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Levens V. (2003)
Medway speech and language therapists have been seeking users' views for over 10 years and, more importantly, changing services as a result. This article shares the wealth of experience they have amassed from focus groups of past and present users of clinic services. For example, users views of waiting times for children to be assessed and treated indicated that families wanted to be seen as soon as possible rather than waiting for therapy to be available. A Users' Views group has also been established with representatives from each therapy department (adults, paediatrics and special needs), and a termly Users' News attachment has been added to the monthly department newsletter giving news, thanks for participation, and encouragement to everyone to gather users' views in a variety of ways. Suggestions for bringing users in, and different techniques for gathering their views are listed.
Judul Asli
I know what people need from my service - don't I?
Levens V. (2003)
Medway speech and language therapists have been seeking users' views for over 10 years and, more importantly, changing services as a result. This article shares the wealth of experience they have amassed from focus groups of past and present users of clinic services. For example, users views of waiting times for children to be assessed and treated indicated that families wanted to be seen as soon as possible rather than waiting for therapy to be available. A Users' Views group has also been established with representatives from each therapy department (adults, paediatrics and special needs), and a termly Users' News attachment has been added to the monthly department newsletter giving news, thanks for participation, and encouragement to everyone to gather users' views in a variety of ways. Suggestions for bringing users in, and different techniques for gathering their views are listed.
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Levens V. (2003)
Medway speech and language therapists have been seeking users' views for over 10 years and, more importantly, changing services as a result. This article shares the wealth of experience they have amassed from focus groups of past and present users of clinic services. For example, users views of waiting times for children to be assessed and treated indicated that families wanted to be seen as soon as possible rather than waiting for therapy to be available. A Users' Views group has also been established with representatives from each therapy department (adults, paediatrics and special needs), and a termly Users' News attachment has been added to the monthly department newsletter giving news, thanks for participation, and encouragement to everyone to gather users' views in a variety of ways. Suggestions for bringing users in, and different techniques for gathering their views are listed.
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of various caseload management practices across our district and was therefore an extra benefit of our first users views activity. At this early point in our users views evolution, we decided it was important users did not meet with their therapists. We thought that might inhibit honesty, and be difficult for the therapist. On a pos- itive note, we did feed back to those who attended, our team, fundholders and commissioners. In the next two years we continued with focus groups, planning to ensure we covered all geo- graphical areas of our Trust and adult users as well as carers of child users. The senior manage- ment team shared out the work so, for example, a paediatric team leader would run a group for people who had had a stroke. We continued to report back and started to work out what changes we could make. In 1996 Julia Ritchie and I wrote a document for our Trust called Informing and Listening. This looked at the literature around users views and current practices. We read and visited, and became even more convinced that this was a valuable addition to our work. We became less anxious about the meetings, and better at encour- aging people to tell us their story. We learned that people could hold painful memories of diagnosis and the realisation of the extent of difficulties described by us. These were often not anyones fault - they just were. Other times, small changes could make a big dif- ference. For example, feedback from therapists to parents about group therapy performance is hard to take if it is felt to be always negative about behaviour and is delivered in a busy waiting room. Similarly, it was great that children with disabilities could come to therapy at a local clinic instead of only at the Child Development Centre - but not if the therapist forgets that your child cant walk into the room alone and she is left in the waiting room without help. In both of these instances, par- ents had concealed their hurt at the time and had only shared it when asked about their experiences in what felt like a safe setting for them. Benefit of hindsight After three years of our rolling programme of focus groups, we took stock of what we were doing. On the plus side we had maintained activity management SPEECH & LANGUAGE THERAPY IN PRACTICE SUMMER 2003 8 first remember being asked to think about users views in the late 80s, when I was told to produce a questionnaire, evaluate it, and write a report about it. Thankfully, I cant remember many details of the paperwork I inflicted on the carers I worked with. If I could remember more, I am sure I would recall a number of embarrassing errors. It would have been from my perspective. I knew what people needed from my service, didnt I? It was paper based and therefore not easy to use for people who are not confident readers and writ- ers. I am pretty sure I didnt feed back to those who were kind enough to respond - just to my boss. Even worse, I cannot remember making any changes to my practice afterwards. Luckily, I was given a second chance when I moved into management myself. A colleague was taking her masters in Health Psychology and she suggested we start to ask parents of children using community clinics what they wanted. We were dealing with huge waiting lists and at the start of GP fundholding. It didnt feel right to leave users out of the equation. (Can anyone else recall those discussions about who our customers were and the linguistic gymnastics that took place to put GPs and commissioners above users?) So, in 1994, Julia Ritchie and I ran our first focus group. We invited 60 randomly selected past and present users of a clinic in Chatham to an afternoon meeting. Ten people came, and others rang or wrote with their views. I saw my first example of a phenomenon since seen many times - people who have had cause to complain to our service being the most giving and energetic in sharing their ideas. High on excitement We prepared for the meeting by agreeing that we principally wanted to know users views on waiting times. Should children be seen quickly and learn if there is a problem, but then wait for input? Or, was it better to wait longer but get intervention straight after assessment? Families were clear that they wanted to be seen as soon as possible and to use waiting for therapy time to put therapy sug- gestions into practice. In discussion, it was felt that eight weeks was a reasonable maximum initial wait, and Julia Ritchie and I used this in negotia- tions with commissioners. It was not always a comfortable meeting, but it was lively and we left it rather high on the excitement. Shifting our clinic work so that children did not l I saw my first example of a phenomenon since seen many times - people who have had cause to complain to our service being the most giving and energetic in sharing their ideas. Medway speech and language therapists have been seeking users views for over 10 years and, more importantly, changing services as a result. From cringe to credit, Val Levens shares the wealth of experience they have amassed. you want to deveop condence n workng wth users encourage reecton on therapy by those nvoved n t harness the energy and deas o admnstrators and companants Read ths I know what people need from my service - and grown our skills and confidence. However, the importance we had placed on users not meet- ing with their therapist had had paternalistic effects we were not happy with. We had kept the work within the senior management team and so prevented others developing the skills we were so proud of. We had missed an opportunity to encourage reflection on the therapy experience between those actually involved in it. With the benefit of hindsight this is so obvious! How could we open up this work throughout the department? Also, having decided that face to face was a better format than paper based methods, were we relying on it too exclusively? We came up with the idea of a Users Views group, which would involve a representative from each therapy team in our department (adults, paediatrics and special needs). This group had a coordinator and met regularly throughout the year. The team representative model encouraged whole team dis- cussion about areas we could explore and was the prompt we needed to widen our range of action. Having successfully won a Charter Mark award for our department, we learned from that process too. We were not especially good at reporting on some of the positive things we did - so we started to produce an annual Users Views report. This enabled us to share our learning with others in our Trust, and allowed us to find out more about each others projects. Thinking we could make more use of our monthly department newsletter to keep Users Views a live issue, we began producing a termly Users News attachment that contained snippets of news, thanks to those who were already par- ticipating and encouragement to everyone to think about how they were - or could be - involved. This may be one of the reasons that the last few years have seen plenty of volunteering behaviour. Looking at our review of work in 2002 (figure 1), there are a number of projects that have been conceived and completed by people in our teams without any prompting. Written up projects arrive with post-its saying, I was doing this anyway and realised halfway through it was a Users Views project. People on the Users Views group now are not surprised by calls that start - I had an idea ......., or What about trying....? A member of our administration team said she would like to be on the group. She contributed generously and enthusiastically, especially in prompting discussions about the therapist/therapy focus of so much of our thinking. For most users, their first contacts with us are through administra- tion services, either in person or by telephone or SPEECH & LANGUAGE THERAPY IN PRACTICE SUMMER 2003 , management letter. How much thought were we putting into these? How could we reduce missed appointments by manipulating the timing of our appointments (eight weeks notice or two? - what we actually found is that, if a client or their carer works, more notice is helpful but, otherwise, less is best). One of the strategies we have used is the per- ception scorecard. This is a page of 10 boxes, with one at the top. It can be used in a number of ways; one of the most useful is to fill in the boxes with an individual or group, firstly listing 10 things they think are important about the service. These are then ranked in perceived order of impor- tance. Next, the group gives marks for how well they think we are managing that issue. It is even more interesting if those delivering the service do the same, logging their perspectives. Process most valuable Comparison, sharing and exploring perspectives prompts lively debate. Actions can be agreed on - which areas to target and how. However, in all of this it is the process that is the most valuable. We need to ensure we do not rush for outcomes at the risk of missing out the gold that is revealed in getting to them. It is usual for therapy teams to have different pri- orities from users. In a way it is both inevitable and right - we train to identify and manage communi- cation problems. We are drilled in efficiency and evidence. That is valuable because no one wants us to waste money or time. However, we still need to know what makes contact with us as positive an experience as it could be and, as the comments in figure 2 show, our team really sees the benefit. We think we have come a long way - long enough to cringe at some of our ear- lier attempts at least! We are more relaxed about the work now, and do it more readily, often without even real- ising we have. We are not complacent, though. We are all too aware that gathering the views of those with severe communication problems is a challenge. We want to do it in ways that are meaningful to the user and which, in themselves, contribute to the therapeutic intervention. Suggestions for bringing users in and the differ- ent techniques for gathering their views are in fig- ures 3 and 4. We will continue our rolling pro- gramme, always looking for new / better / differ- ent ideas. If you have some you would like to share, call us - we would like to hear from you. Val Levens is a speech and language therapy manager for Medway Primary Care Trust, tel. 01634 813738. She thanks Julia Ritchie for her inspiration, and writes this on behalf of Terri Horton, Vicky Kiely, Siobhan Letford, Susan Tyrrell, Louisa Waters and Janice ORegan. We are more relaxed about the work now, and do it more readily, often without even realising we have. +. Get started! (You w earn whatever you do.) . Nake t peope to peope contact. (You can try paper systems ater.) . lsten more than you tak (and sten to the avour as we as to the content.) (. Vaue process more than outcomes. (You w earn more n the journey than on arrva.) . Keep t smpe. (Ouaty not quantty. Ask or a good thng about contact wth you, and or a bad thng. You may be surprsed.) Users vews: steps to better practce dont I? Figure 1 Projects undertaken in 2002 - Contact with carers of adult patients (what did they think about it?) - Sensory interaction project (staff feelings about how we planned and delivered the work) - Parents/carers views on group therapy (community clinic) - Reflections on a drop in clinic (community clinic) - Autism group (childrens views of the group) - Training feedback (what I did this week parent/carer thoughts on introduction of symbol feedback in a nursery) - Leaving the unit (children with language disorder thinking about their time with us). Figure 2 Team views Its what really matters in planning how we improve things. I enjoy the opportunity to really ask people what they think. It seems daunting at first but soon becomes part of everyday working. Things that other teams do can be really useful to see, because it can often be adapted to my work too. Figure 3 How to meet people you can use - Talk with people in the waiting room. - Visit a support group, where people may feel more confident. - Invite a few people for coffee (and cr` eche). - Arrange to meet someone who has complained about the service. Figure 4 Techniques to gather users views - Open discussion - Guided/interview - Structured interview - Perception score cards - Drawing how you felt/feel - Using composite pictures to express views - Feedback slips on reports - Suggestions box - Telephone feedback Whatever you do, include an anything else? section.