‘Lifting the fog’ by Breda Flaherty

January 10, 2014

Where I live, by the sea, the sea mist sometimes creeps up over the beach and the town , encircling us all in a swirling foggy haze, yet just a few miles inland it’s a ‘bright, bright, sunshiney day’ (to quote the song)

In my role as a developer, I often see service users showing heartfelt exasperation that they just don’t feel they can get their points heard, and I see GP Commissioners, genuinely reaching out to understand service users’ viewpoints, end up feeling bemused and misunderstood.  A foggy haze envelops us all.

We’ve recently seen service user –GP Commissioner conversations within Simulation Days help people to work this problem out. Simulations offer a practical way of tackling a real service issue, in a very short time, from the standpoints of all sorts of people with an interest in the service. The aim is both learning (keeping the focus on ‘trying things out’ rather than ‘getting things right’) and real service improvements

In a recent Maternity Service simulation for a CCG, we wanted to identify a real potential improvement in ante-natal and post-natal care in a deprived inner city.

Commissioners worked in teams to access their local stakeholders from provider organisations and service users. Through appointment slots to explore their developing ideas, they sat down with user groups to test their plans, and explore challenges to their viewpoints.

Because Simulations are tightly timed, real-life flashes by within a morning: at first, service users felt they weren’t being listened to very much by the Commissioning teams–

  • “They went straight into how they saw the service, rather than asking what we saw”
  • “They came with a Proposal but hadn’t thought of the patient focus”
  • “They wanted to be in control – not partners”
  •  “Had awareness, but one-sided clinical awareness, not holistic”

Keeping the Simulation focus on learning, team facilitators worked closely with the teams to give them this feedback well.  The summary of this feedback was revelatory to the teams – they immediately began to adapt their approaches.

By mid-morning, service users were enjoying much more of a dialogue:

“Asking questions and interested in our responses – now taking more of the women’s point of view”

“Improvement –more prepared to discuss- curious, interested, more collaborative”

 “Listened – good questions, good ideas”

By the close of the morning, the fog was lifting – proper dialogue, challenge, and mutual curiosity inspired some strong debate:

“Both sides thinking differently – we had a healthy debate; not just questions & answers but the development of a Proposal”

“Asked questions, enthusiastic, had all done our homework, more aware”

GPs said they felt enlightened, empowered and at last able to engage in a conversation that felt  more peer to peer; four  of the GPs suggested they were prepared to consider trying  CCG Commissioning Lead roles as a result.

At last, service users from the local Maternity Services Liaison Committee, and outreach volunteer support workers from a local support group for vulnerable women, felt they had been peers to the Commissioning Support Unit Finance Leads, the Lead Nursing Team for the Acute Hospital, and the Commissioning Strategy Leads from the CCG

Like putting the headlights on through a fog patch, Simulations offer one way of making a rapid change to what you can see and what you can do about it; we all need to work out how to escape the fog, making decisions across the best of all our thinking, service users and professionals.  Here’s to the ‘bright, bright, sunshiney days’

Breda Flaherty


Director: bfadevelopment.com

Msc Course Leader for Leadership & Commissioning, Brighton & Sussex Medical School



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