The Wishing Well Blog

In a busy GP Practice, when do patients and staff get a moment to learn and understand a bit more about each other? Things like: How do staff feel about their role and the work they do? How do patients feel about accessing care, treatment, and appointments? And, crucially, what do patients and staff wish they knew or understood about each other?

Taking a moment to reflect on and share what we wish someone knew or understood about us, can help us develop a shared understanding of each other’s experiences. When we start to understand how we (staff and patients) feel, and what we wish could be different in a service we share – we can begin to make changes to our service; or explain why these service changes might not be possible (at least not right now).

A shared understanding also SIGNALS empathy and compassion – key values underpinning health care and community engagement. Sounds simple. So, how do we bring these values into patient and staff consultation processes to support service and system change?

Now, thinking about consultation processes for a moment: Often, we learn about stakeholder experiences through consultation by (directly) asking for feedback or (indirectly) finding out about people’s experiences through complaints. But are there other ways we can learn and engage with each other? Ways where feedback consultations are mutually engaging for public and staff. Ways that promote mutual sense-making of each other’s views and experiences and help us arrive at a shared understanding.

With these many wonderings and ponderings in mind, we co-produced the ‘Wishing Well’ concept with a Deep End GP Practice in the North East of England – to support patients and staff to develop a shared understanding of each other’s views and experiences of working with and caring for each other in their Practice.

What is this Wishing Well concept?
The Wishing Well concept helps us do consultation a little bit differently. Instead of asking for ‘feedback’ through surveys or working through (minor) ‘complaints’ to understand experiences – we asked patients and staff to make ‘wishes’.

We installed a physical wish box in the GP Practice and made a digital wishing well online accessible to patients and staff. We asked patients and staff to tell us what they wish others knew or understood about them. Inviting both patient-to-staff consultation and staff-to-staff consultation, to promote a shared understanding at all organisational levels.

The idea here, is that: thinking and expressing ourselves through wishes (instead of complaints or generic feedback forms), may help us think about the change we want – without the pressure or expectation that something will or must change as a result.

This simple shift in stakeholder consultation can be particularly important for organisations facing increasing pressure and limited resources. It can help a stretched workforce to learn about aspects of service delivery that their patients may not understand (e.g., appointment times, e-consultations), and, to think creatively about problem-solving.

Through this process, we found that creative problem-solving is enabled when staff are not tasked with making a change, before considering a request, or in this case – a wish.

How did this work?
We worked with the Practice staff to think about ways to encourage people to make wishes. Together, we felt a video would be engaging. So, we co-produced a ‘Love Actually’ style video with staff at the GP Practice, asking patients and staff to make wishes by holding-up notice boards – very much like the famous scene from the film. The video was played in the GP reception area with ‘Build me up Buttercup’ as a musical accompaniment to the video. A song chosen by staff, which (we’ve been told) will now always be a fond reminder of the Wishing Well project.

We received over 300 hundred wishes; mainly from patients and from the digital Wishing Well. We carefully organised these wishes into different thematic categories about service experience – things like: Appointments and Technology, Sharing of Medical Information, and Understanding Me. And then, we created large poster boards for each thematic category (which we called Wish Stations) and decorated them with the wishes of patients and staff.

Next, with the support of the Practice Managers, we asked Practice staff to take part in a Wishful Thinking exercise during a protected learning session. We created a gallery of Wish Stations in the Practice staff room and asked staff to ‘Wonder as you Wander’ around the gallery of Wish Stations, and to think (and ‘ponder’) about how you could make (or could not make) these wishes come true…and why.

What happened?
It was wonderful! Talking and scribbling down wishful responses to the wishes on post-it notes and sticking these on to the Wish Station poster boards – clinicians, reception, and administrative staff worked together to creatively problem-solve system, relational, and organisational barriers to wishes. Things like: providing alternative ways for patients to access appointments and ways to make reasonable adjustments where possible to improve access to treatment.

It also provided an opportunity for staff to reflect on what they didn’t know about patient and staff experiences. Things like: appointment or prescription processes that some patients are unsure of or aspects of their role that some staff find challenging. The Wishful Thinking exercise provided a space for staff to reflect on pressures they experience and what might be needed to improve systems and processes for patients, and wellbeing for staff who are “trying their best”.

A key learning point from this Wishful Thinking exercise was the value of protected learning time to engage the workforce in new ways of seeing and approaching system pressure points and developing solutions. This fun, engaging, novel exercise also facilitated open conversations – a space to wish and play – rather than a procedure to identify and fix.

For workforce wellbeing, we feel it is really important to create innovative ways for the workforce to learn and engage with each other and their patients – to create exercises where workforce collaborate as system thinkers and have fun in the process!

The Wishing Well offered staff and patients a meaningful moment of shared understanding – strengthening relationships and supporting wellbeing.

Many thanks to the staff, patients, and colleagues at Workforce Voices who collaborated on this project. And thank you for reading. We hope you will also read The Be(e) Tree Blog, to learn what we did next…

Written by Dr Rebecca Livingston.