Leading Services

Action Learning for leadership in CAMHS: experience of two action learning sets facilitated by Margaret McArthur & Liz Hill-Smith

In 2004 CAMHS Consultants Ltd recognised that there was limited opportunity for personal and management skills development for those leading change in children’s mental health services. Yet confident leadership and effective management was required more than ever before, in order to deliver the Government’s ambitious agenda for CAMHS. What seemed to be needed was a chance for these leaders to get together and work on the challenging issues they faced, in a safe forum where wider management expertise and experience could be bought in to supplement their thinking. To this end, CAMHS Consultants brought together two Learning Sets, each with 5-6 participants who were all CAMHS clinicians, commissioners or managers. The aim of the Sets was to engage participants in reflection and personal change, giving them the chance to explore management theories and approaches directly relevant to their situations within a CAMHS specific environment.

Each Set met in early 2005 to identify outcomes and objectives and plan their calendar of 6 bi-monthly full-day sessions. Both Sets decided to rotate the meeting venue around their different workplaces, which all agreed added value to the experience of meeting together and facilitated networking. Meetings were led and coordinated by facilitators experienced in managing personal, group and management development, coupled with an understanding of the CAMHS environment.

The design of the process was based on the principles of action learning based on the work of Revans in the 1940s, and the experiential learning cycle formulated by Kolb in 1984¹.

Each participant put forward a real-life problem or issue that was really challenging them at that time. The rest of the group listened hard, noting questions that came to them. Then, the listeners had a chance to ask questions of clarification so that the problem was fully understood. Participants then asked questions that they were curious about, or which offered an alternative way of looking at the issue, or help to move the issue owner’s thinking on in some way. Often, a round of this was enough for the issue owner to sufficiently reflect on and resolve or make progress on the problem. They then decided on some action to experiment with before the next session. Sometimes the group moved on to a further round in which they discussed the problem with the issue owner outside looking on. This enabled the issue owner to gain another perspective and further insights.

On returning to the subsequent meeting, the issue owner gave an update on the impact of their proposed action (or experiment) and reflected on what they had learnt about the problem, and also, importantly about themselves. We observed that this process often led to a shift in thinking, and an increasing flexibility and wisdom of the management style adopted.

The outcomes were many and varied. For some, the sessions began a personal journey of increased self awareness and confidence. Others gained some “aha” moments of insight into the impact of their own behaviour and style on others. All enhanced their ability to reframe problems and to ask more powerful solution focused questions. Participants also grew in their abilities to lead change in their complex environments. As the group got to know and understand each others challenges, old barriers began to break down giving, for example, clinicians an insight into the minds – and priorities - of commissioners, and vice versa. As the year went on, these insights grew, as did the depth of understanding of each others roles. Participants began to notice how such insights were proving valuable to them. Some examples of the challenges faced by participants included:

• Becoming the newly appointed leader to lead change in a team which had been unchanged for many years and had a cosy yet unfocused dynamic
• Steering a CAMHS team through the upheaval of a Trust merger
• Bringing health and social care staff together into a fully integrated team,
• Challenging the appropriateness of team skill mix in the face of entrenched professional positions
• Learning how to focus services to serve the children in greatest need

And a recurring theme which ran throughout the life of the Sets for a number of participants was:

• Giving yourself permission to look after yourself and your own needs while leading a caring service.

The process allowed each participant to step out of his or her day to day busy-ness and explore their most challenging problem in some depth, from a number of different perspectives. This led participants to a much deeper and more systemic understanding, which meant that solutions were then more focused on the root causes. Most solutions were quite personally challenging in that they required the participant to step out of their comfort zone and experiment with a new way of working. But with the support of the Set behind them, participants found themselves able to do this, and returned to the next meeting wondering why they hadn’t taken the plunge before! Most found the process of action learning so powerful that it increasingly became their modus operandi. It enabled them to adopt more thoughtful and ultimately effective approaches to their work, even though these seemed at first glance more personally risky.

As this was a pilot in the CAMHS world, we were out to learn too, and so we did. What we found was that the basic action learning process was extremely valuable in the CAMHS management context. While it needs to be carefully facilitated, particularly in the early stages, it appeared to be very powerful in effecting change at the personal, team and organisational levels. Discussions within the Set meetings demonstrated the complexity of the environment in which participants were operating, which demanded well developed and sophisticated skills and personal qualities. Many had felt quite isolated in their roles before joining the Set, and were relieved at the realisation that they were not alone. As facilitators working across sectors, we were shocked by the lack of opportunities for personal reflection on management and leadership issues (as opposed to clinical issues) and also on the lack of opportunity to access high quality management and leadership skills training, particularly in the areas of leading change and managing teams. The diversity of our groups, containing a mix of managers, clinicians and commissioners from across a variety of services and Trusts contributed enormously to the learning obtained.

We also learned that this approach does not suit everyone. Participants need to be able and willing to share their challenges openly with others and some found this very hard to do. It took time for participants to understand and fully sympathise with each others’ different perspectives. In a hectic and target-driven management environment, it was sometimes hard for participants to commit the necessary ‘me-time’ to attend and to follow through on their resolutions. And solutions to some wider issues of concern to participants, such as how to secure accurate data from IT systems, could not be produced through action learning.

And so what next? We consider that there is a substantial unmet need, certainly in CAMHS and most probably across the wider NHS and Local Authority service system, for management and leadership development that is tailored to individual needs. The service specific, reflective approach described here lends itself well to the CAMHS environment and is flexible enough to meet the needs of diverse individuals. Unlike traditional management courses, the learning is more directly relevant to the participants’ working reality, and therefore often more powerful and of lasting value.

CAMHS consultants will be offering new sets for 2006-7 building on our experience to date. We would also like to see such approaches to learning built into other interventions and more widely in the NHS, and would be delighted to talk to agencies involved in Management and Leadership development, including NHS Trusts and PCTs, about running Sets on their behalf.

Liz Hill-Smith and Margaret McArthur are Associates of CAMHS Consultants Ltd.

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