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PROactive Management of Integrated

Services & Environments


Engaging hearts and minds in a dialogue of appreciative enquiry and exploration is the first objective.  Leadership’s ability to empathise with the frontline will be mirrored by frontline staff’s willingness to open themselves up to the experiential journey of the patient. Co-producing a story that captivates the imagination of the workforce is central to gaining the initiative.

Envision involves enquiry and exploration with empathy.

Enquire:  what’s good and what could be better

Explore:  the contradictions at the heart of mental health

Empathy: help people imagine ‘what might be’

Enquire: Every health care organisation has areas of good practice they feel proud of. In fact every team, however stretched they might be, has something they do well and they would want to showcase as positive and proactive. Valuing ‘the best of what is’ is the key to unlocking ‘what might be.’ Showing genuine curiosity in what works and why can engage staff in a dialogue that initiates the improvement journey. This vital step of appreciating what’s good in the present and engaging staff in problem solving to eliminate reliance on force, helps avoids defensiveness. Staff truly believe they work in the best interest of patients. These beliefs may stem from years of training or practice, from the organisation’s ethos or from common-sense human responses to concerns about safety. If staff feel criticised the leadership will have to contend with beliefs like ‘we already do this’ or ‘you have no idea what goes on’. If this happens, the leadership is likely to respond in a more forceful way, thus and modelling the exact behaviour and power dynamics they are asking staff to eliminate. However, inquisitiveness about what’s good can break down the barriers and so easily lead to a conversation about how it could be better. It is our experience that if staff feel supported and understood they are the first ones to recognise the room for improvement. All improvements benefit both patients and staff.

Explore: There are fundamental contradictions at the heart of mental health: care and control; compassion and containment; risk and recovery. The dilemmas posed are not easy to navigate or reconcile. At PROMISE we have realised that to walk in each other’s shoes is perhaps the principal way to gain insight into the experiential journey of the other. However, when facing one’s own challenges, whether it be experiencing distress as a patient or overwork as a staff member, it is difficult to hear one’s inner voice or open oneself up to navigational guidance from the other. For staff to feel what patients are going through requires a reflective space with low stress levels. The same applies to patients who would otherwise struggle to see beyond their overwhelming distress. There is a time and place for experiential exploration. When we get this right we find that binary positions (e.g. being caring vs being controlling) fade and instead continuums emerge. Either-Or gets replaced by And.  We begin to realise that these supposed contradictions are two sides of the same coin. One does not exist without the other:  with the right care the patient will have more control; without risk there is no recovery.

Empathy: On the PROMISE journey we found the key ingredient of meaningful enquiry and exploration to be empathy. This is the quality that often initiates a career in mental health. Sometimes, though, perhaps due to overwhelming pressures in the job or years of working with people who are struggling to find hope, we may become desensitized to the distress or helplessness a patient often experiences when at the receiving end of a well-intended but coercive act.  There is no doubt that the ability to empathise is always there, it is there in every human being and more so in those who are working in mental health. Peers who have been on their own recovery journey are a valuable resource and have the ability to hold a mirror up to staff by sharing their own experience. Within PROMISE we realized that when the leadership makes a genuine effort to put themselves in the shoes of frontline staff, the efforts are mirrored by those staff who are then able to put themselves in the patient’s shoes. This can open up everyone’s imagination about what changes might be needed in order to completely eliminate reliance on force.

In PROMISE we found that appreciative enquiry and empathic exploration allow defences to break down, and staff who feel stuck in the reality of the present and the culture of the past can emerge energised into a future full of possibilities. It is necessary to engage leadership at every level in a dialogue about where we are, where we need to be and why we need to get there. Once the process has begun, co-producing a story that captures the imagination of all staff is vital. Some will be moved by emotion, others by logic and rationality. A tipping point comes and we have to seize the initiative and encourage leadership at all levels to engage more fully with colleagues and tell the story at every opportunity. By creating the overarching vision of what success would look like we allow the story to organically change without losing its essence, thus creating ownership and buy-in. If this goes well the frontline will come forward with a bank of ideas to be capitalised on.

 Envision: Insight to Ideas

PROCESS - Organizational Change Model