuine will to act on whatever is learned.

 

To be able to write one page profiles with others, we therefore require that people have first written and used one page profiles themselves in their own lives, to gain an appreciation of their potential to make a difference when used well, and to ensure that we don't ask people questions that we have not been prepared to answer ourselves.

 

4.    Introducing One Page Profiles En Masse would lead to tickbox planning.

This is a real risk if one page profiles are implemented by people or systems that don’t care about one page profiles or the people they are supposed to be supporting, and don’t endeavour to train people well in how to use them. Such people implement changes to 'meet targets' without thinking more deeply about the purpose of such changes.

 

In such a scenario, we’d be likely to see plans that are just superficial lists of likes and dislikes. This would be far less harmful than continuing the implementation of tools that focus on deficits, but would not lead to the change we wish to see. Just like any other approach, one page profiles rely on genuine intent to listen well and to act on what is learned, and if change is to happen this intent must be reflected at every level.

 

Where people really are stuck in structures and systems so deeply imbued with this target-driven cynicism, then measures like personal budgets that enable people to seek support from outside such systems are going to be helpful. Good person centred thinking helps with good support planning and helps people use their personal budgets most effectively.

 

We'd also advocate other methods of cultural change within these structures, that shift the conversation away from targets toward the meaning and purpose of the work, and toward practical ways of bringing about system change.

 

5.    There are some things we don't wish to share about ourselves

Don’t share those things then!

 

It’s up to the person what they choose to share in their one page profile. It helps to think about what the purpose of the one page profile is, and therefore who needs to see it, as well as what they need to know and do to support you well. These questions help focus us on what needs to be included in a one page profile, and which people it would be shown to.

 

6.    One Page Profiles are not a panacea

One page profiles will not solve all the problems inherent in health and social care or in our disablist society. If you’re looking for something that does, keep working hard! We’re right with you! In the meantime people still need better lives that mean something to them, and better supports delivered in a way that makes sense to them. In an imperfect and confusing system and a society rife with unjust power and resource distribution, every tiny bit of choice and control we can win back in our lives is precious.

 

7.    One Page Profiles could become a substitute for doing more detailed person centred planning.

 

There’s definitely a risk that someone could write a one page profile and say “And now my work here is done”. However as we explain in this paper, the one page profile is just a first step in the person centred journey. There are many other tools that do equally useful jobs: communication charts, staff matching tools, tools that help us explain to staff their different roles and responsibilities, learning tools, community connecting tools, tools that help us move toward our dreams and avoid our nightmares. These tools are there to try out and experiment with. Find ways to use them that make sense to you. Share what you're learning while you do!

 

Please don’t stop thinking together just because you’ve completed a one page profile! There is so much more to discover, and it could be great fun discovering it!

 

More info on One Page Profiles here: http://www.helensandersonassociates.co.uk/reading-room/how/person-centred-thinking/one-page-profiles.aspx 

 

Person Centered Approaches to Conflict with Max Neill

Rhizomatic Leadership and Meadian Networking

I'm interested in the way movements and their leaders have effectively delivered transformational change. It's quite different from the straightforward almost mechanical model that we usually begin to use when considering how to lead and how to deliver change.

The way we tend to construct organisations, and the way change actually happens can be quite different. We tend to build organisations with a 'pyramid' shape. A small group at the top, a larger number at the bottom. The group at the top sets standards and rules that determine how the whole organisation works. Every organisation has it's flowchart showing the lines of power and responsibility stretching down from the top toward the bottom.

When we apply this model to reality however, we find it doesn't match how human beings actually think and organise. It doesn't reflect the complex knots of different circles and coalitions we participate in, particularly when working to deliver change in a highly complex society. It gives a very false picture of who the leaders of change actually are.

The rigidity and inflexibility of pyramid shaped organisations means they can become obstacles to change and to the kind of coalitions that work. I was privileged to hear John McKnight talking in Preston a couple of years ago about how voluntary community organisations tend to be more 'circular', while companies and statutory organisations tend to be 'pyramid shaped', and that the interaction of such circles and such pyramids can be very problematic.

In thinking about this blogpost, I googled 'Rhizomatic Leadership' and found this PInterest board by Renee Charney. http://www.pinterest.com/rcharney1208/rhizomes-and-rhizomatic-leadership/  I haven't had a chance to speak to her or read her work, but in may ways the pictures of different kinds of rhizomes she has collected together in themselves show the 'knotty' way humans organise ourselves naturally.

In my experience of work for change in my own local area, people with affiliations to different local, national and international organisations, with very different cultures, belief systems, backgrounds, still often managed to network with each other in their every day work for change and to create productive results. These people were showing true leadership, prepared to take on each others ideas, be eclectic, experiment, and work together to see how things come out. Being doctrinaire, being 'pure'; insisting that your path is the only true path are all obstacles to such networking (Though the energy behind such single-minded commitment can be very useful to networks if ways of working together can be found)

Rhizomes are really really interesting. The biggest 'single' living organism in the world is a rhizomatic forest. To the eye it looks like thousands of separate trees, but under the ground, they have a single multiply intertwined and interconnected root system. If a piece of that rhizome root were detached and planted elsewhere, in the right conditions,  it would be capable of forming it's own rhizomatic forest. Rhizomatic root systems are strong because they go in all available directions, what nourishes one, nourishes all. Often they're hidden beneath the surface - people's unofficial, social and virtual networks being at least as significant as their 'official' position in a formal organisational structure. Chop down a tree, the rhizome that grew it is still there, nourishing more saplings!

Margaret Mead wrote a lot about forming networks of very diverse people around common goals, and a rhizomatic approach strikes me as being very similar - understanding that we gain when we're prepared to join with others, let the root systems that nourish us, also nourish them, and vice versa, what is a resource for one, is a resource for all.

David Towell blogs about this 'Meadian Networking' in his blog 'Networking for a purpose' with examples from the work done by very many different people and organisations with many differing interests and visions, to shift the culture of social and health care toward personalisation in the UK.

He uses a graphic developed by Margaret Wheatley and Deborah Frieze to argue that in any major cultural change process, there are 3 stages of emergence for radical new ideas and practices:
1.  A stage where small separate groups of individual pioneers develop groundbreaking countercultural ideas and new ways of doing things

2. A stage where these radical and experimental ideas are being applied in small areas, learning from this is happening and communities of practice are developing and sharing them, and then finally

3. A stage where these communities of practice themselves develop and network further into whole systems of influence that are much more widely accepted. It's easier when you see the picture he uses, so here it is:

 

From a network, to a network of networks, to a whole movement for social change"

 

So what implications does this have for people who wish to be part of leading person centred change today?

First of all I'd suggest that in terms of person centred practices, we're at a point in the transition between stage 2 and stage 3. The word 'person centred' is now widely used, the need for person centred practices and values is widely recognised, even if there are still many people unaware of the practical ways such change can be delivered. The practicalities need to occupy the space opened up by the aspirations before those aspirations become diluted buzzwords.

The experience of the UK suggests the deep value of being willing to network and connect with people with similar and values and aims, even where their way of doing things may seem very different - in complex multifaceted environments many different tactics may be necessary to achieve a single overall strategic aim: Any movement for diversity and inclusion, must by definition be diverse and inclusive. Sometimes this may lead to unfamiliar, uncomfortable and difficult compromises, but the most creative work happens when people with very different ways of doing things get together, and use the conflicts that happen between them as sources of productive energy rather than allowing them to become destructive rivalries.

To become part of  a 'system of influence' we need to work on what helps us influence: Our personal relationships, our work relationships, our online networks, all the multiple circles we inhabit where we can use influence. In areas close to us the chromatography of our influence will be clear, further away it may be fainter, and tinted with shades of the influence of others. This leads to the other role of influencers - finding ways to protect the integrity of the original values that motivated the change, without preventing the change. A subtle and difficult balance, but not an impossible one.