We think practice matters. Put simply, without a commitment to changing the way we work every day, none of the vision, strategy, restructures or reorganisations we’ve worked so hard on together will make any difference - because everyone will go back to business as usual and we won’t see the radical changes we need.
At Living Well, we know that changing practice is challenging. Our programme started some 10 years ago in Lambeth, south London and over the past four years, thanks to The National Lottery Community Fund, we’ve been creating new systems of community health systems in Living Well sites across the UK including Edinburgh, Salford and Tameside and Glossop.
So far the programme has supported some 2,500 people who might not otherwise have been helped and generated over five million pounds of additional investment in local mental health systems - and we’ve recently expanded into Greater Manchester and Derbyshire.
This depth of experience and expertise means we have significant knowledge of, and capability to manage, the disruption and reluctance around changing practice. And we’d like to share the lessons we’ve learned.
Changing practice starts early
In Living Well, attention to practice begins with co-production. Creating a new system starts with the cross-sector leaders and practitioners coming together with the people with lived experience to co-produce their vision - including forming ideas on new ways of working.
In Tameside, we saw people with lived experience, some currently using services, huddled together with practitioners and commissioners in intense co-production sprints, which included testing out new practice on each other.
And in Salford a similar group undertook a co-design session for the new offer and came up with radical ideas such as the Listening Lounge - a place where people with mental health needs can attend and be heard by people with their own lived experience.
Through this activity we learned:
A co-productive model means people with mental health needs have options over what support they would like, and all skills and disciplines are valued
Co-designing principles and describing desirable behaviours gives teams a great jumping off point to turn vision into behaviours and practice
Collaborative and co-productive processes at the start might instil an approach of collaborative and co-productive practice in the future.
Changing practice is hard and difficult
Transforming people’s practice is not a simple task. They need permission to work in new ways, which includes time for them to reflect on and shift the fundamental manner in which they operate and work.
In many cases, this means people letting go of how they’ve always been asked to operate - and, through working in new teams, to rethink the status their roles may have given them.
In Tameside, cross-system stakeholders came together to think about what type of roles and practice local people needed. Coaching emerged as a strong route to empower people to solve problems and make decisions. So it was agreed that all practitioners would be trained in this core skill, which would then form the basis of all key working relationships.
We learned:
Adapting ways of working cannot be ‘done’ to people, rather people need to feel that they have meaningfully contributed to and owned the change.
Empowering practitioners to change practice and own their endeavours invigorates them and increases job satisfaction
Changing practice needs a roll-out plan
Inducting practitioners to the new ways of working is imperative - and induction itself needs a new approach. Living Well inductions involve people undertaking activities together that purposefully build culture and promote interpersonal relationships and interdisciplinary understanding - for example through regular participation in collaborative or co-design spaces, or intensive protected time together as teams are formed or new people join.
We learned:
Induction matters, telling people to work differently isn't enough - allowing time to understand and internalise new ways of working and mindsets is key
Changing practice and culture takes time and requires agile thinking: some people aren't ready and there needs to be compassion and support to bring all people along
Edinburgh’s ambition for a joined up network of support meant that induction days were inclusive spaces with new team members joining practitioners from neighbouring cross-sector offers, people with lived experience and system leaders.
Here, they shared their personal interest in mental health practice, defined what they would bring to new offers and collaborated to understand and articulate what the co-designed values, principles and ways of working would mean in their day to day lives. The content of these sessions were captured in a handbook, given to all new recruits, and allowed people to get inside ‘how we do things around here’.
Changing practice can be done in stages
Change is hard enough - so Living Well ‘prototypes’ new ways of working, taking it slowly and learning on the way.
Using the shared vision and collaborative relationships, a small multi-disciplinary group of practitioners from the statutory and voluntary sector is assembled and authorised to work in new ways.
The team works intensively on three areas:
working with eight to 15 people doing ‘whatever it takes’ to improve their mental health and lead bigger better lives
working together to refine practice, process and culture
learning about what their endeavours are telling them about the new model and the broader system
In Edinburgh, the team prototyped new approaches to risk assessment until they identified that a single open question garnered as much information as they needed from people about their safety. Practitioners were surprised and reassured at how forthcoming people were and how this opened up deeper conversations about what safety meant to the people they were supporting.
For many Living Well teams, prototyping began during the pandemic meaning practice development was constrained by social distancing and repeated lockdowns. Practitioners in multiple sites pioneered 'walk and talk' sessions, where socially distanced walks replaced video or telephone contacts.
We learned:
Protected time for testing, reflection and learning gives the team an opportunity to invite people into a conversation about what really makes the difference for them.
Small practice changes that demonstrate impact for people can ignite people's imagination to new ways of working and this can change complex systems
A continuing cycle of practice development becomes second nature.
Changing practice needs leaders who listen
Co-production of new systems will throw up challenging feedback and exciting ideas - and leaders need to be both responsive to new forms of evidence and open to empowering their organisation to change - not just once but on a rolling, evolving basis.
In Salford, the team uses written feedback bubbles to gather relevant and immediate snapshots, meaning practitioners feel empowered to explore the impact of practice as part of their daily work and implement changes in real time.
And in Edinburgh, Thrive learning labs bring practitioners together to explore cross-city practice through listening to stories of people who are accessing their offer then sharing learning and developing ideas to take back to their local teams for further testing before returning to share the results.
We’ve learned leadership is key to changing practice:
Practice leadership is an art and a skill and requires time and prioritisation
Governance must facilitate good practice not delete it
Paying attention to data, asking for and listening to feedback in the practice space provides fuel for innovation
Practitioners are mighty and passionate, if you trust and empower them they know what to do
Changing practice changes lives
Building in permissions to innovate alongside our core business changes our relationship to one another and redefines our work.
By building a culture of collaboration and shared endeavour we build a system that represents us all.
If you’d like to talk to us about Living Well, including developing a programme in your area, then please email lwuk@innovationunit.org and we’d be delighted to start a conversation.
Living Well UK Programme is funded by The National Lottery Community Fund, the largest funder of community activity in the UK.
