Doing Something Awesome Across the UK

Pritpal S Tamber

November 2, 2017

Our plans to help build a learning environment, followed by an enabling environment, for practitioners in the UK exploring why the health care system fails to reach those most in need

We’re hoping to build something awesome across the UK, although we’re struggling to name it and don’t know if it’ll get funded. Even if it does get funded, we think we’ll get enough for the first 6-9 months, not more – even though we know that what we want to build might take years.

What a mess, eh?

To recap, I, together with seven others, have been exploring whether the importance of ‘community agency’ resonates with innovative practitioners in the UK. We first got our thoughts down into a manifesto (which we then renamed to an ‘invitation’ – see it here), and then reached out to 45 others to test our thinking. 34 responded, which led to us adjusting our thinking and drafting a proposal.

One way or another, all of the ‘innovative practitioners’ are exploring why and how systems – such as health care – struggle to connect with people most in need. I’ve got 96 pages of notes and I’m going to do the practitioners a disservice by distilling their experiences down to two key challenges.

Lonely and Fragile

The first is that they’re lonely. They’re thinking way out of the box, questioning everything about how things are currently done, and imagining new ways of working. But their work is out of the comfort zone of the majority so they’re often lone voices. This leads them to doubt their work, and sometimes their sanity, even though, paradoxically, they’re absolutely convinced that what they’re doing makes sense (or at least the general direction of it). This makes them feel alone, sometimes desperately so.

The second is that the moment they make contact with established systems they rarely survive. Systems have a way of exerting – mercilessly – their world view, which is often the wrong lens to use on innovative work. For instance, a housing innovator may have more traction with a community when he or she frames his work around them thriving collectively but the system just asks how many people were housed – completely missing the broader value being created. A similar thing happens in health; engaged communities start asking for the things that matter to them but the health system just asks, “So, did the rate of diabetes go down?”. Siloed systems are pre-programmed to miss the bigger picture.

A Learning Environment

The awesome thing we want to build is, err, a space. It’s a space where, in the short-term, we hope to help them overcome their loneliness and fend off their impending insanity. The great thing about these practitioners, however, is that they also want to learn. So, we’ll be looking to overcome their loneliness by helping them to learn from each other. We’re calling this a ‘learning environment’.

An Enabling Environment

In the medium term, however, we need to increase their chances of survival when they make contact with established systems. This requires the practitioners being ready for the questions ahead but also the people of the systems being open to seeing things differently. To be frank, not everyone within systems is going to be capable of this, and some may actively resist it. I’ve experienced – and have grown very tired of – doctors that say they care about communities only to render all of their problems down to diet, exercise and education. So, the challenge is going to be to find the people within systems willing to think – and do – differently, and to bring them together in some kind of highly curated environment. We’re calling this an ‘enabling environment’.

Two Immediate Needs

How do we create these environments? We’re not sure but we see two immediate needs: holding the narrative and getting the innovative practitioners to help shape what they need.

The narrative here is pretty simple. Systems are failing many of the people they were designed to help and yet are not relinquishing their power to enable new thinking and doing. People outside of these systems have to realise that they have power and then be encouraged to step into it.

A challenge in getting the innovative practitioners to help shape what they need is that it’s hard to have too many cooks. We need to hear what they’re saying and then make choices around what we build, and how. I’m sure that we won’t please everyone, and also that pleasing the majority may not be right either. All in all, it’s going to be tough but, as a great innovator once said to me, if it was easy it would not be worth doing. Quite.

And One Thorny Issue

As well as those immediate needs, we see one thorny issue. If we – by which I mean the small group of volunteers that I’ve been working (they were named in the post with the manifesto/invitation) and the innovative practitioners – avoid becoming the next ‘elite’? After all, the power shift that’s really needed is from those with power to those without and, to be honest, ‘we’ have power. Our role has to be as transient holders of the power, willing to relinquish it to communities when some of the battle is won. Will we have the authenticity to do it or will we become tomorrow’s problem, yet another elite presumptively speaking for communities?

I don’t know but I’m glad that we’re going to try. I hope we can get the first part funded and I’m convinced that once we have momentum we’ll be able to bring other funders to the table. In fact, that’s going to be a big part of my involvement in the work.

I guess we’ll need to find a name for it too.

Pritpal S Tamber

I’m a doctor who trained as a medical editor and publisher and now researches and consults on the link between community power and health equity. My interest in community power started when I was the Physician Editor of TEDMED and is explained in My Perspective. I also work as a freelance medical editor and publisher for organisations that want to write high-quality articles and a strategy for their publishing and promotion. Find out more on my About page.

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