Let’s Listen by Karen Robertson

NES AHP Career Fellowship Project by Karen Robertson, Occupational Therapist for Children and Young People          – Part one!

When I set out to undertake an Allied Health Professional Fellowship project with NES, I wasn’t fully sure what the opportunity and journey would bring.  As I now approach the half way mark, I can honestly say that I am blown away by the experience so far and the learning along the way.  This has not been from webinars, text books or journals or indeed any other CPD resource.  It is from immersing in the ‘lived experience’ of our local families who are using our service. 

Growing an idea from local dedication and passion

My Fellowship project is titled ‘What does effective family-centred AHP service delivery within neonatal and developmental follow- up really look like?’  On behalf of our close working AHP team, I set out to explore at a local level how our joint Occupational Therapy, Physiotherapy and Speech and Language Therapy team could learn from our local families’ lived experience.  As our capacity to offer this additional enhanced surveillance service continues to be pulled from our general Children and Young People Service services, protecting therapists time while enabling growth of local knowledge and skills necessary to do so, is quite a challenge.  While our post-discharge developmental follow up service mirrors some of the recommendations outlined in the relevant NICE guideline (2017), our capacity to offer a service to babies and families during their neonatal in-patient stay is very limited.  We also offer follow up only until 2 years of age rather than until 4 years of age for this healthcare population.  While what we offer is in keeping with many areas in Scotland, It is fair to say that I, together with my therapy colleagues often feel the weight of this responsibility.  We are passionate about ensuring we use this limited capacity in the most effective ways for those needing and using our service.  I believe on reflection that this is what has motivated me to shelf my imposter syndrome, and try to do something about it!

Discovering Values Based Health Care

In my early research to better understand what Family-Centred Care really looks like, I was quickly introduced to the concept of ‘Values Based Healthcare’ VBHC. 

 “The definition of VBH&C for Scotland is based on the primary principle of person centred care – care that is not only high in quality but also delivers the outcomes and experiences that really matter to people, defined by and reported by them. In addition, VBH&C seeks to reduce the waste, harm and unwarranted variation that exist across our health and care system.”

(Scottish Government 2022).  

I was encouraged to notice that my project aims align quite significantly with VBHC.  I like the concept as it acknowledges that budgets and capacity for offering and growing health care services in this current climate is not fruitful, and asks us to be realistic with what we can offer.  As a children’s therapist for over 20 years, it isn’t my first or favourite thought process when I consider how we can be doing better, but it is a necessary one to have nonetheless!  In our local predicament with our neonatal and follow up service, this is most certainly the case! 

On learning more about VBHC, I have been able to progress with more confidence that I was on to something in my quest to listen to what really matters most to our local families in order to provide care that they really value.  It has also been necessary to enquire about what wasn’t of value in order to redirect capacity to where it will have the most benefit.  Together, I hope that this will enable me to ensure I can recommend on and begin to test out a more sustainable and appropriate resource utilisation across our three teams. 

The art of listening

As I found myself sinking further into how to I could approach this Lived Experience project, I noticed that I had a steep learning curve ahead!  I thought I knew what active and effective listening looked like; but did I really?  It is fair to say that a realisation hit me; I have become hard-wired a CYPF therapist to offer advice and solve problems!  With a focus on patients’ health care problems, it can often feel like we have to offer answers and solutions with little time for silence to accommodate ponderings and wonderings!  By stark contrast, strengths based frameworks such as Appreciative Inquiry lead us into communicating in a different way, to actively listen, curiously enquire and facilitate reflection to support our communication partner to self-discover and problem-solve.

Very quickly, I pressed delete on my reams of ‘possible questions to ask’ our local families! Instead, I began preparations for an unscripted approach to explore what families really think about their neonatal and follow up journey with us locally.

Image from: https://integralcare.org

We won’t know if we don’t ask!

At the time of writing this blog, I am approaching the final project based conversation with our local families I am considering my most important lesson so far?  We as the professionals are not always the experts, as we have not lived through what our patients and service users have.  What we don’t know we may assume and so, let’s be courageous, show our vulnerabilities and ask them.  Most importantly, as David Letterman reminds us, “life experience is our best teacher”, so let’s LISTEN!

So what next?

In Part 2 of this blog, as my project nears its end I will share an update on how our teams have taken on board the lived experience shared by our local families, and essentially redesigned what we would like to offer locally to this healthcare population.

If you would like to know more about the Neonatal AHP role, any aspect of our local practice for this health care population, or about this Career AHP Fellowship project, please get in touch.

Karen Robertson Karen.Robertson8@nhs.scot; @KarenOTRob

NICE 2017  Guidance for developmental follow-up of children born preterm. NICE guideline [NG72] Published: 09 August 2017

Scottish Government 2022.  Delivering Values Based Healthcare; A Vision for Scotland. www.gov.scot

 https://integralcare.org accessed 14/09/2023