Facing Death

My friend, Lucy Watts, is dying. She knows that her beautiful life will be cut short by the condition which she lives with. Death is something we often find hard to talk about, but it is one thing we can be certain of. How do you feel about death? What are your hopes and fears? Have you thought about what would happen to those around you if you died quite suddenly and unexpectedly? Or if you are facing death yourself, in a very real way, have you thought about your wishes, in terms of care, where you might like to die, and what would be important to you about your funeral? Have you instructed a Power of Attorney? Do they know what you would and wouldn’t want? These are certainly not easy conversations to have, but I am so grateful to Lucy for telling her story and how it has given her the determination to really live:

 

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Creating a Culture of Joy – some practical ideas!

I am hugely passionate about how we create great cultures in which to live and work. One particular thing I love is building a culture of joy! My friends Rachel Pilling and Dan Wadsworth have come up with a super easy way in which to practically build joy in work, through this simple but excellent idea of 15-30. This is the magic that happens when clinicians and managers work together. Watch it, if you work in the NHS then sign up and get involved and if you work outside the NHS – the idea is entirely replicable in any other part of life. By you going the extra mile now, you could save your friend a marathon….Building joy in work is, according to the IHI, the most important foundation on which to build a safe, sustainable and excellent health and care system. With staff morale as low as it is, let’s do what we can to promote joy in the daily grind. Here are Dan and Rachel explaining more in their excellent TEDxNHS talk – well worth your time!:

 

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Living with Trauma – The Realities of PTSD

I’ve written a number of times on this blog about the impact of Adverse Childhood Experiences. However, trauma can happen to us at any stage of our lives and its impact can be absolutely terrifying and profound. Here, my friend Charlie Webster (who some of you will recognise from various sports commentary with the BBC) tells her story to shed light on the realities of PTSD and what can help. I’m grateful for her bravery:

 

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Humility Goes a Long Way in Building Great Teams

I am a massive advocate of a Culture of Joy! I really enjoyed listening to the lovely Yusuf Yousef at TEDxNHS 2019 and his incredible ability to build relationships, cross barriers and connect people together. This is exactly what we need more of in the NHS and across our public services.

Simple, but brilliantly effective! There is so much inspirational practice everyday in the NHS – but if you don’t have humility, you will miss most of it!

 

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My TEDxNHS Talk

Last year, I was invited to submit a proposal for a TEDxNHS talk. TEDx are independently organised TED events, and it turns out that TEDxNHS is the biggest of these in the world. I submitted two ideas – one around how we can work radically differently with our communities and one around how we create great working cultures in the NHS – both huge passions of mine. I was well excited to get through the process of selection, but was not at all prepared for the work ahead of me!

 

I do quite a bit of public speaking and really feel alive when I get to communicate things that I’m passionate about. I had no idea how different it is to prepare for a TED talk though! I read Chris Anderson’s book over the summer, and had several anxiety-related dreams . I genuinely thought I was never going to be ready! I couldn’t even really decide what I was going to talk about, let alone get it into an engaging piece of prose, whilst sticking to the all important 18 minute timeframe. Thanks to my amazing coach, Zara Brookes (can’t tell you how grateful I am!) and the kindness of Charlotte Hall and Shane Costigan, with hours of patience and encouragement from my lovely wife, Kat, I finally got it ready – an amalgamation of my passions. I hugely enjoyed the discipline and the focus involved in preparation, and when I got onto the stage at Indigo at the O2 Arena in London, this is what happened – hope you enjoy it:

 

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The Art of Connecting Communities – Day 3

 

So….as has become our custom in Morecambe Bay, we tend to deliver the ‘Art of Hosting/Art of Connecting’ trainings over 3 days, but we have a bit of a break after the 2nd day and then invite people back a few weeks later, partly to let us know what they’ve tried out in the mean time, but also so we can invite our wider community of practice back into the fray!

 

Or 3rd day of ‘The Art of Connecting Communities’ focussed in on how our connections create new possibilities. As a team we felt like we needed to ground a bit more of the undergirding theory that gives depth to this way of working, as well as remembering some of the great practices involved. We checked in, this time using triads, to help us get a bit deeper straight away and then we headed into a 90 minute immersive and reflective piece of learning on the four-fold practice. We drew out a quadrant on the floor to represent the four different ways of thinking about ‘hosting’ and then used circle practice in each quadrant to really reflect together on what it means to: host yourself, be hosted, host others and host together.

 

In each of the quadrants we put a question for the circle to explore. Learning to host and host well is a shift in practice for many of us. But it is a leadership style that is open to all and gives each person a deep sense of value and confidence.

In the ‘host yourself’ quadrant we asked: How do you host yourself well in the midst of chaos? There were some really creative insights. Some which stood out were: Breathe! Be Patient. Just be. Take care of yourself. Accept Chaos.

In the ‘be hosted’ quadrant we asked: When were you last hosted well? Our key agreements were that humour really helps, along with knowing the space is safe, there is no hierarchy, lots of voices are recognised and given space and lived experience is given space to come to the fore.

In the ‘host others’ quadrant we asked: What are your strengths in hosting others? It would be fair to say that this is the question that people struggled the most at. we are so used to knowing what we don’t do well, that we felt a bit of ‘Appreciative Inquiry’ was needed. We all realised that we have strengths to bring to hosting and it’s ok to play to our strengths. It allows us to use empathy and bee aware of the needs of others as well as using humility.

In the ‘host with others’ quadrant we asked: Why host with others? There are, of course, tonnes of reasons, but the ones which stood out for us were: it’s more fun, we learn from each other’s, we support each other, we play to each other’s strengths, we value our diversity and we make better connections.

 

We then had a ‘knowledge cafe’, which enables some quick space for learning about things people might want to go a bit deeper on. It’s adult-led learning! We had 3 rounds of 15 minutes in which people could choose to go to 3 of 4 options around core theory for the ‘art of hosting’:

Theory U

Working with Powerful Questions

The 8 Breaths

Harvesting

 

After lunch we then had an OPERA! No – we did not all start singing (although much more the shame in my view!). Opera is an excellent way of helping to converge a conversation around consensus and decision making. It’s a beautifully relational and democratic process in which a group of people can make collective sense of the options available to them and what they feel really need to be the priorities.

 

We used OPERA to explore a question around saving money in the NHS locally. Basically what happens is this:

 

First you have to ask a good question! Ours was “What ideas do you have about how the NHS can save £120million pounds over the next 3-5 years (with some context given of the issues involved)?

Then everyone works silently on their own to come up with the OWN ideas. After this, they work in PAIRS to agree on their top four ideas. Then they EXPLAIN their ideas to the rest of the group. The group, having heard all the ideas, then RANK them in order before ARRANGING them into groups for action planning. It is quite remarkable to watch this process in action and to see participatory democracy really work in practice! I LOVE IT! There were some really great ideas and it was amazing to see what the group had appetite for and what they resisted or didn’t think would make enough difference. It’s a hugely helpful process that we will use again and again!

 

To finish our day, we had a ‘dream world cafe’. George Monbiot states that the only way to replace the current narrative we are living in, is not through more data, or compelling facts and figures. The only way ahead for us is to tell a better story – one that we want to live in together – one that awakens our imagination. The problem is that we have forgotten how to tell each other good stories. So, we spent some time doing just that – telling a better story of Morecambe Bay and awakening our imaginations to future possibilities. We asked ourselves: Imagine we are better connected? What new possibilities can we now envision for Morecambe Bay?

 

Imagine if we kept on doing this – what kind of stories might we tell and begin to live in? Here is a summary of what we came up with (not bad for 45 minutes!) – the last sketch is particularly moving:

 

 

 

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The Art of Connecting Communities – Why Bother Connecting? (Day 2)

As with any training, we kicked off day 2 with a “feed forward” – there are loads of different ways you can do this, and the idea is to bring day 1 into day 2 and remind everyone what has happened in the previous day. It helps people to be ‘present’ and have a sense of continuity. Day 2 is always hosted by participants in the training, with the team acting as coaches for them. Our hosts decided to use a large heart in the middle of a circle and asked each of us to write a few words of reflection about what had really stood out for us on Day 1. It was a great way of collating a collective sense of what had happened and gave us a really positive platform to build on.

 

Following this, Mike Love, a really experienced and excellent host from Leeds, who has been such a key person in helping us on our journey in Morecambe Bay, framed the day for us by helping us think through the process of opening up conversations (divergence), how to hold the groan zone (emergence of ideas) and the process of bringing a conversation into a point of agreement/next steps (convergence). The diamond of participation, as well call it, is a great way to understand our own preferences in conversations. Some of us love to open things up with great questions and get a conversation. Some of us a really comfortable hold the space for the emergence of ideas and love to see what is generated. Others of us, like to focus more on tasks and getting something delivered. The truth is that all of these are REALLY necessary if we’re going to create spaces in which we can discover collective intelligence. There was a real ‘aha’ moment when someone from the public sector said – “Our consultations are not really consultations at all, in any way. They are really a con and an insult”. This insight really provoked some great discussion!

 

Having fed forward and framed the day ahead together, we then checked in before heading into Open Space! Open space is a fantastic way of having the conversations that the people in the room want to have! Ours was framed around the question: “What do you believe we can achieve locally?” There were so many great conversations!

 

Then it was time for more theory. Mike Love, helped us again with thinking through ‘complexity theory’. We work in incredibly complex and chaotic systems and yet we often approach and measure them as if they were simple and complicated. If we are really going to learn to work well, we have to examine what it is we believe and how we see complexity, so we can learn to be far more adept in how we work in connection and relationship to others.

 

Designing for Wiser Action’ is another art of hosting tool, which is extremely useful if you are designing a project and would love to get the help and insight of others in knowing how to make it as effective as possible. We took most of the rest of the afternoon for people to work on ‘live projects’ which they wanted help with or needed to refine – another immersive practice where we learnt as we went along. This is a great tool, but also takes some guts! There is a point in the process where, having designed your project, you listen as other people come and find all the holes in it and offer some alternative solutions, whilst you have your back turned, cannot interject no try to justify yourself! Brutal love in action!

 

We ended the day by checking out, talking about our next steps and inviting people to help us plan for the 3rd day of training, where we will welcome back other members of the community of practice. We have now seen 250 people go through Art of Hosting/Art of Connecting Communities training in Morecambe Bay and are growing a wonderful network of hosts, who are learning to host ourselves, be hosted and host others (alone and together) in a way that creates space for new things to emerge. I am full of hope for the future!

 

 

 

 

 

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The Art of Connecting Communities – Why Bother Connecting? (Day 1)

Over the last few years, ‘The Art of Hosting’ has been transformative to my thinking and practice as a Doctor, as a Commissioner and as a Director of Population Health. Part of the core theory that undergirds this way of working is the 4-fold practice. It involves learning to:

 

  • Host Yourself
  • Be Hosted
  • Host Others
  • Host with Others

 

Hosting yourself means doing the inner work, and tending to your own needs. It is important, if I am to give my best-self to those around me. As a type-7 personality, for me this has meant learning to embrace disciplines like silence and fasting. It has also meant learning to rest, learning some healthy boundaries, to take care of my physical needs, embrace pain rather than running from it and become more aware of my emotions, resisting the need to rationalise everything. In being hosted, it’s about letting go of control, embracing humility and receiving the gift of others. In hosting others, it’s about learning to hold space for someone else, to deeply listen and to resist the need to fix things, but rather to respond and to coach, where this is welcomed (perhaps the very art of the classic GP consultation!). Hosting with others, is about learning to collaborate, to play to each other’s strengths, to enjoy the dynamic of relationship and to create a space together which opens up exponential potential!

 

We have now hosted 5 different trainings across Morecambe Bay in the last 2 years, and hosted many more conversations. Our latest training, in the City of Lancaster (our first without the incredible Linda Joy Mitchell), was an amalgamation of some of the ‘art of hosting’ practices with our own developing practices, here in the Bay. We called this training, “The Art of Connecting Communities” and together we explored some of the theory and practice under the question: “Why Bother Connecting?”

 

We began with the amazing, Yak Patel, CEO of the CVS in Lancaster District welcoming everyone and framing our 2 days together. Yak has become a good friend and is one of the best connectors of people I have ever met. He is deeply humble, kind and compassionate. He has lived and worked in this area all his life and has taken the time to build really wonderful relationships across many communities, which means he is trusted. So when someone, like Yak, puts out a call across the area to invite people to come and learn together about how we connect communities, people respond very eagerly. there has, perhaps, never been a more important time to connect together. Isolation and loneliness is literally killing us, and our walls of division and suspicion are leading us into dangerous territory. Bringing people and communities together is an art form and one which is worthy of serious collaborative learning.

 

To welcome everyone in, we did a ‘check-in’ using circle practice. Circle is an ancient practice, and is great for breaking down hierarchies, welcoming everyone into a space and ensuring that every voice is heard and every person knows that they matter. It can be quite simple and straightforward, though my experience is that it tends to go quite deep, quite quickly. For us, in Morecambe Bay, this has always been helped by having members of ‘The Well’ communities with us. People from The Well know how to be community at a level you won’t encounter in many other places. They know how to be vulnerable, with such a natural humility and so when they open up, it gives permission to the rest of the room to also go deeper. When this happens, we find people meet at a very human level and relationships form within the group easily. in this circle, we gave people pipe cleaners and asked them to make something which represented them. We than asked them to share this with the circle. Our harvest from the circle was very rich and the amazing Jon Dorsett, a truly brilliant host and one of the best graphic harvesters around, transformed it into a stunning piece of spoken word.

 

 

After a short break, the team hosted a world-café. Hosting a good café, depends on taking time to set the room well, explain the process and have a really good couple of questions. Our café took an appreciative enquiry approach. Our first question was: “What gives the Lancaster District It’s Heart and Soul?” – after two rounds of incredibly rich conversation, we than asked: “Where and How do you Experience This?”

The beauty of a world café is the ability to find great connection and synergy in a room. The sense of positivity this conversation brought about the assets we have in this district was palpable and it created a dynamic in which everyone felt like a real participant and collaborator in the process.

 

Sue Mitchell, one of our team, a seasoned, wise and excellent coach and host did a teach-piece on ‘Deep Listening’, which we could also call ‘Transformative Listening’. Listening is an art form and one that many of us never really learn – at least not to the deepest levels. Sue, expertly took us through those levels and helped us develop a framework to challenge ourselves about how well we really listen. Level 1 ‘My Turn’ is when we’re not really listening at all and we’re just waiting to jump in with whatever it is we want to say. Level 2 is when something the speaker says sparks a memory in us and we start contributing about our own (perhaps) similar experience – oh yeah – ‘me too’! It’s about us trying to sense make and find connection, but can mean we really miss what is actually being said! Level 3 ‘My Fix’ is about the listener stepping in and trying to fix the problem. It’s a level at which we don’t really want to connect too deeply, so we try and sort it and move on! Level 4 is where it begins to be about real listening – ‘I WITH you’ – it’s quite a sacred space. It’s where we allow ourselves to feel real empathy, to be with someone in their moment and experience, putting our own thoughts and experiences aside and creating a space for them. Level 5 is where ‘we begin to hear’. It is the art of self-awareness, it’s where we allow ourselves to be changed by the encounter and have our previously held perspectives and understandings changed. If we are to really connect within and across communities, we need to learn this art of listening.

 

Having learned about the art of real listening, we practiced it, using one of my favourite practices – Triads! The concept is pretty simple – three people, together – one is the speaker, one is the listener and one is the witness. The three people take it in turns to be each role, and each time, the same question or theme is explored. The theme we worked with was: “Share a story of a connection you made that changed your life. What was the impact?” – The listener asks the question, the speaker has 10 minutes to speak, with perhaps a few questions of clarification. At the end of the time, the listener sums up what they have heard and then the witness can give any feedback on what they have seen, things which have perhaps remained unspoken or anything else they have noticed. It is a very powerful experience to be listened to and to really hear another human being.

 

Learning to harvest is one of the most important aspects of hosting well. We harvested the learning from the triads, by bringing two triads together and asking this question: “What do we know about what builds connection?” – We then asked the 6 people together to come up with one sentence that reflected this knowledge and learning. Our harvesters then cleverly weaved a web of the learning.

We finished the day by checking out, again in a circle, simply speaking words of gratitude for the day and how we left feeling ahead of Day 2. As always happens on these days, people left feeling encouraged, hopeful and connected. I love it, because it is in the spaces formed between us that creativity is catalysed, ideas are formed and new things begin to emerge.

 

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Wisdom From My Nanna

Last week, I was on the closing plenary panel at The Kings Fund, as we reflected on what we had learned together about ‘PopulationHealth’ across the UK. There were some really excellent contributions throughout the day.

 

Councillor Matthew Brown, leader of Preston City Council, talked powerfully about the new economic models they are using there and the incredible regeneration they are seeing. Councillor Becky Charlwood, spoke about the great work being done across the city of Leeds and how strong relationships enable them to flex around complex legislation. Mayor Andy Burnham spoke with humility and realism about the power of devolution and the challenges they face as a city in Manchester in giving kids a great start in life and ending homelessness. Liz Gaulton, Director of Public Health in Coventry, spoke about how the Marmot principles are radically shaping the future plans of the city in thinking about inequalities and how they face them together. Prof Kate Ardern, from Wigan, talked about how we need to change our relationship with power and work radically differently with our communities. Prof Dominic Harrison from Blackburn brought his wisdom on how we face up to multiple unhealthy risk factors. Perhaps the most important contributions from my perspective were from Carina Crawford-Khan, lead organiser of Citizens UK and Dr Charlotte Augst, CEO of National Voices who asked us to reflect on how “Powerlessness leads to ill health” – that’s a statement worthy of pause and much reflection. Power is the ability to act. Anger without power leads to rage. So, if we don’t radically change our relationship with power, we can never see true population health – rather we have disempowered people who feel angry and unable to be part of the change we need to see.

 

The reality is that all of the things we long to see in society will not happen unless we ourselves are willing to change. In all the uncertainties we face and admidst the brokenness of our political and economic models, how do we stand firm and find a new way through to a way of being together that is socially just for humanity and sustainable for the future? In reflecting on all of this in the final panel, I drew on the wisdom of my Nanna.

 

My Nanna, Joyce, who is 97 years old this year and who still wakes every morning to play Mozart and Chopin on her beloved piano, has always been one of the most important people in my life. In our family, we call her “Yoda”, because she is strong in the force and exceedingly wise! This 5ft tall lady, who taught me to bake, spent hours helping me with my music and can still whip my butt at scrabble and rummikub, is a truly remarkable woman.

 

When I was a boy, we used to talk to each other whilst making ginger biscuits. My Nanna is a deeply spiritual woman and she used to tell me about her favourite bible verses, one of which is from the book of the Prophet Micah, Chapter 6 and verse 8. That verse says – “God has shown you the best way to live – act justly, love mercy and walk humbly with your God”. I think those three statements hold profound and ancient wisdom that we need to draw on in the complexities of what we face together now. What does that actually mean for us in practice, as we try and transform culture, relationships and behaviours? I suppose I think it’s pretty simple.

 

Firstly, as leaders and as people who want to see change, we must act with justice. We must care deeply about issues of injustice in our society and be willing to challenge it whenever we see it. But we must not just care, we must act. We have to be willing to put justice into practice in what we build. We’re beginning to see this, and it’s exciting!

 

Secondly, we must love mercy. I think that means we have to love the principle of mercy and therefore we have to love people with mercy, or as I put it at The Kings Fund, with real kindness. I love what Prof Micheal West says, when he talks about looking at people with kind and fascinated eyes. We did a lot of thinking about the need for a different kind of power. I think we need to unashamedly talk much more about love and the transformative power it holds. MLK said that love on it’s own is anaemic – it certainly can be. Power alone is destructive. But power and love together is a force to be reckoned with! We need this kind of love in the power that we hold to keep mercy at the fore and kindness as our way of being.

 

Thirdly, we need to walk in humility WITH our communities. I replace the word God here, with communities, not because I don’t believe in God (I do), but then Nanna and I used to talk, she would tell me that walking humbly with God means walking humbly with other people – with your community. It is worked out in the practice of every day life and being willing to interact with and be changed by the person you most look down on or despise. Nanna isn’t a fan of people getting too big for their boots. She sticks her tongue out at arrogance and blows raspberries at pride. She’s not into titles or pretensions. As a true elder, she knows humility and walks in it. I have learned so much from her and it has shaped so much of who I am and how I choose to spend my time. We must learn to sit with, be with, learn with and create the future with our communities. We don’t have the right to dream up plans and do them to people. Together with, is the kind of humble, mercy-loving, justice-acting way that we so badly need. Without those under-girding, foundational truths, we will never see true population health. Our guiding principles and undergirding culture will shape what we become together.

 

In a time of so much uncertainty and complexity, we do well to stop and draw on the wisdom of the elders. And so I offer that of my lovely Nanna – in all you do, make sure you act with justice, love with kindness and walk in humility with your community. 

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The Morecambe Bay Approach to Population Health – The Double Pentagon

In this podcast (iTunes or Spotify), I give an overview, as Director of Population Health in Morecambe Bay, about the approach that we have developed as ‘Bay Health and Care Partners’ (BHCP) around population health. The double pentagon model draws on learning from across the UK and the world, leading think tanks, like the Kingsfund and local communities. The model has been developed with Dr Jane Mathieson – our wonderful Public Health Consultant, who retires this month, Prof David Walker – Medical Director at UHMB, Marie, Spencer, Jacqui Thompson, Hannah Maiden and Vicky Hepworth-Putt. BHCP is an Integrated Care Partnership which includes the GP Provider Alliance, The University Hospitals of Morecambe Bay Foundation Trust, Lancashire Care Foundation Trust, Morecambe Bay CCG, Cumbria County Council and Lancashire County Council and is committed to ‘better health, better care, delivered sustainably’.

 

So – if you’re interested in Population Health and/or you work as part of one of the organisations within BHCP, then listen in, enjoy and let’s continue this conversation.

 

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