Radical thinking or is it?

           Is Radical the new Common Sense?

written last year before I discovered #SHCR

After 30 + years directing and producing in the corporate arena I decided to see if my acquired skills would benefit the Care, Health and Social Housing sectors. The work was far more rewarding and there was and is a genuine chance to “make a difference”.

As I began to immerse myself in these sectors the serial problem solver in me saw opportunities where a bit of lateral thinking and not knowing what I couldn't do led to concepts popping up where I was challenging the conventional wisdom for the benefit of all.

All well and good until I tried to take these ideas forward, the NHS is such a sprawling and complex entity it was always impossible to find a way in. I had more success in the care sector, having won at a Skills for Care tender I produced a recruitment tool for identifying applicants for carer roles who had that “special thing” a compassionate nature.

They are the ones who get real job satisfaction and always put the patient first without the need to be trained to do so, it’s a human instinct for them.

I count myself as one of them and believe that if it’s “not in you” it can be a hard trait to even recognise for many, let alone place the real value in those qualities that I believe one should. So if you can’t spot that quality in people at the recruitment phase then everything that follows becomes process driven to compensate and we are where we are post Francis. 

I don't believe for example that training nurses to be more compassionate was the right response, they just needed enabling as that was the reason they chose the to be a nurse, they were born to care in the vast majority of cases. 

Too much process also means people loose ownership of their role and the obsession with hierarchies and the toxic combination of financial pressures chocked off internal communication, there was a one way valve only allowing communication to flow downwards.

So as I see it, innovation, creative problem solving, ownership of your role and any form of "risk taking" to challenge the conventional wisdom to improve patient experiences and outcomes was killed off. “I will never get that past my manager” became the mantra as did bullying cultures and all the negative fallout that generates. 

As an outsider the prevailing culture in recent years has been that people like me who might have positive things to offer can't be heard. After all what could someone with no medical or academic experience have to offer? So over the last few years I have tried and failed to present simple common sense solutions to anyone in the NHS...sure you know where this is going:) 

Given I am not a spring chicken and have definitely experienced ageism in recent years, at the age of 60 going to an event where Helen Bevan quite exquisitely described the attributes of people like me, so called  “citizen radicals” who could be trusted and whose ideas were based on common sense & experience was liberating.

To put that in context I have for the past 18 months put my heart and soul in to creating a suicide prevention tool for people with a learning disability. Getting people to test it and feedback was a slog and the NHS remained like Fort Knox.

Within 7 days of attending the NewHCVoices event in Birmingham I am now having to slow everyone down from helping me so I don’t waste this fantastic opportunity to create a meaningful evidence base for the project so it has the support to go national and hopefully help save more lives.

Then within a few months Jodi tweeted me an invite to join SHCR as a student,has turned my perceptions of the NHS on it's head. This organsiational change in mentality, acknowledgement of the value of "people wisdom" and open door approach to embracing new ways of thinking and bringing about positive change is to my mind one of the biggest and most positive things the NHS has ever done to improve itself.

It is possible.

@Chicustard

 

How do you test a tool like this?

Testing a Suicide Prevention tool for

people with learning disabilities

Having produced a “See and Hear” version of a 40 page legally worded tenancy agreement for supported living tenants I was approached by Grassroots, a suicide prevention charity based in Brighton to make a suicide prevention tool for people with learning disabilities.

In common with many creative people the “black dog” of depression wags its tail from time to time. On reflection, although it made working on such an emotive subject really heavy going sometimes there was an upside. It gave me some insight into how my audience would be feeling.

I have always thought that having a learning disability does not mean emotions are perceived in a different way, it just means you have a “learning” disability not an emotional one.

When you invest as much as I did in a project like this it gets very personal, I had also foolishly promised a “benchmark” solution so when it came time to launch it in to the “Twittersphere” of academics and experts in the field I was one nervous puppy!

As the feedback started to come in each day was another box ticked and apart from a few technical glitches that were easy to resolve we have yet to receive and negative comments. Better still there seems genuine interest in it being used nationally rather than just Brighton and Hove.

That’s where you come in, we need your help, some things lend themselves to “trials” or “market research & consumer feedback” in my parlance. So how do you evaluate a suicide prevention tool, not a by mortality rate that’s for sure! I found it to be quite a brainteaser.

So here is my question for you...

What are the criteria you suggest for measuring the effectiveness of the tool and gaining “data” that is both meaningful and steers any refinements to be made? 

Through meeting people at the @NewHCVoices event in November my options have increased dramatically to the point where I have needed to take a step back and slow the roll out down to make best advantage of us all working together to make this a benchmark tool filling a gap as there is nothing else like it. We are also exploring its potential use in prisons.

Tweet me @Chicustard & @grassroots and let’s get the conversation started. 

Jon Bryant Copyright  2018 

Engaging Heads Hearts and Minds

Heads Hearts and Minds

Copyright Jon Bryant 2015

My mentor the creator of the Andrex puppy adds, Captain Birds eye and the iconic Old Spice surfer campaign taught me the value of understanding the Heads Hearts and Minds of any audience you wish to talk to.

With 35 years of corporate programme making under my belt I have had to communicate with virtually every audience imaginable, over time you learn to speak “their language” and almost instinctively ask the right questions and listen to get inside their thought processes at an emotional level.

To me this is a very informal gut instinct human process, I should add that I have dyslexia so left school with one O level in art, so I don’t follow the academic route when it comes to research. 

For me the test of a programme is simple… does it work for its intended audience? This being far more important than making it work for the commissioner, that is the only evidence base I have ever needed, you are only as good as your last video production in my line of work.

Then along came this project…. When you find yourself talking to a mother whose 16 year old boy hung himself just a few months previously it becomes very real and you realise the stakes you are playing for…it was very grounding and humbling experience.

I have some insight into an audience with learning disabilities having converted a 40 page legal tenancy agreement in to a “see and hear” version for supported living tenants. So I had already faced the daunting challenge faced in communicating to as wider audience as possible across the LD spectrum.  I worked with a group of about 10 supported living tenants who were my very willing testers as I refined my ideas.

But this project was not about rules, rights and regulations, but pure emotion. So for my research as the director there was the more practical quantifiable stuff like visual language to establish and where it should be pitched in terms of its complexity but that only part of the task.

The other aspect to my “research” was better understanding what it is like for a person with a learning disability to have these feelings and how to express them. I did a lot of my learning via twitter just joining in to conversations, asking questions and trying to get insight in to the person with a learning disability through the eyes of their principle carer.  In time I started exchanging emails with some of these twitter contacts and spoke to a few by phone as well.

Two mothers came forwards who really added hugely to my understanding so big thanks to them.  One had very recently lost her 16 year old son, he was on the high functioning end of the spectrum and via his mum I learned so much about what made him happy and how he communicated finding text and chat far easier than face to face.

The other mother has a daughter with autism, who could do very little for herself although she was getting a lot of life skills coaching, she was prone to regular bouts of severe depression. 

Her mum said there was one thing her daughter was proficient at, one life skill where she showed her ability to plan, organize and think ahead…and that was attempting to take her own life often several times a month. As a result of deliberately overdosing on her prescribed meds she now has further damage to contend with.

I also came to the conclusion that I had to be realistic regards where I targeted the programme, some people were going to fall outside the envelope of what I could hope to achieve with a video that was targeting the “middle way” in order to work for as wider audience as possible.

On the more practical side I created some sheets with images on and asked our test group to tell me which best summed up various feelings, the results were surprisingly unambiguous which made my job a lot easier.  We also ran a Survey Monkey aimed at carers in an attempt to get as wider input as possible as they were my secondary audience.

With a better understanding of the task ahead I set myself the goal of the programme working with or without sound, or as just a soundtrack. The idea being that no matter how people learned best I had covered all the bases.

After developing the character we showed short clips to our testers via Speak Out, I didn’t want it to be too real as this might appear threatening, nor did I want to reduce it to cartoons as that I felt that was too abstract and hard to identify with.  I spent a long time refining the eyes, based on feedback from my testers, they said they were too intense so I muted the colour and also the time the character spent looking directly at the viewer, mindful of those on that end of the autistic spectrum.

During development I tried to ensure every aspect of what appeared on screen was correct for the job in hand. I spent a good deal of time looking at many typefaces, I know from my own experience with dyslexia that some fonts are just easier to process, this combined with the right choice of words gave me the best option in terms of reach.

My final choice of font Architect Small Block had all the right characteristics and was developed for its legibility for people with learning disabilities, it has a friendly approachable, handwritten quality to it and compared to similar style fonts ticked all the boxes. There is a very helpful blog by a typographer that I have included in our research that explains why it is so legible.

The last element is the scripting and the voice over, we tested several delivery styles and where we pitched it in terms of simplicity. It is a fine line between sounding patronizing and ensuring that you are not loosing one part of your audience for the sake of another. It took time to fine the right balance, and feedback thus far seems to indicate we are in the right zone.

I have suggested a review in 6 months time when we have a sufficiently wide enough pool of feedback from our target audience to see if there are areas we can improve on. Unlike other commercial projects this is not about creating something that it fun and entertaining…it’s all about engagement and retention, and getting that message across in a sensitive, lucid and gentle manner. I was through out all too well aware of the emotional state of my viewers in dealing with such powerful and emotive subject.

UPDATE 

Very Excited!  Its now October 1st 2015 and I have been invited to present the toolkit at the prestigious Kings College to and audience of LD clinicians at the end of this month, in my terms we are really gaining traction at last and it finally feels real! 

During the pilot phase and after having recieved clinical sign off from the Brighton and Hove Councils LD team we have received nothing but great feedback from all directions including Professors of Learning disabilities,  Lead LD Nurses in the NHS, LD clinicians, WeLDNurses, Dr's, Universities, major charities and the well known voices in suicide prevention here and around the world. 

So after what started as a very personal challenge and a desire to give a little something back the feedback has done a lot to validate my thinking! phew:)  its always scary stepping into other peoples areas of expertise to present your vision for something armed with nothing but a vision and zero qualifications.

The current version is targeted is focused on the UK, there is an affordable option to "customise it so the voice over can be in a more local dialect, or targets a particular community, or even in another language. The same applies to the text and resources. 

We would love you to register your interest especially if you are NHS people (this will help us make the case for it to be made available nationwide). 
As many have observed the tool kit is also a unique way of facilitating important discussions about life events, feelings and fears its not just a public information tool. 

I will be posting some real world experiences of an NHS team in the coming months to show how its been deployed. 

If you want to start using the toolkit or want to know more about it you can contact me via Twitter @Chicustard ...don't ask but I will tell you one day:) 

Or drop me an email jon.bryant@btclick.com

Grassroots Suicide Prevention      http://www.prevent-suicide.org.uk
is the charity behind this, they have also produced an award winning suicide prevention app and one of our next goals is to seek funding to include the LD suicide prevention toolkit with that app.  

Jon Bryant    Creator and Director of the toolkit.

                                                                             Copyright Jon Bryant 2018

 

Building Staff Morale into the Finacial Equation

A common sense approach to bringing the true “value” of positive staff morale into financial planning, budgets & change management.

As far as I know pretty much everything in the NHS has a cost code, this information is then used to plan, manage and of course generate “charges” for treatments and procedures for accounting purposes. Thus management can see how their budgets are being deployed and identify areas where savings and improvements can be made.

Sounds perfectly sensible, or does it? So is there something missing from the equation, something not factored in to how budgets are calculated and managed that is actually creating unseen costs downstream?

If the above is the conventional wisdom lets challenge that for a moment drawing in part from my experience with internal comms, managing change and workforce development matters.

A friend of mine has had a very tough life, from childhood sexual abuse to time in prison for violent episodes, for him hospitals represent institution and authority, as he say he still never enters a room without first looking for his escape route.  

Against all his expectations and fears his experience when being assessed for a hip operation was an “epiphany”(his words)  and he was so moved he wrote to the hospital concerned to thank them, as everyone one he encountered from cleaner to consultant showed a kindness and compassion that was alien to him at the age of nearly 70.

This tells me that from a patients perspective interacting with what is clearly a very happy organisation has had a very positive outcome. It goes beyond just that visit, he is now far more likely go to the NHS with a problem rather than waiting till it becomes critical and needs expensive intervention.

Now reflect on what it is like working at Homerton who made him feel so at ease and where the caring nature clearly runs through every strata of the staff.

I know if it was me working in that atmosphere it would make me want to stay, to make best value of training when offered and my job satisfaction would be very sustaining.

If one continues this line of reasoning and you take a look at how hospitals perform, there is a very strong correlation between the morale of the workforce and hospitals that have “problems”.  Can anyone show me a hospital with high staff morale that has got itself in the news for the wrong reasons…I am pretty confident that if there are examples out there they - are isolated?

So in summary the up sides of a happy workforce where morale is high do have tangible and quantifiable benefits:

Less cost of recruitment as your workforce wants to stay.

Organisational memory is retained as a consequence.

Patient experience is improved with all the proven benefits to them

Happy teams look after each other, problem solve and collaborate.

The culture becomes far easier to manage when change happens.

In an open culture good ideas are given space to emerge.

If I wanted to make a change to how the NHS spends its valuable resources it would be to factor in the “value” of the benefits I have highlighted.

So how do you make that work within the existing framework?

I think the answer is simple, it’s not rocket science to work out the cost to the NHS of people leaving having received training plus the cost of recruitment. High staff turnover rates in a department means the core staff are constantly having to bridge the gap till the new person is up to speed. What does that cost in terms of efficiency and team morale?  

In the care sector, if a carer leaves after the first year the hard cost to the sector is said to be around £3,500! The figure for those leaving the Health sector would be considerably higher given the additional investment in training.

So that if you like is the business case, now how to integrate that in to the cost code model?

My solution is to award a financial value to staff morale, to think about it in financial terms.

So that actions taken that may enhance staff morale have a cost code with a positive value applied to it, which is included in the calculations.

If all plans that involve staff should be required to factor in the morale costs, so those with a negative value that were damaging to morale would be working with the true and real costs to the organisation, not in isolation on a project by project basis.

The approach means that financial planning has the human element inbuilt in to the accounting process, initiatives that have a high score on the “morale scale” factored in to the total budget are actually saving downstream costs that still have to be covered by another part of the business anyway, it’s all part of the same pot of money after all.

To engage staff in the process, who I believe would see this as an extremely positive step in their workplace by management; they could be asked to help put the value on the things that they feel are important in terms of staff morale.

I suspect it will vary very little from hospital to hospital, this is a people thing. After a year there would be an extensive data set from which one might be able to standardise the “morale/wellbeing cost code”.

To not factor in the positive and negative effects of staff morale is to bury ones head in the sand because the figures and evidence around retention and recruitment alone can show that these are hard costs to any Trust.

Compassion is another area that has a direct financial value to both care and health, I don't personally believe you can train people to be compassionate in any lasting way. It is very poor value for money.

You can however facilitate those with compassionate natures to the benefit of patients and the service overall, but you have to think a little different.

I would go further and say that the "common good heart found in compassionate people " is the glue of happy teams, the source of real job satisfaction. 

There has been a huge investment in training around "compassion" post Francis, such an insult to many for whom putting the patient first is instinctual.

It is possible to identify the people with the right stuff in them at the recruitment stage. I created a tool that was very good at measuring compassion http://tinyurl.com/bfp3qw3

Jon 

copyright Jon Bryant 2015