Global Patient and Public Involvement in Research

Sally facilitated the inaugural meeting of the International Patient and Public Involvement Network in late 2017, momentum is gathering with a plan to;

….create a social movement globally, changing the paradigm, content and nature of research, so that embedded collaboration between patients, clinicians and researchers focuses on answering key questions in ways that create the most benefit for patients. As Heraclitus stated, “big results require big ambitions.”

An update on progress and developments is here 

National Standards for Public Involvement

Since 2016 Crowe Associates have been working with a UK wide Partnership of representatives from the Chief Scientist Office (Scotland), Health and Care Research Wales, the Public Health Agency of Northern Ireland and the National Institute for Health and Research (England) to develop a set of standards and indicators for public involvement in research. These are currently being used by a diverse group of 10 research organisations and collaborations.

You can follow the conversation on Twitter by using the #PPIStandards hashtag!

Working on self confidence in Coaching

Self-confidence  refers to a feeling of trust in one’s abilities, qualities, and judgement. Confidence” comes from the Latin fidere, “to trust.” To be self-confident is to trust in oneself, and, in particular, in one’s ability or aptitude to engage successfully or at least adequately with the world. A self-confident person is ready to rise to new challenges, seize opportunities, deal with difficult situations, and take responsibility if and when things go awry. Another way of putting is about individuals having a deep conviction and feeling in their own importance and value as a person, irrespective of their performance and behaviour. I understand none of us are immune from others opinions, but generally self confidence is like a well rooted tree of self awareness and a positive view of self.

A few overall thoughts on self confidence in relation to coaching;

  1. The first thought building on the definition of self confidence is that the highest form of self confidence is from the inside out, rather than the outside in. If a person needs validation from outside all the time they look to others too frequently for affirmation, recognition and approval. They gain their confidence through a sense that others are approving of them, their choices and behaviour. One of the the main issues with needing external validation is just how tiring it can be to have to perform for others all the time. This isn’t to say that we don’t need an awareness of others, but a sense that we are filling our own reservoir, with a bit of top up from others, not the other way round. In coaching work this may be looking at how much internal reflection and self compassion the individual gives themselves.

2. I am struck in coaching work in self confidence around the idea of authenticity and values. Having authenticity is about having a good degree of self awareness and making choices that align with knowing who you are, your strengths, your challenges, and ultimately, your values. Values represent your core beliefs: what is important to you? What drives you? These create the building blocks for everything you do (there is more around values and coaching tools for these here). These create your base. Everything grows from here. At their heart, values are fundamental “policies” that define who we are, and when we wander too far from them, we can lose a sense of our core. Sometimes people haven’t ever had the opportunity to look at what their underlying values and purpose are , particularly professionally.

3. The next thought is being able to embrace our vulnerability. I sometimes reflect when I see behind individuals intricately built and outwardly effective screens/masks, how much they are struggling with feelings of low self esteem and “imposter syndrome”. One of the key principles of vulnerability expressed in Brene Brown’s work is to understand that we are not alone; there is a universality to feelings of periodic anxiety and vulnerability that others feel too, and it can help to be able to share these feelings with trusted others that somehow help us to overcome and defeat them over time.

 

4. Finally, holding onto our resilience. The whole area of resilience is an important constituent of self confidence. None of us sails through life without tough stuff happening. Resilience is the ability to recover quickly from setbacks and adversity: to stay committed and increase our efforts when the going gets tough, and have a well developed “bounce back facility”.This coping may result in the individual “bouncing back” to a previous state of normal functioning, or even using the experience of exposure to adversity to produce a “steeling effect” and function better than expected. For me its linked closely to self confidence, as it provides us with the faith that we will steady the ship, that even in the midst of tough times, we will emerge out the other side intact and have gained a lot of learning from the experience. The encouraging thing about resilience is that if we know what to work on to build our self resilience reservoir, we cal learn to do this.

Working with clients with low self confidence issues isn’t uncommon in Coaching. If I reflect on client work over the last few years, I can hardly think of a instance where self confidence hasn’t been part of the coaching work in some form or other. There are a number of possible tools that may help identify the causes of low self esteem, and some that help “find” or bolster self confidence that has temporarily been lost.

Diagnostic Tools

These are tools that help the Coach identify in more depth the issues and challenges the client is facing with self confidence, before moving onto possible ways of working with them to understand where things go wrong, and how they can react differently (click on the blue highlighted words to go to links/downloads of the tools) :

“Autobiography”

  •  Asking someone starting work in Coaching about the whole of themselves is a useful and probably essential part of the initial session. The “whole” person has evolved from life experience, so for both the client and the Coach, telling and hearing the life story is one way to begin to understand the client’s world.
  • It’s important to take care with this tool, and not to stray too far into interpretative aspects, but it can unearth important aspects of where aspects of low self esteem originate from, whether recent or longer standing
  • It’s also important to stress the Coaching approach here, rather than more of a therapeutic approach. In the latter, it may be enough to bring issues around low self esteem to the persons awareness to be able to “work through”, but in a Coaching context its more about an action orientation; e.g. using CBT techniques in troubling situations the client faces
  • For more information on how to use the AUTOBIOGRAPHY tool click on the highlighted word

Self confidence assessment

  • A series of questions to help the client (which could be done at a session or independent of a session and brought to talk through)
  • Covers areas such as: what is self confidence; where do you struggle with it? What are your coping mechanisms?
  • To view an example template of the Self Confidence Review, click on the highlighted words
  • Or alternatively, complete the Mind Tools self confidence questionnaire

Practical Working exercises

Psychoach : the ABDCE way of thinking

A CBT technique that helps clients challenge difficult situations they encounter by taking them through a 5 step process of challenging negative thoughts and feelings, and thinking about difficult situations in a more balanced and realistic way

The Confidence Wall

  • To convince yourself that you’re a successful person who can continue to achieve great things, it may be helpful to take some time and reflect on all your achievements and what matters to you. This exercise commits people to acknowledging their achievements through looking at their values, their skills and attributes, and tangible and intangible achievements
  • Part of the sustaining part of the work is for the client to keep the exercise close at hand to refer back to over time

NLP Anchoring Techniques

The Anchoring technique works on the basis of using an “anchor feeling” of positivity, especially when faced with a difficult situation. It requires the client to select a feeling they would like to have in a particular situation and create a physical “anchor” of that feeling that they can go back to when they need to

 

 

Drivers Working Styles

  • A driver is a part of us that believes if we behave in a certain way then we will do well, avoid problems and earn the respect of others (e.g. hurry up, be perfect, please people). There are five characteristic working styles, called “Drivers”, and each of us tends to have a preference for one or two particular styles, taken from Transactional Analysis theory
  • Whilst our driver can sometimes be strength, under stress it can severely limit our capacity to be effective. The more stressed we get, the more we get locked into compulsive driver behaviour. This exercise requires people to find their key and secondary driver, and work out some improvement strategies

 

Do research priorities of patients and doctors really matter?

research-directionsRecent publications by Sally Crowe and others highlight the challenges of developing and funding research priorities as part of the James Lind Alliance.

A blog introduces the context for the research and gives the top line results.  The full research paper is available here, in the launch issue of Research and Involvement and Engagement from BioMed Central.

A second paper explores missed opportunities in representing the patient voice (Type 1 diabetes) in research priority setting. This was one of the first James Lind Alliance research priority setting partnerships. A small team led by Rosamund Snow and Joanna Crocker re-analysed data looking at the relative influence of health professionals and patients and carers.

Latest Coaching Resources; spring 2018

These are articles and resources I have come across whilst reading around Coaching, and preparing for running Coaching Supervision sessions:

The latest collection are ones I used in spring 2018.

An overview of Team Coaching article about approaches to Team Coaching and Team Coaching tools Coaches can use

INSIGHTS TEAM EFFECTIVENESS REVIEW using the 4 foundation areas of the Insights personality profiling; team focus, team “flow”, team climate and team process

Resilience Resources and Exercises 2018 a wealth of information and exercises around the area of Resilience

For lots more articles and resources, click here

Plans for 2018?

David’s take on new years resolutions focussing especially on areas of personal resilience and wellbeing, and career plans for 2018

Overview

We arrive into January, the start of another year, and the opportunity for me to fulfil one of my new year’s work resolutions: to start a Newsletter on interesting topics around Coaching and Resilience and send out at periodic intervals during the year. I am aware though that new year’s resolutions are hard to keep; if I’m honest this has been a “work resolution” for at least a couple of years and haven’t got around to doing it with level of busyness! I’m in good company though: a recent poll of 2,000 British people, published by BUPA, found that of those who said they would be setting a New Year’s resolution for the following year, half were not confident they would stick to it. In a recent Psychology at work article researchers looked at success rates of peoples’ resolutions: the first two weeks usually go along beautifully, but by February people are backsliding. And by the following December most people are back where they started—often even further behind. Among the top resolutions are weight loss, exercise, stopping smoking, better money management and debt reduction (I couldn’t find one about Newsletters….)

Why is this the case? Making resolutions work involves changing behaviours, and in order to change a behaviour, you have to change your thinking (or “rewire” your brain). Brain scientists have discovered, through the use of MRI scans, that habitual behaviour is created by thinking patterns that create neural pathways and memories, which become the default basis for your behaviour when you’re faced with a choice or decision. Change requires creating new neural pathways from new thinking. There is a wonderful piece: Neuroplasticity; changing our belief about change article that illustrates this idea that “neurons that fire together, wire together” well.

So, I got to thinking what if we took a more holistic overview for the new year in a couple of areas that are typically important in our lives; our personal resilience and well-being and our careers?

Personal Resilience and well-being

I am noticing resilience and well-being offerings springing up in all sorts of contexts at the moment. Perhaps because of these times of unprecedented turbulence, individuals are being stretched like never before. Many of the teams and individuals I work with are doing more with less people, facing huge reductions in budgets amidst constant changes happening within the organisation and across the public and private sectors.

Resilience is the ability to recover quickly from setbacks and adversity. Resilient people stay committed and increase their efforts when the going gets tough, and have a well-developed “bounce back facility” (the word comes from the Latin root ‘resili’ meaning to spring back). This coping may result in the individual “bouncing back” to a previous state of normal functioning, or using the experience of exposure to adversity to produce a “steeling effect” and function better than expected (much like an inoculation gives us the capacity to cope well with future exposure to disease).

More recently, there has also been evidence that resilience can indicate a capacity to resist a sharp decline in functioning even though a person temporarily appears to get worse. Resilience has been shown to be more than just the capacity of individuals to cope well under adversity. Resilience is better understood as both the capacity of individuals to navigate their way to the resources that sustain their well-being, and their capacity individually and collectively to negotiate for these resources to be provided. My own metaphor for holding resilience is that of a reservoir; the bottom of the reservoir is the “plug” which is open to give out and do the work I do in supporting others as a Coach and Facilitator. The top is the “tap” where I need to practice self-care to maintain a level of fill for the reservoir.

The article I have written on personal resilience goes into this whole area in a lot more detail, and looks at possible ways of supporting our own resilience, as well as the areas of mindfulness and self compassion which underpin our ability to stay resilient.

It may be valuable to think about:

What your own level of resilience is: e.g. there is a good free questionnaire developed by Kristin Neff that helps you review and score this
What approaches to self-care do you take; how well do they work?
• Consider completing the Resilience coaching exercise: Resilience – self assessment exercise

Career direction

I have worked with several clients going through career change in the last couple of years. Some come wanting to work on CVs or practical interview practice: for others it’s more of a step back from what they are doing and take stock approach. The work is often about “what do I really want” and/or confidence building when they have been in a role for a long time and having to start job searching because of changes in their current role.

A recent “State of the career” Report by Blessing White found that most employees understand that they, not their employers, need to control their careers. 57% of respondents overall don’t expect their employer to provide a clear career path, and that sentiment increases with age. Opportunities with current employers aren’t promising, as only one in two respondents believe they have decent career opportunities with their current employer. In the report, over a third expect their next career move will take them elsewhere. Most employees want work that works for them. As in previous studies, interesting work, meaningful work, and work/life balance were identified as the most important criteria for future jobs.

For me, thinking about 2018, this coming year will be about some elements of consolidation and some elements of change; the things I want to move more towards are more 1-1 Coaching work, Team Coaching, working with teams on Resilience programmes and building in house Coaching programmes for organisations. The things I want to move away from are; direct training in areas like Leadership and Supervision skills, and one off Away Days, where a weight of expectation is put on making changes to Teams with a single day intervention.

Things to consider in terms of what your 2018 will look like are:

What does your year look like in relation to your career development; consolidation, pastures new, learning new skills for example?
• What are the things you want to move towards and the things you want to move away from?
• Different career assessment tools can help individuals gain a better understanding of themselves, expand career options, find a good match with employers, and identify strengths for the ever-shifting workplace. Here are a few that I have found useful working with clients including looking at your career drivers, your ideal job description and a skills/interest model.

Overall reflections

So, approaching this new year, what might it look like for you? There are planning tools that can help unlock ideas like the Futures tool. The idea of the Futures map is to create the opportunity to do a brain dump to help structure that confusion in our minds about all the different elements around making such a big change decision. The map has 4 areas; work, home/location, partner/family/friend’s considerations, and a personal/growth section. The idea is to go through each of these and think through what the implications of change might mean.

Another approach is the The PATH Tool that encourages you to focus on all the things that you would love to do in life, things you would like to achieve and what the initial steps of the journey look like. The most critical part of this is deciding on the initial steps and getting started. We may plan the entire journey, but one thing is guaranteed – it won’t turn out exactly how we imagined it

It’s also worth thinking about who or what will help you make the changes. If we are changing something that has some history, we will probably need to enrol other people into helping us. This requires some vulnerability and the ability to ask for help. However, when an issue that we are working on is out in the open, it tends to feel lighter and has less power than when it is tucked away in our heads only; from a coaching perspective it also increases the chance of us actually making it happen. This might include sharing with a small number of trusted people your goal and plan, why it matters to you and that you recognise you need help.

Whichever routes you choose for this coming year, I wish you well in realising your wishes and ambitions this coming year.

New Coaching Tool around career futures

I have been working with several clients in the last few months looking at possible new futures and changes in their work; some through organisation re-structures and downsizing, others through the desire to move on and find new challenges.It also came up at one of our recent Coaches network sessions.

What has struck me is that like a sailing ship, there are links and interdependencies across lots of sails and rigging, and one change in our lives in the arena of work, will impact hugely on our relationships, our family lives, and where we live. This is a hard nut to crack thinking about what we put first. Do we say that living by the sea for example (a big future factor for me despite still living in the middle of Oxfordshire!) is more important than the job we are doing? We went down to Poole a couple of years ago to look around with a view to thinking about a move, but ended up reflecting on the stages the kids were in their lives and all the networks we have locally were too much to give up. However, it may not be right now, but in the medium term/longer term future.

The tool

The idea of the Futures map is to create the opportunity to do a brain dump to help structure that confusion in our minds about all the different elements around making such a big change decision.

  • The map has 4 areas; work, home/location, partner/family/friends considerations, and a personal/growth section. The idea is to go through each of these and think through what the implications of change might be, but also look at the whole map for the connection between these 4 strands
  • There are also a few questions that might help unlock thinking: what is the first step you might take? Who do you need to talk to you about it? What might the obstacles be?
  • As ever with a tool like this, its really helpful to talk through with a Coach/trusted friend after the initial “splurge” of creative thinking

You can access the futures map here:  FUTURES MAP

New Coaching tools and articles; the “spring collection”

As part of preparing for a set of spring Coaching Learning sessions with in house Coaches, I have identified  some new articles and tools (click on the link to access all the information) , along with all of the previous articles and tools over the last couple of years, which I think are worthy of a read. I usually try and find a blend of practicals tools that Coaches can use with clients in sessions or outside the sessions, and background articles.

The “spring collection” is:

Values and purpose Tool: This is a Coaching tool I created from merging (like 2 ends of a car!) your core values with the idea of creating your own personal coat of arms. It came out of some coaching work with an individual who really wanted to connect their personal values with the work they were doing.

Neuroplasticity: Changing our Belief about Change. I came across this doing some research on neuroscience. This article is about the power of neuroscience: as the saying goes, “neurons that fire together, wire together.” The more we practice something, the more we strengthen the pathway, and the easier the skill becomes

The talented Coachee article: interesting article that looks at the role that Coachees (clients) play in the coaching work, and especially their “enabling” and “defensive” skills

“The Life Canvas”; similar to the values and purpose tool, but a bit more comprehensive, I thought this was interesting in how it borrows from strategic business thinking to apply to  us as individuals to chart who and what we are across our whole lives; if you want a bit of background reading to the tool, take a look at this link: http://songyakesler.com/blog/

New Coaching Tools and articles

autumnAs part of preparing for a set of autumn Coaching Learning sets with in house Coaches, I have identified  4 new articles and tools, along with all of the previous articles and tools over the last couple of years, which I think are worthy of a read. I usually try and find a blend of practicals tools that Coaches can use with clients in sessions or outside the sessions, and background articles.

The “autumn collection” (!) is:

  • A short article as an overview of the initial contracting phase of Coaching
  • A new Coaching tool based on the comfort stretch panic model
  • A coaching progress review: a reflective exercise that allows clients to think about their next session, the positives and challenges and how the work is going for them overall
  • Stakeholders Coaching exercise: a psychological exercise that will help us reflect on the border between Coaching and counselling, this exercise looks at the power of key figures in our lives;

New Coaching articles and tools

PSYCHOTHERAPY 2As part of preparing for a set of spring Coaching Learning sets with in house Coaches, I have identified 4 new articles on various aspects of Coaching, along with all of the previous articles and tools over the last couple of years, which I think are worthy of a read. I usually try and find a blend of practicals tools that Coaches can use with clients in sessions or outside the sessions, and background articles.

The “spring collection” (!) is:

  • A deceptively simple Purpose Practice Sheet Tool which links values-options-making room for what you love
  • A background career tool to start thinking about what motivates you at work called Career Drivers Assessment
  • A Brene Brown article showing how to work with emotion and change your narrative: Brené Brown on how to Reckon with emotion and change your narrative
  • An article on Gestalt theory in Coaching, an interesting approach to try and adjust between the “figure and ground” in a coaching context

Coaching and Mentoring new articles

challenge 2We are really pleased that looking through the web site statistics on Google Analytics, that since the start of the year, we have had over 5,000 visitors and over 10,000 pages viewed!

Our aim is to make as many useful and accessible resources freely available as possible.

In the Coaching and Mentoring skills section we now have around 25 articles on all sorts of ideas, tools and articles relate to Coaching and mentoring; a recent addition has been a new article on Mentoring skills, along with some Mentoring models.

As well as these overall pieces, there are also a number of new articles that I come across and use in work with a group of Coaches in Action Learning set sessions including innovation in Coaching, understanding your values and the “PRACTICE” model of Coaching if you scroll down to the most recent articles.

What matters in early osteoarthritis of the hip and knee? A new James Lind Alliance partnership

JLA pictureA new James Lind Alliance Research Priority Setting Partnership has started and we invite people to take part.

Who can take part?

Patients, carers, and healthcare professionals.  If you have (or have had), or are caring for someone who has (or has had) early stage osteoarthritis (OA), or work as a health or social care professional with people who have (or have had) early stage OA….we want to hear from you. 

Why should I take the survey? 

This exciting initiative will be overseen by The James Lind Alliance, a non-profit making organisation funded by the National Institute for Health Research, ensuring the exercise produces an unbiased result, with equal weighting given to the views of the different participating groups. So whether your interest is personal or professional …your opinions will count.

How do I take part?

The survey is available at http://tiny.cc/3d71vx or contact the James Lind Alliance Project Manager at the Oxford Biomedical Research Centre to request a paper version (tel / voicemail 01865 223298, e-mail sandra.regan@ouh.nhs.uk).

New Coaching and personal growth articles

Jigsaw HeadsThere are now 24+ articles on lots of different aspects of Coaching, the most recent three being a “past, present and future” tool, an article and free assessment on the big 5 personality traits, and an article on Mindfulness. You can access the Coaching articles here.

There are also some new articles on Teams on managing trust and working with dispersed Teams

 

 

calm mindOn the personal growth side, there are new articles on the feel of intuition, an article on the poetry of resilience, and one on the virtue of doing very little! Access the articles to take a look here.

Research Priorities for Hip and Knee Replacement

Every year, about 150,000 hip and knee replacements are done in the UK because of osteoarthritis.  But we still don’t know enough about which patients benefit most, when is the best time for surgery and how do we ensure that patients recover quickly and well?

James Lind Alliance

A James Lind Alliance Priority Setting Partnership gathered research uncertainties from a wide range of people with osteoarthritis and health professionals that treat and look after them.  There were prioritised using a James Lind Alliance approach and the results and process to achieve the Top Ten Research Priorities are detailed in this report.

Resilience; the latest information and self assessment toolkit

With all the changes happening in organisations, resilience is becoming a critical quality to survive. People working in the public sector particularly seem to be suffering from it at the moment – first there’s a budget cut, then a re-organisation, and then a threat of redundancy. This is without anything that may be happening at home. And it’s not just the public sector  –  the private and voluntary sectors are suffering too. Continue reading

Managing change article that’s worth a read

 

Change is nothing new to leaders, or their constituents. We understand by now that organizations cannot be just endlessly “managed,” replicating yesterday’s practices to achieve success. Business conditions change and yesterday’s assumptions and practices no longer work. There must be innovation, and innovation means change.

Yet the thousands of books, seminars, and consulting engagements purporting to
help “manage change” often fall short. These tools tend to neglect the dynamics of
personal and organizational transition that can determine the outcome of any change
effort. As a result, they fail to address the leader’s need to coach others through the
transition process. And they fail to acknowledge the fact that leaders themselves
usually need coaching before they can effectively coach others.

WilliamBridgesTransitionandChangeModel : in this article (that is worth 10 minutes of your time) William Bridges describes three stages of transition:

• Endings
• The neutral zone (explorations), and
• New beginnings.

PPI Toolkit – “Perfect Pocketsized Instructions”

This toolkit book, published by Wiley Blackwell  and part of an evidence based series for British Medical Jounral was a year in the making. Sally Crowe and Julia Cartwright, together with editors Doug Badenoch and Carl Heneghan have been  on an interesting journey to make the theory and practice of Patient and Public Involvement accessible, interesting and useful.

The design is quick reference, digestible chunks of information, with lots of case studies and resources.

We hope that the book will become a handy ‘aide-memoire’ for those practitioners that seek to engage, and involve patients, service users, carers and the public in service development and research.

Continue reading