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By Sue Walsh & Sharon Warden © S.Walsh & S. Warden 2013.

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Presentation on theme: "By Sue Walsh & Sharon Warden © S.Walsh & S. Warden 2013."— Presentation transcript:

1 By Sue Walsh & Sharon Warden © S.Walsh & S. Warden 2013

2  Values, peoples and structures  Digesting current NHS organisational processes/dynamics: in the service of your own learning needs; and to enhance your supervision of others  Taking you through a set of ideas, concepts that we have found useful in our own practice (healthcare culture, pulls to perversion and resilience)  Set up your learning groups-get into a pair, when ready make a four (what suits you? Familiarity or stranger group?) © S.Walsh & S. Warden 2013

3  The analogy of the perfect storm  Failure to thrive healthcare cultures & the pull to perversion  An organisational Case example  ‘Therapeutic alliance’ as model for resilience © S.Walsh & S. Warden 2013 Sharon: Healthcare culture, understanding the dynamics of “the perfect storm”


5  Industrialisation of healthcare  Commodity relationship - consumer / Provider couple  Financial cuts and survival angst  Increasing demands of population changes (eg: age, obesity rise in chronic conditions) © S.Walsh & S. Warden 2013

6 ‣ A small group struggling to survive in a large organisation struggling to survive in a climate of severe cuts ‣ Embattled Perception of the small “unwanted” group © S.Walsh & S. Warden 2013

7 Adrift = “failure to thrive”? ‣ Staff feel devalued, demoralised, frustrated & afraid (survival anxiety – fight, flight, freeze) ‣ Suspicious of “hidden organisational agenda” ‣ Risk of “repetition compulsion” self defeating replaying old wounds (split between Psychology / Psychotherapy) © S.Walsh & S. Warden 2013

8 Do the ideas make sense? Have you experience of these processes? Through your own supervision & of others? © S.Walsh & S. Warden 2013


10 My hypothesis – “failure to thrive” organisational culture…  Leads to an attack on the capacity to relate (“kin”) reduced reflective function due overwhelming survival anxieties. © S.Walsh & S. Warden 2013

11  Overwhelming “survival anxieties” / fear  Disconnection - not seeing the ‘whole picture’  Forgetting – ‘slips’  Shut down - “turning a blind eye”  Magical thinking – “obsessions”  Punitive / moralistic concerns or judgements © S.Walsh & S. Warden 2013

12 Loss of “kin”- ship?

13  What is happening when things go wrong?  What frameworks/ ideas can we hold in mind to help us digest “the perfect storm”  Recent examples of failures – Mid Staffs & Winterbourne & Norfolk © S.Walsh & S. Warden 2013

14 Rationale for Perverse Organisations  Individual pleasure at expense of general good  Knowing & not knowing (turning a blind eye)  Instrumental relations are dominant – others seen as ‘things/objects’ opens possibility of abuse  Engagement of others in system  Once engaged others are corrupted because they become accomplices

15 Can you apply these concepts to your work environment if so in what ways?

16 ‣ Containing anxieties: the “safe harbour” function ‣ Integrating splits ‣ Staff can become “irradiated by distress ” of work © S.Walsh & S. Warden 2013

17  Atmosphere  Culture  Attuned links  Space to reflect  Emotionally intelligent anticipation of failure  Culture of curiosity – “duty of candour” © S.Walsh & S. Warden 2013

18 Evidence based Promotes change Predicts outcome Fosters resilience © S.Walsh & S. Warden 2013

19  “It is written that when you do not have hope you look for it in the face of your friend” Gazan man quoted by Gordon (2009)  The word ‘solitude’ expresses the glory of being alone, whereas the word ‘loneliness’ expresses the pain of feeling alone. (Tillich, 1959 as quoted by Cacioppo et al 2010) © S.Walsh & S. Warden 2013 Sue: Resilience and supervision

20  To consider the literature on resilience  To reflect on individual, organisational and social resilience  To connect this literature up with our supervisory practice both in terms of what we give others and what supervision we have for ourselves © S.Walsh & S. Warden 2013

21  “resilience has been defined as successful adaptation or absence of pathological outcome following exposure to stressful or potentially traumatic life events or life circumstances” Seery et al 2010  maintaining a healthy outcome in the context of adversity and the capacity to rebound after a negative experience  Most people experience adversity in their life yet most of us rebound © S.Walsh & S. Warden 2013

22  Is it about recovering from adversity (baseline functioning) or is it about deriving a greater capacity for future resilience?  A positive toughening effect when exposure is limited with time to recover. This toughness leaves individuals more emotionally stable, better able to cope. Once toughness develops can permeate to other domains  Moderate adversity predicts better mental health than either high levels or no adversity © S.Walsh & S. Warden 2013

23 ◦ A clear acceptance of reality ◦ A clear value system- that life is meaningful ◦ An ability to improvise ◦ (taken from Coutu 2002 Harvard Business Review) © S.Walsh & S. Warden 2013

24 ◦ Facing down reality ◦ The search for meaning (not necessarily ethically minded - Barclays, cohesive identity of the group) ◦ Ritualised Ingenuity- ‘bricolage’ © S.Walsh & S. Warden 2013

25 Social resilience  e.g. Caioppo, Reis and Zautra 2011  Individual achievements vs collective action  “social resilience is the capacity to foster, engage in and sustain positive relationships and to endure and recover from life stressors and social isolation” © S.Walsh & S. Warden 2013

26 Social resilience  Adversity into strengthening social engagements, developing new relationships, collective action, emphasizes an individual’s capacity to work with others and therefore to enhance the groups capacity to do so  ‘Social’ –building more adaptive social ecologies for people/organisations, groups © S.Walsh & S. Warden 2013

27 Is there anything different about maintaining a resilient stance in the NHS? Are there additional issues for the caring profession?  Holding Fast (2005) Kahn  Not too close or too far away  A paradoxical stance needs to be maintained of being open to others and detached from those we help © S.Walsh & S. Warden 2013

28 How do you create the conditions for resilient supervision? (personally and professionally) © S.Walsh & S. Warden 2013

29 Creating a holding environment- Kahn  Yet these things are very difficult to do well in the context of current fragmentation ‣ In caregiving environments members generate with one another the experience of being contained and provided for… ◦ Primary task as integrating mechanism ◦ Integrity of roles and authority ◦ Structural interdependence © S.Walsh & S. Warden 2013

30 Pick a case/issue with you as supervisee or as supervisor (that you don’t think is going well). Using the previous 3 exercises, what factors may help you to understand what changes need to be made to your supervision? In line with social resilience prepare your feedback for wider group © S.Walsh & S. Warden 2013

31 Holding on to your good objects  Facing a reality ◦ Not being alone- making connections ◦ Being prepared to prioritise yourself and your learning (including being prepared to pay for supervision) ◦ Anxiety about revealing your work and having ‘your mistakes’ seen © S.Walsh & S. Warden 2013


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