IMPLEMENTING RECOVERY THROUGH ORGANISATIONAL CHANGE.

Transcription

1 VICKY McCULLOCH IMPLEMENTING RECOVERY THROUGH ORGANISATIONAL CHANGE. TRANSCRIPT OF NOTES TAKEN AT ImROC LEARNING EVENT, THURSDAY 23 rd MAY 2013, LONDON. People who attended from Worcestershire Health and Care NHS Trust were: Derek Hammond, Janie Greville, Oliver Orr and Vicky McCulloch. SOME USEFUL INFORMATION: Find ImROC on Twitter, at: #imroc Powerpoint slides will be available afterwards.* ImROC has some publications already; more will follow.* *I think these must all be available online. ImROC website: PERSONAL PERSPECTIVES OF PEOPLE FROM ImROC: Phil Morgan: My brother had severe learning disabilities and I had an appreciation of social justice, etc. from childhood. Recovery is not just about mental health. From forensic to general psychiatry, in Dorset. Embed recovery in thinking, if not yet in doing....to transform the experience. Clinical recovery>>> move to personal recovery framework. Fiona Large: We are all human, with life experience. I saw a Mind ad. for a job in a free local paper. Working to raise awareness of mental health in the community. For this job, mental health lived experience was VALUED. Talked about Recovery Colleges and Time-to-Change campaign. About people telling their story and people listening with empathy. Fiona has lived, witnessed and enabled. Glenn Roberts, ImROC Consultant: 1

2 Person-centred. Psychiatry 33 yrs., 23 yrs. consultant in Devon: 15 yrs. working in recovery. I know what it is like to feel suicidal, etc. Personal experience of mental health problems: people as fellow travellers. I disclosed my history of mental health problems in my job application and I got the job. (So many employers look at the gaps in your CV when you are recovering, and they view them as negative). My employer saw my personal experience as a qualification for the job. People detained, read their consultant s personal experience in a publication, and it broke down the barriers. Glenn listed all of the things going on, to do with recovery, within his organisation, but said, Still, there was no organisation-wide strategy (for recovery). Then, ImROC Phase 1>>> and they ratified or endorsed their strategy following on from this (in Jan 2013). There are still struggles/ frustration on the ground % of time of the organisation is towards trying to get Foundation Trust status... We live in hope... We have a half-time paid worker now. The Implementation Group is working at present, Recovery Learning Community starts in June LEARNING FROM ImROC 1: CONTINUING THE JOURNEY ACHIEVEMENTS AND CHALLENGES: (Glenn Roberts) N.B. See ImROC Document: Continuing the Journey. Develop staff and organisational capabilities. LESSONS: 1) Everyone is different. 2) Change is possible. 3) Training is not enough (i.e. changes for practitioners need support: supervision and leadership). 4) Leadership is critical, but always pleural. 5) Risk is a pivotal issue. 6) The most powerful driver for change within the NHS workforce is the inclusion of appropriately trained and supported people with lived experience in staff positions 7) Two specific service developments have led in offering such roles: a) Recovery Colleges; and b) Peer support workers. 8) Progress will be greatly enhanced by evaluation of individual outcomes: 2

3 -Recovery outcome measures. ImROC 1 funded by DOH. Rt. Hon. Norman Lamb, MP (Care and Support Minister), 14/2/13, talked about: More choice, More focus on self-management, Spread the concept of Expert Patient far wider. After Phase 1, DOH will electively endorse ImROC products (ImROC is a charity). ImROC publications: By people working on the ground, therefore written around practicalities etc., i.e. not just theory. DISCUSSION: Continuing YOUR Journey: What have we done with previous learning/ our achievements since last time? What does it mean to me/ us to be members of ImROC 2? What are our hopes and ambitions for making the most of this opportunity going forwards? HACW: Discussion, then Derek Hammond gave feedback: Recovery College up and running; Money to train our Peer Support Workers (2 full-time posts); Recruitment in progress; Statement on Positive Risk Taking- Guidance- ratified by the Trust (and work in progress); Chief Executive is Big Recovery Champion on the Trust Board; Co- delivery of staff training courses, i.e. involve service users in giving the training, as well as clinicians). St. Andrew s Healthcare (shared our table) (Sam Tema was the representative): Recovery Centre, working now; Secure, therefore outreach onto the wards; Work placements 10 weeks: Clinical/ Non-clinical: over- subscribed; Service users help with staff training. Courses are co-delivered/ co-attended, or just for service users or staff. Ex- service users>>> sessional trainers. 3

4 RESOURCES IN DEVELOPMENT: ImROC MEMBERS WEBSITE (Alexander Rushton) (Alex works for Mental Health Network Communications) Log in, and you will find: 1) DASHBOARD: Here s what s been going on : events/ resources. 2) FORUMS: Start discussions. E.g. you can share your Recovery College Prospectus. 3) RESOURCES: You can upload to the Members Library. 4) MEMBERS: Site profile. Personal profiles (You can edit these). It is interactive>>> Create a community. 5) ANNOUNCEMENTS; 6) EVENTS. At the end of next week, you will receive s, inviting you to log in. MODELS OF CHANGE: HOW DO WE PUT PRINCIPLES INTO PRACTICE? (Fiona and Phil of ImROC) Fiona said, It is good to see your enthusiasm and how far each organisation has come. Do one tiny thing and there is a ripple effect: people will notice it. Fiona has seen this in staff training. Phil said: Hope is great, if you ve got it. Hang on in there. Validate perspective and empower to action. Fiona: When someone speaks of distress, you have an impulse to change, but you can choose not to do anything. Parallels of individual/ organisational change. We are all CHANGE AGENTS. Slide: The change acceptance cycle: (Losses>>> shock, disbelief, disorientation, then denial, dismissal, etc.). >>> Hope and Acceptance and Commitment>>> New Ways. Give models of change to understand. Help to THINK, rather than just FEEL. Process of Recovery: 4

5 LISTEN to staff experience/ service user experience. A parallel process: a) Individual; b) Team; c) Organisational. Take small steps, that you have some control over, that can make a difference. a, b, or c: Where are they in the cycle of change? Another slide: The stages of recovery: Moratorium, Awareness, Preparation, Rebuilding, Growth. Anguish, awakening, Insight, Action Plan, Determined commitment to be well. (Recovery Advisory Group, Recovery Model). Arrows link them in both directions. --From Ralph and Corrigan, Fiona: Change your identity, but slowly: support people through that change. Phil: Remain connected to where we have come from. How do we pace our change? New ideas/ practices EVOLVE. Learning/ testing... Learn from things that have gone wrong. Change Agents and the Role of Recovery Education: Seek inspiration; Persistence; Resilience; Seek support; Be tactical: marketing strategy. Glenn: Be irritating!!: because change is difficult. 5

6 Reflect and learn; Be subversive: If we re not annoying people, we are getting it wrong. (disruption and chaos needed); Able to recognise and celebrate success. Glenn: Change on average takes 10 years!! Crisis and Urgency. Phil: Small steps, gathering momentum. WHAT WORKED FOR YOU? WHAT......TO ACTION? PLANNING FOR THE YEAR AHEAD: Choices for Learning Sets : (I am not sure in which order they will happen). 1) Developing a recovery competent workforce, including supporting staff in their recovery journeys; and establishing peer support workers in different settings. 2) Developing a recovery focussed approach to risk assessment and management (safety planning). 3) How do we know how we are doing?: outcome and evaluation. Move from A project, to THE project, within the organisation. CO-PRODUCTION AS A FOUNDATION FOR RECOVERY ORIENTED PRACTICE AND SERVICES: (Phil Morgan) A definition of co-production was given (Boyle and Harris, 2010). DISCUSSION: What is our Local Experience? (For this discussion, everyone moved places, to mix people from all of the different organisations at each table). What Have we Found Helps? (Feedback was recorded on a flipchart; ImROC will type it up). A balance of service users and professionals; Making it appealing and involved from the outset; Skills and confidence to co-produce; Shift in power, facilitation; Clinical and lived experience; 6

7 Lived expertise: peer roles; Skilling people up; Recovery expectant community; Job Centre Plus, friends, family, colleges;... service users and carers; Staff bringing their lived experience rather than just a clinical role; Critical mass: tipping point (query meaning of this); Honest listening; Accountability, etc; We have a risk averse culture. FEATURES OF SUCCESSFUL CO-PRODUCTION: (Phil Morgan) Recognising people as assets; Building on people s existing capabilities; Mutuality and reciprocity; Peer support networks; Breaking down barriers; Facilitating rather than delivering. CO-PRODUCTION: What Have We Found Hinders? (Challenges of Co-Production): 1) Changing the way services are developed: Mapping assets and resources as well as problems and needs. Working with people who... (slide gone!!) 2) Changing the way services are delivered, with peer support, etc. Etc. 3) Changing the way professionals work. Sources: from recommended reading: 1) Alba Realpe and Prof. Louise M. Wallace: What is Co-production? (The Health Foundation, on behalf of the Coventry University Co-creating Health Evaluation Team). 2) The New Economics Foundation: In This Together: Building Knowledge about Coproduction. CO-PRODUCTION: (Fiona Large) Recovery College: Preparation for peers each other. Prepare clinicians/ professionals, i.e. prepare both sides, complement 7

8 Students want to speak to a peer, which makes the clinicians uncomfortable, therefore need to show clinicians that they are still valued, will help the process. Students go to peers for empathy, and to clinicians for technical info. They (clinicians) need to feel that they are making a contribution. There are challenges on both sides, i.e: some people have their identity as a service user, so it is a challenge, to become a peer. In discussions, someone said: Skills are recognised: lived experience To work within (?)the NHS, because this is what I know. Someone else said: CPA: Operational Guidance for staff, how to write it. We re-wrote it, Operational Guidance for service users. --Implement it in a co-productive way, but must word it to make it less boring and therefore to improve uptake. (Glenn Roberts) Enabling, hospitable environment. Change the culture. The Autumn Festival of Recovery and Wellbeing, Devon 2011: Event was co-designed, co-produced, etc. 50/50 service users/ professionals attended. Demonstrated co-production at the level of organisations, or communities. This event was inspirational and an opportunity to try something new. Co-production at a service and organisational level. Interesting reading: Last week s BMJ Editorial: Let the Patient Revolution Begin. 2013;346: What is next for you? Are there steps you d like to take in embedding co-production in your recovery developments? AND FINALLY, Glenn Roberts said, ImROC to be supportive of us as we do what we need to do. 8

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