Transcript Appreciative Inquiry - Healthy City

Welcome and scene setting
Councillor Olwen Hamer, Chris Dawes
and Professor Zafar Iqbal
STOKE 2012 - 2020
SUCCESSFUL – WORKING CITY
Economy, Employment, Education, Housing, Security &
Environment
Council & Partners
HEALTHY CITY
Health Promotion, Improvement & Community Development
Council, Public Health, Care System & Communities
CARING CITY
Care System
NHS, Social Services, Third Sector & The Individual
Professor Zafar Iqbal
Acting Director of Public Health
Why Now ?
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Eye of an economic storm
Health of most vulnerable and poorest
Evaluation of pioneering programmes
Assets and community empowerment
A City Council with a PH outlook
Mandate for Change
Opportunity for Refresh and Renew
Charles
Baby
Aged 10
Aged 20
Aged 45
Aged 60
Born to affluent
parents – will
live 10 years
longer than Mark
Enjoying a
good life, lots
of opportunity
to play sport
At university with
10 x A* at
GCSE. Plays
rugby and eats a
healthy diet
Fit and healthy
businessman,
manages stress
by playing
squash
Retired early to
spend time with
his grandchildren and
travel
Baby
Aged 10
Aged 20
Aged 45
Aged 60
One of
teenage
conceptions.
Will live 10 years
less than
Charles
Growing up in
poverty
Left school with
no qualifications,
casual labourer,
drinks, smokes
and takes drugs
Weighs 18
stone, has high
cholesterol, type
2 diabetes
Died from
massive stroke
Mark
Estimated impact on public’s health and
well-being – role of the local authorities
25%
50%
Illness Care
System
Social & economic
environment
15%
10%
Genetic
endowment
Physical
Environment
Source: Canadian Institute for Advanced Research
“ Health-related behaviour is all about
resolutions to give up the things you do
not want to give up and to do the
things you do not want to do. You
cannot do that; you cannot make the
resolutions and stick to them, unless
you are feeling on top of life”.
( Richard Wilkinson giving evidence to the House of Commons
Health Select Committee, 2008)
“The Story So Far”
Infant mortality in SOT between 1973 and 2000
20
18
Mortality rate pe 1,000 live births
16
14
12
10
Stoke
England & Wales
8
6
4
2
0
1973
1976
1979
1982
1985
1988
Year
Office for National Statistics 2007
1991
1994
1997
2000
Interventions
•Scale – visible from space
•Intensity – improve the poorest
fastest
•Local needs – local intelligence
•Ambitious - risks
Cobridge Community Health Centre
• The new three storey community
health centre will bring together three
local GP practices with a combined
patient list of 11,000.
The building will also include a wide
range of health services including:
• District nursing, health visiting,
school nursing
• Adult physiotherapy, podiatry,
occupational therapy and speech
therapy
• Integrated sexual health unit
including Genito-urinary medicine
(GUM), contraception and
Chlamydia screening
• A pharmacy
• A chest clinic and other outpatient
services
• Specialist out-patients clinics
• X-ray
Impact
• 15,000 health checks
• 5,000 more young people accessing
sexual health
• 5,000 lifestyle programme
• Record numbers of smoking quitters
• 5,000 diabetics better blood sugar control
• Ambition to have 1000 community health
champions
Percentage improvement in health indicators in SOT
70
60
Relative improvement (%)
50
40
30
20
10
0
Male life
expectancy
Female life
expectancy
All cause
Circulatory
disease
Health indicator
NHS Stoke-on-Trent 2012
Cancer
Respiratory Infant mortality
disease
Teenage
pregnancy
2011 Health2011 Health Profile for SOT (1) Profile for SOT
(1)
Association of Public Health Observatories 2011
Vision
• Inspirational and ambitious
• Galvanise/empower communities to raise
aspirations
• Grounded in JSNA and evidence
• Shift treatment to early intervention to
prevention
• Cover all influences : place , communities
and services
• Root causes – Mandate For Change
The greatest danger for most of
us is not that our aim is too
high and we miss it, but that it
is too low and we reach it.“
Michelangelo
Appreciative Inquiry
Introduction and the principles of the
approach
Trevor Hopkins
Asset Based Consulting
“Good organisations know how to preserve
the core of what they do best.
Preserving the right thing is key.
Letting go of other things is the next step”
David Cooperrider
Definition
Appreciate – Valuing, recognising the best in
people or the world around us, affirming past
and present strengths, successes and potentials
Inquiry – The act of exploration or discovery or
to ask questions and be open to seeing new
potentials and possibilities.
Principles
Reflection – remembering times when our
culture, values and identity made us proud.
Affirmation - inquiring into those strengths and
how we can use them to create the future
Action – practical planning towards the future
First some background
Traditional approaches to development:
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Identify problems and barriers to progress
Maybe analyse why the problems exist
Propose solutions
Create an action plan
Also …assign fault or blame
Focus attention on what is missing, and the gaps
Can sap energy and motivation
Characteristics
• Appreciative - AI looks for the ‘positive core’ of the
organisation and seeks to use it as a foundation for future
growth
• Applicable - AI is grounded in stories of what has
actually taken place in the past and is therefore
essentially practical.
• Provocative - AI invites people to take some risks in the
way they imagine the future and redesign their
organisation to bring it about.
• Collaborative - AI is a form of collaborative inquiry. It
always involves the whole system or a representative
cross-section of the whole system.
The Appreciative Approach
• Focuses on existing resources and capacity
• Identifies what is desirable
• Creates energy, interest and motivation
The appreciative cycle
Deliver
Design
Define
Discover
Vision
Definition:
“What would Stoke on Trent look like
if it was a healthy city by 2020?”
Discover
Appreciative interviews
Discussions in pairs
Appreciative interviewing
• Can you tell a story of a time when you made a positive
change to improve your own health and wellbeing?
• What do you believe is now the single most important
thing that positively influences your own health and
wellbeing?
• Now turning to your work; can you tell a story of how you
involved others as equal partners in bringing about real and
sustainable change?
• Imagine your community, your friends, your family, your
colleagues and the wider community in Stoke on Trent
telling stories about how you have worked together as
equal partners to achieve your dreams of a healthy
community.
What would these stories be?
Sharing your stories
Vision
The six Marmot Policy Objectives
Delivering Together on the Social
Determinants of Health in Stoke on Trent
Visioning event
5th March 2012
Dr Mike Grady.
Principal Adviser
Institute of Health Equity
UCL
Review of the
Social
Determinants
of Health and
the Health
Divide in the
WHO
European
Region
The CSDH – closing the
gap in a generation
The Marmot Review – Fair
Society Healthy Lives
Male life expectancy at birth, local authorities 2008-10
Life expectancy
(years)
86
84
82
80
78
76
74
72
70
0
30
60
90
Local authority rank - based on Index of Multiple Deprivation
120
150
Female life expectancy at birth, local authorities 2008-10
Life expectancy
(years)
95
90
85
80
75
70
0
30
60
90
120
Local authority rank - based on Index of Multiple Deprivation
150
Areas of action
Sustainable communities and places
Healthy Standard of Living
Early Years
Skills Development
Employment and Work
Prevention
Accumulation of positive and negative
effects on health and wellbeing
Prenatal
Pre-school
School
Training
Employment
Retirement
Family building
Life course stages
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Strategic Drivers.
Fair Society: Healthy Lives: 6 key Policy Objectives
A. Give every child the best start in life
B. Enable all children, young people and adults to maximise
their capabilities and have control over their lives
C. Create fair employment and good work for all
D. Ensure healthy standard of living for all
E. Create and develop healthy and sustainable places and
communities
F. Strengthen the role and impact of ill health prevention
Fair Society, Healthy Lives (Marmot Review)
• Health inequalities are not inevitable or
immutable
• Health inequalities result from social
inequalities - ‘causes of the causes’ –
the social determinants
• Focusing solely on most
disadvantaged will not be sufficient need ‘proportionate universalism’
• Reducing health inequalities vital to
economy - cost of inaction
Local Government
• Complex, disparate and
diverse systems of Local
Government .
• Focus on needs of local
population and place.
• Differing capacities to
orchestrate action to
address the social
determinants of health.
• Whole System Leadership
• Increasing participation
and empowering
communities.
Health,Wellbeing and resilience
• Evidence participation and improving life skills ameliorates
impact of health inequalities through developing social support
networks. (Bynner and Parsons 2006)
• Learning and skill development impact positively and fosters
community action.
“ I have learned ..I use my counselling skills with my family. I
listen more and I know my daughter will say I am really proud
of what you are doing ,Mum “ (Jane)
• Social networks create the conditions in which people thrive
“ I would say that people in the group have more confidence. At
one poInt they would have been sat at home doing nothing
,now they are out and are involved. Once you get there it ‘s
amazing to see how far you can go.” (Joyce)
Creating conditions in
which individuals and
communities have control
over their health and lives
and
participate fully in society
Vision
What would things be like in Stoke if it
was a healthy city in 2020......?
Break
Vision and outcomes
Trevor Hopkins
Definitions
• Vision (Dream)
• Outcome
• Indicator
• Performance Measure
Vision
Outlines what the organisation wants to be, or how it
wants the world in which it operates to be
(an "idealised" view of the world).
It is a long-term view and concentrates on the future.
It can be emotive and is a source of inspiration.
For example, a charity working with the poor might have a vision
which is "A World without Poverty."
Outcome
“A condition of well-being for children, adults, families or
communities”
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All babies born healthy
All people enjoy good mental health
All people live in safe communities
All people enjoy a clean environment
All people benefit from a prosperous economy
Positive, jargon-free statements of well-being in plain
language that people can understand
“A condition of well-being for people in a place......”
Indicator
A measure which helps quantify the achievement of an
outcome.
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16+ current smoking prevalence
Incidences of self harm
All age, all cause mortality rate
Adults with learning disabilities in employment
Rates of serious violent crime rate
How would we recognise these outcomes in measurable
terms if we tripped over them?
Performance Measure
A measure to evaluate how well a programme, agency
or service system is working.
Three questions:
• How much did we do? (quantity)
• How well did we do it? (quality)
• Is anyone better off as a result? (quantity and
quality of effect or customer/client outcomes)
Performance measures tell us how well service providers are
working as opposed to the impact on whole populations
Performance
Accountability
Population
Accountability
From ends to means
Outcomes
“A condition of well-being for children,
adults, families or communities”
Indicators
Ends
“A measure which helps quantify the
achievement of an outcome”
Performance
Measures
“A measure to evaluate how well a
programme, agency or service
system is working”
Means
Priorities
What is most important to us?
Prioritisation
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Six coloured sticky dots each
• Move around the room
• Read what others have said
• If it helps, interact with other people
• Vote for your six most important outcomes
• If you feel particularly passionate or committed to
one particular outcome you can sign up to this with
your name and telephone number/email address
What next?
• Vision, outcomes and priorities from this session to
be presented at the Health & Well-being Board for
discussion and agreement
• A further workshop to be held (possibly in April/May)
to take forward the ‘Design’ and ‘Delivery’ of the vision
for health and well-being in Stoke by 2020.
• The ‘vision’, JSNA, annual report and strategic
framework to be launched in June/July 2012
Closing Comments
• Blank box for Trevor to insert bullets of the key points from today’s session