Gillie Bolton (Photo: Paul Schatzberger, www.paul.schatzberger.dsl.pipex.com)

Gillie Bolton

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Making an Impact

3 April 2003 - www.natpact.nhs.uk

Making an impact?

How does slowing down or becoming a reflective practitioner help us to make more of an impact? How can you evidence your practice? Or your PCT's practice in Patient and Public Involvement?

  • So how do we make an impact?
  • How do we know when we've made an impact?
  • When do we have the time to stop, turn around and check how far we've got to?
  • Or to double check we are on the right track to continue proceeding in the direction we were proceeding?

The 'busyness' of our working contexts provides seemingly little time for reflection. Often results are based on targets, and numbers. There is an Eastern premise that 'Less is more'.. Indeed you may find that unimaginable with 100 emails waiting your attention, 15 phone calls to make before lunchtime, and 3 papers to write before the end of the day.

However, reflective practice provides time to synthesise your thoughts, to bring to gether in your mind the many different strands of activity demanding your attention. Doing this enables you to work smarter. Working smarter (as an individual or a PCT) can mean achieving three tasks by doing one action, it can mean you realising that two of your tasks are superfluous to your core role, or that they are merely 'red herrings'

Taking a breather can re-energise you with twice the energy so that you achieve more efficiently.

One way of looking at this is to build in what good programme management writers suggest as ' Islands of stability'. You literally find an 'island'; it could be the coffee shop, the grounds, or a quiet room; it could be with colleagues or alone. You then 'take stock', not only on what you are doing, but HOW you are doing it. Attention to process/approach as well as content is key to this for you and your PCT.

Reflective practice is a.

  • " process of learning and developing through examining our own practice, and opening this to wider scrutiny by others and studying texts from other spheres. with a zoom/wide angle lens" (Gillie Bolton, 2001).

This can helpfully be categorised in two ways:

  • Reflection in action - during practice the attentive practitioner watches, observes, interacts, and adjusts - and approaches through thinking in a focused way whilst working; an active participant/thinking observer approach
  • Reflection on action - occurs after action when details are recalled through rich description, and analysed through careful unpicking and reconstructing of all aspects of the situation, to gain fresh insights, and make amendments.

Next time you undertake a piece of Patient and Public Involvement, or community engagement, or a board meeting where you are presenting a paper around the patient experience take some time

  • before (island of stability)
  • during (reflection in action)
  • and after (reflection on action/further island of stability)

to review

  • What impact did you (or your PCT) make at that time in that situation?
  • how could you (or your PCT) have made more of an impact,
  • What could you (or your PCT) have done differently, in terms of behaviour, attitude, practical arrangements and processes ?.

Here is another step by step process that may help you become more effective, and indeed more rigourously 'evidence based' in your practice.

Define the question/issue
(this may be from an individual patient of aspect of a service)

Find the evidence
(to support or answer the question, to explore the question or issue, or to understand the issue, to verify the issue or to evidence the issue)

Critically appraise the 'evidence '
(by asking rigorous questions such as how reliable the 'evidence' is, whether there is any research basis, and how rigorous this is, does what you read/find out 'add up', has anything been overlooked, how else could the 'evidence be interpreted' do you need any more 'evidence' before going ahead or presenting your case/evidence etc.?)

Suggesting Implementation of relevant findings/implementing the findings in practice

Evaluating the impact of this change. (and checking back with the original question or issue).

There are many good texts on reflective practice and evidence based practice - see below for three starters Reflective practice is a useful approach not only to your own work, or the work of your PCT, but it is also part of the way patients and users can be encouraged to review the services they receive.

In a future Connectors I want to talk more about some more specific issues around making an impact in managing change such as the implementation of Strengthening Accountability, on a cultural, behavioural or system based level.

Jane Keep

Reference:

  1. 1. The Pocket Guide to Critical Appraisal - Iain K. Crombie 1996
  2. 2. Evidence Based Healthcare : A practical guide for Therapists - Tracy Bury and Judy Mead 1998
  3. 3. Reflective Practice: writing and Professional Development - Gillie Bolton 2001