Stoned to death by cornflakes

As most people know the meaning of the word Cynefin  does not really translate directly into English, its literal translation is habitat or place, but the fuller, more poetical meaning talks of the place of our multiple belongings a sense of being situated in multiple flows over time which profoundly influence what we are, but of which we can only be partially aware.  I recently received an email from Ireland, which is the source of material for this post which suggestions (and I quote) that Cynefin in Irish would probably be “Áit dhúchais” or “gnathóg”. Gnáth signifies custom or habit. One might say “de gnáth” meaning as usual or as a rule. Áit means place or position. Dúchas has a range of meanings; hereditary right or claim, native place or traditional connection, kindred or affinity, innate quality, natural or wild, inherent or innate.  I’m adding that to other equivalents and more are welcome.

Most of the time people use Cynefin for organisational purposes, but every now and then an email comes in where it had utility at an individual level.  One of those came in from Sé in Ireland recently.  Sé works for an NGO and is caring for his wife who has a less common form of dementia.  Best I let his own words speak for him:

I find the idea of sense-making useful in discerning the most helpful and kindest approach at different times and in different situations. Because of the progressive nature of Máire's condition I find I am often searching or probing rather than engaging in linear planning. Its interesting that from the beginning some people have been telling me that I must make plans. I suspect they see the situation as complicated. They would see it as a case of thinking it all through and putting a plan in place. I can see the wisdom of this and have tried to do this in some areas. But I have also found myself somewhat resistant to making all these plans for Máire. I would much prefer to accompany her on the pathway she is on. Because she cannot engage in conversation now I am constantly on the lookout for signals to see what is and is not helpful to her. All of this is very challenging of course but I think I would rather spend my energy aligning myself with an unfolding situation than trying to exercise a level of control that is not realistic. I think what the Cynefin Framework did was to give me a language for some of my instincts and help me see which practice is most helpful and kind. Best practice, good practice, emergent practice and novel practice all have a place. The challenge is to move between them and that often involves moving my head, heart and hands. I hope this is “making sense” to you. I am really writing to say thanks for the sterling work you and your colleagues have done on the framework. I imagine dementia care was not a situation you were thinking about when developing the work but I hope you experience a small sense of joy and satisfaction in knowing that your work has contributed to my work of caring for Máire. I have no idea if anyone else involved in dementia care has used the framework. If you aware of any I would love to know about it. I hope I am not doing an injustice to your work in the way I am applying it. However in saying that I am reminded of a line in the film Il Postino. Pablo Neruda chastises Mario the postman for using his (Neruda's) poetry to woo Maria without revealing that it is Neruda's poetry. Mario tells Neruda that poetry belongs not to the one who wrote it but to the one who has most need of it.

The emphasis is mine; it was always one of the major objectives of creating Cynefin that it give people a language of differences that allowed a contextually appropriate solution to be adopted.  Its a moving story and wonderful final line.

It made my day when I read it, but the email had a second case from one of Sé’s friends.  Again Sé’s words are better than anything I could write:

A friend of mine accompanied her father to an Accident and Emergency Department twice in the space of two months. He had a very serious chest infection. He suffers from dementia. Despite her protestations and pleas to accompany him and act as interpreter, the staff insisted on applying their best practice in the situation. They had their protocols and insisted on following them. On both occasions the situation quickly became chaotic as my friend's father became more and more upset. Applying best practice moved the situation into the chaotic. Following these two incidents she took up the matter of her father's treatment with the hospital authorities. She asked me to support her in thinking through her dealings with the hospital. In one letter the hospital said they were looking at ways of dealing with disturbing behaviour in dementia patients. I am somewhat more combative than my friend and suggested that she ask the hospital to consider who was the actual disturber in these instances. As the hospital saw it her father was the disturber. I thought it was the A and E personnel who applied procedures which disturbed her father. She sent a letter with a milder version of this. Anyway the struggle goes on to develop ways of responding to people with dementia in A and Es. I am not unsympathetic to the workers in A and E who work under a lot of pressure but I am “disturbed” by the insistence on a single, one size fits all approach. In supporting my friend I told her of the framework and it helped her make sense of what was going on in A and E.

There isn’t much I can add to either of those stories but I was moved by them and I wonder if there are other examples.  In our subsequent correspondence Sé raised the question of care and it resonated for me with the recent advocacy by the Chief Nurse in the UK of a focus on care as well as the functionalism of dealing a medical condition.  That all sounded good to me until I read some of the plans which looked like a classic consultancy roll out of a care training programme.  Sé raised a similar issue from a recent course he attended for carers.  Again I quote:

The organisers were kind, considerate, well informed and utterly convinced of the need to give us every single piece of information that a carer might need about every situation they might face. We were inundated with tips for carers. After the first night my sister rang to ask me how the course was going. I said it was like being stoned to death by cornflakes.

The last phrase was too good to miss as a title for this post and without my mentioning it Sé goes on to describe exactly the situation that concerns me about what we might call ‘soft skills’ training.  Sé expressed his concerns to the organisers, in particular that the course was more focused on delivery than discovery.  The response he got is all too familiar to anyone who has encountered the impact of over structured systems thinking on public service provision:

I wrote afterwards to thank the organisers for all their hard work and consideration shown. I admire and benefit from the work of the organisation.  I also made some points about the huge emphasis on delivery rather than discovery. In the side conversations I managed to have with other participants I could see the immense experience and wisdom in the room and yet it was not mined. It was as if it was a course for carers in general or carers in the abstract rather than for the carers who were actually in the room. I received a very detailed response to my letter. It contained the following sentences, “The main course content and learning objectives had to be submitted with detailed plans when we applied to (named funder) in 2008. Current and past carers were asked for suggestions. Course materials, prepared in 2009, were based on the experiences and feedback of family carers in contact with our Helpline, support groups and our services, but as you correctly observed, not specifically from the participants attending the course in X.” I had made the point that while I had benefited from the course the benefits would have been enhanced if there had been more inquiry into the challenges faced by the carers in the room and the solutions and resourcefulness they have developed. The reply gave me an insight into the level of pre-course planning they were obliged to do to get funding for the course. I relate this story because of your mention of numbers rather than thinking differently in Government circles. In going to the course I was hoping to have my thinking and resourcefulness validated, strengthened and challenged but the organisers overwhelming desire to tell me things they thought I needed to know dominated the sessions. I suspect this approach is not confined to courses for carers

If we look at the NHS historically nurses didn’t learn to care through attending courses, instead they learnt it through mentoring, interaction and correction – its called an apprenticeship and its a form of learning that is too neglected in these 'systematic' times.