Wednesday, 5 November 2014

Elevators and services

We live in a world where most of us want to move away from what we call 'The Elevator Effect'. The Elevator Effect is where people get in a lift and look away from those in the lift with them. We will look at the ceiling. We will look at the lift numbers intently as if we expected them to go somewhere else. Where just two people are in a lift they will often stand as far away as possible from each other. We understand that this is an enclosed space and we want to give others as much as space as possible. But there is something else. When we speak of the Elevator Effect we means where people together will not speak or connect. We are often glad to get out of a lift. That might be to do with the enclosed space. It is also to do with a group of people together but not together. In the closed in elevator it is somewhat understandable. In life, work and business it is less so.

We have integrated care services and programmes across health and social care. We have partnerships between the third sector and the statutory services. There are also moves to involve patients and carers more fully.  We also have work with the faith communities. These are all initiatives we support as it brings us all together. It means new understanding, work and co-operation may occur. For patients and clients better, faster and more inclusive services are the planned outcome. This bringing together of all for the common good should be welcomed, nurtured and developed. All of us have so much to learn from each other. It gives us a great opportunity to hear and grow.

There is however a concern for us in this process. The worry has a name and that name is silo. It's easy to work in a silo. We work in our own space and never look up or out. We are like goldfish in a bowl going round and round. We may occasionally look outside the glass and see the world working and moving. We, however, keep on moving. Even in teams with different sections people will sometimes have not team work but section work. This focus on looking at our work but not around and beyond is not the way to create the best services for clients or the best cultures for the future. If the glass of the goldfish bowl breaks the poor fish dies. However if our glass breaks we have the opportunity to live in new and creative ways.

Silo work is a result of a silo consciousness. Silo consciousness always lives in a black and white world of separation. It is always us and them. Our concern is that unless we deal with this consciousness we will bring it over in our efforts to create new joined up approaches, partnerships and services. If we do this we will have elevator meetings where people are not connected or even talking in an engaged way. Silos leave their mark and moving on involves a transition. Silos also go two ways. They go across and up / down. They go across where different services work separately rather than together. This is where we see each other as units that can be called upon when needed but not core and essential partners and co-creators of best care. Silos work up and down where in the same organisation people work as if other sections did not exist. This can be fed by illusions and judgements some people hold of each other. This leads to non-contact and hence non-understanding of roles and struggles. It's so sad when we don't listen to the other. It should be so commonplace for the doctor and social worker to really listen and learn from his patient and for different agencies to meet and co-learn together. There may be some parts of an organisation where silo work is what is needed. That would be fine. It's the silo consciousness that we see as the problem.

The opposite of the silo consciousness is the relational approach. This is a fancy word for something very simple and rich. It means that relationships are what our work is all about. We are social beings and need each other. We live in communion and communication and it is this context that we flourish and grow. At York Street Health Practice we talk in our presentations of 'Circular Care' where all should work together with the client ( in our case homeless people and people in the asylum system ). The symbol of a circle is used as it co-joins us all. It can't be complete until we are all there. It also means that we can't do this alone, we don't want to to do this alone and we don't do this alone. This relational approach is also expressed as a circle where the circumference is the practical work we do - the GP writing the prescription, the nurse bandaging the wound, the support worker making the phone call. The centre of the circle is and has to be the call to rapport, connectivity and relationship. This relational cannot and should not stop at our service door. It needs to extend across services and cities. It is the dissolver of silo consciousness. This post is an example of where Leeds Adult Social Care and Leeds Community Healthcare NHS Trust meet to see what we can do and write to bring together people and communities for change and connection. The Migrant Access Project is another example. It is chaired by the Head of Adult Social Care Commissioning and has statutory and voluntary sector as its members. It exists to support networking across different communities.

Relationships are what will offer the most authentic integration,partnership work and patient engagement work. It is in relationship that we understand others and grow ourselves. It is here where we can jointly see solutions and create change. There is a price here too. That price is that relationships to be genuine need certain features. For the best relationships we have to be our best. Respect, kindness, equality, humour, giving as well as taking and mutual support are all needed. If we grow these seeds great things can happen. We see this in our own city where positive relationships are bringing forth positive results. We have so much to give and learn from each other. We can only receive this in lasting ways when our minds are set on the greater good and open to others. We know that Social Care and the NHS face major problems. Our words will not solve them. What the words point to may offer the best context and bond in which they can be addressed. This is our hope.

John Walsh. Support Manager. York Street Health Practice

 Pria Bhabra. Commissioning Officer (Migrant Access). Leeds Adult Social Care 

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