I like not knowing what I can’t do….
Copyright Jon Bryant 2013
In
at the Deep End
So let me boldly go, not
knowing what I can’t do and offer “an outsiders” uneducated view of how
communication passports might work….note to self … not your strongest sell so
far Jon! That said I do place great value on “the novice mind” so there is an
outside chance I won’t need an orthopaedic surgeon to remove feet from mouth,
sure you will tell me if I do
One of the pleasures of being a video director is the way one gets parachuted into new areas and subjects that you know nothing about, you have a short time to absorb a great deal and then deliver solution to a totally new audience. I imagine that in some ways this is very similar for LD Nurses with each new patient.
The Joy of Tweet.
I joined in on a recent #LDnursechat the topic was communication passports and as it's been suggested by LD professionals that my visual language could play a “powerful role” in this area, things have been fermenting ever since (odour free I promise).
The History bit in 138 words… a lucky escape!
Some years ago I created a visual language for people with a learning disability with, as usual:) no previous experience of the subject or the audience. This is the story of how it first got started http://tinyurl.com/b8twhhy Converting a 43 page legal document into pictures and simple language was not the easiest “first place” to start, but a look will help make better sense of what follows.
Didn’t expect this to happen.
Since I first mentioned it on Twitter in January this year I have had almost 1000 hits on the blog and to my surprise and delight the professionals, academics and experts in the field of Learning Disability have given me great feedback and support. This has lead to several meaningful projects, helping a hospital make its POVA services accessible to the very people they are reaching out to.
I am also delighted to have been approached to collaborate on creating a Suicide Prevention tool for a
Am I over simplifying things?…I rather hope so.
Would it work if we had 50 signing languages for the deaf?
Obviously not, one of the themes I picked up on from the #LDnursechat is a lack of consistency, there seemed to be local/regional differences in the format and content of communications passports around the
If you are giving a blind person directions…it's pointless pointing.
Communication is a two way affair. One essential role of communications passports I would have thought is the ability to help both parties understand each others needs and provide a common language to facilitate this. It’s vital for good outcomes that both patient and the hospital staff communicate effectively.
Takes 2 2 Tango and 2 2 Communicate...
A catch 22?
The lack of standardisation and awareness dilutes the effectiveness of communications passports. Sometimes they are not even looked at, apparently. Trying to raise awareness of something that comes in multiple forms can only be targeted with a scatter gun approach and as a consequence its effectiveness is hugely diluted. Selling a single proposition is always a much easier process, more cost effective and more sustainable. It's not like we have a different driving license & tax disc for each County we pass through, or when on-line every form is different depending on where you live! I have spent all my working life raising awareness so it is part of my solution.
He’s put that hat back on!
With my novice hat firmly in place I may at this point enter the foot in mouth zone. My knowledge of what is already in use re passports is to be honest, sparse, so I'm putting my hands up to that now. Being non medical it’s not that easy to get sight of current passports. Therefore I'm hoping to substitute my lack of knowledge with what I hope is common sense.
Out comes the Directors Hat next.
Looking from the outside in, the first thing that seems“logical” is to harvest as many variations of pre existing communications passports along with feedback on what works, what doesn’t and also a “wish lists” from all sides.
I never mind being called “Big Ears”.
The critical thing is to listen in equal measure to passport holders themselves and their carers/family and on the medical side, HCA’s, LD Nurses, Dr's and Consultants. My focus will always be on the users shaping the final output, only they know what works in the real world. The objective being to distill all the “good practice” from the cocktail of current solutions that is in use across the
When hurdling don’t forget your vest!
I realise the vested interests in peoples own version of the communication passport is the biggest hurdle to overcome if my solution is to become a reality. This asks a fundamental question “what is best for LD people and more widely the NHS?" It would be a great shame if the reason a project like this stalls is because people don’t really want to act as a team with one goal in favour of retaining their version of the comms passport. So I have a plan B, that’s my job - bet you didn’t see the producers hat go on:)
Plugging my Plug-in Bolt-on Standalone
It would be possible to keep your vest on and still join in the game... I see the visual language as being a powerful plug in or bolt on to pre existing communications passports, providing the additional communication tool to enhance the many interactions that are part of being a patient in hospital.
Like the Family Courts project with the Dudley Advocacy this aspect of the work is about helping prepare for the daunting ,and making the unfamiliar a bit more familiar before the event. I can see the visual language tool being very effective in this role.
Just getting my other foot ready now:)
I am pretty sure that much of what currently exists is in written form, and while it’s designed to provide a “profile” of the person and information about them, aspects of their personality, abilities and limitations, preferences etc, I wonder how helpful these passports are in enhancing the frequent communications that relate to a stay in hospital for a person with LD and those interacting with them
? It is this role that I want to expand on next.
Pick a card... Any card you like.
When I first mentioned my ideas around this I was rather firmly put in my place on Twitter, “and just how did I expect to train all the people like LD nurses to use it?” Call me radical…though I prefer Jon, but if my vision for this works for the passport holder with a learning disability or perhaps brain injury then it should require no training for staff to use it anyway.
It’s a game of 2 halves.
On one side is an image that the person with LD understands to have a specific meaning. You will have seen the sort of images I make from the visual tenancy project. The back of the card could be pre printed with a written explanation on it so that anyone shown a card simply has to read it to know what it means. So as promised no training required.
Its OK to take sides
The reverse of the card could also be blank, this means that staff or carers can write down what this card means to that person…. "I feel sick; I am a bit scared; can I have a drink?; can you take me to the toilet?; I like tea not coffee; are you a doctor?" Or "my bed is wet; can I get up for a walk?; thank you; I feel better now; I have a headache; mine's a vodka! ;can I play football here?; What time does the party start?"
I do actually think humour should be part of the mix, the LD people I worked with when creating the visual language all “got” humour and its value should not be overlooked in a hospital setting and what it does to improve communication and a sense of well being.
By working with both LD people, their carers and staff, the archive of images will build up based on what is proven to work. Those involved in interacting with the person, HCA’s and LD especially will from their years of cumulative experience be able to identify the 20 or 30 most common communication problems very quickly I am sure. This is gold dust for me.
The Pig and the Monkey
My role will to be that of “piggy in the middle/translator” listening to both users and providers to create a“vocabulary” that bridges the communications gaps they identify. I will be setting up a survey monkey so I can get that list of communications issues from everyone’s perspective.
Future proof… no Tardis required
If I could now ask you to now install your imagination app and jump in my Tardis… after wobbly visual effect and suitable radio phonic soundtrack you arrive with a carer and person with learning disability preparing for a stay in hospital.
The Nirvana of this concept would be that over time the archive grows to cover all aspects of independent living for LD people ,enhancing communications for both them and care and support services, for better quality of life. In time, like road signs, the images become standardised and universally used and understood like signing for the deaf and braille for the visually impaired.
Less process more action, did someone say “action?”
This could be created and delivered very easily, it doesn’t need endless meetings and committees, external consultants, why? All the expertise is out there now held by people like you, and its about me listening and responding creatively. What do you want to say and who do you want to say it to?
Scaleable Start
What I am suggesting is completely scalable so one would start with a one ward pilot, getting input from everyone. When it feels like the concept is refined, then role out a little wider and listen and learn, adapt and modify all the time.
Organic is good for you
The critical thing is that it needs to evolve organically, ward by ward, hospital by hospital, user by user. Trying to go the route the NHS prefers e.g. come up with all the solutions before implementation, spend years in consultation, testing and research, is pointless and will be wasteful and disproportionate. With the right support this could be up and running in 3 months at a ward near you.
Buddy can you spare a dime?
To get the ball rolling this just needs funding and support from one phase to the next, so there is minimal risk to the NHS or charities involving themselves in it as it grows in well managed stages. When critical mass is achieved, the evidence base is there and then that's the time to roll it out more widely. Like all resources of any real value it will expand and change to meet demand over time.
Simple peeps!
The cost of the research, creating the images, the cards and the apps is insignificant, in creative and production terms it’s not complex at all and would represent a few months work with a small team. This project is purely about communication and that’s what I have done for 35 years, there is no huge changeover, re training, or new working methods to implement or overcome.
Did I mention Simple and Cost Effective Awareness Raising and Training?
As to training and awareness raising across the NHS, "If a patient shows you a card with an image on and you are unsure of what they mean just read what is written on the back" ....so that's the training session over....only took 5 seconds and 27 words....Job Done! ...or have I over simplified things?
999
Do I need that surgeon I wonder?
I would love to get a small representative group together, comprising LD people and their carers, especially LD nurses and also relevant charities and organisations to give me their input and see if we can get this to a pilot stage.
I am sure I have bitten of a few more toenails than I can chew so please put me right via jon.bryant@btclick.com or @Chicustard on twitter.
I am on a bit of a mission to make this work and hungry to learn more so got my big ears on, not decided about the hat though:)
jon.bryant
About Jon http://tinyurl.com/bxtp7bx
M 07831 832 439
Copyright Jon Bryant 2013
