Developing neighbourhoods – principles of action
When developing a Neighbourhood, more important than knowing a lot of theory is to understand principles of Community-Oriented Integrated Practice, then follow your instincts to apply them in ways that fit your specific situation. Principles arise from the ideas that: a) What We See and Do are Snapshots of Stories-in-Evolution; b) Health is whatever helps to Take Good Steps in Life’s Journeys; c) Change is a process of Incremental Transformations, helped by Repeated Opportunities for people to Positively Interact, Co-Develop good things and See the Effects of their work. Principles include developing things like:
- Shared developmental spaces – where participants co-create shared projects, repeatedly moving their minds between thinking about whole systems and focused detail – between long-term journeys & next steps.
- Multidisciplinary teams – that develop trust and understanding so they are together more than the sum of their parts.
- Continuity of care that empowers people and teams – especially those with multiple, difficult or complex things to deal with; and those who care for them.
- Leadership that motivates – work with motivated people & those who feel that they are failing but want to succeed; develop shared projects that motivate participants; use success to stimulate motivation in other places.
- Cycles of collaborative reflection and coordinated action – that help participants to feel confident to engage with the constantly evolving nature of life (as everything changes in response to changes in everything else).
- Learning sets that help people to reflect on their experiences and become more competent and connected with others.
- Comparative data – that show something of the overall effect of collaborative actions (e.g. within a Neighbourhood).
In a previous blog I argued that homes where Carers live are good places to learn how to apply these principles. The home can be a shared developmental space where multidisciplinary teams of GPs, Nurses, Social Workers and others provide continuity of care and leadership that motivates all to take part in cycles of collaborative reflection and coordinated action, to help the household to be a happy place. At the same time, learning sets help Carers to fulfil their roles with confidence. Data can show the combined efforts of everyone involved.
It helps to know some theory – 1) To feel that you are on the right track, 2) To have options of what to do next, 3) To find soulmates, and 4) To reassure others that you know what you are doing (or at least enough for now!). When I became a primary care facilitator in Liverpool, I attended a course on Adult Learning – it helped enormously. But soon I found that trying things out, bouncing ideas of others, feedback and reading helped me more.
My two books describe much of what I have learned about developing organisations, systems, localities. Many resources helped me to think and act confidently – for example, King’s Fund’s Working Whole Systems; Bunker & Alban’s Large Group Interventions; Hope, Timmel & Hodze’s Training for Transformation; Geoff Meads’ Primary Care in the Twenty-First Century – an international perspective. You/I/we should use such resources as ‘food-for-thought’, NOT models to be blindly followed.
Friends, teams and especially experience, helped me to plan and develop confidence in myself. Again and again I saw the value of cycles of collaborative reflection & coordinated action – repeated opportunities for people to learn from and with others and agree complementary actions for change. It is a form of participatory democracy – a sequence of workshops (meetings) help participants to understand each other’s perspectives about something that concerns them all. Role play and small group-large group iterations helped to get ‘into the skin’ of others and co-develop shared vision, shared projects and complementary actions for the next stage. Repeating this again and again helps participants to modify their own ways of thinking and behaving. It feels like being alive.
Many traditions describe how to think and act in this learning-oriented way. For example, Senge, and Argyris & Schon describe organisational learning and reflective practice. The Brazilian philosopher and educationalist, Paulo Freire, explains the thinking well – he argued that people learn more from reflecting on their experiences and acting on their conclusions (‘praxis’), than they do from words alone (e.g. theories), however profound. Nevertheless, words and theories can reassure and challenge. Theory and experience are both needed.
Freire’s thinking makes sense to me because Words and Experience are different things. Words are symbols, metaphors, tokens. We use them to communicate something about our experiences; but they are NOT experience itself. Some experiences obviously translate poorly into words – Love, Grief, Meaning and Joy, for example. But even everyday objects mean different things in different contexts. Everyone needs to be aware of the limitations of words and the importance of experience to make words meaningful.
Courses can help you, as a Neighbourhood leader, to get started and learn some methods. But, practical experience, whether course assignments or life itself, are needed to ‘get inside the skin’ of the people you are working with. Trusted friends who listen and give thoughtful feedback are important. So is listening to what others have to say – MAKE SURE that they know that you are listening.
Further Resources
Paul Thomas. Integrating Primary Health Care – Leading, Managing, Facilitating, Paul Thomas. Collaborating for Health. Paulo Freire. Pedagogy of the Oppressed
PCC provides support to neighbourhoods using an action learning set approach to support collaborative reflection, planning, empowering and transferring capability to local leaders for the future. Contact enquiries@pcc-cic.org.uk to find out more.
Paul Thomas, in collaboration with the Journal of Holistic Healthcare & Primary Care Commissioning
This blog can be seen as a video podcast at https://youtu.be/nhxZSiHwjGE