Emotional Touchpoints

I sat in today on a talk given by Catriona Kennedy.

Catriona is Reader and School Director for Research

and Knowledge Transfer in the School of Nursing, Midwifery and Social Care

at Edinburgh Napier University.

Catriona presented a summary of work undertaken at the Edinburgh Napier University in nursing. I was very interested in her discussion of the Cochrane Review process and outputs. I liked the diversity of methods she and her team had used and are using. I noted in particular her use of emotional touchpoints in qualitative research.

I was intrigued by the possibilities of emotional touchpoints for my growing interest in deliberation and conversation. I think too these touchpoints might help in exploring learning biographies and coaches’ stories.

Paul Bate and Glenn Robert (2007) provided the stimulus for Catriona and her colleagues’ use of emotional touchpoints. The 2007 paper reports on an original experience-based design (EBD) intervention methodology “designed and tested by the authors and colleagues in a cancer clinic within the National Health Service”. Joanna Goodrich and Jocelyn Cornwell (2008) report that:

Experience-based design (EBD) is a methodology for working with groups of patients and staff to improve services developed for health care settings by Paul Bate and Glenn Robert. Drawing on the knowledge and ideas of the design sciences and design professions, where the aim of making products or buildings better for the user is achieved by making the users integral to the design process itself, the focus is on how patients and staff move (or are moved) through the service and interact with its various parts. Patients work with staff to ‘co-design’ improvements in the experience of using the service (mapping the subjective as well as the objective pathway of care). The involvement of patients and staff on an equal footing is much deeper than that in ‘patient involvement’ projects where patients are often treated as objects for study, rather than partners. How the service ‘feels’ or is experienced is seen as equally important as how fit for purpose it is (functionality) and how safe it is. Bate and Robert have given a step-by-step guide to the methodology and illustrated it with the case of a 12-month pilot, funded by the NHS Institute for Innovation and Improvement, in head and neck cancer services at Luton and Dunstable NHS Foundation Trust.
Joanna Goodrich and Jocelyn Cornwell (2008) observe that the “act of bringing patients and staff together to hear the others’
stories about how they experience the service works as a dynamic catalyst for change and improvement.” They summarise Paul Bate and Glenn Robert (2007) thus:
During the pilot, patients and staff worked together to identify the key ‘touch points’ (or ‘moments of truth’) which had shaped their personal experiences of the head and neck service. This then enabled them to work together to prioritise and then implement – through 70 separate actions – a total of 43 improvements. Two of these improvements have directly increased the efficiency of the head and neck service (for example, the throughput of patients at the outpatients clinic), four have improved patient safety (eg, expanding staff competencies on the post-surgical ward), while the remainder – the majority (37 improvements) – have improved the experience of the service (eg, giving patients a choice as to when their feeding tube should be fitted). Of these, 12 related to better information provision at various points of the patient journey, 11 related to changes in the physical environments experienced by the patients, 9 related to changes in staff behaviour and 4 related to a desire for greater support mechanisms (particularly involving other patients).

Belinda Dewar and Richard Mackay (2009) used an emotional touchpoint approach to their work to learn more about the experience of compassionate care. They report that using emotional touchpoints:

has been a powerful experience. They are easy to use and it’s really hard not to be driven to action from the story. Hearing the positive things about practice has been a real insight – we often don’t know the small things that matter so much to the patient and perhaps we take for granted. One example: “My mum needed the loo and I told somebody – they said it wasn’t a problem and asked me to wait outside. I could hear them outside the room and they were chatting away to mum at her level – they were having a laugh together and sharing things. I felt proud as the staff had probably heard what she was saying so many times already but they reacted as if they had heard what she was saying for the first time. This felt good.”

Belinda and Richard suggest that this approach has improved practice in the following ways:

  • Seeking feedback based on the person’s emotional response to a situation cannot be disputed and it has helped us challenge assumptions about what we think the patient/family feels and wants.
  • Staff are more at ease about hearing negative aspects of a patient/family experience as the method doesn’t directly focus on blaming the service.
  • Better relationships have been developed with patient and family members especially if they have been involved in shaping the service.
  • Actions taken forward are based on real and meaningful evidence and staff feel moved and motivated to have another look at what we do.

I think this approach has a great deal to offer a range of qualitative research approaches. I do want to explore these touchpoints in the context of deliberation and conversation. I think they will become powerful connections in inter-professional learning and practice.

Photo Credits

Floating Hospital Nurses


Helping Grandmother Walk

Lessons Learned and Collective Knowledge

Tuesday morning brought me a great link from Stephen Downes to Nancy Dixon. Nancy posted about a model lessons learned system – the Unites States Army.

Nancy observes that the “US Army Lessons Learned system has evolved over 40 years to become a model lesson learned system. What began as an AAR process in the 1970s has become a robust system of identifying, collecting, analyzing, transferring, and moving lessons learned at all levels of command.” She identifies three eras in this 40 year period:

  1. Leveraging Explicit Knowledge
  2. Leveraging Experiential Knowledge
  3. Leveraging Collective Knowledge

In a separate post on the Knowledge Eras, Nancy characterises the era of leveraging collective knowledge thus:

Those that are inventing processes for collective knowledge are finding ways to bring the whole organization to bear on strategic issues. Process like Knowledge Cafés, Appreciative Inquiry, and Search Conferences bring together all levels of the organization – the whole system in the room. The processes used to leverage collective knowledge are conversation based, alternating between small group and large group configurations. Even regularly held organizational meetings such as staff meetings, team, and project meetings in these organizations are turning to conversational forms to address their most difficult organizational issues. There is a growing understanding that in an age of increasingly complex organizational issues, leaders cannot be expected to have all the answers; rather the task of leaders becomes convening the conversations that can come up with new answers.

I read Nancy’s post after writing about John Gastil and his approach to deliberation. I think there are some great synergies between John and Nancy’s positions. I am excited by the rediscovery of conviviality through their work. They took me back to thoughts of Ivan Illich in the 1970s when he suggested that conviviality is “autonomous and creative intercourse among persons, and the intercourse of persons with their environment”.

As I was mulling over these thoughts some of the many feeds I receive each day created virtual conversations for me. Within a short period of time I was able to access some fascinating visualisations including:

Each of these took me back to Nancy’s characteristics of a a robust and effective lessons learned system:

  • Collection
  • Repository
  • Transfer Process
  • Implementation
  • Analysis and Data Mining

These characteristics were brought into focus by Nancy in her 2010 post about leveraging collective knowledge at NASA. She noted in that post that leveraging collective knowledge involves: joint sensemaking; cognitive diversity, and organizational transparency.

It is fascinating where an early morning link from Moncton, New Brunswick can take you.

Photo Credits

Eerste Wereldoorlog, mobilisatie

Staff officer discussing matters on a pile of bombs


Groups and Deliberation

John Gastil was a guest on Margaret Throsby’s program today. I thought what he had to say was fascinating and followed up on his work:

  • The Jury and Democracy Project that aims to understand the impact that jury service has on citizens. (“Too often, people think of the jury as nothing more than a means of reaching verdicts. In fact, serving on a jury can change how citizens think of themselves and their society. Our purpose is to study those changes.”)
  • Deliberation (“Public talk needs to be democratic by giving each participant adequately speaking opportunities, ensuring participants can understand each other, and by giving each other due consideration and respect. Such talk needs to be deliberative in that it establishes a solid information base, prioritizes the key values at stake, identifies a broad range of solutions, looks carefully at the advantages, disadvantages, and tradeoffs among choices, and ultimately makes the best judgment.” Link)
  • The Group in Society (and the importance of co-presence, coherence, boundaries, communication, shared purpose and interdepedence).

I do think there are vital lessons in John Guptil’s work. Here in Australia we are learning enormous lessons about civic responsibility and personal resilience. The flourishing of voluntarism is remarkable in flood and cyclone-damaged areas.

I am hopeful that the lessons we are learning about collaboration in crises might extend to a deliberative and deliberating democracy. It would be remarkable if our political processes could acknowledge our sameness rather than invented difference. What an incredible society and culture we could have: empathetic, supportive and celebratory.

John Gastil has a message for our time. I am delighted I was able to spend an hour in his company.

Photo Credits

Partaha Village

Horsham Flood 2011