Unleashing the Solution-Focused Power of the Ormskirk Model by Minding Your Language

ARTICLE Unleashing the solution-focused power of the Ormskirk Model by minding your language Dominic Bray, Mark Guyers, Sze May Ng A solution-focused approach engages and motivates patients and their families, Citation: Bray D, Guyers M, Ng M (2020) Unleashing the solution- resulting in positive clinical outcomes and better healthcare professional–patient focused power of the Ormskirk interactions. It requires a change in language used by healthcare professionals, Model by minding your language. Diabetes Care for Children & however, which can be a challenge for some when it comes to turning worthy Young People 10: DCCYP058 principles into day-to-day practice. This article provides grounded, real-life examples illustrating how to ‘speak solution-focused’ and outlines how common Article points 1. Solution-focused language challenges can be successfully overcome in paediatric diabetes practice. shifts focus from biomedical targets and critical terminology (fix-it mentality) to what the patient wants and how they can be helped to achieve it. lsewhere, we have written about what a and organisational wellbeing through application 2. It is useful to ask questions, solution-focused (SF) approach looks and of the related principles of: relentless interest in such as ‘Where would you sounds like using words and pictures, what matters within those contexts; and what like to be?’ and ‘What is going E well?’ to identify what is and suggested significant benefits accrue from expertise already exists within these contexts important to the child/young engaging with children/young people and their towards those ends. Guyers et al (2019a) gives person and their family. families in this way (Guyers et al, 2020). Such examples of how SF-style questions can be applied 3. Persist with this new language – psychologically-informed practice should not specifically within the paediatric diabetes arena. the discomfort, self-doubt and challenges you may initially be the sole preserve of psychologists. When Such questions you might ask yourself/your experience will diminish and everyone – families, teams, whole communities patient include: What are XXX’s best your ability to effectively apply – engages in this enterprise, the benefits are qualities? What does s/he already know about solution-focused practice will improve over time. magnified. Many of these benefits will be lost if diabetes? What really motivates him/her? the parties involved do not speak, or understand, What would s/he be most pleased to be telling Key words the language being used. In this article we consider you about next time you meet? The Queen, in - Language - Ormskirk Model what lies behind change in language. We look at her COVID-19 broadcast to the nation and - Solution-focused brief therapy what it takes for healthcare professionals (HCPs) Commonwealth on 5 April 2020, invited us to - Solution-focused practice to move from heavy reliance on a problem-focused harness the power of the future in just this way: model towards a largely SF one. We also address “I hope in the years to come everyone will be one of the apparent paradoxes of SF practice, able to take pride in how they responded to this namely how it is that something so apparently easy challenge. And those who come after us will say and simple to describe can be so difficult to apply that the Britons of this generation were as strong as in practice. any. That the attributes of self-discipline, of quiet good-humoured resolve and of fellow-feeling still Solution-focused approaches in brief characterise this country. The pride in who we are SF approaches claim to make significant is not a part of our past, it defines our present and Authors’ details contributions to health, social work, education our future.” See page 2 Diabetes Care for Children & Young People Volume 10 No 1 2020 1 Unleashing the solution-focused power of the Ormskirk Model ‘“We Scare, Because As well as being a predominantly verbal problem and fix it” model to such an extent they We Care” can approach, albeit with craft-based adjuncts such are frequently unaware they are applying it. Such as the Tree of Life, taking a graphical approach positivistic cause–effect philosophies first became remain the motto for in the clinic may yield great results. We have pre-eminent in the 18th Century, when the employees of Monsters, suggested replacing the usual ‘problem-saturated’ practice/philosophical assumptions of medicine Inc., not the NHS; if thermometer of the glycaemic index – with its became elided with the principles of engineering. the right conversation/ associated messages of impending pathology – with In short: there’s a problem with the machine; approach is employed, a more motivationally-informed scale we called the identify problem, rectify; job done. Now this Ormskirk Model (Guyers et al, 2020). appropriation of an engineering metaphor has favourable results many merits when the challenge is straightforward, will follow’ Solution-focused approaches as as in the case of curable infectious diseases, countercultural to standard practice broken limbs and so forth: X + Y = Z. But what of Historical hangovers ailments that do not permit a straightforward, one- SF practice de-emphasises biomedical targets and hit fix? What of messy human beings that have the use of scare tactics along the lines of “if you ideas of their own and appear to be irrational? We don’t comply, you will be ill, go blind and die would argue that irrationality is in the eye of the young”. We Scare, Because We Care can remain the beholder. motto for employees of energy-producing factory The good news is that far older philosophies Monsters, Inc., not the NHS. (Interestingly, the are also available, for example the Stoicism of the moral of that film is that laughter – in comparison Ancient Greeks and Buddhism. SF shares many to screams – provides more energy and in turn ideas with Buddhism, for example the assertion makes the job easier.) that change is constant, implying that any given The assumption is made that if the right problem is not a fixed, immutable monolith but a conversation/approach is employed, favourable transitory event that will come and go in intensity, results will follow. Experience seems to bear this coexisting with ‘un-problems’ – or solutions, as out with evidence of good biomedical outcomes we might call them. We would argue that it is following SF practice. For example, significant particularly helpful to look at our clinical practice quality improvements were seen in the National through more than one lens. Ultimately, “there’s Paediatric Diabetes Audit between 2016 and 2018, nothing more dangerous than an idea… when it’s which reported a median HbA1c of 62 mmol/mol the only one you have” (Émile Chartier [Alain], (7.8%) for our unit – significantly better than the 1868–1951, Libres-Propos). national average (RCPCH, 2020). In addition to this: We all have an agenda l 35% of all patients achieved HbA1c targets It is obviously not the sole preserve of patients to of <58 mmol/mol (7.5%) and 17.5% achieved bring their messy humanity into the consulting <53 mmol/mol room. We all do, and run the risk of doing our Authors l The non-attendance rate improved from 22% to clientele a serious disservice if we believe otherwise. Dominic Bray, Consultant Clinical Psychologist, Southport 11% (5% for <10-year-olds) There is evidence of at least some doctors being and Ormskirk NHS Trust; Mark l The length of hospital admissions due to ‘dangerously mistaken’ because they assume they Guyers, Assistant Psychologist, diabetes has been reduced by 1.8 days in the past know what a patient’s preferences actually are Southport and Ormskirk NHS Trust; and Sze May Ng, Honorary 2 years (Guyers et al, 2019b). (Mulley et al, 2012). The Health Foundation Associate Professor, University of has written about the anxiety present in both Liverpool, Consultant Paediatric However, as is likely apparent, for many medical parties to a consultation, resulting in the creation Endocrinologist and Associate doctors, nurses and associated care professionals, of a medically-imposed ‘glass maze’ to manage Medical Director at Southport and Ormskirk NHS Trust, Chair of the SF practice is decidedly not business as usual. concern about ‘cans of worms’ or over-running. In Association of Children’s Diabetes Undergraduate (and, in the case of clinical an observational study, Walsh et al (2000) wrote Clinicians, UK (ACDC) and Chair psychologists, post-graduate) training is decidedly about the temptation for the medic to assume the of the NIHR Clinical Research Network/BSPED Children’s not of this hue. HCPs are generally trained mantle of ‘hero’, only to become a ‘zero’ when Diabetes Clinical Studies Group and acculturated into a Positivist “identify the the wished-for miracle fails to materialise. Hence, 2 Diabetes Care for Children & Young People Volume 10 No 1 2020 Unleashing the solution-focused power of the Ormskirk Model there is emerging evidence that not only does it The conclusion to the above is that for better Page points matter what the HCP construes the patient, but outcomes for children/young people and their 1. Consider what concordance can how they construe themselves and their general families as well as themselves, the HCP’s behaviour be hoped for if little attention is paid to building concordance. self-awareness can be important factors in the needs to change. 2. If a one-up-expert stance is success – or otherwise – of the consultation, and by taken or scare tactics used, extension outcomes. What does it take? how can we be sure patients From our own observations and colleagues’ What is really required is a deliberate effort on the are telling the truth rather spontaneous self-report, some self-construal may part of the HCP to talk a new language.

Load more