the programme successfully across 52 diverse clinical areas. One participant stated:
‘Being part of the Productive Ward programme has made me look at everything differently and inspired me to get involved in supporting greater change and share the skills I’ve learnt with others.’
(ITU nurse)
Active work‐based learning facilitated my transformation and was my turning point, where I truly recognised and understood transformational PD facilitation. I had developed skills in this methodology which I could now underpin with a name, formal training and tools which further validated what I had been doing. I had been transformed to think, do and be different, which in turn enhanced my confidence in my ability to facilitate.
I recognised that a shared purpose that draws teams together in a common direction is a vital starting point for effective change and improved workplace cultures. I learned that listening with intent provides a sense of authenticity and an appreciation by the participant that they are truly being heard. I learned that asking enabling questions and supporting teams and individuals to reflect and explore their own ideas and solutions leads to greater engagement and therefore sustainable change. I found that in leading and facilitating high‐challenge conversations and ways of working combined with high support I could enable people to challenge ways of working and behaviours, and free them to explore new ideas. The importance of giving feedback in a constructive way promoted creative thinking and how to receive feedback without feeling defensive. These active learning skills laid the foundation of my facilitation practice going forward.
Enabling effective workplace cultures through role modelling and facilitating active work‐based learning has been core to our maternity transformation programme. This work was the starting point for establishing trusting relationships with staff in which they were freed to share their existing ways of working and future change ideas. The values clarification contributions were drawn into a conceptual framework, identifying both the ultimate purpose and how the community midwifery team could focus on improvement areas of work by thematically analysing comments into enablers, inhibitors and consequences of best practice services.
Presenting these findings to the leadership team was heralded as ‘true transformation’. Some change ideas were approved immediately, including the required equipment that midwives said was essential for them to carry out their roles effectively. The staff appreciated this different approach where their feedback was valued, and that they had been empowered to implement grassroots improvement. This was the start of developing a positive workplace culture. Simple but powerful tools that you could apply to your own workplace that have lasting impacts and bring something magical. The contributions from this foundational piece of work informed development of the full maternity Transformation Programme that can be traced back to the original thematic analysis of participants’ comments; this demonstrated true authenticity.
Understanding our own staff, women and organisational demands and priorities for improvement and aligning these to the national direction was key to ensure engagement and ownership (National Maternity Review 2016). Working with and supporting staff to lead on areas of transformation using the workplace as the main source of learning was key to building the programme and enabling change to progress.
In the ideal world, PD methodology would be implemented and embedded in usual workplace business throughout hospitals and maternity teams. Role modelling and visibility of the principles of PD actioned in clinical practice settings can produce change over time. The core improvement team on this programme continue to live and role model the PD principles, facilitating workplace learning and co‐production events with women and our maternity partners at every opportunity. They promote change that is aligned to a shared vision and purpose and aim to grow the critical mass of people with PD facilitation skills.
I hope that my experience has shown that PD can comfortably sit together amongst other methodologies that you may be using, but will add something truly transformational through supporting the development of effective workplace cultures that are person‐centred and safe.
Co‐production – collective ownership
Co‐production is advocated as an effective and efficient method of service improvement. It can help with problem‐solving, resource utilisation, decision‐making and improving relationships between those who use services and those who provide them. There are many examples of its use from across the spectrum of health and social care with great success. The principles of PD explicitly lean towards making co‐production a success.
We have used the facilitation tools described above to host a number of collaborative co‐production events bringing together two expert groups, providers and recipients of care who learn and co‐create together (Realpe and Wallace 2010), leading to the development of effective partnerships. We solved wicked problems such as smoking cessation in pregnancy through to undertaking a full‐service evaluation via the lens of women, families and staff. Sense checking our governance systems, what we think we are doing well and where we think we need to improve and align that with where women and frontline staff feel these priorities lie. This approach has led to several simple but effective quality improvement measures, which improved feedback from staff and women. For example, ear plugs for partners to get a good night’s sleep through to myth busting about women not wanting to engage with video consultation when in fact we found they were enthusiastic about it. This change in resource utilisation led to a reduction in waiting times in our diabetic clinics.
Staff told us that they felt empowered by actively evaluating and making changes to improve their service. Those in managerial and formal leadership positions also benefited as they explicitly enabled staff to make changes, which resulted in them practising with a collaborative, transformative leadership style.
PD facilitates us to keep a critical eye on how co‐productive we are during every interaction and decision made which, directly or indirectly, affects patients. The clinical experience should be an act of active co‐production, an opportunity for the two expert groups to make sense of the words used and to bridge the gaps between their thinking. This collaborative effort can help them reach a joint understanding and creates appreciation on both sides for possible or desirable future action: a co‐produced care plan or new service pathway. PD tools can support us to do this all the time.
It requires users to be experts in their own circumstances and capable of making decisions, whilst as professionals we must move from being fixers to facilitators. To be truly transformative, co‐production requires a relocation of power towards service users. This necessitates new relationships with us as frontline professionals who through training in PD can use the tools to be empowered to take on these new roles. Here we describe how you can overcome the many challenges of generating system‐level change from the ground up.
Giselle’s experience with co‐production
I am an innovation specialist for a large manufacturing company where I problem‐solve with customers through co‐creation and co‐design. I am also a mother of two children and had two empowering natural birthing experiences through the Midwifery Group Practice (MGP) at my local hospital. Through my connections with women in my community I realised that not all women had experiences like mine. They had a terrible spiel around interventions in the birth, how they were not involved in decisions about the birth and how they did not have access to midwifery‐led continuity of care. I became impassioned by the inequity in these stories and set out on a journey as a consumer advocate to re‐shape the birthing landscape for women in my area. The advocacy group Better Births Illawarra was born.
Elements of this journey that I believe were key to successful change were accurate evidence, robust engagement, commitment to the cause and seizing opportunity. We identified anecdotally that women were not gaining access to the MGP programme due to limited availability, which we believed impacted on their birth experience. We knew we needed evidence that this was an issue, so we conducted a survey of women in the area, which received overwhelming support. We reviewed the evidence in the Cochrane