© PROMISE 2016 - All Rights Reserved | Em@il:promise@cpft.nhs.uk

PROMISE.global

PROactive Management of Integrated

Services & Environments

PROGRESS PROCESS PROMOTE PROTECT

Explore: More Light, Less Heat



The right question is like a spot light, lighting up a specific territory to explore. An appreciative enquiry approach is geared towards generating more light than heat. But given the sensitive nature of the exploration at hand, some heat is inevitable. This is not that bad an outcome but it does call for an approach akin to Heifitz adaptive leadership. In Crisis What Crisis, Irwin Turbitt has created an aide memoir to put Heifitz theory into practice. In the seven principles of leading adaptive work he highlights the need to ‘cook the conflict,’ by creating heat, sequencing and pacing the work and regulating distress.  However he acknowledges that this can only happen in a constructive way if there is an adequate holding environment, whether that be a physical space or space within relationships that are built on trust.



If the frontline is feeling run down, particularly in this current era of both internal and external scrutiny, trust can be in short supply. Any change process is bound to be met with skepticism, particularly if it involves monitoring and regular reporting like in the case of incidents of physical interventions with special emphasis on prone restraints. It is another thing that staff have to do and one can very easily fall into the culture of tick boxes. There is so much that staff do that is ‘Requiring’ i.e. ‘have tos’ that even activities which can be ‘Inspiring’ i.e. ‘want tos’ are not perceived as energizing and/or engaging. Powerful questions can generate reflective space but there will be a reluctance to engage if the frontline cannot frame the transformation journey as true a ‘want to’. Trust is a vital ingredient of any open and honest exploration particularly in a situation like this where staff have to take ownership of the change and overturn set custom and practice. If such trust can be gained one can get across why cooking the conflict between binaries like care and control can be energizing and has benefits for everyone.





























Figure 1: Marinating balance at work (Have Tos Vs Want Tos)



In order to build trust and bring things out into the open, the PROMISE team recommend using the framework of the Johari Window (Figure 2). Created in 1955 by American psychologists Joseph Luft and Harry Ingham it increases self-awareness and connection.












































Figure 2: the Johari Window


The two by two matrix gives rise to four areas:


1. Arena (Open Area): this quadrant represents knowledge that is out in the open e.g. patient care on a ward is being affected due to staff shortages, the leadership on the ward have documented it on their risk register and escalated it up to the next level who have authorised special measures to deal with the situation. A large arena is indicative of an organisation where there is trust. Staff are able to highlight issues without worrying about blame or retribution.


2. Facade (Hidden Area): this quadrant represents what an individual/team might be aware of but it is not known outside e.g. patient care on a ward is being affected by staff shortages, the ward leadership are aware of it but are anxious about escalating it to the next level as they feel worried about the spotlight being shone on their slow recruitment or poor retention of staff. The problem with the facade is that it works only up to a point, it invariably comes down and when it does, people lose trust leading to more scrutiny which then leads to further efforts to hide and mask emerging issues and problems. A large facade is indicative of an organisation with low trust and perhaps even a culture of blame and scapegoating.


3. Blind Spot (Blind Area): this quadrant represents what others outside can see but the team or the individual are not aware of e.g. due to staff shortages on a ward, the morale of the frontline staff is quite low which is manifesting as obstructive behaviour, this is apparent to everyone else that out of self-preservation staff on that ward are behaving in this way, but given how busy they are they have no reflective space to pick up how they are coming across to others.


4. Unknown: this quadrant contains all the knowledge, potential, and opportunities that are yet to come to light. The goal of any exploration is to make this as small as possible by bringing things out into the open arena.


How do we go about this?

The answer lies in setting up a virtuous cycle of self-disclosure and feedback through mirroring.

Self-Disclosure: Sharing information is at the heart of this phase. It goes without saying that one has to use their judgement and common sense as to what to share and how to go about it. Done in the right way others would mirror and disclose issues that they are struggling with as well. If the process continues it will lay the seeds of open honest conversation and make the facade smaller and the arena larger.


Feedback: Embedded in the disclosures is feedback for each other. If one takes on board the feedback they are receiving, it will set up a virtuous cycle of the other in the relationship genuinely listening and understanding and taking on board what is being told to them. Although the word is feedback it really should be ‘feed-forward’ as this process is feeding the future of the relationship and building trust by encouraging more self-disclosure. It is a fact that the one who is investing time and energy in giving feedback cares more about the person/team/relationship than ones who can’t be bothered. However, for parties to remain open to feedback it has to be done in a sensitive fashion so that defences are not triggered. If that happens then the blind spot will become smaller and it will bring things out into the arena.


Over a period of time the leadership and the frontline are able to develop trust as disclosure and feedback flow freely in both directions. This lays the ground for both self and shared discovery of opportunities that lie in the unknown. Within PROMISE the frontline have developed a number of tools, No Audit, Parity Promoter, Microslicing to name a few which when used in a trusted space challenges the status quo and moves the discourse forwards towards more humane services.


An effective exploratory discourse that challenges the status quo requires time and patience. They are key to building trust. Without trust one cannot facilitate open honest conversation and without that the hurdles and the opportunities that lie ahead will not come to light. Emergence from conflict into a new trusting reality involves developing the confidence to mirror self-disclosure and feedback within and across the leadership and the frontline. In order to ‘cook the conflict’ the right amount of heat is essential, not much will change if there is hardly any heat and too much heat will result in avoidance, disengagement and perhaps even rupture of the holding environment. Shining a light by framing powerful questions and providing a trusting space in which the right amount of heat can facilitate guided shared discovery are at the foundations of the PROMISE change process.