The Health Foundation has just finished its first Q Improvement lab with a series of blogs illustrating the journey that led them to adapt this methodology.
The Q Improvement lab is an Innovation lab. Innovation labs are dynamic interactions of collaborators from diverse backgrounds with the aim to find solutions for complicated ‘wicked’ problems. Famous Innovation include the Radio Lab and the Danish Mind-Lab. These have worked on subjects such as etc etc. Innovation labs have been involved in developing better ways to combat polio, support people with mental health problems or understand human nature, By the time that even banks are opening Innovation labs you can be sure that there is something happening.
Interestingly the first HealthFoundation Innovation lab focuses on peer support. Let’s have a look into the dictionary to see what peer means:
peer1 | pɪə | verb [no object, with adverbial] look with difficulty or concentration at someone or something: Faye peered at her with suspicion. • be just visible: the towers peer over the roofs. • [no object] archaic come into view; appear: for yet a many of your horsemen peer.
Mmmh: this is not much help!!!! To be made a peer in parliament indicates to be part of the elite of the political system, peer review for academic literature is the critical analysis of academic manuscripts by other senior academics, usually by other researchers, and usually for free (!!) Peer review of services is an established way to support struggling organisations by putting them in touch with experienced people who come from a related background and are usually sympathetic in their problems and supportive in trying to resolve them.
And maybe this is the first glimpse of the type of meaning that The Health Foundation was looking for: When we are in a tricky situation then getting help from someone professional with amazing skills sounds an obvious solution. But: for complicated problems it is often more helpful to get in touch with someone who is not a specialist but has been in a similar situation previously and can share the pain, the experience, and reassurance that things will get a bit better. This is the type of peer support that I was offered when I returned from working with Médecins sans Frontières (MSF) in Angola: we looked after a feeding centre for malnourished children in a country that had been ripped apart by civil war. Little kids between five months and five years, many sick with diarrhoea or tuberculosis or malaria or AIDS. Daily death. Or children. Small children. At the time I thought I was coping, the pressure to perform, to keep a team together, to educate, train, diagnose, treat, organise, write … but then back home with those colleagues removed who understand the experience things were getting tricky. And suddenly the pressure set’s in. I felt tired, exhausted and really low. And this is where MSF organised peer support. Expatriates that had returned home, who are there to talk, to share experience, emotions, to listen: A very reassuring feeling of being understood.
For those of us under professional pressure this type of support can be life saving. Burn-out is common under healthcare professionals and peer support is one of the interventions that has a proven track record to improve resilience and balance. It is thus understandable that The Health Foundation was trying to find ways on how this wonder medicine is best deployed and how as many people as possible can become part of peer support networks.
Interestingly peer support does not just work for healthcare professionals but also for patients. Particularly patients with chronic diseases are often struggling under the weight of the illness, scared by the perspective of complications, difficulties to realize life-style changes and feelings of isolation if a previous specific way of life can no longer by maintained. In this situation it is equally important to have the company of someone who understand just this situation, who has been there, who has found ways to cope, who is sympathetic. And it is relevant that it is often easier to accept advice from a friend than from someone that is talking to us in a hierarchical relationship where our reflex might be to resist something that feel patronizing or paternalistic.
Finding a good peer if often just luck: someone with just the right experience about the right problem might seem to be more difficult to locate than finding a partner! But in the age of new technology and social media we should be able to find someone for a sympathetic cup of tea and chat about the experience with diabetes as simple as finding someone for a Saturday night-out.
The application of peer support has potentially wide ranging implications for healthcare. It is perceivable that patients will support each other more, teach each other how to treat chronic conditions (something that NHS Wales has already encouraged with the program of Expert Patients’). Where else is this a potentially important way forward? Can it be applied to safety – patients teaching patients how to assure safe care after operations or a heart attack?
The Health Foundation has laid down the first building blocks for better access to peer support. After workshops with 200 “clinicians, patients, designers, academics, Q members, non-Q members, representatives from charities, social care, housing associations, national bodies and think tanks” it is creating a depository of evidence for learning about peer support. This can only be the first step and feels traditional given the innovative framework. Taking things further The Health Foundation has announced its second innovation lab and the Royal College of Physicians is working on related topics so watch this space.
So while we will continue to need subject matter experts, much of how we learn about healthier behaviour might in future be better supported by our own peerless peers!
It remains to be seen whether spread is socially acceptable for patients and healthcare professionals and efficient for providers.
While usage of peer support in health
is likely to translate into high satisfaction and greater impact on behaviour it remains to be seen whether this leads also to greater understanding of patients about their own safety.
What will be the positive effects and where should we be cautious ?