Values, not just systems

Image: https://openart.ai/home

Since my last post (yesterday?!) I’ve been thinking and reflecting both on the analogy of the PPI rowing boat, but also some new concepts I’ve been absorbing today.

I’ve been reading Participatory Pedagogic Impact Research by Mike Seal. I’ll be honest, I’m finding it a dense read and I think his ambition that this book would be accessible to the public is a bit unrealistic – however, there are some really good points in his book which he references really well and it’s gotten my brain churning…

One of the first things which chimed with me, was the observation that one of the barriers for workers engaging with the public seemed to be a practical focus and a wish to get on with the job rather than “have all this talking”. In the past I have been asked: “Well, all this tea and cake is very nice, but what are you actually doing?” I gritted my teeth, smiled brightly and explained that relationship building was key to any community engagement. Those of you work in this space know that building those relationships takes time, and that time is sometimes spent doing something sociable – such as drinking tea and perhaps also eating cake.

The thing which often gets missed here is: the talking is the work.

I think we often make the mistake of thinking that the project (research study, community art project, school event etc) is the main goal and the only thing of real value. We think to ourselves: “We’ll get the planning bit done and then we’ll start doing the actual work.” But without the planning, without the team building and time to get to know each other and build trust there is no study, or community art or school event. You need the team and the relationship building part, in order to achieve the main thing you set out to do. It’s simply not possible without it. Seal goes on to quote Bovaird and Loeffler (2012) saying: “Most funders measure only some of the outcomes achieved from their funding.”

It got me thinking: what if one of the outcomes you put on a grant funding application was: build a strong and unified team of specialists and public contributors to plan, design and deliver the study. Of course, we never include that in a grant application because it’s kind of assumed that you need it in order to achieve your aim, but how would it be if that all-important preparatory work was included as a measureable outcome? Suddenly that process moves from being a means-to-an-end to an essential part of the process because we’re being measured against it.

Another point which Seal raised is: “The starting point for many managers is how to enable service users and community partners to engage in their structures rather than asking themselves how they will need to change their structures and methods of planning to incorporate service users and communities, culture and languages fully.” 

Now this is a cracking point, I really liked this and he backs it up with a comment from Nestor and Galletly (2008):

Overall, the challenge seems to amount to one clear problem. Co-production, even in the most successful and dramatic examples, barely fits the standard shape of public services or charities or the systems we have developed to deliver support, even though [in the UK] policy documents express ambitions to empower and engage local communities, to devolve power and increase individuals’ choice and control. ” 

Now the question which naturally follows on from that is: do managers or staff within organisations actually believe that they could change the systems they work within, in order to make it easier for the public to engage? Or do they think it’s an impossible task, and therefore don’t even bother to ask? The assumption of what is possible, informed by past experience, can be the worst inhibitor of innovation – even if the policy of the organisation and the funder states that they wish for meaningful public involvement. This links back to the comments made by my friend, who said: “…the oppressed will not be liberated until the perpetrators are liberated too.  And that is one of the hardest challenges we face.  In the instance of PPI, how do you help to liberate the researchers so that they can experience transformative engagement?

Seal also comments on the tension between policy and practice: funders write policies which say they want meaningful engagement and they want to see it fully costed in the budget and evidence of PPI – BUT – they also say that they want something scaleable and replicable or repeatable, in order to ensure value for money (Buy-One-Get-One Many-Times-Over). But what this fails to take into account is that every community, every city, every human context is different. He comments:

“This is an organic contextual process. No one model will work for all…In my previous work (Seal 2009), I noted that there is no single model for effective user involvement because users are not homogeneous and there needs to be a multiplicity of methods. I linked this to the concept of diversity, saying that all co-production approaches will allow certain groups to dominate, and this must be acknowledged, and the key is having a diversity of approaches.

Funders and organisations seem to like systems because they provide a blueprint, a roadmap which lays out exactly what to do and where to go. Measured, scaled and precise. But people are all different, communities are different, so what works for one community won’t necessarily work for another. This is the kind of phronesis* or practical learnt-on-the-job knowledge which public facing workers such as teachers, nurses, social workers etc all learn within a very short time. Yes, there are broad similarities between people, between rural communties or elderly people, but they are still distinct from one another.

So a one-size-fits-all system won’t work. It can’t. It’s too rigid. It won’t be effective in the long-term. Certainly it’s useful to have clearly articulated boundaries and expectations…but it’s more than that.

I think it’s the values, attitudes and then outworked behaviour which remain consistent across the board, rather than the system of ‘how things are done’. It’s the people-centered, values-driven approach which says: “I recognise that you have worth and value, simply because of who you are. I understand that you have knowledge and experience that I don’t. Please will you help me to make this work better? What would help you to work with me to do that?”

That’s the kind of approach which can be replicated and shared. Those values and beliefs can be used to inform how we choose to work with people. The system or framework needs to be adapted to suit the setting and the context, but I think it’s the values which are scalable and repeatable. Rather than a rigid system which we have to work to adjust, a values-driven approach is more like a good quality jumper: it will cope with being stretched a bit and pulled about – but it won’t ever cease being a jumper. Even if it eventually has a couple of small holes in it, it will still be recognisable for what it is.

So, that’s where I’ve got to. Look out for future brain-burblings in the coming weeks!

*Phronesis is my Word of the Week!

5 responses to “Values, not just systems”

  1. […] about how public contributors are viewed and valued? Why don’t people understand that the talking is the work? It’s not just the components for PPIE that are needed, but an understanding of how and why […]

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  2. […] This is an important and necessary addition to the research landscape, and whilst I anticipate that some will find it challenging, others may welcome the imperative to include patients and the public more proactively in their work and to be able to justify the time spent on it. After all, the talking is the work. […]

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  3. […] building and planning for the project. I’ve mentioned this before when I’ve said that ‘the talking is the work’ but crucially, there is rarely any funding for this planning period. You can apply to the Research […]

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  4. […] the cost of authenticity. The desire to be and act in a way which is relational and respectful is a values based approach not a systems based approach. The systems based approach is one where we have a mechanism set up to […]

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  5. […] If I do research as part of my role at HDRC, then logically it should compliment the work I’m doing with them – therefore the relational practice route makes more sense. But what about public involvement in research?? This still feels like important work – not just for people with lived experience, so that they get treated more considerately and less like a commodity, but also for the public involvement practitioners, who often stand in the gap between researchers and the public, trying to support good quality research whilst also maintaining high ethical standards for working with public contributors. The role of PPIE Lead or facilitator has been neglected and undervalued for too long, often lumped in with other roles such as Comms or Patient Experience, both of which are already a job in themselves. The skillset for working successfully with public contributors is entirely based around relational practice which is a values driven model, whereas research practice operates within a systems driven model – and so they often clash. […]

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I’m Sharon

I’m on a journey to discover authentic patient and public involvement in research in a range of settings, through conversations, creativity and cake!

This blog is a reflection of my research journey and the things I learn along the way; some of it may be technical, some of it may be reflective, or inviting a conversation. Views are my own and don’t reflect the values of any organisations mentioned.

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