Keep your Spirit Level: a Mindful Use of Subliminal Stories

By Simon Bell

At the Bayswater Institute we make use of short stories as a means to engage individuals and groups in a considered appreciation of their context, issues and concerns. We find that stories provide a powerful means for self-examination. The fictions engage a kind of back-door to the things that concern us. They can provide a powerful means to start a conversation with yourself about the things that may be upsetting you or just causing you angst.

Here is an example for you to try.

You will need about 20 minutes in order to engage in the Subliminal Stories process.

I suggest that you place the story in a mindful setting. So, settle down in a comfortable place and take a few seconds to control your breathing, focusing on the in-breath and the out-breath. Give this a couple of minutes.

When you feel ready, let your mind wander over the issues of your day, the thoughts of the moment and your main concerns. Try not to hang onto any of these elements, just try to let your mind wander, like a bird flying over a great landscape of trees and mountains. All of it is important but it is all below you. Stretching out. No single element is necessarily more important than any other part.

When you feel calm and your breathing is steady, read the story below, The Walk. Read it carefully and try not to judge the content too quickly. Let the story seep into your mind.  and then, look at the questions which follow:

The Walk

“You regularly walk. You like to walk and there is always a good reason to indulge yourself. A walk can be for a variety of reasons. You walk maybe to work or to see friends.

Today the route is well known to you, held in muscle-memory and repeatable almost with your eyes closed. Parts of the walk are really pleasant. Vistas of park, trees, well-thought out housing developments with good combinations of different kinds of dwelling. The people you see seem to belong and to know that this is ‘their’ place. You do not feel like a stranger. You are sharing their neighbourhood, but it might as well be your own. A walk among familiar homes.

But, parts of this particular walk are more mysterious. At times your leisurely pace quickens. In some parts you walk a little quicker. In these districts you have not looked around, tending to keep your eyes in front. You have not looked down all the side streets, but you have glimpsed dark and curious buildings and there are shops which seem to have no obvious purpose. There is one shop in particular.

It is on the corner of a particularly shady side street. Is it even a shop? Well, when it first caught your attention you noticed it because it stood out in strangeness, darkly against the shadow. it has a shop window and a shady, glass door but there is no writing above the window and the interior is so dark it is hard to make out anything in the dim light.

You don’t know why but one day you are a little ahead of your schedule and your curiosity is peeked. Deliberately turning down the side street you stand in front of the glass frontage. Now you are here you notice that there seems to be a blue flickering light deep inside the interior and, as you shade your eye to look more intensely, you can see weakly lit the outlines of mysterious shapes. Statues of curious design, mirrors reflecting back the blue light onto paintings or hangings, tables littered with un-guessable objects and stands providing space for shadowy curios. You would like to go in but you are not even sure it is a shop let alone if it is open. You hurriedly retrace your steps back to your habitual path.

Each time you pass you ask yourself if you will be brave enough on this occasion to stop and enter, each time you don’t.

Then, one particularly dark and dreary day, when the rain is saturating, as you pass, you see that that the shop door stands open. Without thinking you turn from your usual route and enter.” 

Now, take a moment to breath and reflect and, with the story still fresh in your mind, read and consider your responses to each of the following questions:

Question 1. What is the main meaning of the story? – What message or core or essential meaning does the story hold? There may be many meanings which occur to you but, for now just think of one.

When you are ready. Read the next question:

Question 2. How is this meaning of relevance to you? How does it impact on your life and your challenges right now. Why is it important? Again, give yourself time to think of your response and, when you are ready try the next question:

Question 3. Think about what is the main value that you can draw from this relevance of the story. What does this value bring to the concern you identified earlier? Don’t rush your response. Take time to think about the value. The word ‘value’ is an interesting word. What do we value and what of value is here? When you are ready try this:

Question 4. What insight does the identified value provide for you? Finally:

Question 5. What action might you engage with as a consequence?

When you have considered what you might do next, spend a couple of minutes just breathing and thinking about nothing at all.

See what changes this day as a result of thinking about the story.

Subliminal Stories – a BI method developed by Simon Bell

Post By Professor Simon Bell

In solitude or with others, some things are too difficult to be dealt with directly. Sometimes we need to find a way to address underlying issues by roundabout means.

My starting point is two-fold. It can be summed up by the two following sentences:

We are needful of harmony with each other.

We are needful of peace with ourselves.

By: “needful of harmony with each other” I refer to the quality of the relationship we have with the others who come into and move out of our lives.

By: “needful of peace with ourselves” I refer to the quality of our self-knowing.

These two precepts underlie the intention and content of the Subliminal Stories method.

The intention of Subliminal Stories is to provide prompts or ‘calls’ to mindful consideration of the various elements of our inner relations. In reflecting on the stories used by this method, you are encouraged to reflect upon your Self and your Self with others and with things. Others like your family, work groups and friends. Things like nature, technologies and events in your life for example, interviews and holidays.

Reflections prompted by the stories may include questioning your motivations and motives, assessing your strengths and your weaknesses, considering your impact on others and their effects upon you. You may find the stories mirror some obvious and explicit event in your life; you may find that the stories address implicit and subliminal sources of concern and anxiety.

The prompts or ‘calls’ contained in the stories are invitations to sublimate, to look below the surface of your accustomed responses to yourself, your social context and your relations with the things that surround you and to allow new ideas and responses to emerge. Looking below the task in hand to the task below can free us from restrictions, allowing us to move ‘through the walls’ of the presenting problem. This in turn can lead to responses which you might not have considered before.

In this process I make use of fictions, stories which are objects which can provide means to address subjective problems, but problems which are too sensitive to be openly addressed more directly at this time.

There are no intended outcomes other than success in your exploring.

One of the Subliminal Stories is included in the video below:

Resist the nudge in 2019: Becoming GroupAware

Post By Professor Simon Bell

Making the Connection

Wikipedia suggests that ‘Nudge Theory’ “proposes positive reinforcement and indirect suggestions as ways to influence the behaviour and decision making of groups or individuals”. The problem seems to be that the reinforcement can work in any of a number of directions and some are surely not healthy.

Increasingly our experiences are mediated by the groups, teams, communities and associations we share. And, also increasingly, these groupings are online.

Recent experience in the polity of the USA and the UK (among others) indicates that groups of all kinds are being nudged in directions which may well not be healthy for wider society or even the sustainability of the groups in question.

Nudging has been weaponised.

At the Bayswater Institute we have a profound respect for groups and associations of all kinds and, deriving our inspiration from the work of Harold Bridger working at an earlier time of world hazard (the 1940s) we have developed ways for groups of all kinds to achieve wisdom in groups.

Wisdom in Groups, making use of Bridger’s ‘Double Task’, encourages groups to become GroupAware.

See: GroupAware

Here is a short, subliminal story which might provide a clue:

 

Welcome to M world

I live in M-World. You live in M-World too. In my M-World I don’t exist. In your M-World I exist but you don’t. In your M-World you don’t exist. I don’t meet me in my M-World and you don’t meet you in your M-World. But I meet you all the time and you regularly bump into me too.

We are strangers to ourselves in our M-Worlds. That is just the way of it.

When you and I are at our best with each other we leave our M-Worlds and come together for a while, we meet in another place. Let’s call it S-World. S-World is very, very similar to M-World. It is really, really close, closer than the hundredth of the width of a butterfly’s wing. You could not put a piece of paper between M-World and S-World. But they are so very, very different and they occupy very different places – they are an infinity apart.

In M-World I am isolated, my perspective is stranded to itself, my thoughts are my own and my journey is the journey of the solitary.

But, when we meet in S-World I am part of a community, my perspective is confronted and completed by yours and others, my thoughts are shared, and my journey is not so lonely.

The problem seems to be that S-World is hard to find. But is it?

Oddly people who need each other find each other effortlessly in S-World. All M-World separation disappears, the needy are united in an instant. When the need is great, in an instant they are all moved to and share in S-World.

But people, even really, really clever and talented people who do not want to need each other can never find S-World, not even if they are all together in the same room, sitting right next to each other for hours and hours and hours, looking right at each other. They remain in their M-Worlds where they do not even meet themselves.

Wisdom in Groups 2019

Wisdom in Groups – Leadership, Strategy and Teams

Post by Professor Simon Bell

In a fractured world where it seems that people are pulling further and further apart, where we find it hard to understand each other and where conflict seems likely to break out at any moment, we present Wisdom in Groups.

Wisdom in Groups from the Bayswater Institute.

You can think of the Wisdom in Groups event as a ‘headspace’, where beliefs and assumptions are renewed and refreshed.

Uniquely, Wisdom in Groups contains and implements the Double Task approach development originally by Harold Bridger. Double Task provides clarity both about the work we do and the way we do it. The outcome of applying Double Task is what the Bayswater Institute refers to as ‘Group Aware’. A person who is GroupAware is more reflective and more capable, better able to manage the overt and covert challenges of life. Wisdom in Groups is intended to help people to feel stronger and more resilient. It can mark a step change in our understanding of ourselves as leaders.

In all the turmoil of the contemporary world, maybe to be truly GroupAware is the most powerful gift that an organisation can provide to its people.

Peter Drucker came up with a saying ‘culture eats strategy for breakfast’ and we see this in many of the organisations we at the Bayswater Institute go into. Using Double Task with leaders and teams helps us to work together on strategy and culture at the same time, so that changes, introduced are firmly rooted in the reality of the present, and lead to better outcomes in the future.

Understanding how and why the NHS adopts innovation

Post by Dr. William Maton-Howarth

Adoption of innovation in the NHS

The adoption of new technologies and innovation in the NHS is a challenge, with many barriers along the way from early stage development to full scale implementation and delivery of all of the potential benefits.  The BI were commissioned by the NHS Innovation Accelerator (NIA) in March 2018 to undertake a rapid study focused on improving our understanding of the organisational processes involved in adopting innovative developments.  A report on this work has now been published providing new insights into how decisions are made within NHS organisations.

NHS Innovation Accelerator Case Studies

Through in-depth case studies of nine innovations our research has explored:

  • How and why organisations take up an innovation
  • The enabling factors which facilitate the uptake and embedding of an innovation
  • The impacts of adopting an innovation on organisational practices

The approach we adopted included an examination of eight theoretical perspectives in the  literature on innovation adoption.  These were then used to guide our interview questions as well as providing a lens through which we analysed the data gathered from the interviews.

Innovation Adoption Theory

In capturing these real-world case-studies we have gained new insights into how the organisational context plays a significant part in adoption and we highlight in the report a number of recurrent themes relating to the effective spread of innovation across the NHS.

Our analysis is organised into three sections:

  1. the adoption journey,
  2. the adoption network, and
  3. common tasks in the adoption journey.

Key Adoption Themes

Some of the key themes emerging from our work include: the complex nature of adoption; the dynamic and non-linear process of adoption within organisations; the need for mutual adaption and iteration between the organisational context and the innovation to facilitate adoption; the facilitating role of multiple champions operating inside and outside the adopting organization; and the interplay of push and pull factors that supports implementation and builds the capabilities of both the adopting organisation and the innovator.

NHS Innovation Accelerator report “Understanding how and why the NHS adopts innovation”

The Past, Present and Future of Sociotechnical Systems Theory

Bottom up and Middle Out Approaches to Electronic Patient information Systems: A Focus on Helathcare Pathways

Wisdom in Groups – WiG 2019 & WiG Intensive – NOW BOOKING!

WiG 2019: 5 days: 8th–12th April 2019
£3,200 per delegate. Please book early.

WiG Intensive: 3 days: 1st–3rd July 2019
£1,500 per delegate.
Presented for the first time, WiG Intensive is intended as an advanced immersive event for the alumni of earlier WiG or the Bayswater ‘Midhurst’ Conference. Again, please book early.
The WiG Intensive three days at a central London hotel builds upon your experiences of WiG and advances into areas such as: reading the group, understanding the unconscious in group work and refining your skills as a Double Task, GroupAware practitioner.

Digital Change in Health and Social Care

Digital change in health and social care – a report by the King’s Fund

Reviewed By: Dr Adam Hoare

Digital change in health and social care King's Fund Bayswater Institute
Digital change in health and social care

This report by the King’s Fund, presented at the Digital Health and Care Congress 2018, usefully draws out some of the challenges in adopting and scaling digital health and care interventions through consideration of five significant case studies. It begins by recognising some of the unique challenges of digital change and goes on to identify some key themes. The report is a practical and timely contribution to the practical understanding of digital change and not only references some of the work that The Bayswater Institute (BI) members have been involved in for many years but raises many of the issues that the BI come into contact with on a daily basis.

The report recognises several challenges around large-scale digital change. The negative memories around the National Programme for IT (The Implications of e-health System Delivery Strategies for Integrated Healthcare) and the inability to undertake such change whilst under pressures of current demand on resources being key issues.

The Evidence About Managing Digital Change

The report references the Wachter review (Making IT Work) which identifies the need for change processes using digital technology to be ‘adaptive’ and ‘technical.’ That “Adaptive change is change that relies on human behaviour for its success.” At the heart of this challenge lies approaches that are central to the BI way – action research and sociotechnical systems. Action research involves iterating towards a solution and sociotechnical systems thinking recognises that the solution is a collaboration of people working with technology. This recognition represents a significant departure from the “big-bang” approach to system change where it is assumed everything is known up-front. It signifies a shift to more “test and learn” thinking that underpins so much successful innovation in other industries and endeavours.

The report goes on to recognise the productivity paradox identified by Brynjolfsson (Beyond the Productivity Paradox.) That efficiency gains accompanying widespread digitisation is often absent in the traditional indicators. Our work indicates that it is often necessary to expand the range of indicators and evidence to understand how new practice is being enabled and what that means. This means that the evaluation approach must evolve with the intervention.

The work of Prof. Eason (a member of the BI) is discussed with regard to the tensions between top-down and bottom-up approaches in digital innovation (Bottom-up & Middle-out Approaches to Electronic Patient Information Systems.) The benefits of a middle-out approach are recognised in trying to link front-line change to national standards and frameworks. The work of Eason goes on to recognise that large-scale digital change is challenging and frequently fails (Getting the Benefit from Electronic Patient Information that Crosses Organisational Boundaries – Final report NIHR service delivery organisation programme)

In considering the barriers to successful digital change the work of Greenhalgh is cited (Beyond Adoption: A New Framework for Theorizing and Evaluating Nonadoption, Abandonment, and Challenges to the Scale-Up, Spread, and Sustainability of Health and Care Technologies ) which distinguishes between complicated and complex interventions. Complexity in this sense arises from systems that are interconnected and dynamic and produce emergent behaviour. Too often solutions are assumed to be complicated and fail because they do not address the complexity. In discussing the use of telephone triage in primary care the report refers to the absence of clear evidence of benefits but that some practices improved their ability to cope with demand. The same intervention in a different sociotechnical implementation could yield completely different results. Further, the originally identified benefit may not always be the useful benefit found in practice. This complexity again goes back to the need for a “test and learn” approach. This situational complexity and lack of a one-size-fits all approach underlies the challenges of the Whole System Demonstrator which saw the intervention as fixed and tried to generate an economic value (or QALY) for the intervention. Although the value of telehealth in reducing emergency admissions and better managing patients is generally recognised (Reduced Cost and Mortality Using Home Telehealth to Promote Self-Management of Complex Chronic Conditions: A Retrospective Matched Cohort Study of 4,999 Veteran Patients) it is highly situationally dependent and cannot be implemented as a black box approach as it is a sociotechnical intervention. The report reiterates that digital change is adaptive and does not lead to static states for testing – it evolves.

The report goes on to explore five different digital interventions across very different sites and applications. It identifies five key themes that are highly correlated to themes we see recurring in our BI work.

Leadership and Management

A key theme here was that personalities count. Often, selecting the right person to lead on a particular aspect was central to success. This is reinforced by the observation in the report that technology implementations should not be seen as IT projects but as a cultural change that is highly dependent upon good leadership. This leadership is most effective when clinically driven. At the BI our experience shows that many digital projects are approached as linear implementations that do not seek to learn or understand what is working and what is not. The need to build collaborations, often across organisational boundaries, is underestimated. In our work we regularly see digital projects pigeonholed as IT and lacking in the attention to culture change and leadership identified in the report.

User Engagement

The report recognised that a common approach across the case study sites was to recognise user engagement not as a single event but as a continual collaborative process involving users of the technology. The work we did at the BI in the BOLD-TC (Better Outcomes for People with Learning Disabilities – Transforming Care) project was based on just such an ethos involving not just the front-line practitioners across health and social care but also people with learning disabilities and their families. The move to a more collaborative, ongoing engagement with users is essential if services are going to evolve.

Information Governance

The case study sites focused on cultural rather than the technical aspects of information governance. By creating the right environment for partners to come together and solve the problems of sharing data it was found that collaboration, in general, was increased. Leadership and approaching information governance as a framework rather than trying to solve each problem as it occurred led to sustainable approaches.

Partnerships

It was identified that the right supplier could act as a facilitator for change by coordinating actors and change processes. Our experience at the BI is very similar. The ability of a supplier to see all of the challenges being addressed by the organisations coming together in pursuit of a common digital solution puts them in a key coordinating role. By providing each of the stakeholders in the intervention with valuable reporting and evidence specific to their needs they can act as the glue that binds the intervention. However, this requires an open supplier that sees the long-term benefits in building trust and collaboration. As the report points out choosing suppliers is a significant contribution to the success of the approach.

Resourcing and Skills

For the project to succeed the resources and skills need to be there, over and above what is required to keep the engine of delivery going. For large-scale digital interventions this is challenging in the current environment. Recognition was given to starting small and evolving solutions in a phased way. This was particularly important when crossing organisational boundaries. Trying to do too much at once absorbed resources and slowed progress. Our experience reflects this. Developing solutions that can have an impact on day-one but evolve over time to cross boundaries is essential and, again, part of the ongoing “test and learn” approach.

Evaluation

Although not a separate heading the importance of evaluation was noted. Significantly, the importance of evaluating success and failure was recognised. One of the quotes equated randomised control trials with a lack of rigour recognising that iterating understanding and learning was essential. At the BI we are committed to evaluation that engages with complexity and evolves with the intervention to develop learning and understanding. This requires formative evaluation and an understanding of the challenges the collaboration partners are facing.

Conclusion

The report is a significant contribution to understanding the challenges of implementing digital change. The use of case studies that demonstrate both the barriers and how they were overcome is the most useful way to share learning and understanding. At the BI we hope to see more of this kind of sharing and a move to learning “what works for who and under what circumstances.”

In my work with Airedale NHS Foundation Trust we addressed the issues of one-size-fits-all, the black box view of technology and the need to embrace complexity. Beginning in 2008 as part of the Assisted Living Innovation Platform (ALIP) we worked with Airedale NHS Foundation Trust and partners to use video in the home to address a range of care scenarios. Over a period of eight years Red Embedded Systems Ltd. developed the v-connect service. We developed a communication platform that could facilitate a range of care scenarios including video calls through the TV and delivery of educational content. We implemented interventions for long-term conditions, social care interventions such as virtual visiting, support for people with renal failure and remote support for people with learning disabilities. We integrated ambient monitoring, remote physical measurements, evidence collection and reporting (A Socio-technical Approach to Evidence Generation in the use of Video-conferencing in Care Delivery and Factors Affecting the Move to an eSystems Approach to remote Care delivery.) Many of the challenges discussed here were addressed in working with a broad range of partners in care delivery. We overcame barriers in all of the key themes identified but failed to make the commissioning case in every situation. Digital interventions have the potential to prevent and reduce current activity in the care system. Better educated and managed patients are more independent, and this reduces the need for care. For people with learning disabilities, remote support enables them to live more independent and confident lives. Prevention reduces need for care, independence and confidence all reduce the amount that the current providers are paid. This raises significant issues for leaders and for culture change. Often the right thing to do for the patient or client is the wrong thing for the financial standing of the organisations involved. This requires leadership at the policy and Governmental level. The focus of this report is on how successful digital interventions can be against the resource and skills challenges in the current climate. Imagine how successful they could be if there was a strategy and funding to facilitate a market in solutions.

We can only hope that future initiatives such as the Industrial Strategy Challenge Fund on Healthy Ageing (Industrial Strategy Challenge Fund: for research and innovation) and the recently announced £487m Transformation Fund for Healthcare will begin by taking notice of what we know and not try to reinvent the wheel.

 

 

Routledge Handbook of Sustainability Indicators

Description:

Routledge Handbook of Sustainability Indicators

Routledge Handbook of Sustainability Indicators

This handbook provides researchers and students with an overview of the field of sustainability indicators (SIs) as applied in the interdisciplinary field of sustainable development. The editors have sought to include views from the center ground of SI development but also divergent ideas which represent some of the diverse, challenging and even edgy observations which are prominent in the wider field of SI thinking.

Edited by: Simon Bell, Stephen Morse
© 2018 – Routledge

Available from: https://www.routledge.com

Transforming care and health through information and technology: Local Investment Programme – Interim Report

By Dr Adam Hoare

Local Government Association – Local Investment Programme

Local Government Association Local Investment Programme Interim Report

Local Investment Programme – Interim Evaluation Report

In 2017 the Local Government Association in collaboration with NHS Digital introduced the Local Investment Programme. The programme recognised that the imperative for local care services to transform has never been greater due to rising needs, citizen demands and expectations alongside sustained pressure on resources. Although technology will never be a replacement for the delivery of care it can, if used appropriately, support people to live at home for longer, enable professionals to work more effectively together and help commissioners target services where they have the greatest impact. The Local Investment Programme (LIP) supported transformation through one-off local investment funding of up to £50,000 for projects that seek to use information and technology to improve adult social care and health outcomes and deliver financial savings as well as supporting more resilient care services and in improving outcomes, including people’s experience of care.

The programme was underpinned by a number of key principles:

  • encouraging open and replicable approaches which enable other LAs to adopt digital ways of working
  • supporting innovation and new thinking within adult social care and health, assisting its digital maturity within a challenging financial environment
  • assisting cross-council or multi-agency use of information and technology
  • developing an evidence-base and tools to support ongoing local digital investment in adult social care and health.

It was expected that the outputs and learning from these projects would be reusable and replicable, enabling them to be shared and implemented widely across the sector.

Councils who were successful in their bids for funding received support from an external partner organisation to help evaluate benefits, capture learning and support dissemination to assist other local areas. Participating local authorities were required to actively support this work, over the course of the programme, including in the development of guidance and tools for the sector.

The Bayswater Institute and OPM Group (now Traverse) were successful in winning the opportunity to evaluate the 19 technology interventions funded by the programme. In April 2018 an interim report was produced capturing the learning on the ground as well as considering the programme itself.

 

Mindfulness in the Group context – simplicity and presencing

In this third blog we want to talk more about what you can expect coming to the conference.

WiG (Wisdom in Groups), is derived from the earlier BI “Midhurst Conference” and the format was originally conceived by Harold Bridger. The Midhurst Conference was a tried, tested and successful formula. But it needed to change to suit the needs of a rapidly changing world. It has evolved over the years and 2018 marks its most radical evolution yet.

As part of this latest iteration our intention is to make the process more accessible, whilst at the same time maintaining the depth needed for real transformation to take place.
WiG has three core components: search groups, supported by consultants, which provide an open space for participants to explore issues of common interest in their work (task 1) and at the same time experience and comment on what goes on in a working group (task 2). The second component is consulting groups where participants bring a particular concern or problem and are supported by the others in the group, including a consultant to explore it and devise a way forward. The third component talk/discussions is a more familiar way of learning for most of us. We will keep the talks short and the discussion flowing.

The Consulting Group is small and allows individuals to learn more about the experience of consulting to others – asking, listening and actively learning. The Search Groups are, some might say, more challenging. They are both larger and less structured.

We haven’t changed these core components much although we will be issuing some clearer guidance as to how to navigate the search groups. We have introduced some new ‘tools and processes’ which you can take away such as:

  • Rich pictures –which enable you to explore the issues you bring visually
  • The Leadership Compass – which gives you a chance to find out more about your working styles and those of your colleagues

For those of you who haven’t been to an experiential learning event before, WiG might feel a bit different. It requires you to ‘jump in’ using your own experience, in the moment, to learn. It is exhilarating but can also feel challenging and even scary at times. For this reason we will be given you an opportunity to have a short coaching session, on how you make best use of the event as you are in it, rather than on any external issues.
We want WiG to be transparent and accessible so that the learning process is visible and mutual. We are really looking forward to your feedback on your experience during and after the week we spend together. Working together in this way will we hope develop a lasting and mutually beneficial relationship between you, the delegates and the BI.