Entrepreneurial Queen's Nurse and innovator Heather Henry argues for a new system of community involvement.
In relation to working with communities, NHS organisations regularly put their left leg in – out – and shake it all about. How many of us have seen HAZ, SRB and the like come and go? Have we ourselves been guilty of building a close relationship only to get a new job, new project and move on? This is extremely damaging to residents’ relationships with health professionals. This blog is my attempt to tell you why and how we need to change our behaviour.
I was talking to a group of men in a community garden about my upcoming work supporting men’s wellbeing. After about half an hour of chatting, Stuart put his trowel down and fixed me with a firm smile. ‘Look, you seem like a nice lass,’ he said ‘…But we’ve seen people like you come and go. There was a lad from the PCT. We liked him a lot and we helped him with his project. Then we came to realise that what we were really doing was helping him tick his boxes and he didn’t really care about us. Then his project ended and we didn’t see him again.’
The primary care trust's (PCT’s) history with that community had left its mark, making it very tricky for others working in this hard-nosed, disadvantaged community. In effect the PCT’s action – and those of predecessor organisations - had compounded inequality locally.
In addition to ‘consultation fatigue’ and ‘projectitis’ we have added a new iatrogenic ailment, the ‘Hokey Cokey’. We get involved – often in a leadership role, we build relationships and expectations. Then the money ends, people move on, policy and priorities change and the community are left high and dry. And bitter. And wary of the next people to come along.
What I am suggesting therefore is that instead of putting our left leg in, we put our whole selves in and leave ourselves there. We in primary care are able to do this because of our unique position, often as primary care contractors, in it for the long haul as owners of our own businesses. Avoiding the Hokey Cokey requires the following:
When I was a student nurse I was taught, alongside orientating confused patients and using egg white and oxygen as a treatment for pressure sores, to keep a professional distance. When working with communities this is a major barrier. It goes far beyond ‘Hello my name is…’. I remember Helen Bevan teaching me about Marshall Ganz’s organizing principles. To engage people, we have to share our ‘story of self’ – who we are, what we stand for– before we can move on to ‘story of us’ -the issues we share that bind us - and eventually our ‘story of now’ – our ‘call to action’.
Keen readers of my past blogs will notice shades of this three-step formula in my writing. It’s deliberate. So to build relationships when engaging in community development we have to be authentic. Routinely I share parts of myself, my experience, my values, with residents. As long as your intentions are genuine, this also encourages reciprocity. We do this naturally in social interactions and this is what community and patient engagement is.
2. Going the extra mile
Standing outside a polling station after work, in the rain, to undertake an exit poll with residents about their views on their local community partnerships was a turning point in a somewhat ‘tricky’ relationship I had with one particular group of resident leaders. My engagement worker and I can be now seen brewing up, tidying up and even volunteering for community litter picks. If residents ask you to volunteer in this way, this is a test of your commitment.
Forget your job title and do not fail it – this is not outside your job description if it involves community engagement, believe me. Learn humility – delivering invitations to listening events door to door with residents is one of the most important things you can do in order to build relationships and trust. I have GPs, local authority and clinical commissioning group (CCG) leaders doing this in East Lincolnshire right now.
3. Always start with sustainability in mind
Sustainability means them not us. I might be the one up front on day one explaining why I am there, but two months later it has to be alongside residents as equal partners and by six months they are leading and I am helping them. After two years I am still answering the phone to them or visiting to see how they are doing.
4. Their priorities, not yours
Even very experienced community development workers fall into this trap. One day I was at the annual general meeting of a community partnership that was also celebrating its 10-year anniversary. All was going well until the community development worker, employed by an outside agency, was invited to speak about a new project. He wanted 13 people (a bakers dozen) to volunteer to do a cooking project.
We all looked at each other. Cooking was not a local priority and this request came out of the blue as an instruction from him. The whole atmosphere changed and they became polite but distant. This damaged his credibility and his relationships with these residents in an instant. Don’t be the one to do this.
5. Listening rather than always doing
As clinicians, we are excellent at listening when undertaking clinical work. Why is it then that I constantly see us speaking or doing and not listening to communities? A fellow nurse leader invited the CCG chair to a new community partnership. He immediately said ‘What do they want me to talk about?’ She said ‘Nothing, I just want you to be there and listen.’ He was extremely disconcerted by this and did not go. Another GP leader once said to me that we are afraid of what residents or patients will ask us for in case we cannot afford it. He added that we shouldn’t be, for often such requests are very modest and in fact they may tell us something important that we are unaware of. He was right.
At that very meeting residents told that GP about a vulnerable adult that had been passed around the system and could have suffered harm. Then he heard that the biggest priority for those residents was basic clothing and furniture. He chose to personally investigate the case of the vulnerable adult, promised to report back to them and to offer help to a local furniture project. Residents hold GPs, nurses, pharmacists and other primary care personnel in extremely high regard. They will respect you just for turning up and listening. If they think you are there to tick boxes or count their participation you are shutting the door on your greatest untapped asset.
Because THAT’S what it’s all about.
Heather Henry is the NHS Alliance National Executive lead for culture and behaviour and for inequalities
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