Partnerships, power and persuasion:lessons from other worlds

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Partnerships, power and persuasionlessons
from other worlds

• Anna van der Gaag
• Keynote address
• RCSLT Conference,
• London
• March 2009

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Outline

• Good practice
• Poor practice
• Lessons from conflict resolution
• Lessons from complexity theory
• Conclusions

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Partnerships, power and persuasion

• Speech and Language Therapy
• the ultimate renaissance profession

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Key attributes of successful partnerships

• An ability to build respectful relationships and
  engender trust
• Group process skills
• Awareness of political issues
• Self awareness of bias
• Tolerance for complexity,unpredictability and
  conflict
• Commitment to equality of relationships and
  conflict resolution
• MacCauley et al. (2000)

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Good practice in partnership working

• Examples from the conference
• Standards on CPD

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Standards for CPD

• A registrant must
• maintain a continuous, up-to-date and accurate
  record of their CPD activities
• demonstrate that their CPD activities are a
  mixture of learning activities relevant to
  current and future practice
• seek to ensure that their CPD has contributed to
  the quality of their practice and service
  delivery
• seek to ensure that their CPD benefits the
  service user
• present a written profile containing evidence of
  their CPD on request.

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Standards for CPD

• Professional Liaison Group helped develop the
  standards
• 6,500 attendees at 46 UK wide events
• Professional bodies helped develop sample
  profiles and detailed CPD guidance
• Each profession involved in mock CPD assessments
• In 2009, profiles will be assessed by an assessor
  from SLT profession

Standards Consultation Involvement
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Poor practice in partnership working
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Failure to see
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Failure to see

• Lessons from Baby P and Haringey
• Methods of inspection open to manipulation
• Tick box approach
• Lack of coordination and communication

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Failure to engage

• Professionals dont
• want to involve
• parents and carers
• Parents are still not
• listened to by
• professionals

• Tokenistic
• partnerships

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Putting poor practice in context

• Complaints against SLTs tend to be about record
  keeping and communication issues

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Complaints data 2007
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Power in therapeutic relationships

• Different ways of viewing power
• SLTs often feel disempowered
• Power can be difficult to share

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Power relationships

• Doctors
• Managers
• Allied health professions
• Carers, parents
• Adults with CD
• Children

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Power relationships

• Men
• Women
• Children

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Power relationships

• Rich nations
• Poor nations

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Power relationships

• Power is relational
• between therapist and
• client

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Power relationships

• Power relationships in SLT
• Heirarchies of power
• Imbalance of power
• Managing power

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Managing power

• Traditional approach in health care
• Command and control
• Heirarchies of accountability
• Protocol driven interventions
• But..
• Not everything fits within this model!

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Lessons from other worlds

• Conflict resolution
• Complexity theory

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Conflict resolution

• What is work based conflict?
• A condition between workers whose jobs are
  interdependent, who feel angry, perceive others
  to be at fault and who act in ways that cause a
  problem for the work environment
• Daniel Dana (2001)

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How do we recognise work based conflict?

• Must contain four elements
• Interdependency
• Blame
• Anger
• Results in problems at work

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Example of work based conflict
SLT and OT working in a rehabilitation setting
Conflict over roles and resources
Poor partnership working
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Example of work based conflict
SLT and parent
Conflict over expectations of therapy
Poor partnership working
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Example of work based conflict
SLT and teacher working in a school
Conflict over ways of working
Poor partnership working
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What is the impact of work based conflict?

• Wasted work time ()
• Bad decisions
• Lowered motivation
• Sickness
• Lost employees
• Theft/ fraud/dishonesty

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Ways we resolve conflict

• Power contest
• Rights contest
• Reconciliation
• of interests

• Use of physical strength, verbal force,
  threats
• Use a source of authority
• (manager, policy, courts)
• Negotiation,communication,
• (What do you really want?)

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Resolving conflicts

• Define the problem
• (Why does this persons behaviour matter to me?)
• Plan the context for dialogue
• (time, location, setting, who is present)
• Keep conversation focused
• Support conciliatory gestures
• (me against you to us against the problem)
• Make a deal
• (and write it down)
• Hold a review meeting soon after
• ( to see how relationships are working)

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Caveats

• Not all conflict can be resolved this way
• Some conflicts re-occur in different guises
• Some issues seem to be outside the realm of
• agreement
• The next step is not obvious to those involved

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Complexity theory
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Complexity Theory

• Low
• High Low
• Degree of certainty
• Stacey (1996)

chaotic
complex
Degree of agreement
simple
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Complexity Theory

• Low
• High Low
• Degree of certainty
• Stacey (1996)

chaotic
Long term interventions Coordinating
care Involving users in decision making
Degree of agreement
simple
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What does complexity theorysay about partnership
working?

• Explore power relations
• Try multiple approaches
• Shift slowly towards those options that work best
• Use reflection
• Accept unpredictability
• Experiment and review
• Plesk Greenhalgh 2001

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Power as relational

• Involving people with communication
  disabilities, parents, carers in decision making
  is well within the zone of complexity
• Recognising that sharing power is a risky
  business but an integral to successful
  partnerships

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Power and persuasion

• Coercive power
• Used to dominate
• Manipulative
• Diminishes autonomy

• Persuasive power
• Used to persuade Influence by example
• Creates opportunity
• Greenleaf (1998)

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The nature of power

• Real power is the persistent courage to be at
  ease with the unsolved and the unfinished
• John ODonohue

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Conclusions

• Speech
• Language
• Therapy

• A renaissance profession
• A reflective profession
• A diverse profession
• A strong profession
• A partnership profession

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References

• Dana, D. (2001) Conflict Resolution New York
  McGraw Hill
• Greenleaf, R. (1998) Servant leadership
• HPC Fitness to Practice report 2007
  www.hpc-uk.org
• Mol A (2007) The Logic of care health and the
  problem of patient
• choice. LondonRoutledge
• Mowles, C, van der Gaag, A, Fox, J. (2009) The
  Practice of
• Complexity review, change and service
  improvement in an NHS
• department. Journal of Health Organisation and
  Management
• (forthcoming)
• Plesk, P Greenhalgh, T (2001) Complexity science
  the challenge of
• complexity in healthcare. BMJ 323 625-8.
• Stacey, RD (1996) Strategic management and
  organisational
• dynamics. LondonPitman Publishing.