Category Archives: Health

Coronavirus Learning Log Week 6: Putting ideas into action

Last week’s findings focused on moving from a theoretical base for our work to putting it into action.  I’ve reflected on the 5 main challenges and what I’ve learnt from them.

  • Collecting data
  • Working in a ‘rapid learning’ environment
  • Working across the organisation
  • Explaining the idea
  • Managing our time

Collecting data

triadThis week saw the launch of our Sensemaker data sharing tool.  We sent our survey out to the teams here at Audit Wales to find out what they had been seeing about the way public services are changing their behaviour.  We wanted to make sure that we don’t miss anything that might not seem relevant in itself but taken alongside other input may be significant.  We addressed this upfront in the survey, telling participants:

“Please set aside any concerns about ‘is this relevant?’. All information is of value and may be exactly what someone else needs to know”

We ask them to describe exactly what changes they have observed.

We ask them to specify the focus is of what they’ve described. Is it on meeting the organisations aims, responding to society, or on an individual level? Could it be an economic change, an environmental one, or one aimed at changing the way people interact?

Participants are then asked to specify the impact of the changes our auditors have observed, and what can be learned from the changes said services have made

We also ask them to think about any failures connected with the change and what can be learned from them.

  • When doing research or gathering data, account for different outcomes. Be thorough in your analysis and ask if there are any ways to approach the research which you haven’t yet explored. This will allow you to have a thorough and well-rounded view of the area your exploring, without massive levels of confirmation bias.

‘Rapid learning’ environments

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Rapid learning’ environments are environments where learning is allowed to happen quickly, using a trial and error approach to decisions and making use of technology.

We hadn’t initially thought of the work we are doing in terms of rapid learning. However, the rate at which we’ve been developing this project, alongside our use of tools such as online conferencing places it firmly in that category!

We plan to ask which of the changes that we are seeing we want to keep. We can then organise a series of events or webinars to discuss these issues, sharing information back through channels such as blogs, podcasts and videos, drawing out key findings as we go.

  • Facilitate ways in which learning can be achieved quickly and easily; this could be through an organisation hosting learning events, furthering their use of technology – including video conferencing, and making it easier for staff to network. Furthermore, by occasionally pausing to review your actions you can exercise discipline and teach yourself to constantly improve.

Working across the organisation

trelloRapid learning is reflected in our ways of working as a team too.  From using Trello to keep track of and share the tasks we’ve been assigned, to changing our working patterns to emphasise communication and a robust editorial process, we’re learning and adapting. We feedback our findings for the week on Fridays, we’re meeting with our communications team to agree activities and we’re also engaging with audit managers to share the data we’re gathering.

Other ways we’re exploring rapid learning is through ideas such as informal catch up meetings and randomised coffee trials which you can read about in the last learning log.

  • In sharing your ideas consider the questions that may be asked. Take into account the interests and thought processes of the individuals or organisations you are engaging with, allowing them to understand anything they’re presented with. This will enable and strengthen opportunities to collaborate.

Explaining our idea

This week we’ve been out and about talking to organisations who are interested in the work we are doing to see how we can work with them and their networks.  Some expressed an interest in how we can share and analyse the data we are all gathering, making it transparent and open.

We also held meetings internally to make sure the intentions of the survey questions were understood.  Taking the time to do this will mean that responses come from observing how things are – not becoming weighed down with critical judgements or indeed praise and providing an honest and unbiased account of anything that has been observed.

  • Make sure to explain your ideas clearly and comprehensively. Networking and speaking to people from different organisations and backgrounds will make this process easier and will improve your communication skills.

Managing our time

One of my colleagues said this week ‘I find that mobility is the best way of hiding from the kids. Keep moving they won’t find you’

We’re all having to adjust our working patterns from home due to our personal circumstances and the fact that everything can feel different in the context of the coronavirus. Last week I attended a webinar on precisely this subject that highlighted the importance of flexibility and empathy. One important quote from the webinar is singled out below:

‘Those not already working from home may have been thrust into a world without structure and must adapt while managing anxieties. We now might all have something to learn about self-discipline, isolation and motivation. And the separation of work and the person has been eroded tremendously. It is not impossible that an important virtual meeting might be intruded upon by an over-enthusiastic toddler. Just weeks ago, that might have been a point of embarrassment.’

We now have even less of a distinction between work life and home life. In a world where we need to fit our home life around family life and continue to have those informal chats with colleagues using the available technology, ideas of being overly formal and detaching the two mindsets, are arguably less relevant than ever.

  • Manage your time effectively. When working from home we are not exercising leisure time, yet we are not in the most formal of environments either. Realising both those things and organising our day effectively can make for a better sense of emotional wellbeing.

Coronavirus Learning Log Week 5: Collaboration and storytelling

Key Challenges:

  • Explaining why we are doing this work
  • Harnessing the ability to collect and share data
  • Working across silos
  • Being open and accessible
  • Operating differently

Telling the story

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So far our work has focussed largely on prototyping a way of working involving gathering data on a different way of working in response to the coronavirus. We’ve used theory and analysis to explain our logic behind the project and we’ve been focused on illustrative stories to explain our work to different audiences.

We know that we now need to move from concept to operationalising

We’ll explain how we’re approaching this in the coming weeks but thinking about this led me to consider how a journalist might approach it.  It would probably go something like:

  • They pitch stories to editors, or storyboard the idea to see if it warrants covering
  • They do their research, selecting and sorting relevant information
  • Over time a narrative starts to emerge, making for a cohesive story
  • A story or narrative that gains mass appeal has the potential to influence behaviour and decision making

Our narrative so far has been – ‘Over the coming weeks people and public service organisations will do things that they have never done before. Some of this novel practice will be useful for the future’ – having pitched that idea we are now looking at how we can collect and share data, from which discernible patterns or narratives may emerge. Our intention is that these will, in turn, influence the way we think about public services both during the coronavirus pandemic and in the future.

Collecting and sharing

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As a team we’ve been discussing this week how we should move to more ‘data informed decision making’ – we’ve recognised that we’ve not reached all the areas we would like to in our events and discussions and therefore may have gaps in the evidence we are collecting. A conversation inevitably ensued about data during the coronavirus pandemic.

One of my colleagues really felt that the ‘flatten the curve’ narrative was doing its job.  He shared with me a podcast he had listened to, featuring Carl Bergstrom, a computational biologist at the University of Washington, there was an interesting point made about the way data visualisations can be used:

  • To demonstrate how the world or a situation is: saying to the public; here’s the situation, take or leave this information
  • To tell you how you should be behaving in life; and what actions you should be taking

The graphs we’ve seen about the need to keep hospital capacity below a certain point serve both purposes in that they illustrate both where we stand in NHS capacity as well as providing a visual aid to the motto ‘Stay Home. Protect the NHS. Save Lives’

What that particular model did, argues Bergstrom is ‘show people why social distancing is necessary’.

‘The model itself is arguably neutral. However, they are made for a reason’ he goes on ‘Models have a feedback – they influence our behaviour in a way which in turn changes the situation we’re in, which changes the data’

We want to use these learning logs to present different ways of working and mapping the responses we’ve seen, using different models for visualising it. That data will hopefully serve to make a point that we should be looking to adapt the way we work and identify those innovative practices that we may be able to carry into a post coronavirus world. On the other side, it may also help to demonstrate the mood of public sector workers and provide a detailed picture of their response to the coronavirus. Importantly, we need to interpret that data fairly, gathering a wide range of views, avoiding assumptions about how services are operating or should be operating.

Working across silos

In these learning logs I’ve talked a lot about working together as an organisation and using our skills and abilities to advance this project to share knowledge gathered from responses to coronavirus.

One way we are doing this is by working closely with our communications department. Considering that Audit Wales has adopted this project as a way for the performance audit teams to conduct their work, during this period of unprecedented disruption, the project requires a clear communications strategy for sharing information and who better to turn to for that than our comms team?

While we’ll be presenting a lot of the knowledge gathered through infographics and data, we want to look at how we can share what we are learning wider.  We want to expand on our current strategy of writing these learning logs and publishing them on the GPX blog to a relatively limited audience. One idea that was suggested is that different people could contribute content each week, as a means of showcasing different perspectives. Making this project part of the wider Audit Wales comms approach, allows us to reach a larger audience, while simultaneously presenting the project as an organisation-wide responsibility, rather than a niche activity, limited to one department.

Another way we are overcoming silos is by trying to dispel lack of communications within our team itself. As I write this, we’ve just agreed to have weekly skype meetings where we discuss what we’ve leaned in an informal and discursive setting. At the moment, that learning is represented by these blogs, and – much as I like to think of these as a useful resource – they have their limits in that the slight confirmation bias of the editor (that’s me), and the mental shortcut of retrospective coherence (by which we order and structure experiences), stifle our attempts to communicate freely and openly as a team.

One last thing to mention regarding communication; a word about randomised coffee trials. If you are unfamiliar with the concept, it’s a way of networking, where individuals agree to take part in the project, are randomly paired and then have to organise a chat with each other over coffee (choice of drink is optional). Trials of the idea occur across organisations, sectors or entire industries.  We for instance, are running pilots with Newydd Housing Association and the group CLARI (Change Lab Action Research Initiative), who are based in Nova Scotia. It’s a simple idea yet enables conversations between individuals who would not usually have an opportunity to network. The idea is just one way of making those conversations happen.

Open and accessible

Making information open and accessible is not only important to demonstrate accountability, but it is important if we are asking people to change behaviour and take action.  yesterday a colleague said to me ‘I went to the shop yesterday and there was a gang of boys stood in the doorway.  The shopkeeper told them to move, but it felt really intimidating. I was wondering whether I should call the police but didn’t know if it was a waste of their time’. She later found out that you can message the police via Facebook messenger for crimes such as this one.

This story stresses the importance of making sure that information is publicly available, so that individuals wishing to engage with public services can make the right decisions. Discussing this further, my colleague referred me to two websites she found:

Senedd research, describes what it does as providing ‘bite-sized and easily digestible information and commentary on topical issues and developments within the National Assembly’. It categorises this information from environment to economic, to human rights, and openly stresses the need for simple language in making the content understandable to the widest amount of groups and people possible.

The other resource was a home office website detailing the support that exists for victims of domestic violence – there’s been a particular focus on this lately and with Covid19, it is believed that the lockdown has been resulting in more instances of domestic abuse. The website specifically provides a definition of abuse as well as contact details for victims, and guidance on what they can do to get out of the situation.

This raises some important lessons as we start gathering and disseminating learning about novel and innovative practices. We want to make sure the information we produce is understandable and easy to access. Importantly, finding ways of achieving that goal can be viewed as good practice in and of itself.

Operating Differently

Earlier this week I attended a panel led webinar on Corporate Innovation. I will likely revisit this topic at a later date yet one subject to catch my attention was why we weren’t operating before, in some of the ways we are operating now. In the webinar Stuart Laws from the Ministry of Defence points out – ‘Some response teams have shortened working times for cleaning ambulances and getting those products into the market as quickly as possible. The problems in front of you, solve the problem, move on to the next problem. Think longer term when everything comes back to the ‘new normal’.

Later in the same Webinar, Dave Grant of Zoom, explained that ‘We’re taking the time. We moved fast before – we didn’t always move efficiently’. Ultimately, this speaks to a need to respond to immediate problems in new and innovative ways and then to think longer term about how those ideas can be employed in a ‘new normal’ setting ‘after all of this is over’.

We need to think carefully about how we capture the learning and understand what will be of value ‘after all of this is over’.

Learning Opportunities

  • Have a narrative. A good story to complement your intentions can help make your ideas easier to explain and rationalise to different audiences. Take care to remember that developing these is a continuous process and that your narratives or ways of describing your work to people may change as you progress.
  • Present any information or research that you gather in a truthful way; being honest about what the data you’ve collected shows, as well as drawing a discernible line between analysis and fact, and accounting for any discrepancies or potential shortfalls in the information.
  • In any concept that prioritises communication and working together as a value, it is important to acknowledge the ways in which your own thinking may be siloed and work to overcome that by reaching out to relevant organisations, departments or groups that you may have left in the dark.
  • Make sure the information produced is accessible to a wide range of people; it is not helpful if you’ve write a blog post designed to be read by everyone, that can only be understood by auditors. Constantly examine the accessibility and availability of your work.
  • in the process of finding innovative practice it is important to realise why we behaved the way we did before the pandemic. If it is the case that there was a great reason for acting the way we did, we may need to consider the effectiveness of substituting that method. If there was no good reason or the reasons behind a method were decidedly small, look for alternatives.

Coronavirus Learning Log Week 4: Trust and Networks

Key Challenges:

  • Leaving the door open for people, not backing them into corners
  • Learning to develop a project in real time
  • Trying to maintain a sense of structure and ritual
  • Not jumping to conclusions from the research that we’re doing
  • Working within established networks

Open Doors

Sometimes you have to allow people to make their own mistakes and learn from them’ says Chris Bolton.

“We’ve designed a system around asking, how do we analyse and share learning quickly with people who need to know? Just collecting things is no use if you can’t find a route where it can be effectively used. I don’t think they had thought adequately about that”

Chris received coaching from a friend who advised him that you sometimes have to allow people to make their own mistakes and learn from them. ‘Having evidence to show for your way of working, doesn’t mean you’ll be listened to’

He cites a quote by the character Yoda in Star Wars ‘’Fear leads to anger; anger leads to hate. Hate leads to suffering’’

yoda

This may not be the most professional source, in this galaxy anyway. However, illustrated here, is the lesson that backing people into corners provokes bad reactions.

This refers to having trust in ideas outside of your way of thinking. One piece of literature I read in my research this week was ‘Information, networks and the complexity of trust’ by Henry and Dietz. They point out that pre-established ways of thinking ‘’(are) an important motivator for considering the role that individuals’ belief and value systems play in motivating political behaviour and conflicts over policy-relevant information’’. Another term for this ignorance towards new information is Confirmation bias.

Structure and Ritual

‘Ritual’ Definition: ‘a set of fixed actions and sometimes words performed regularly, especially as part of a ceremony’

People often talk about ‘morning rituals’ and routines in a contented way. This week, Sion Owen had more of a ceremonial ritual when he attended a funeral of a relative, which he observed online. ‘I missed the ritualization of the farewell, the communal singing, the meeting up with family’. He says that transitions in someone’s life through religious ritual can allow you to move on, and the same logic applies to day to day ritual.

You’ve heard the term ‘the days blur into one’, and that’s true. Getting on a train, buzzing into work, talking face to face to a colleague…These not only ensure a degree of mental wellbeing, but provide a logic to the way humans act, allowing them to separate their home life from their work life, from their social life. That said, there are ways that we can retain that: ‘Skype meetings are a good point to anchor your day around’ Sion says. I would add that going out for walks at a set time every day and sketching out schedules for yourself, are all rituals which can help us.

This relates to the theme, in that people trust rituals and are suspecting of uncertainty. Having those online meetings and taking part in those Skype calls can create a notion of trust between colleagues. That said, there are instances where putting too much trust in routines can be unnecessary, …

Developing Projects in Real Time

‘Longer term should our role in GPX be about responding to the here and now?’ asks Bethan Smith. She’s referring to our annual programme – a schedule of events, webinars and seminars, attended by those in the council and public sector, and themed around the Audit Wales national studies.

The reason this hasn’t been done is that responding in real time to real world events has been seen as ‘too difficult’

However, as proven by Covid19, ‘business as usual’ can be disrupted. As Chris elaborates: ‘Typically, you start with an idea of what you want to do. We’ve come up with this very quickly. We very rapidly got to a point where we could manage a project in real time’

That’s why we’ve been reviewing our annual plan and seeing which events to move online, and which to delay.

Some are particularly relevant, including the one on domestic violence ‘which is a bigger issue than ever before’, The National Domestic Abuse helpline has seen a 25% increase in calls since the lockdown, and the government has pledged to donate an extra £2m to domestic abuse charities. We also had ‘poverty’ on the agenda – even though the issues surrounding poverty have changed, this is still markedly relevant, considering the potential economic effects of the coronavirus.

This relates to trust in processes – often, when you are used to one way of working it can be difficult to divert, even if you realise that unseen factors, such as the coronavirus. could force you to change your plans.

Don’t Jump to Conclusions

 ‘Someone saying “we can’t predict what’s going to happen” is different from someone doing back of the envelope calculations’ Sam Williams points out.

We’ll see lots of data flying around about the Coronavirus, and while you can use that to analyse trends, trying and draw conclusions about what will happen is unlikely to paint a full picture.

‘one of the easiest ways to interpret it is scaling something in days – “we’re fourteen days behind Italy” – being x days behind someone applies you’re on the same trajectory’ Sam elucidates. i.e forces such as policy, social distancing, and health systems can alter the spread of a virus. Therefore, while scaling in days is useful for showing where we are in comparison with another country, it does not imply we’re going to be in exactly the same situation as that country, by that time.

One example of this is the reference to ‘flattening the curve’. However, ‘this does not mean the curve is actually flat’. One aspect which can cause a discrepancy is weekend reporting. It is possible for a lack of reporting one weekend, to give the illusion that cases are dropping, and then for the numbers to rocket up the following Monday, as figures from the weekend are included.

Testing is another factor. While its worth pointing out that increased testing and tracing can make an epidemic easier to handle, Sam points out that ‘with increased testing, the number of reported cases will increase’

This is not a dismissal of those who use data to make predictions – used correctly, you can make educated predictions. It would be a mistake however to blindly trust that the virus is going to take one course, due to your observations from an academic graph, without taking into account the different circumstances which determine the way datasets look and the course the virus takes.

Compromise

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For a quick recap, everyone’s abilities being mobilised, means that traditional hierarchies of ‘I say, you do’ can become largely obsolete in a crisis. ‘Best practices’ cant be applicable due to the fact that no one is familiar with the situation. Thus, through experimenting and ‘seeing what works’, we can discover innovative ways of working, which we can carry into the post-coronavirus world.

With that in mind, lets talk about a completely different way of looking at the situation. In any crisis, it is to be expected that the hierarchies in place will regroup and try and find out the ‘best’ way of dealing with the situation. ‘If in doubt you cling to the structure – that’s why the army and police are set up in such a hierarchical way’ posits Sion Owen.

‘There are five stages of grief. Is there an equivalent for an organisation?’ he asks. There might be. A model that was sent to me by Deb Allen last week, is Forming-Storming-Norming-Performing: The process by which teams group into hierarchical structures, have arguments over the ‘best’ way of working and resolve their differences before settling into a compromised normal, which they excel at! This stands in contrast with the experimental model we’re using in GPX.

Ultimately, we need to learn to respect more managerial styles of working, while advancing our own.

  Learning Opportunities:

  • Don’t try and force people to see matters from your perspective, no matter how convinced you are. Peoples experiences and ways of working determine how they see the world. Therefore, you often need to allow people to make their own mistakes and learn the lessons, before lecturing them on alternatives. In that situation, keep an open door so they can seek your help again in the future.
  • Maintain a sense of structure and ritual that allows you flexibility but stops days ‘blurring into one’.
  • Always asses whether your plans are relevant and helpful; If you find you’re doing something out of an abstract sense of obligation or routine, ask how you could be more helpful in the way you spend your time; this may involve abandoning long-term forward planning, and responding to your circumstances and immediate environment.
  • Don’t jump to conclusions about anything. The knowledge you have gained from research or analysis into a certain topic is often only as good as the research behind that. Instead look for faults in the data, ask questions of the learning and knowledge you’ve found, and keep an open mind to material that contradicts your own ideas about the world.
  • learn to reach compromise through working with people whose ways of working may not necessarily suit your own. Respect those differences while working to meaningfully reconcile any difficulties or failures in decision making that may arise from them.

Coronavirus Learning Log Week 3: Adaptation and Sense-making

In last week’s learning log, we discussed our aim to reach across Audit Wales and the public sector, using our connections there to gather information and data on innovative ways of working they’ve adopted in response to the Coronavirus.

Key challenges

  • Making sure our time is well spent
  • Learning how to communicate in different ways
  • Making understandable media and data content
  • Overcoming misunderstandings, and communication breakdowns
  • Learning to work in different environments

Time Well Spent

How many targets that you created months ago are still the right things to be focusingHIYXZTHLGRIWVLBLKXAMVX7YLM on’ asks Toby Lowe

We know different situations require different ways of working. I’m struggling to think of an industry where this doesn’t apply.  In translations, you might be working from home and translating content about the coronavirus. In supermarkets, you must be prepared to implement distancing regulations.

Performance Audit work has been temporarily suspended and projects such as the Covid19 learning log are determining the work we will be doing for the foreseeable future. In that sense, it is necessary to adjust the work we do.

Before the pandemic, I aimed to release podcasts, interviewing the Welsh Police and Crime Commissioners about Adverse Childhood Experiences. Considering the context in which those podcasts were recorded though, and that PCC elections are postponed, Coronavirus content is a more constructive use of my time.

Despite this, some are keen to avoid habit change. “People are saying ‘here’s a big scary situation. I’ll make myself busy, so I don’t have to think about it” Chris Bolton says, pointing out that familiar routines can act as a distraction mechanism.

This is not entirely bad. Sticking to familiar working hours for instance can keep you focussed. However, Andy Brogan points out that it’s important to avoid routine, to the extent where alterations provoke more uncertainty or result in chaotic situations ‘forms of uncertainty provoke anxiety in us. This predictably leads to pathological behaviours’

Interestingly, Bolton goes on to say that ‘If you can explain why you’re doing something a certain way, it’s probably okay’ – highlighting the need to continuously evaluate ourselves and assess whether our actions are productive.

Communicating In different ways

‘We need to liberate ourselves to behave differently. To be mutual and to listen to one another’ elaborates Brogan, alluding to the concept that complex situations often require a range of views to be brought to the table.

1_w9xolgS_-ON5qp5jplGebgConsidering our intention is to work with auditors, public bodies, and other departments to collect information on new ways of working, one challenge is adjusting our tone and the way we present ourselves.

Chris Bolton explained the work that he’d done convincing auditors and directors to take on this work as a project for the organisation ‘’For the purposes of communicating to a different audience, I had to speak I a much more formal way’’ he explains ‘’I see my role as an abridging role – that’s what we do as the Good practice team. How do we bridge into different environments?’’

Sion’s comments show a more systemic perspective ‘As auditors are trained to think forensically, they are going to be asking awkward questions’ he points out, drawing attention to the fact that what we are asking – i.e. for those we work with to think differently about the work that they do – is quite significant:

 “We’re trying to repurpose audit wales, from checking that money is being spent appropriately, to seeing how people are reacting to this crisis, asking ‘How are you going about this, flipping from being a regulator, to being an observer”

Sion goes on to say that he has experiences of having to put on different masks when working for Gwynedd council. ‘I was always available to help Councillors with their IT questions, to the point where I helped with their IT support and took a little pressure off the IT department’. He remarks upon the importance of allowing yourself to make connections, in any aspect of life, but especially when trying to broaden your skillset, to gather views or experiences:

‘Turn up where the people you want to reach already are, then take advantage of that audience’

It is acknowledged that we as a department do not have immediate access to public service boards, and councils. However, we work with people who do have that sort of access. This explains the necessity in starting with your immediate contacts and branching out more widely from there, when seeking to make connections.

Overcoming misunderstandings

People interact differently when there’s a crisis on

Deb Allen tells me a story about one of her neighbors, who lives on their own, and who had their 81st birthday last week. In a show of moving kindness in these times of isolation, the neighborhood came out of their houses, stood on their doorsteps and sang happy birthday. This provoked two very different kind of reactions.

The first was from another local, who returned to see members of the community stood outside and took to social media to lament that there was an irresponsible street party happening, and that the action showed recklessness in a time where we are supposed to be social distancing. In their defense, what actually happened was later explained to the individual and the post was removed. More important than that though, were the reactions from people who saw the recording of the gesture, and left comments of praise.

‘It brings out the best and worst in people’ says Deb, citing another case she witnessed in a shop where an employee stacking shelves went ballistic on a customer, when they walked past them. ‘You wouldn’t see that in normal circumstances’ she goes on, raising attention to how people have begun to see each other in the context of Covid19.

There’s potential that the coronavirus will make us more appreciative of each other in the time following. There’s also a worry that it will make people more mistrustful. Which occurs more may depend on the way we respond to this pandemic, through our online and essential interactions, and the way we choose to treat those most adversely affected by these changes to society.

Working in different environments

A conversation that has come up between me and numerous members of staff are what are our future workplaces going to look like.

Sion Owen points out that workplaces that didn’t previously allow home working are likely going to struggle to justify not allowing it, after the Coronavirus – if you can trust staff through a crisis, you can trust them in peacetime.

A member of our law and ethics team points out to me that Audit Wales was trialling hot-desking, i.e. moving away from fixed physical spaces where people work, to having computers that any employee can log on to.

Indeed, it may be case that our future workspaces are significantly scaled back, and that initiatives like these become a ‘new normal’

The argument against this of course is that working from home is not convenient for everybody, and that many enjoy the sociable aspects of going to work. I know that I certainly miss the commute, the environment and corridor conversations.

Therefore, an important action for workplaces to take in these situations is to gather the views of staff, looking for consensus solutions which work for a wide range of people, and adjusting our workplaces accordingly.

Not only does this help make decisions, but it empowers employees to help make them.

Making Understandable Content

“I think the coronavirus visulations will be looked back on as iconic in the world of data’’ says Sam Williams, referring to the graphs used to accompany attempts to reduce the growth of coronavirus cases.

‘’I’m someone who is quite comfortable looking at a spreadsheet…though, better data visualisation can enable you to assimilate information far more quickly’’ he continues

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A discussion ensues about the way Covid-19 is being represented visually. Colour coded graphs showing the growth of the virus are nearly always accompanied by words stating the need to ‘flatten the curve’. News outlets produce incredibly well-made visual guides to the coronavirus pandemic. These serve the dual purpose of making the situation understandable and acting as a behaviour change tactic, to make groups of people take the epidemic seriously.

Good visualisation can bring a narrative or provide a way of looking at a situation – that’s partly why, in furthering the learning log project, we will likely see increased emphasis on data sets to make sense of different ways of adapting to Covid19.

One of our projects is using data to analyse the amount of people who attend our physical events. Although this project dates back before the Coronavirus, it provides some useful context for how and where we hold our events in future (pictured)

Then there’s the challenge that comes from media content. ‘Editing is an arcane art’ says Sion Owen, referring to his recent attempts to edit a pre-recorded talk by a representative of Conwy family centers. It’s a poignant observation in that ‘the editor gives structure – they need to make judgements’. Perhaps I’m reading too much into this but considering the current state of society, structure and order can seem like archaic phrases.

Perhaps that’s our role. We can’t re-order the world but through content such as Data visualisation as well as content such as blogs, videos, podcasts and posters – matched with the extensive research we’re doing in partnership with the rest of Audit Wales, we can help to make sense of the world in some small way.

Learning Opportunities:

  • The work that we do should be necessary and we should always be able to explain why we are doing it; realise that being busy is not necessarily the same as being productive. If our schedules are hectic, it may be worth looking at them and asking which activities are useful, and which ones we are doing out of routine
  • Seek to make connections by involving yourself in different opportunities and speaking to people you may not normally speak to; this may involve changing your tone or the way you present yourself slightly, to suit different environments, so make sure you understand the needs and thought processes of who you’re addressing.
  • Always make sure that you have a full picture before jumping to conclusions about someone’s intentions or actions; these times require a certain amount of trust to be fostered between people so being careful with how we use social media, and how we advise people is especially important.
  • Take on views that aren’t your own; you might have a strong case for changing something about the way your organisation works. However, somebody may have different ideas and perspectives on how to do this; consult the facts and try and build consensus
  • Make sure that any content you produce can be understood by an outside audience. You might be skilled in one way of perception, but someone else will have a different set of cognitive abilities. Think of different ways you can help others make sense of the information your trying to convey and trial those methods!

Coronavirus Learning Log Week 2: Communicating and Cynefin

My findings this week focussed on finding new ways to communicate. This blog post will expand on those ideas:

Challenges:

  • Learning to think in theoretical terms of complexity and the cynefin framework
  • Working on a collaborative, peer to peer level with the WAO directors and Auditor General
  • Making sure to distribute tasks among ourselves evenly
  • Avoiding retrospective coherence
  • operating in a space that can feel ‘outside of the world’

Complexity and Cynefin

We had a webinar with professor Dave Snowden this week; His theoretical work around the Cynefin framework, has been an important part of our learning as a department, so I’m going to try and explain the theory as best as I can with relation to Covid-19.

In its simplest explanation, the cynefin framework, is a way of facilitating people to make decisions. It plots challenges on a scale of simple, complicated, complex and chaotic:

Simple:

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This is the realm of ‘Best practice’ solutions that we know work:

 

  • the relationship between cause and effect is easy to work out
  • Snowden gives the example of ‘’changing a light bulb’’.
  • Working from home is a good example of a simple solution for office closure, as it’s something we’re already equipped to do
  • It’s important to make sure ‘’best practice’’ doesn’t become generic practice, to stop crises becoming chaotic when they occur

Complicated:

This is the realm of ‘Good Practice’, and more difficult to figure out solutions:

  • Experts may disagree on cause and effect, but there will always be at least one solution
  • An example of this could be performing a medical operation – most people wouldn’t have the knowledge to do that
  • In the first week of remote working Sam Williams’ laptop broke – this required him to see a member of our IT team
  • It is possible for Complicated to become Simple, as knowledge improves and becomes widely shared

Complex:

‘Emergent practice’ – learning as we go along – is key here

  • Relationships between cause and effect are not immediately visible in this scenario
  • This requires setting up ‘safe to fail’ experiments and trying new ways of working to find worthwhile solutions
  • One example of this is the shift to online event we’ve had to do. We initially didn’t know if this was going to be workable
  • In vaccination development, lots of trials are being carried out around the safety and effectiveness of a vaccine

Chaos

Novel practice’ or deciding action is vital

  • There is no relationship between cause and effect
  • The aim here is to take decisive action to move to a complex situation as fast as possible
  • Governments have had to take very decisive action to stop the spread of the coronavirus

Peer to peer facilitation

A key component of complexity mentioned by Snowden, is the idea that traditional hierarchies can break down in complex situations.

Part of the focus of unnatural hierarchy’s, can be an insistence on targets and quota’s which are often relaxed during a crisis

Crises require an acknowledgement that different people have abilities and knowledge, which the leader may not have

We are hoping to extend our research into innovative ways of working across the organisation and public sector bodies who are willing to engage. This requires using the communication tools at our disposal to reach out to staff and create a web of connections.

Sam and Chris have developed a sense maker tool to aid in the project.:

This allows Audit Wales to respond appropriately to the Coronavirus. Chris Bolton mentions ‘I’m having to change the way I work’.

This tool allows us to gather good, emerging and novel practice, from different perspectives.

From there, we can analyse this information to provide insight, sharing when appropriate.

Vitally, the task helps us achieve our purpose of connecting people and organisations.

Making sure to gather in real time helps avoid distortion and retrospective coherence

Distributing tasks

‘We are hugely connected as a department. Everyone’s got a piece of unique knowledge’ says Chris Bolton, pointing to the fact that crises such as this one can require more horizontal forms of order

Sion Owen tells me that he understands the way we go about ourselves as a department, referring to the focus on letting staff learn new skills focusing on a ‘safe to fail’ way of working, whereby you don’t get punished for failing

I can personally relate to that in the sense that ideas such as ‘safe to fail’ and ‘complexity’ seemed quite abstract when I first encountered them – now they feel like part of my thought process!

A quote is circling round in my head about GPX being told that we are ‘no longer incidental’. By making sense of those ideas we can realise we all have our part to play and that complex situations require no one to be incidental

Avoiding Retrospective Coherence

Pictured: How I imagine a story vs how it actually happened

Retrospective Coherence is the idea that when we tell a story we imagine it as an ordered sequence of events. This often reflects the sequence of events that people ‘think’ happened. It can also be highly biased and reflect things like an event from one person’s perspective, how they would have liked events to transpire, or a version that represents their view.

There’s nothing wrong with retrospective coherence. I’ve employed it here. However, our aim behind trying to collect information in real time is to capture what was felt, decided and understood, avoiding the formulaic nature of post incident reviews.

In their interviews with me, each member of the team has mentioned that they’ve made notes throughout the week. I wrote a post a few weeks ago where I talked about pretending to be a journalist at an event on town on community councils. One of the responses I kept getting was, we’ll brief the ‘press later’ i.e. we’ll consult and then get back to you’. This perfectly represents the dichotomy

Operating ‘Outside the world’

‘I’ve been seeing stories of people flouting Coronavirus guidelines’ says Debra Allen

‘Other people are scary’ says Sion, drawing attention to the fact that the government guidelines involve trust, while increased isolation from each other during this situation, fosters mistrust: ‘first time I’d been outside the boundary [of our house and garden] for a week and a half. I don’t know what we’d do with the kids if we became ill’

Snowden points out that in a crisis you need to find consensus for what would otherwise be unacceptable change. Case in point: banning gatherings. ‘Start to do that by finding the experts you previously ignored and apologise’ he advises, giving the example of doctors who have to use expertise to decide who lives and who dies as illustration of difficult decision making.

More than one member of my team describes the society we’re living in as feeling ‘dystopian’. Snowden goes on to compliment the fact that because the social distancing restrictions contain some flexibility, people like Sion can still ‘attack the garden’ as exercise. ‘You can’t over constrain the system…full constraints like the ones in Spain wont work for three months’

Due to the measures taken to combat the epidemic and the possible effect they may have society, he points out ‘after this is over the politics will be horrendous’,

While I don’t want to get into the political processes in this country, the US, or the rule by decree laws just passed in Hungary, the way we interact with each other now will affect the way we think about society. Panic buying, crossing the street when you see someone coughing – these are responses to a complex situation, that have implications.

It’s in this context that Sion says ‘The longer I’m outside the world, the more scared I am of it’

Learning Opportunities

  • Using the Cynefin Framework as one measurement, thinking theoretically about the work that we do can be an alternative way to asses ourselves, finding out if the activates we consider standard are worthwhile, or require a rethink. It can also help to make sense mentally of your behaviours, by giving you a framework to measure them by.
  • Traditional hierarchies may not work in a crisis, so it is important to use peer to peer networks to asses each other’s strengths and abilities, and to work in democratic, team orientated ways in order to improve decision making and work to utilise everyone’s abilities, to achieve good outcomes.
  • Do not overburden one member of the team, giving each other opportunities to learn from different experiences, and realising the necessity of failure as a learning method.
  • If there is a new practice or idea emerging, capture it! Don’t wait until after this is all over to provide an account of what worked and what didn’t. Chances are that’s going to be laced with retrospective coherence!
  • Realise the larger scale implications that the Coronavirus will have on society. Many people are beginning to think that society will never be quite the same again. Try through your work and your behaviour to make sure that the lessons learnt from Covid-19 can serve positive ends.

Coronavirus Learning Log: Week 1: Innovating through complexity

Due to the Covid19 outbreak, Good practice is now entirely remote. Given our purpose is to share learning in order to discover new ways of working, these logs will chart how we, our colleagues, and bodies across the public sector have chosen to innovate in this situation. As Knowledge exchange officer Sion Owen put it: ‘We now have to innovate out of necessity rather than out of choice’

Challenges raised:

  • Using our connections at the Wales Audit Office, to enable us to directly engage with public bodies and councils.
  • Our event on Adverse Childhood Experiences eventually being cancelled
  • Having to find ways to shift our face to face work – meetings, webinars, events – to an online sphere.
  • Dealing with the confusion and anxiety rising from the situation
  • Having to alter our working patterns

I predict our challenges will become significantly more specific week to week.

Using Our Connections

At the start of the week, Chris Bolton asked ‘Is anyone deploying innovation and learning alongside Covid19 response teams?’ We will go into more detail on this in future learning logs. However, as you’re on this journey with us, we felt it necessary to share the beginnings of what we have developed.

As mentioned, the aim is to digitally collect information about how public sector bodies are working differently

We can process that information, identifying novel practices and long-term (‘when this is over’) opportunities

We can share that data, through data crunching (charts, stats, graphs) and media content (podcasts, blogs)

We continue to Repeat the process

Auditors could easily engage in this, as well as teams such as Data Analytics. Its benefit is that it helps us make sense of responses to a complex situation. In Chris Bolton’s words it’s about ‘helping the citizens of Wales during a crisis’

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Cancelling an event

We had an event planned on Adverse Childhood Experiences. We had a sizeable number of delegates for both North Wales and Cardiff. The event was going ahead as planned! As news unfurled, this became hard to justify. Plan B: we would disinvite delegates and seize an opportunity to collect recorded content from the speakers. A day before we were supposed to leave, the government recommended against unnecessary travel. Plan C was to rely on our speakers to create content for us. Event organiser Sion Owen commented:

 ‘I had an idea of how everything was going to work. It felt like a loss of control. I’ve got three or four people who have stayed in contact with me. Though, their priorities are going to be different during a lockdown’

This speaks of a need to create stability in the team, while realising that in a complex situation, learning and adapting to changing circumstances is vitally important.

Moving Online

Questions remain over our ability to host events that emphasise group exercises. Most recently, Bethan Smith was due to host a discussion with South Wales Police featuring ritual dissent – the exercise by which ideas and approaches by individuals, are intentionally subjected to criticism. She expressed concern that not being able to hold in person events makes networking difficult.  Despite this, Sam Williams pointed out that a lot of the chat’s we would generally have in corridors has shifted to the end of meetings – that informality still exists, ‘just in a different way’.

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One positive that came early was utilising Zoom and Skype as platforms for hosting online meetings, webinars and conferences.  Features such as recording and screen sharing prove useful in communicating, without sacrificing any learning opportunities. Deb Allen, for instance, took notes at a senior meeting that occurred via Skype. One negative was the occurrence of technical issues. However, it provided an opportunity for everyone to be heard without the interruption that usually occurs at meetings, and attendees spoke concisely as a result.

We managed to host a webinar on complexity via Zoom. The favoured of the online conferencing platforms, one benefit is that the meeting won’t close down if the host leaves. ‘My laptop crashed halfway through’ says Sam, detailing one in series of technical issues he faced this week. Coincidentally, the event focussed on moving away from systems of targets and arbitrary notions of the way we work, realising that:

 ‘best Practice can’t be true. What works is always changing. What works will stop working in a complex environment’.

Testing a new way of engaging as a result of the complexity created as a result of Covid19, was a great way to demonstrate innovative, creative practice, during a learning session about that very topic.

Confusion and Anxiety

During my conversations with team members, a focus on mental health emerged.

Some pointed out that a long day of calls can be draining, especially without the commute and interaction that comes from being remote. I heard comments that expressed anxiousness over contacting others, unsure as to whether they’re doing the ‘right work’. While some team members are used to working from home, it was noted that having other options taken away can feel ‘restricting’

Coronaanxiety1

Then there’s the anxiety caused by the effect on society. Boris Johnson has now announced a nationwide lockdown. ‘I don’t want to live in that sort of world, but I’m prepared to’ says Sion Owen, before pointing out that we’re privileged to work for the WAO, and that he’s understandably worried about his family members who are self-employed or have lost work. ‘We don’t like uncertainty’ he goes on, highlighting that we don’t know how long we will be suffering under the effects of the coronavirus, He concedes: ‘relax, no one else knows what’s going on. See what you can do now’

here’s a link to an article that gives some useful advice on looking after your mental health during the coronavirus.

Altering working patterns

One aspect which became apparent in interviewing team members was the need to manage expectations.

‘I’m having to juggle work and personal life’ Bethan Smith says of balancing home working and her duties as a mother to a two-year-old. ‘It’s different from anything any of us have ever experienced, so I’m learning to not put too much pressure on myself’ she continues. There’s an interesting challenge here in that this is simultaneously one of our most and least hectic times. As you will see, we are at the centre of a project to gather and disseminate knowledge learned from the changes to society resulting from Covid19. However, it is acknowledged that working in this way could understandably result in lower individual productivity.

This means that there has to be an acknowledgement that we are in a difficult situation and that our collective efforts as a team are needed to retain our role as knowledge sharers, responding to a complex situation.

Learning Opportunities

  • Create mutual trust: Remember, we’re not trying to criticise but to ask people ‘what can you teach us?’, learning from their innovative practices. This may take time, but we can start by reaching out to our colleagues and partners, who we already know and trust, and creating connections from there.
  • Accept the fact that we won’t always be in control: In the current context for example, everybody’s way of working depends on how the situation unfolds and so activities such as organising an event can be thrown into chaos. The focus should be on learning, from the way others adapt and the way we adapt as individuals. Not everything we try will be a success!
  • Do not try and look for the absolute best way of doing things: realise that circumstances can stop them from working or at least being practical. Instead try and respond to changes in your environment. Analyse the wider social context and consequences of your actions and ask yourself, ‘is this the most useful or productive thing I could be doing?’
  • Look after yourself: Do not become dragged down by feeling as if you are not doing enough work, but do not try and overwork yourself either. Make sure to take breaks, take time to indulge in hobbies or exercise. Importantly, be reassured that the situation we’re in at the moment will not last forever! I find looking at any problems through a temporal lens a useful coping mechanism
  • Create shared goals: By this I mean, find things that your team and group can aspire towards, that still allow individual members to work at their own pace, and in their own way. Ours is to share good practice but we all have unique ideas on how to achieve that. In the complexity webinar we held, this was referred to as ‘Inter-ternal’ – a coming together of individual liberty and external factors which influence you.

Until next time, remember to stay inside, look after your mental and physical health and wash your hands!

“The platinum of social prescribing”

https://www.youtube.com/watch?time_continue=21&v=pO7SXGX3V8Q

Homelessness is a symptom not a cause – here’s an approach tailored to the needs of the individual.

Doctor Karen Sankey recently presented at our preventing unnecessary hospital admissions seminar. Her presentation gave an authentic insight into the very complex world of people who don’t currently have a place to live. Karen invited us to experience how they have designed this service to support people living in these circumstances. Here’s our thoughts on what we saw.

Alongside Karen in the creation of the Hub was Dewi Richards, a mental health manger, and Tanya Jones, who was at that point an outreach worker for the Wallich.

We were truly blown away and tried to put ourselves in the shoes of the people we met there. We started off with a really brutal question: If you didn’t have a place to live, what would you do? If you were in the Wrexham area, this might be the answer.

So what is the Community Care Hub? (CCH/“the hub”)

Every Friday morning, all sorts of services come together and station themselves in a hall in Wrexham, offering their help and advice to people who are homeless or sleeping rough. There are no appointments, it’s a walk-in situation. When you’re there, you can access services as diverse and varied as housing, podiatry, the GP, the DWP or Probation under one roof.

A human approach

This holistic, individual-centred approach was developed because, as Dr Sankey explains, she, Dewi and Tanya started from a place of “no rules”. They created the hub to ensure that all the needs of some of the most vulnerable people in society are met. Dr Sankey says that often, people who are homeless or sleeping rough live very chaotic lives. Homeless people are often marginalised and living on the edge of society. What this can mean is that they are often very far away from having the same equal access to services that others may have, because of the chaos of their life situation. Overcoming this is at the very heart of the work being done at the CCH, and they are definitely going some way to achieve this.

Dr Sankey told us that somebody came along and said they were concerned about hepatitis, so the hub went away and organised a clinic drop-in session for the weeks following this issue being raised. They proactively listen to the individuals they work with and respond meaningfully to their needs. They truly do have the commitment to follow through for the needs of the individual. Although this service is specific to homeless people, it’s not hard to imagine this very different model being adaptable to different issues. This is a very person-centred approach and something we thought was having a real impact on people in Wrexham. By having all the services in one place, it prevents escalation of the issues and gives individuals a better chance of getting back on their feet. It makes sense!

There was a real buzz in the room at the CCH. They’ve created a lovely atmosphere; nobody wears a badge or a uniform, so you can’t tell who the service provider is or who is receiving the service. They have created an equal, power-structure-free, safe space for services to be accessed with dignity and respect. They take a very human approach. Lots of the individuals who’ve been recipients of the services at CCH are actually now volunteering and mentoring others who are coming to the hub. This really does show the impact that the hub has. They are turning people’s lives around with this approach.

So, what’s next?

The hub is in the process of taking over 3 GP surgeries in Wrexham with a list size of almost 20 000 patients and they wish to use their ‘everyone in the room’ model developed at the Hub within a Primary Care setting.

I’m sure after reading this, it’s got you thinking – so have a listen to the people involved, both delivering and receiving the services. You’ll be glad you did.

If you’d like to learn more, get in touch with Karen on the CCC website.

Read the BBC article here: https://www.bbc.co.uk/news/uk-wales-48556009


Access our resources from the preventing unnecessary hospital admissions seminar here

Public Health Wales Youth Forum – Jessie Hack

Jessie Hack from Public Health Wales’ Youth Forum has blogged for us about being involved in the young person AQS and the Young Wales Youth Summit ahead of our ‘Young People Influencing Decisions about What Matters to Them’ event.

The young person Annual Quality Statement (AQS) was such an experience. I’ve had so much fun creating the AQS, from improving my photography skills to seeing a cartoon version of me on the middle page of the booklet. I specialised in promoting the help me quit programme. Public health Wales were hoping to reduce the amount of smokers in Wales. I also wrote about passive smoking and how it does and will affect you just as much as an actual smoker. We put lots of time into the AQS. We went out into Cardiff City centre and took photographs of the problems we believe could talk about in the AQS. We also had a question and answer session with the chief executive of Public Health Wales; Tracey Cooper, we asked her questions to enhance the information we wished to include in out statements. We then wrote our statements and attended a design workshop for the AQS.   We decided on cartoon faces, colourful writing and photos and large, easy to read text.

Another memorable time involving Public Health Wales was the youth summit with Young Wales. It was a great opportunity for young people to learn more about different area of health and talk about issues that matter to me personally. There were workshops to take part in throughout the day. Firstly there was a how can I get where I want to in life and how can I achieve that session, then a session on what is being successful and finally a session on Adverse Childhood Experience and Resilience. I thoroughly enjoyed those sessions and am so grateful for this wonderful opportunity to learn so much and be part of such an educational day. I would love to do it again!

Thank you so much Public Health Wales for giving me the chance to do such amazing things in the past year or so.

Senedd yr Ifanc – Wrexham

It’s easy to want change, its bloomin’ difficult to make a change

Toby Jones from Public Health Wales’ Youth Forum has blogged for us about his experiences representing young people in a variety of roles ahead of our ‘Young People Influencing Decisions about What Matters to Them’ event.

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My Youth Forum experience has been life-changing.  Local consultations, research and presentation of findings to decision makers in an attempt to adjust specific topics like the area we live in or bullying in schools to benefit young people better has set the foundation for many national projects I have taken part in.  Although I take extreme pride in regional and national experiences like representing my home county of Wrexham in the House of Commons as part of the UK Youth Parliament and representing North Wales young people as part of an intercounty advisory group.

However, out of all the work I’ve done, none have been able to display immediate change quite like the work with Public Health Wales.  To have the full backing of an organisation right from the first day of my involvement writing the inaugural young person’s annual quality statement in April 2017 which was fully designed and published to be young person’s friendly was an incredible sign of things to come.

At the youth health summit in the early winter of the same year, a speech from Chief Executive Tracey Cooper was the most passionate I’d ever heard an official of a non youth focussed business or organisation truly believe that young people’s voices matter.

Availability of resources aside they have set the perfect example of facilitating young people to change access to their product, in this case health information, for the future and for the better.

Too many times I’ve seen a youth group used only as a tick box exercise or a youth group allowed to chase their own tails without professional input for too long, getting the right balance is absolutely key. A group has to tackle issues step by step and you have to prioritise issues to tackle appropriately.

It’s easy to want change, its bloomin’ difficult to make a change.

But it’s overcoming that challenge and the intricacies involved that keeps me loving youth work and ensures I maintain my connections with Public Health Wales.

 

 

Our Public Health Diary

Neath Port Talbot Youth Council has blogged for us ahead of our ‘Young People Influencing Decisions about What Matters to Them’ event.

What’s it all about?

This is a summary of Neath Port Talbot Youth Council’s journey with Public Health Wales. This includes the residential where the Youth Council and other young people wrote and designed the Young People’s Annual Quality Statement (AQS) – ‘it was a brilliant learning experience’.

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Day 1 Summary

Junaid arranged a tour of the building and we met heads of departments so we could understand what their jobs were and how they manage. We could see the smoking cessation helpline ‘Help Me Quit’ going on.

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We had lunch –too posh – give us party food anytime!! Not that we weren’t grateful.

After lunch we had a walking tour of Cardiff city centre taking photographs for health issues and our graphic design workshop – we really enjoyed this.

Day 2

We learnt a lot in the communications workshop with Dan the man Owens. We spent the afternoon putting this to good use reading news articles then developing our own stories trying our best to make them interesting and captivating. We also questioned Tracy Cooper CEO of Public Health – thanks Tracy for getting in our selfies – legend!

So we’ve been doing a lot since this residential like setting up our own health sub group on the youth council, we also told the Leader and councillors in NPTCBC all about the AQS. They made sure the document went out to all the schools. We’ve been asked to train as mental health mentors in schools so we can help our peers get help or signposted to services if they need it.

We also helped plan then attended the youth health summit #UGotSummittoSay so young people can shape health services. Two of our youth council members sit on local health boards. We also presented our work at the Public Health AGM. Please read the Young Peoples Annual Quality Statement we learnt a lot.

 

Seren, Hannah, Jodie, Erin & Corey

(Part of NPT Youth Council Youth – Youth Excellence Award Winners 2018)