When help doesn’t really help

Monday, 16 April 2018
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Many public services assume that giving advice and solutions to people is enough to make a difference, but we know that a ‘fix it’ style approach is often unhelpful and can actually result in the opposite effect - inaction. People tend not to follow advice unless it feels relevant and connected to their own reasons for change. The ‘Good Help’ report explains how crucial it is to tap into people’s personal motivations to achieve better outcomes.

A recent experience of my own as a patient brings to life the subtle differences between ‘good help’ and ‘bad help’. This short interaction is not obviously ‘bad’ and I chose it purposefully to highlight how small differences in language and behaviour can turn a helpful interaction into an unhelpful one, despite the best intentions of practitioners.

In spite of being a practitioner myself and having recently written a report on building confidence, in this interaction, I felt powerless and unsure about my care. It showed me how hard it can be to demand ‘good help’ and how the power of the system can override practitioners’ capacity to connect with patients. I found myself wanting four of the seven characteristics of ‘good help’ which were missing: 1. enabling language, 2. power sharing, 3. tailoring and 4. transparency.   

A few minutes into a midwife appointment I was told that I needed an extra appointment with a doctor because of one aspect of my medical history. Before finishing his sentence he dialled the phone to get me booked in. As I watched him doing this I tried to clarify why I needed another appointment when I had no concerning signs or symptoms, but he was already in the middle of the call. The midwife was following a medically-informed process and trying to do this as efficiently as possible. But I felt powerless and as if I was expected to follow the decision that had been made for me. My own motivations were not recognised.The midwife could have given me a chance to ask a question before he made the call (enabling language) to help me understand the value and purpose of the appointment (transparency). He could have offered it as a choice (power sharing).

The midwife responded. “It is nothing to worry about, it is just routine. They will ask you similar questions and check whether you are okay.” I thought to myself, “I am not worried, actually I am feeling frustrated as I don’t want to spend time attending extra appointments. The fact it is routine makes me doubt its personal value to me. I feel like a process.” The midwife was trying to allay my worries, but his assumption about my feelings was incorrect so unfortunately it didn’t work. Being in a position of authority he expected me to trust that he had made the right decision for me. The midwife could have asked how I was feeling (enabling language) and given us the chance to explore the best option for me (tailoring). It would have felt nice to make the decision together (power sharing). I left and cancelled the extra appointment. I am happy with my health and my decision, but I am nervous to see the midwife again at my next appointment!

 

Having worked in the NHS for several years I understand that certain processes need to be followed, for reasons of accountability, safety and efficacy. I also understand how the power of the system can override a more flexible and nuanced approach from practitioners. Even with these contextual factors in play, I believe this interaction could have involved more ‘good help’ principles as outlined above.

In fact, with some small tweaks to language and more equality in the relationship, the outcome of this interaction could have been quite different. Maybe I would have been persuaded that the extra appointment was of value to me or maybe we would have agreed together that it wasn’t necessary to book it in the first place. Either way, I would have left that interaction feeling more confident and in control of my health. Could these subtle but important relational aspects of care help to shed light on non-attendance rates in health and beyond? 

I think a core part of what went wrong was a misalignment of purpose, represented in the diagram below. The midwife’s purpose (I am making an assumption) is to deliver the safest care possible to his patients, whereas my purpose is to have a healthy pregnancy whilst also being able to get on with other important things in my life, such as work. If purpose is misaligned and people disengage, there can be serious consequences for people’s care.

Image from Good Help report

I do not want to convey ‘bad help’ as an issue for practitioners to address alone. There is a clear organisational role to make clear the level of clinical flexibility that practitioners can exercise. There is also a role at the level of the citizen and I have reflected on what I want to do differently as a citizen if a similar situation arises in the future:

  1. Interrupt. This takes confidence, but I would like to be able to say ‘please can I interrupt because there is something I don’t understand’.

  2. Express my feelings. I want to help practitioners understand what I am going through. If I am unsure about a decision I would like to say, ‘I feel a bit uncertain about this, do I have a choice about my treatment?’

  3. Be honest. Rather than leave an interaction and go against what has been recommended, I will try to be honest and explain the decision I have reached in the moment. This also takes confidence.

‘Good help’ and ‘bad help’ are on a spectrum and there is no clear line between them. I have come to realise that one of the biggest challenges we face when trying to mainstream ‘good help’ will be the established cultures of help - in particular, shifting and sharing power between help givers and help recipients. We will be exploring the cultural aspects of power in our upcoming People Powered Health conference on 2 May 2018.

Esther Flanagan is leading a breakout session on Good Help at the Future of People Powered Health on 2 May 2018. Read more about the event and join the coversation on Twitter #peoplepoweredhealth

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