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/QWZVszeRhcs
As a leader of Neighbourhood development, you will know (or you soon will) that linear thinking and direct actions are inadequate on their own. They help to address specific problems, but processes that develop a positive sense of joy are also needed. As the Dalai Lama & Desmond Tutu said in The Book of Joy: “Joy is a by-product; the person who wakes up in the morning and grits their teeth saying ‘today I’m going to be happy’ is the person who misses the bus”. Joy, like trusted relationships, happiness, health, fun, love, are co-created, not given. They are good markers of progress – like the jumping salmon is a marker of the health of Canadian rivers – but policy must create the conditions that make that salmon want to jump.
Effective Neighbourhoods use cycles of collaborative learning and coordinated action to motivate participants to make positive changes about shared concerns. In these, people with different perspectives share experiences, contribute to shared projects, and witness the positive effects of their collaborations. Then, joy, trust, caring communities have a chance to develop…. as ‘by-products’.
Neighbourhoods need a vision for Primary Health Care (PHC). Not primary medical care, but PHC as envisaged in the 1978 Alma Ata Declaration, approved by 134 countries. It says that Health is Everyone’s Business. As John Ashton & Howard Seymour put it: “… the New Public Health is an approach which brings together environmental change and personal preventive measures” (p21)… “Health promotion depends particularly on public participation” (p25). Medical services are needed, but so too are environments where joy and trust have a chance to develop.
Difficult situations can be good places to start, because people in them often want change, and are ready to contribute. But you must judge where it is best to start. Early wins help everyone to see that good things are happening, and be encouraged to do more. Having said that, rather than making a big splash in one place, it is often better to start a lot of small things in different places and encourage creative interaction between them – developing momentum for change throughout your Neighbourhood, and across boundaries.
Many methods help people to believe that system-wide change is possible, engage in it, and reduce fear that they are being too adventurous. My two books give examples – whole system events, backwards mapping, complex power diagrams, rapid appraisals, local multidisciplinary facilitation teams…. But methods are of little use on their own. They need to be used to facilitate long-term conversations and interlinked improvements – helping participants to coalesce around issues they care about, learn to appreciate others, think deeply about the issues, and act in concert to improve things.
This five-minute video of the Southall Initiative for Integrated Care – a 2009 initiative that developed an area of 80,000 – shows the powerful energy for change when this approach is used: www.youtube.com/watch?v=aM1nAAODa1E.
To help you sleep at night, develop these multidisciplinary teams around you:
- A planning and implementation team(s)
- A team(s) for your personal support
- A network of policy-makers to support you politically
- A database of people & projects that matter, and those you want to keep engaged
Like a gardener, you need to nurture new plants that may not flower for years, as well as those that are immediately beautiful for just one day. You may need to plant new trees – but more powerful is to position the trees so they cross-pollinate and develop themselves. And you need to fix broken things. You need to ensure that data appears at the right time to evidence success (or not), both to stimulate discussions about the future, and also to ensure that policy-makers, enthusiasts and various constituencies remain involved.
You need to engage key people early in the process, so they can get used to the approach, take their parts in timely ways, and see the need to ‘make haste slowly’ – so people have time to internalise what is happening and think for themselves. People often don’t trust things outside of their immediate vision; they want to see change more quickly than is realistic; they imagine that things happen from direct force. You must find ways to keep them engaged in this persistent, strategic, learning-oriented approach that may not be what they (think they) want to see.
So, when developing Neighbourhoods, routinely develop:
- Multidisciplinary Teams in most things
- Cycles of Collaborative Reflection & Coordinated Action in most things
- Senior Level Support
- Personal Support
- Long-Term Vision AND Short-Term Wins
- Principles of Action accepted by your key people
Make the processes and vision clear to everyone you are working with. It takes time for people to understand the process; they often need to see it work again and again before they stop thinking of success as a fluke, or ‘caused’ by one person.
Further Resources:
Dalai Lama and Desmond Tutu. The Book of Joy
John Ashton & Howard Seymour. The New Public Health
Paul Thomas. Integrating Primary Health Care – leading, managing, facilitating
Paul Thomas. Collaborating for Health
Southall Initiative for Integrated Care – www.youtube.com/watch?v=aM1nAAODa1E
