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Wednesday, 18 July 2012

Listening to learn and deliver


Listening to clients/customers/patients is fundamental for developing the right products and services. I am still amazed that something so simple and effective is often skimped or ignored. Yesterday I listened as a worker vented her frustration that a potentially valuable pilot scheme was being undermined before it started because client involvement was being squeezed out.

Today Louise Casey published her report on 'Troubled Families'.  It reminded me of work I undertook in 2010/11 in a Metropolitan Borough. That work was concerned with re-designing services for families with complex needs. 

We started by listening to fourteen families whose lives had moved successfully from chaos to stability. We asked them to tell us about what had happened and what they thought had made the difference.

Listening is so powerful and so revealing. People's stories can reveal what needs to happen to make real change possible. The experiences, analysis and ideas reveal aspects of an issue that even the most experienced workers might never spot. Interventions based on what is revealed increase the chances of future success.

Listening to paid staff, especially frontline staff, is equally important. We followed on from listening to families, by listening to frontline staff and their managers. Pasted below is a summary of the learning that emerged from that listening.

Three ingredients for success – The families’ stories and experiences revealed a clear pattern for success in helping families to move from vulnerability to stability.

This happens when an identified worker:

-       Treats the parent as a full partner by drawing on their strengths and experiences and building a trusting relationship;
-       Ensures that the immediate needs (identified by the parent) are met, drawing in the help of other agencies where necessary;
-       Ensures that the parent has the opportunity to learn about tools and strategies that will enable parents to cope with their lives.


‘ (The intervention) leaves people with plans and feeling in control. I have the tools to do it myself. It has created a feeling of being more in control.’ (Parent)

The right relationships‘She talked to me like a real person’. (Parent)
‘She kept me on the straight and narrow. She told me when I was doing well.’(Parent)
‘The nurse remembered what I had said. She’d read the notes’. (Parent)

Seeing the family as a whole - Both families and staff understand that in order to do the best for children, it is vital to see the family as a whole and pay attention to all the factors that affect it. ‘We never rescue the mother ’ said by a senior manager as she described the repeated damaging behaviour of some mothers.

The following were identified as important:

-       Building trust between parents and workers.
-       Developing a culture that sees family support as being a good and natural thing to access. Several parents commented that often parents do not like to admit that they need some help. Typical parent remarks: ‘He is my son, I should be doing this’. ‘You don’t want to feel you are pestering’. ‘ I was afraid they would take kids away, it stopped me getting help earlier.’
-       Empowering families to make their own decisions.
-       The worker being free to offer enough time at the right time to build the right relationships and respond to issues.

The right practical help – ‘I needed practical things doing and she did them’.
       ‘She gave me practical help with debts. When I have been down she has helped me sort things out’.
       ‘She acted like a sort of research assistant, information and help that she could find out about away from the house.’

This is both powerful in terms of building trusting relationships, particularly where the worker in the first instance responded to what the parent thought was needed. One of the staff focus groups suggested that a ‘joined up’ pot from all agencies’ could be created for this purpose of giving practical help (e.g. childcare and transport). They made the point that the ability to help needed to be immediate and not involve a long drawn out process.

The right time I just got letters from school. They didn’t know him. He started missing school when it was English. I tried to get him tested for dyslexia. Even with (the intervention), it was still a fight at the end.’ (Parent)

Offer help sooner by having lower thresholds to allow earlier intervention. Improve the ability to have an early identification of families that might have problems in the future. Provide preventative work that is client-led. ‘

Taking a positive approach to build resilience – ‘I have always worked, gone to college. I have got a place at Uni. I want to show people.’ (Parent)

Build on and build up the strengths of families with the clear aim of strengthening resilience in families by: developing a family’s own idea of their existing strengths; praising and encouraging positive change; empowering families to do things for themselves

Having a leadership that learns and liberates – The interviews and focus groups demonstrated just how much knowledge, skills, experience ad ideas for improvement lies with families, frontline workers and their managers. There is a huge opportunity to build a flexible, responsive, cost-effective service by drawing on that. The expressed desire was:
-       for a leadership that has a clear authority;
-       builds strategy and policy from families and staff experience and knowledge;
-       notices and rolls out what works;
-       gains the commitment of all services;
-       is able to rationalises interagency working;
-       ensures permanent services that leave fewer gaps. 

The Power of One – From the emerging practice of the lead practitioner, staff and families felt that this could be taken further to included:
- one assessment;
- one strategic plan - achievable outcomes for all and no random acts of intervention;
- one worker - lead practitioner who is accessing services from any agency/sector (anybody);
- one email -that can trigger response from all agencies when needed.

The Power of Many – At the neighbourhood level:

- staff based together wherever possible;
- opportunities for networking to strengthen multi-agency working;
- more support and flexibility from ancillary services e.g. transport /   housing;
- involving children, young people and families in deciding how services should be delivered.

Communicating what services can offer to families and listening to them, honouring their strengths and experiences.

Simpler and smarter bureaucracy – see the Power of One.

Building up a ‘can do’ staff whose skills are valued and respected. Enabling structures that give permission to act, support flexibility and working creatively and provide the right support and training.

The right services  - services that are in the right place, at the right time. Features include:
 holistic drop-in services,
- daily face to face contact,
- one to one,
- group work and
- self help.

Services that are family focused rather than service focused; are proactive rather than reactive; and allow creative and innovative approaches eg 3rd sector approaches. This would include services available at the very local level, with out of hours and some 24/7 cover

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