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PROactive Management of Integrated

Services & Environments


Recovery_Stories_book2_Feb 2014.pdf

Impetus for the PROMISE journey emanates from the key insights. As laid out in this article understanding continuums gives one the confidence to move away from a paradigm of success and failure and take the risks to make the small changes which are the seeds of innovation. When these innovations are shared, celebrated and incorporated into systems of care, we create recovery pathways. Actions speak louder than words, and for frontline staff to see their change ideas making a difference inculcates not just fulfilment but creates an ethos of leadership at all levels. Nurturing creativity is the essence of creating the workforce of tomorrow, the pathfinders who will continue to redefine the frontiers of humane care.

Power to Empower lies Beyond Binaries

There is a fundamental contradiction at the heart of mental health services between care and control, risk and recovery. On our PROMISE journey we have grappled with our understanding of these binary dilemmas. In this brief article we share our evolving insights that might help organizations who are setting out on this journey.

Board briefing

Compassion is not a binary position. Most staff engaged in using coercive practices believe that they are acting in the patient’s best interest and what they believe is kind compassionate care.

Painting the picture which conveys the case for change is a tightrope between staff feeling they have a role to play and feeling criticised. Engaging defensive staff could be challenging, especially if it is over what they thought was an act of compassion.

To change culture one needs to somehow get frontline staff to own and lead the change process and open themselves up to the experiential journey of patients.

Need to know:

One cannot pull a lever and make this happen, but they can set the tone and act as catalyst by creating the environment in which staff feel safe and supported to take positive and proactive risks.

Frontline insight

Force is a continuum not a binary position. Every interaction is an opportunity to rely more on the power of human relationship and less on the one that stems from professional authority or organizational policies and procedures.

Each act of use of force even in the patient’s best interest is preceded by many lost opportunities to pre-empt and diffuse situations.

Problem patients are patients amidst problems, positive and proactive care targets problems unlike the use of force where the patient invariably ends up feeling targeted.

Need to know:

There is a belief that use of force is a part of the job but it spoils the job, the reality is there is always a choice and when supported by the leadership these positive and proactive choices can provide fulfilment in ones daily work.

Patient’s journey

Recovery is not a binary position, it is a journey, and every interaction is an opportunity to take the next step towards life beyond illness even when symptoms persist.

Understanding ones mental health challenges and taking the initiative is a key part of staying well and avoiding being at the receiving end of any well intentioned coercive practice.

Situations that warrant help to be enforced are often preceded by many lost opportunities. One can ask for help and in the process alert staff to capitalise on the opportunities to pre-empt and diffuse a situation that might otherwise be overlooked.

Need to know:

If one does not ask for help, help is often enforced by friends, family or professionals. Making positive and proactive choices puts one in the driving seat and engenders self-belief, agency and hope.

Power to Empower

Power is not a binary position, the contours of the landscape dictate how it ebbs and flows. Power-play occurs in every relationship, whether it be in the one between the board and the frontline of an organization or within the patient professional duo. Leaders often believe that power flows from their positional advantage, but leaders are only powerful if followers follow. When it comes to power related cultural change and changing the nature of day to day interactions at the frontline, leadership have to be aware of the need to role model and live the change they are proposing. Dictating from the top is a futile exercise, as the balance of power lies in the accumulated inertia of what we call culture. The goal has to be to win hearts and minds so the frontline feel empowered to take the initiative and take ownership of the organizational journey.

If such power is invested in the frontline they then will have the influence and attributes to empower patients. Traditionally, in the patient professional relationship, the one with the clinical experience and theoretical knowledge holds all the aces, i.e. the professional. The patient’s experiential knowledge is often undervalued and sometimes disregarded. When power is skewed in this fashion it can result in patients trying to assert themselves in an unhelpful way, as they inherently feel ‘done unto’. These power struggles which often play out in the form of coercive practice stemming from professional concern for the patient, can so easily be avoided by ‘doing with’ rather than ‘doing to’. In order to work together and come to a consensus, professionals need to be able to see things from the patient’s perspective i.e. understand their values and priorities, attitudes to illness and risk. If knowledge gives rise to power, then surely an increase in the available knowledge bank will increase the power to improve outcomes. Since hope, agency and self-belief are such vital ingredients of recovery this approach of combining power is not summative but multiplicative. Unfortunately the cultural inertia in this relationship is such that either the professional unconsciously takes a paternalist role or the patient a subservient one. The opportunities lost from not utilising the combined power that lies in a partnership are immense. There is a strong case for the frontline to redress this balance by transferring the power they have inherited from the top, thus empowering patients to identify their values, needs and goals. How to do so is the question and in PROMISE therein lies the answer.


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