Deep dialogue

Dialogue is probably a word like inclusion which we all use and may never unpack and seek it's authentic meaning. It is also something we all are in favour of. Yet this doesn't prove we know what it is or even practice it! So what is dialogue? Is it discussion? Is it listening? Or something more?

I attended the first session of the Leeds Indaba Programme last week. This is a leadership, ideas and innovation fellowship in Leeds based at the Centre for Innovation inHealthcare Management. Based at  the University of Leeds, CIHM is a centre of inspiration, idea generation and testing, community outreach and teaching in innovative and creative forms. To my mind, CIHM is both an assett of and gift to the city of Leeds.

The Indaba programme is a joint partnership between the Centre, the University of Stellenbosch University in South Africa and the VU University in Amsterdam. Becky Malby, director of CIHM, Professor Erwin Schwella and Professor Goos Minderman were the facilitators. Indaba is a word meaning an important conference held by members of the Zulu or Xhosa people of South Africa. The Leeds Indaba was a meeting of a number of leaders from across the country from business, the NHS and the Third Sector. Its aim was to allow a discussion about leadership, positive passions, the NHS and its future and new fresh thinking.

I learnt many things. There was a large number of times when my mind lit up at comments made as they made sense of other things or connected them. In this post I will focus on the concept of dialogue. At the beginning of the session we each went around and spoke of who we were and our roles and interests. This was very different from when this is usually done. Usually people say their name, role and place of work. This was deeper. Those who attended spent some time talking about themselves and their journey. Throughout the day the honesty, depth and openness of the sharing was stimulating.  At the beginning of the day, Becky spoke of dialogue, she said, "It's only when we really know each that we can really have dialogue." This was one of those statements that illuminated my thought. In trying to unpack it the following things seem to come to view as learning points.

Perhaps to define dialogue we can look to a place where it holds a central place in everyday practice. This common place the word is used is in the religious world where different faiths will meet to work together and have dialogue. This is interesting as the world faiths have different views of the world and each other. Dialogue is the language or road they use to meet, listen and engage respectively with each other. The World Council of Churches has some wonderful words on the definition of dialogue. It states, "All dialogue involves an exchange, an interplay between speaking and suggesting on the one hand and listening and receiving on the other. Dialogue is, therefore, the opposite of monologue. It requires reciprocity and a certain equality...Dialogue is not merely 'discourse'". It is primarily a way of being together in charity, which gradually changes and renews the atmosphere.....where profound exchanges of thought and expression can achieve something which goes beyond clarity of conversation or individual conviction. ' ( WCC, Joint Working Group, 1967, 1). This definition embodies a rich message and offers a powerful praxis. It says to me that dialogue is about

          * being with the other

          * listening to the other

          * trying to understand the other's place - this doesn't mean necessarily agreeing with it

          * allowing the possibility of changing by exchange with the other.

Dialogue can only be deep when we know the other. Yet to know the other we have to dialogue with him or her. So there is a circle of connectivity and conversation which leads from dialogue to knowing and then to further and deeper dialogue. This circle of dialogue can keep going on and on. To be committed to deep dialogue means to be committed to deep listening, deep respect and deep sharing. It points to what the famous novelist Charles Williams called 'co-inherence.' This word gives us a clue to deep dialogue. It suggests connecting and in a sense dwelling in the other. To share in the hopes, struggles and life of another. This mutual indwelling while remaining ourselves would be the deepest dialogue. I have no doubt such dialogue has a power and connection that can cause real change and newness of vision.

Yet this deep dialogue seems to demands something else. A deeper dialogue seems to assume  a deeper commitment and conversation than we often have. I would suggest it demands an inner freedom in ourselves. The late British theologian Charles Davis spoke of "the openness and love that derive from inner freedom." This is a powerful insight. It's when we have authentic inner freedom that we can really love and be open. Our closed minds, fear and lack of real freedom within all make the most important things we both need and can offer very difficult. Charles Davis spoke of the need to find 'self-appropriation.'  He explained this by writing the following, "Happiness isn't not a quiescence gained by a narrowing of consciousness; it demands that a man accept the autonomy proper to him as a free person. A man has to take in hand his own becoming, decide what he is to make of himself, and then carry out his decision. Just to follow what others do or say and wait passively upon events is to live a diminished personal existence......to be fully a person does mean freely to take the decisions that determine the direction and growth of one's existence."

Deep dialogue flows from deep freedom and deep living. Perhaps this brings us to the fundamental lesson of leadership. Leadership is not something primarily we do - it's something we are. And that something we have to seek as we seek the freedom of self appropriation. I enjoyed the first Indaba meeting and look forward to the next. It was great to meet such good colleagues from different sectors and sit with them trying to listen and engage. It struck me that the Leeds Indaba was not just a space to learn but a school for deep dialogue. In that deep dialogue lies the possibility of some really invigorating and stimulating offerings. It's good to be on board the Indaba.

John Walsh. York Street Health Practice

Dancing in Winter

Leeds Beckett University and York Street Health Practice are just starting to plan research on the work, model and care the practice tries to provide to people in Leeds who are homeless or in the asylum system. I met the other day with my good friend and Leeds Beckett colleague Dr Erika Laredo. Erika teaches Youth and Community Studies and has been a key element in the work between York Street, the university and Adult Social Care in working to create the academic and practical space where best practice and theory can emerge. We met for coffee to discuss York Street and I tried to explain how we work, what we do and the model of care we use. In the context of this dialogical exchange I realised more fully and deeply then ever that Erika could not properly understand York Street and neither could I without seeing it in terms of what was happening in the NHS nationally. It was only in the bigger picture that York Street makes so much sense and offers so much possibility. The metanarrative here was this. This bigger theme was the real story of which York Street was both product and response.

 At the end of the day I thought of the people I had spoken to or had contact with that day. The answer was both surprising and charming. There was my great and true colleagues from Leeds Community Healthcare like Steve Keyes, Catherine Hall, Eleanor Wilman, Anne McGee, Jo Speight and Lisa Falkingham. There was Anne Cooper the Lead Nurse For Informatics at NHS England. There was Alicia Ridout from the Health Innovation Services at The University of Leeds, Maxine Craig, OD Lead at South Tees NHS Trust, Becky Malby from the Centre for Innovation in Healthcare Management and the Leeds LAMSOC ( medical students championing quality and caring leadership ). There was Dave Ashton and the inestimable Yvonne Coghill. There was of course my good colleagues at York Street working for the homeless. And there was an inspirational student nurse called Louise Goodyear who is at Wolverhampton University. What struck me was all these people connected with the NHS represented a movement - a force might be a better word that represents what the future of our service could be. Feeling both humbled and proud at the same time I saw how York Street was part of this energy that was working to create new ways of thinking and being a health service. In fact I believe the connections were precisely because people were moved and held by the same visions and hopes.

So what is this movement? What does it mean? What does it seek? What happened at Mid Staffs Hospital is the clue and key here. It  shows us the old system at its worst. Hence the need for fresh thinking and ideas about where we go. Across this service people and movements are working to ask the questions, have the dialogue and seek the solutions we all need. Creative innovative thinking and practice are mushrooming all over the system.

What are the signs of this movement and its people? There are probably many. The following come to mind.

    * Innovation

    * Openness to others and new ideas.

    * Effective and learning / teaching partnerships with the third sector and faith communities

    * Compassion and goodness as central values

    * The use of digital technology to enhance the speed and quality of access to healthcare

    * A move away from 'We know' to 'We offer - let's work together'

    * A real commitment to dialogue

    * A listening to needs and hopes

    * Positive risk taking

    * Seeing gaps and issues and raising them

    * The use of intuition. Einstein's point about the intuitive mind rings so true here. 'The intuitive mind is a sacred gift and the rational mind is a faithful servant. We have created a society that honours the servant and has forgotten the gift.' This movement celebrates the gift.

    * This movement values systems but sees beyond to people and communities as central and as living and vibrant assets.

When I think in images of the old and new, I see two things. When I think of the old system I think of a great mechanical machine that works to produce something. To be fair much good was done through and in the old system. Yet the image of machine echoes true to me. And this new movement? The image that comes to mind is a dance where the dynamic interchange goes on and on in different forms and shapes. The Hindu faith tradition has a wonderful way of describing the cosmos and life itself. It calls it a  dance - a dance of energy, power, being and opportunity. The symbol of   dance helps understand this move across Health. There may be disagreements and debate but there is a direction. There may be different voices and ideas but there is real vision,potency and participation. 

Mid Staffs probably represented the worst point in the history of the NHS. It was a dark night for our service. The shock, scandal and heartbreak we all saw and felt expressed our devotion and commitment to the NHS. Health had entered a winter season. These new movements, services and people are a counter sign to that. They are the signs of a better and new tomorrow for the NHS. They are the signs of hope and renewal. They are the signs of spring.

John Walsh. York Street Health Practice                      

A timely call

The Centre for Innovation in Healthcare Management has this year produced a manifesto with the wonderful title 'Giving Inspiration a Chance to Flourish' . The manifesto is a bright and colourful production. I don't think the brightness and clarity of the publication is accidental. It reflects the method and spirit of the manifesto's message.

The CIHM is a health innovation centre based at the University of Leeds. Its website describes its dynamic work well  as a 'network of doctors, public sector managers, organisational change consultants and academics, who are passionate about improving public services. We believe that CIHM is unique in that it is a ‘think and do tank’: not only do we undertake major pieces of academic research but we also work with health and social care organisations to help create the conditions in which change occurs.' The Centre is  led by Becky Malby, a deeply respected and inspirational figure in the world of innovation and health. Becky recently visited York Street Health Practice.  Becky, Catherine Hall and myself spent nearly two hours in discussion and dialogue. It was one of the most enlightening and inspiring talks I have ever had in nearly 20 years of working in the NHS.

 The manifesto is a challenging and positive road map of where we can go and what we can be. The heart of the manifesto is 'finding solutions with people that deliver and use services.' The manifesto has eight key parts.

 (1) Develop local solutions with local people.

 (2) Provide conditions that allow staff, patients and communities to adapt, innovate and improve together

 (3) Create space for communities to provide health and social care,prevent ill health and be well

 (4) Support regulation to stop unacceptable behaviour; not to improve the behaviour of the majority.

 (5) Choose co-operation as the expected and default behaviour

 (6) Understand what’s going on around here now, how things work now.

 (7) Give people the chance to talk about what matters to them and how they will act towards each other.

 (8) Create opportunities for patients, their families and carers to have a voice in all aspects of their health and social care.

 Each of these elements has a 'Why?'and 'How This Works' explanation. The important thing about this manifesto is that it is underpinned by a clearly stated set of core beliefs about us all. The manifesto terms them as 'self evidently true' ( perhaps borrowing from the US Declaration of Independance's self evident truths ). These are located in a view that we are not just individuals but part of communities, that we have great potential, possibilty and can organise ourselves and that systems should learn from each other and understand each other. It is these clear and liberating beliefs that underpin the manifesto.  

This manifesto seeks to ground itself on what is best in us and others. It offers a picture of how the NHS could develop. In the section 'What We See What Inspires Us' we find people going the extra mile, kindness and the spirit to keep asking difficult questions. The manifesto is not a theoretical construct living in the clouds neither is it a collection of practical recommendations. It is rather a call for us to link mind and heart in positive action for the future. It marries the need for clear thinking with rooted actions. It is space that starts that discussion of what the inner being and external expression of the NHS can be. I would ask all colleagues to read this manifesto and let its aspirations and power challenge us. By all means debate and question what the manifesto says but let's have that dialogue. From this discourse, great things can emerge. Without it, I am not so sure. I hope we can all commit ourselves to grow opportunities and spaces for this Manifesto and it's challenge to become living practice. 

John Walsh, York Street Practice

A Timely Call

The Centre for Innovation in Healthcare Management (CIHM) has this year produced a manifesto with the wonderful title 'Giving Inspiration a Chance to Flourish'. The manifesto is a bright and colourful production. I don't think the brightness and clarity of the publication is accidental. It reflects the method and spirit of the manifesto's message.

The CIHM is a health innovation centre based at the University of Leeds. Its website describes its dynamic work well as a 'network of doctors, public sector managers, organisational change consultants and academics, who are passionate about improving public services. We believe that CIHM is unique in that it is a ‘think and do tank’: not only do we undertake major pieces of academic research but we also work with health and social care organisations to help create the conditions in which change occurs.' The centre is led by Becky Malby, a deeply respected and inspirational figure in the world of innovation and health. Becky recently visited York Street Health Practice. Becky, Catherine Hall and myself spent nearly two hours in discussion and dialogue. It was one of the most enlightening and inspiring talks I have ever had in nearly 20 years of working in the NHS.

 The manifesto ( http://www.cihm.leeds.ac.uk/new/wp-content/uploads/2014/06/CIHM-Manifesto-2014.pdf ) is a challenging and positive road map of where we can go and what we can be. The heart of the manifesto is 'finding solutions with people that deliver and use services.' The manifesto has eight key parts.  

 (1) Develop local solutions with local people

 (2) Provide conditions that allow staff, patients and communities to adapt, innovate and improve together

 (3) Create space for communities to provide health and social care, prevent ill health and be well

 (4) Support regulation to stop unacceptable behaviour; not to improve the behaviour of the majority.

 (5) Choose co-operation as the expected and default behaviour

 (6) Understand what’s going on around here now, how things work now

 (7) Give people the chance to talk about what matters to them and how they will act towards each other

 (8) Create opportunities for patients, their families and carers to have a voice in all aspects of their health and social care

Each of these elements has a 'Why?'and 'How This Works' explanation. The important thing about this manifesto is that it is underpinned by a clearly stated set of core beliefs about us all. The manifesto terms them as 'self evidently true' (perhaps borrowing from the US Declaration of Independance's self evident truths). These are located in a view that we are not just individuals but part of communities, that we have great potential, possibility and can organise ourselves and that systems should learn from each other and understand each other. It is these clear and liberating beliefs that underpin the manifesto.  

This manifesto seeks to ground itself on what is best in us and others. It offers a picture of how the NHS could develop. In the section, 'What We See What Inspires Us', we find people going the extra mile, kindness and the spirit to keep asking difficult questions. The manifesto is not a theoretical construct living in the clouds, neither is it a collection of practical recommendations. It is rather a call for us to link mind and heart in positive action for the future. It marries the need for clear thinking with rooted actions. It is space that starts that discussion of what the inner being and external expression of the NHS can be. I would ask all colleagues to read this manifesto and let its aspirations and power challenge us. By all means debate and question what the manifesto says but let's have that dialogue. From this discourse, great things can emerge. Without it, I am not so sure. I hope we can all commit ourselves to grow opportunities and spaces for this manifesto and its challenge to become living practice.

John Walsh, York Street Practice