People work together to discover what is currently working well and what they value in the organisation/unit. This may relate to generally what is working well or to a specific topic- e.g. caring conversations, mealtimes). There are a number of ways we can do this which include:
Observation involves consciously looking at practice focusing on anything that stands out, for example practice that seems inspiring, surprising, extraordinary, exciting, or practice that you are curious about or find puzzling.
Observation is useful in appreciative inquiry to find out practices that are working well but are not recognised or articulated as such by those involved. For example during observation of mealtimes we noticed that staff were calm and had an unhurried approach. Residents were also given a choice of where to sit and were encouraged to eat food in a way that was comfortable for them, which might include using their fingers.
To appreciate what is working well it is important to:
- observe different aspects of practice on a regular basis (such as meetings, mealtimes, general care)
- notice what works well and what seems valued
- feed back and check this out with others to understand more about what helps this to happen and how it can happen more of the time
To hear more about the process of observation watch this short video clip
We can learn about the experience of others in a number of ways. Two different methods are described below:
We can learn about the experiences of others by using a technique called emotional touchpoints. Each person’s care experience has a number of touchpoints, for example, coming into the care home, mealtimes, talking to staff, working in the team and getting information. People are invited to share how they feel about these touchpoints by choosing from a selection of positive and negative emotion words. Emotional Touchpoints helps the storyteller to share their experience in a structured way. This structured approach helps us to have caring conversations. The information gleaned from the story can be used to discover the little things that play a big part in shaping people’s experiences overall. It can also be used to identify small improvements that can have a huge impact on how care is provided and peopleʼs sense of well-being.
To learn more about emotional touchpoints watch the following short video clip:
To see an emotional touchpoint story being carried out watch this short video clip:
Once you have collected some stories from practice, the next step is to share them with the team. When sharing findings, it is important that people are supported to discuss those things that worked well and why, and those aspects that could be developed further.
A useful framework for discussing stories could include the following questions:
- How did you feel after hearing the story/quote from the story?
- What bits stand out for you or struck you?
- Why was this?
- What does the story tell you about what matters to you and others?
- Why do you think people acted in the way they did? What do you think was going on here?
- What are the positive elements of this story?
- What happened in these positive elements?
- Is this usual (the positive element) in your area?
- What helps this to happen?
- How could this happen more of the time?
- What do we need to do to help it to happen more of the time?
- For aspects of the story that were expressed by the storyteller as negative – what do you think was going on for the people involved?
- What would a positive slant on this part of the experience look like?
- How could we make it happen like this in our area?
For a handout of a “Framework of questions” to help you to facilitate story sharing sessions see resources.
Use of Images Photo Elicitation
We can also learn about the experiences of others by using a technique called photo elicitation. Individuals are invited to choose from a selection of images picking an image that best sums up how they feel in relation to a particular experience. For example, when invited to select an image that sums up how you feel when conversations work well here, one resident chose the image below and offered the following explanation:
The use of images can evoke different emotions and a different cognitive response than questions alone and allows us to explore the meaning of people’s experiences. Uncovering the meaning of experiencesand then sharing this with others can help us to think about how to develop practice in a more human and empathic way.
To learn more about using images to open up conversation watch this short video clip:
To see an example of photo elicitation in action watch this short video where a relative is asked by a member of staff what it feels like visiting her father in the care home:
To download a set of images please see the resource “Envision cards”
Asking questions about what matters to a unique and particular person, and what he or she values can help to open up conversations in the workplace. It can help us to understand other people’s perspectives, which can be different to our own.
Learn more about the outcome of asking such questions in the following short videos.
In the first short film, a member of staff is asking one of the residents the question ‘what matters to you here living in the care home?’
Notice how much we learnt about Martha by asking one question:
- her commitment to her faith
- how she sees the end of life
- her relationship with staff
- her continued love of looking after plants
It is interesting to note that the positive way in which Martha sees the end of life by marking the beginning of a journey is in contrast to what staff might believe. This had the potential for staff to feel more comfortable to open up more conversations about this new beginning with Martha.
In this second short film we find out what matters to a second resident:
Notice how much we learnt by asking Greta one question:
- how much she values trying to help people
- the attributes she values in people, including consistency and a friendly smile
- how she copes when relationships are not strong
There is much in this learning that could influence future caring. For example, staff wanted to have further conversations with Greta to consider how her desire to help people could be encouraged in the care home.
Alongside observation and the other methods discussed we found using a specific set of appreciative questions useful in finding out what works well and how peoples’ experiences could be made even better.
Notice that this tool does not ask about problems, instead it asks how peoples’ experiences might be improved, therefore shifting the focus to what is possible rather than focussing on the negative.
To learn how a member of staff uses the positive inquiry tool with a relative to find out what works well and how the experience could be made even better, watch the following short video:
Notice how much we learnt from the relative about what she values and how her experiences could be enhanced. The conversation is balanced and the staff member is using a number of the c’s from the Caring Conversations framework. For example, she uses:
- courage – to find out how things can be improved
- curious questions – to consider other perspectives and find out what is valued
- celebration – to find out what works well and then thanking the relative for her contribution
To download the positive inquiry tool go to resources
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