communities, rights and inclusion: a whole system approach ... · led social enterprises who worked...

Communities, Rights and Inclusion: a whole system

approach to developing culturally competent organizations

Dr Jon Bashford @JonBashford [email protected]

Communities, Rights and Inclusion - CORIIN

The innovative techniques used within CORIIN included:

•  using a maturity model for organisational self assessment against pre-defined standards for cultural competence;

•  development of service user and community led social enterprises who worked alongside healthcare staff in designing and delivering culturally competent services;

•  a comprehensive programme for developing skills and capacities for culturally competent leadership.

Communities, Rights and Inclusion

Measuring success:

•  improvements in patient experience - feedback as part of local and national surveys;

•  use of the self assessment tool to provide qualitative measures of developmental progress;

•  survey data on staff satisfaction and performance; and

•  improved data collection and analysis on equality – access, experience and outcomes from services.

Communities, Rights and Inclusion

•  The programme also demonstrated the business case for organisational cultural competence e.g. value for money was achieved through a unique and innovative approach to shared services for cultural competence and access across the local health economy including an integrated governance structure.

Leicestershire: In the heart of the UK

4 NHS Trusts: •  Leicestershire Partnership NHS Trust

(LPT) •  NHS Leicester City Primary Care

Trust (NHS LC PCT) •  University Hospitals Leicester NHS

Trust (UHL) •  NHS Leicestershire County and

Rutland Primary Care Trust (NHS LCR PCT)

Population – 1,000,000 Super diversity e.g. Leicester City BME population > 50%

LEADERSHIP AND GOVERNANCE

Integrated Strategy Governance CommiFee -‐ Leicestershire Partnership NHS Trust, University Hospitals Leicester NHS Trust, NHS Leicester City, Leicestershire & Rutland PCT; City & County Councils; SHA; GP’s

EQUALITY OBJECTIVES

ConsultaJon &Involvement

Transparency

INTEGRATED EQUALITY AND HUMAN RIGHTS STRATEGY

Community & voluntary sector

Service users and carers

Capability Evidence

Integrated Equality & Human Rights Team

Achievements §  Strategic objectives – revised

§  Governance enhanced – CRIC/IEHR SGC

§  Community engagement – Adhar, Akwaaba Ayeh, Savera, LGBT Centre, Action Deafness...

§  Service users and carers – involvement strategy

§  Delivering Race Equality – assessment framework

§  Social enterprises – Inspired, SISO, Aspiro, Art-tea

§  Personality Disorder Pathways

§  Clinical Trailblazer – shared care protocol

§  Integrated equality and human rights service

§  £1.2 million external investment

“...for a public enterprise to be judged worthwhile, it must pass a test beyond the mere demonstration that the value of its products exceeds the value of the resources used...it must explain why the enterprise should be public rather than private.”

(Moore, Mark H. 1995. Creating Public Value: strategic management in government p.42).

Emergent and senior leadership development

Mentoring for inclusion

Board development

•Trust Board development sessions on inclusion.

•A joint Trust Board development process that seeks to provide a leadership focus for inclusion a c r o s s t h e L e i c e s t e r s h i r e healthcare economy.

•A series of master classes involving emergent and senior leaders.

•Practical change initiatives developed across Trusts to embed learning and directly improve the developmental pathways for inclusion.

•A single framework of mentoring for inclusion that enables each Trust to evaluate effectiveness and outcomes from mentoring.

•Training on inclusion for senior and director level mentors.

•  The Board room: the strategy discussion -‐ how inclusion informs strategic thinking and planning.

•  From the Board room to the office: the management discussion -‐ how inclusion is implemented and managed.

•  From the office to the staff room: the water cooler discussion -‐ how staff groups informally interpret and make sense of inclusion.

•  From the staff room to the consul5ng room: the clinical discussion -‐ how service users are empowered to be involved in their care.

•  From the consul5ng room to the bus stop: the community discussion -‐ how local communiJes perceive the value of the organisaJon and their engagement with it.

IncLeaD – Inclusive leadership toolkit

IncLeaD – The Board room discussion

IncLeaD – Inclusive leadership toolkit

§  Traditional OD and change management models use the metaphor of the organic, open system adapting to its environment

§  Dialogic change models – while not opposing the view of organisations as open systems – are more concerned with the idiosyncratic nature of organisations as defined through their individual stories and narratives

§  This approach suggests caution in attempts to lift one change paradigm or model and transplant it in another organisation

Values based OD – dialogue v diagnosis

“...attempts to simply copy an innovation or change process from one system to another system, without thoughtful leadership adapting to local conditions, will usually result in unwanted outcomes”.

Bushe, G. R. and Marshak, R. J. (2009) Revisioning organization development: diagnostic and dialogic premises and patterns of practice. Journal of Applied Behavioral Science 45:3 , pp. 348-368


“Dialogic changes centre on the processes of social construction and systems of meaning-making with a view to changing mindsets rather than changing more concrete phenomena (e.g. behaviour, procedures or structures)”.

Todnem BY et al. JCM v11 No 1.1 – 6 , March 2011


“The real-time social negotiation of meaning associated with dialogic change offers a significant challenge to the manageability of processes of change management insofar as it involves ‘coordinating’ and ‘facilitating’ change conversations in the moment and on a largely improvised and unscripted basis rather than engaging in more established forms of planned change.”

Todnem BY et al. JCM v11 No 1.1 – 6 , March 2011


Poor equality monitoring

Not hearing complaints

Unwilling to discuss


“Whereas both Diagnostic and Dialogic OD are interested in changing actions and the consequences of those actions, their assumptions about how that happens differ. Dialogic OD doesn’t seek to change behavior directly, as Diagnostic OD does. Instead, Dialogic OD focuses on changing the frameworks that guide what people think and say.”

Bushe, G. R. and Marshak, R. J. (2009) Revisioning organization development: diagnostic and dialogic premises and patterns of practice. Journal of Applied Behavioral Science 45:3 , pp. 348-368


“The assumption is that people don’t so much resist change as they resist being changed

(Wheatley, 2006).”


Partnerships

Effectiveness

Communications

Quality

Reputation

Patient experience

Equality & Rights

Wellbeing

Membership Recovery & Inclusion

Community engagement

Safety Social inclusion

Performance

Service user & carer engagement

The field of discourse

“There does not appear to be a single area of mental health care in this country in which black and minority ethnic groups fare as well as, or better than, the majority white community. Both in terms of service experience and the outcome of service interventions, they fare much worse than people from the ethnic majority do”.

Inside Outside: Improving Mental Health Services for Black and Minority Ethnic Communities in England; (March 2003)

Race and mental health in the UK

§  People from Black and minority ethnic communities are more likely than the rest of the population to be poor

§  Members of Black and minority ethnic communities are 50% more likely to suffer from ill health than their white counterparts

§  Twice as likely to be unemployed §  Four to six times more likely to be

excluded from school than white pupils


§  Disproportionately represented

amongst those in medium/high security psychiatric care

§  Vulnerable to homelessness

§  Over-represented at every stage of the Criminal Justice System

§  Five-fold increase in Muslim prison population


Outcome and treatment: Odds of being sectioned at first contact

00.5

11.5

22.5

33.5

44.5

section risk

Caribbean menCaribbean womenAfricanWhite

Delivering Race equality – self assessment tool

§  It’s a process of self assessment – maturity model §  Questions that are designed to prompt more in

depth thinking about the collection and use of data

§  A means of getting different types of people – providers, commissioners, managers – working together on how best to use the information

§  A common framework by which reasonable assumptions about benchmarks can be worked out for local and regional performance assessment

§  A learning tool – not intended to give all the answers, its about being a critical friend, walking people through

Five levels: Level 1: Data collection

Level 2: Analysis

Level 3: Reporting

Level 4: Performance Management

Level 5: Strategy


…across 4 functional areas •  Information Management

•  Clinicians

•  Commissioners & Planners

•  Leadership, Boards – local & regional


Information Management –  addressed at corporate level –  how feed into internal conversations e.g.

•  board reports; •  clinical team meetings; •  quality & performance review; •  regulations & standards - inspection •  legal duties – equality and human rights


Clinicians –  addressed at frontline staff & clinicians

•  Adults; •  Learning disability; •  Children and Adolescents Mental Health •  Older people •  Specialist services


Commissioners & planners –  addressed at those who need to be

directing and framing services through commissioning and planning;

–  how to use evidence to map progress in Quality and performance systems


Leadership, Boards – local and regional –  look at the issues for leadership in terms of

how Boards should seek to use the assessment e.g. what it means for:

•  Strategy and vision; •  Business planning; •  Public engagement and accountability; •  Quality


A: Information management Level 5 – Strategy

A29: Is there a locally agreed information collection management plan for DRE agreed with commissioners, partners and local stakeholders including BME groups, service users and carers?

A30: Do Board reports provide analysis of information that enables the Board to set strategic priorities?

A31: Do Board reports use performance monitoring to enable recommendations on strategic priorities?

A32: Are reports provided to stakeholders that enable meaningful participation on setting strategic priorities?

A33: Are local BME groups, service users and carers involved in setting strategy?

Partnerships

Effectiveness

Communications

Quality

Reputation

Patient experience

Equality & Rights

Wellbeing

Membership Recovery & Inclusion

Community engagement

Safety Social inclusion

Performance

Service user & carer engagement

The field of discourse

Hard-boiled eggs and nuts

ˆ  ‘Hard boiled eggs & nuts’ he said. I looked straight at him & he said it again. Then slowly something began to coalesce in my mind. A spark of recognition. I began to smile & then we shouted ‘Hard boiled eggs & nuts!’  #

ˆ  I started to laugh & kept laughing for what seemed like ages. It was something I hadn’t done for months, I had forgotten how to. #

ˆ  I don’t think that recovery is not hearing voices, starting full time work, or walking around with a permanent smile on your face. Recovery means different things  to different people."

Safe Inside-Safe Outside Toolkit:

§  Developed, led and delivered by users of mental health services §  Focuses on the relationship between positive

mental wellbeing, a safe, inclusive community and the relationship in making the ‘Recovery Journey’ a reality.

§  A Measurable Self Management tool to take control over illness

§  Uses creativity as a means of communication & self expression

Safe Inside-Safe Outside Toolkit:

§  Provides holistic/psychological resources & techniques to increase confidence & self-esteem to challenge stigma, celebrate diversity and increase opportunity

§  Considers the importance of housing and the impact of issues such as Anti-social behaviour & fractured communities as factors in negative mental wellbeing, providing interventions and solutions

§  Increases community engagement and opportunities e.g. being part of and getting the best out of community life; Employment, Education and skills development

• Space for acJviJes to support SISO toolkit • OpJon for community cafe • Library of resources including SISO toolkit • Sensory room • Befriending scheme • Advice clinics • Counselling services

•  House/ shop front in local community providing capacity for drop-‐in and shared acJviJes and bedroom space. •  Offers dayJme or overnight respite as an alternaJve to hospital admission with an opJon for staff sleep-‐in •  Also offers respite from difficulJes in local community being experienced by individuals through a supporJve community, opportuniJes to catch up on sleep and SISO resources and networks. •  Users of mental health services taking control to drive improvements for individuals and both SISO and wider communiJes.

SISO Social Enterprise BoardDirectors = Service Users / Experts by Experience

•  Focus on building community resilience/ safer communiJes. •  Paid project management to lead on developing responses to tackling abuse, harassment, ASB etc in local community. •  Strong links to housing bodies and local authoriJes. •  Provides representaJon on local strategic partnerships and other statutory boards around community safety issues. •  Links to iniJaJves such as Coast to Coast. • Links most closely to Home Office and Department for CommuniJes and Local Government agendas.

•  Focus on individual resilience and Recovery model of posiJve mental health. •  Paid project management to focus on conJnuing development and markeJng of SISO toolkit and associated training. •  Links most closely to Department of Health agenda, including social enterprise.

RecoverySafetyRelationships Empowerment

Information

PartnershipCommunity

Individual Participation

Inclusion Communities of influence

Culture

Service users

Carers

Staff

Partners

Public

Communities

‘Wellbeing’Trust

Communities, Rights and Inclusion - A holistic approach

communities, rights and inclusion: a whole system approach ... · led social enterprises who worked...

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