Atelier WeekNotes w/c 16 October 2023
'Using Time Well'. Invitation: soon (I promise).
I am writing newsletter of #weeknotes of starting the Atelier of What’s Next (What’s needed, What’s ready? What can we do? What next?). For my rationale for starting the Atelier see here.
This week covers:
Atelier project: 'Using Time Well'
Invitation: soon (I promise).
Atelier project: 'Using Time Well'
Step: 2/DISCOVERING. Themes: Nurturing effectiveness over efficiency. Time. Healthcare.
Background
This week I had a couple of conversations relating to 'Using Time Well', a project that tries to build on the research of my late wife, and creating a legacy in her memory.
She was an NHS child and adolescent psychotherapist, before she died at 46 of cancer. She had been studying towards a doctorate on the theme of ‘how much time do we need?’, a question she had been asked by a parent of one of the children she was working with.
For her, that question was emblematic of the deep tensions she was experiencing as healthcare provider in the NHS. She wrote about it in this academic paper (paywall), with the following abstract:
"In the UK National Health Service, there is pressure to do more in less time: the norm is once-weekly work. Such an expectation does not sit comfortably with psychoanalytic theory and training, which remains rooted in higher frequency, longer-term cases. For trainees, this can lead to feelings of fraudulence and questioning whether less frequent therapies imply that the work is not psychoanalysis.
"The author explores, through a literature review, a case study and research material, how one might acknowledge the tension between these conflicting values about time; how psychoanalytic work in all its forms might be valued and be valuable for patients; and urges the need to feedback clinical experience into training structures and ongoing learning."
My shorthand for it is: efficiency vs effectiveness. Roughly, the incentives and pressures and expectations are about maximising throughput but her sense of caring (plus training) caring wanted to focus on improving outcomes. Although acutely felt in health and other explicitly 'caring' professions, I believe many people will have experienced this tension in their life and work. I believe we need to find ways to prioritise effectiveness over efficiency, as part of transforming (see My broad take on what's needed).
About her own approach, Jo wrote:
“I find it helpful to keep in mind the three Ancient Greek 'gods' of time: exercising some control through the boundaries of chronological time (or ‘Chronos’), in order to allow opportune moments to arise (or ‘Kairos’) and for communication with the timeless unconscious (or ‘Aion’).”
That is quite the practice to emulate and embody.
Current articulation of the challenge
Soon after her death, I had a notion of continuing that work. My intention is to have an on-going, positive and practical contribution to the profession. I set up a fundraising page (for boring reasons, I'm now on a second version here). Cumulatively people have donated £2,750 so far to explore the question:
How can we ensure the experience of clinicians on 'using time well' is used to help the whole discipline to improve -- and so improve the outcomes for children and adolescents?
My starter for 10: an annual prize selected from descriptions of emerging good practice on using time well for child and adolescent psychotherapists. The hypotheses behind that:
The key need is for a process of social learning (see immediately below).
A prize would accelerate that process.
The best way to keep to Jo's memory is to focus on her professional niche.
On social learning, I'm using a piece of knowledge management from Boisot via the International Futures Forum. In the diagram, two axes represent the codification of knowledge and its diffusion.
Let's assume that there are good practices widely scattered but not codified (bottom right). A prize would get people to submit their practice, so then the judges have the methods (bottom left). They can then codify them (up to top left) and broadcast a short-list plus winners (across to top right). As people absorb those practices (down to bottom right), there are now more people using good practices, which will generate more variants. And repeat.
Testing what's needed and what next
Frankly, I have made little progress in the last 2 years. Appropriately enough, some of that is because my time has been stretched, but also Jo’s former colleagues, who are overwhelmed with the pressing need of the mental health crisis.
I’m currently exploring:
1) To what extent practitioners would recognise the issues around using time, and on the tension of efficiency vs effectiveness?
2) Whether there is enough readiness and energy that some professionals would act, given a good-enough opportunity.
3) What that good-enough opportunity might be?
4) Who could be allies and collaborators in all this? (My assumption is that an outsider like me can only get so far.)
This week I had the chance to speak with a retired GP who also involved with the Human Values in Healthcare Forum ('working to foster healthcare that puts ethical and humane practice at its centre'). The headlines of our conversation:
1) Healthcare practitioners would hugely recognise the issues around using time, and on the tension of efficiency vs effectiveness?
2) Many would act, but do not have the time, even if given a good-enough opportunity.
3) Very unclear what that good-enough opportunity might be. A prize feels like it creates an unhealthy competitive dynamic.
4) There are many others who are exploring adjacent or overlapping concerns. Now I have more of a list.
The key challenge (and irony) is that every confirmation that tensions over time are crucial, also confirms that as a key barrier to making any progress.
WHAT NEXT
Keep collecting funds for eventual use (here, if you feel moved).
Reach out to the people and organisations working in similar domains.
Recognise that this will be a slow burn.
Invitation: soon (I promise)
Step. 2/Discovering. Theme: Atelier management.
Last week I promised I would be finishing the Invitation. This is the document I want to use to engage others, as the 'learning-by-doing' way of answering the two questions to explore about the Atelier's future:
1.What pain points do possible funders (and other resource providers) have that Atelier of What's Next could address?
2. How could the Atelier be organised for abundance?
Alas, it is delayed. First, a new piece of work has come in which required lots of attention. I can't say what it is yet. On one level it is supporting a strategy process for an NGO, which isn't automatically 'in' the Atelier. (I've said to myself I will take on good strategy projects as a parallel income, which allows me to do unfunded activities in the Atelier.)
However, this is a 'keystone actor' in a vital issue (thanks Prof Jan Bebbington for that 'keystone' framing). It wants a strategy and theory of change that maintains high ambition (unclear whether that, in the terms of the Depth of Change Spectrum, is Strong Reform or Deep Transformation). I think the engagement will be on the frontier of Theory of Change practice (both content of the ToC and the way of deriving it).
Second, I realised that, in order to write the invitation, I need to do two things first:
Tracking what is in the Atelier. Turns out there are lots of project ideas, methods and communities which I've said I want to be, or already are, in the Atelier. So, I've come up with a first cut of what those are.
Collating the themes raised. Since w/c 5 June, I've been tagging each WeekNots heading with a Step and themes. I took the opportunity of tracking what's in the Atelier to also collate the tags.
This WeekNotes will not go out if I have to bring both of those up to a point of public consumption. So, they will follow in subsequent weeks.
WHAT NEXT
Finish the Invitation. Send out to first wave.
Unpack the content (and choices) in the next WeekNotes.