A meeting of minds
Focus group, customer service forum, group therapy, democratic community meeting, therapeutic community meeting, trade/student union meeting. Meetings don’t come more complex than ward community meetings! The variety of names reflects both the multiple aims and also, perhaps, ambiguity about their purpose and value – eg therapeutic community meetings, ward meetings, ward group meetings, daily/weekly meetings, Start of the Day meetings and patient meetings. Their origins are in the therapeutic communities of the 1950s and 1960s and the concept of a safe, reflective space remains a vital feature of ward life.
Community meetings can provide a reflective and listening space for both patients and staff to discuss what’s working, what’s not working so well, highlight needs and help inform. They can help generate ideas, roles and help engender meaning, understanding and a sense of safety.
Wards vary in the frequency of community meetings, from having them at the start and end of each day, to weekly events. Given the potential benefits and challenges, it’s really essential to have a strong sense of the meetings’ purposes. The main ones are usually some combination of:
- Information sharing eg activities, ward changes
- Relationship building between staff and patients – developing the ‘therapeutic alliance’ (the positive relationship between patient and therapist that is crucial to therapy being effective)
- Helping patients get to know and appreciate each other; nurturing mutual support
- Developing a positive sense of the ward as a community, including understanding the ward’s rules and norms and promoting a sense of responsibility for oneself and others
- Addressing and ideally resolving conflicts. There needs to be a balance between expressing concerns and not getting drawn into over-personal or over-specific accounts.
- Opportunities for expressing appreciation of staff and patients
- Problem-solving and reinforcing the legitimacy and value of different perspectives
- Confidence and self-esteem building
- Risk assessment
- Interest, curiosity and fun!
Who should chair/facilitate?
This is a separate issue from which staff should come to the meeting and the most important qualification is someone who is good at chairing ward meetings! This could well be a nursing assistant, Therapeutic Liaison Worker, or ward manager, OT, or some wards use outside facilitators eg a skilled service user representative. In a ward where patients live for many years, there may well be one or more patients who would welcome and benefit from taking this role, even occasionally.
Getting staff there
As emphasised (repeatedly) in the research by Novakovic (see below), it’s essential that all ward staff and management (and consultants and visitors….) recognise how important community meetings are. Ones that are constructive and inclusive should motivate staff to take part, and robust support structures such as staff reflective groups (see Idea #75 Reflective practice) help colleagues cope with stressful or perplexing issues that arise including boundaries and coping with one’s own and others’ emotional responses. Community meetings may have anything from just one member of staff to all those on duty at the time, including catering and domestic staff. Obviously choices will depend on ward philosophy, patients’ preferences and abilities, workload demands and The Unexpected.
Getting patients there
On the whole, if patients feel the meeting will be some combination of useful and beneficial, they’ll come. And the better the refreshments on offer, the larger and happier the group! Patients will easily pick up staff ambivalence or worse about the meetings, so staff need to be positive and to remind people of the timing and value of meetings. A nicely designed poster/notice helps and lots of wards have a sheet of paper on a noticeboard where patients can suggest items for the next meeting. Depending on how confidential or sensitive the meeting notes are, it can be helpful to put past minutes on the noticeboard as well.
Again it’s different in wards with longer-term patients, who may well have seen the same concerns come up over and over again without resolution. This is understandably very frustrating for everyone, and if the issues are unlikely to be sorted out (eg because of financial constraints) it can be best to agree to drop those issues at least for a while. Conversely, longer-term wards have patients and staff who know each other relatively well so it’s possible to get into more therapeutic territory than on other wards.
Meetings which include dementia patients need very careful and imaginative planning, and speech and language therapists as well as OTs may be able to advise. Involving patients’ relatives or friends can be very productive.
Managing patients’ contributions
Very very common issues include:
- Getting patients to contribute as equally as possible
- Keeping to the subject
- Preventing over-personal information being disclosed and personal attacks
- Managing unconventional, disruptive, distressed or outright aggressive behaviour
Staff are fabulously skilled at handling these sorts of situations throughout each shift, in group situations and 1:1. But training in group facilitation is a real help, as is the chance to see colleagues running community meetings effectively. It’s all about getting a balance between an individual’s needs and those of the group, being flexible up to a point. But staff also need to be prepared to suggest (or if necessary insist!) that if a person is persistently disruptive, they should go and have a chat with a member of staff or a ciggy or a go on the exercise bike….
- Start the Day groups also provide the chance to talk about expectations and emphasise that there are other people on the ward with similar experiences and feelings as you’ve got. The OT made the interesting observation that people arriving on the ward are still half in the outside world so have the same social skills and willingness to listen and be supportive, illness allowing.
- Each ward has fortnightly community meetings which are chaired by patients on a rotational basis.
- A ward described one of the benefits of the daily community meeting being that inappropriate behaviour can be dealt with by patients responding to each other. The value of peer pressure rather than staff leaping in. The ward manager is sanguine that “Not every community meeting is going to be an easy one” and told me that a student contributed the valuable idea of making sure meeting ends on a positive note.
- Community meetings help decrease agitation and confusion and encourage peer-to-peer support.
- Regular patient meetings take place. A group called ‘Your voice’ has been established which provides a framework for feedback on the services provided that go on to inform the organisation at Board level.
- Patients and staff collect locally relevant information for Notice boards in both units. Up to date information is provided relating to MHA, Advocacy, Community meeting minutes, local groups, multi faith and benefits.
- Community meetings, facilitated by Therapeutic Liaison Workers happen on a weekly basis and everyone is invited.
- The clients have a daily forum to express their views and shape their experience of the ward, from fully engaging in identifying their own needs and planning how to manage their care and deciding how to spend their time. There is more engagement as the focus is on activity, positivity and enjoyment, rather than containment and service led assessment (‘what do you have problems with?’ etc). It appears that the number of incidents has decreased although we are awaiting conclusive data but both clients and staff report increased wellbeing.
- Short ‘end-of-day’ meeting are held which are optional for patients to attend. The aim of the meetings is to provide patients with an opportunity to reflect upon the day they have had, voicing both positive and negative experiences.
Who takes part
- New admissions are able to meet and get to know existing patients and gain reassurance.
- Representatives from the Involvement Centre come along to talk about any activities happening in the centre and provide a two-way link.
- Protocol for their weekly community meeting to involve all staff and patients including domestic and catering personnel
- Community meetings twice a week for patients to attend and one where staff, doctors & matrons attend as well.
- weekly community meetings with guest speakers.
- The charity fund can be used for patient-determined budget, decided by patient meetings
- OT runs a 9.00 Start the Day group which has good attendance because people are curious about the day. Sometimes they have an add-on to meeting eg a Buddhist chaplain did a meditation session and they’ve had keep-fit expert and Rethink giving a talk
- Community meeting suggestion book to be kept in the day area (no it doesn’t go missing but the staff will need convincing).
- PALS officer comes to the weekly community meeting and transforms these notes into a lovely newsletter with pics
- A member of the meeting is invited to chair the session and someone else takes the minutes.
- the service user consultant chairs daily meeting
- The OT dept and recreational workers worked intensively on the ward to share their skills with the nursing staff and support their growth. It led to a well-attended morning meeting where the activities for the day are reviewed along with any issues and the evening activity is agreed upon by the participants.
- Need the buy-in from consultants so people are not pulled out to be seen.
- Including conversation/thought starters
- All wards in the Trust have a Start of the Day group, a mini-community meeting + bulletin board about what groups patients would like that day and what fixed groups are happening, eg talking therapies, gardening, walking.
- At the morning planning meeting, patients can book for local activities eg bowling or Tai Chi. They no longer makes detailed plans a week in advance because so much can change. Make rough plans and confirm with the people who will be visiting from outside organisations.
- Day starts with community meeting, with coffee and newspapers, as well as chatting about the day’s plans.
- The minutes are copied up, printed off and displayed for patients, staff and ward management to see.
- Anyone who couldn’t attend the meeting has the opportunity to make any comments and provide further input.
- All ideas and suggestion are taken seriously and considered and are not simply met with a default answer.
- Community meeting notes book ensures actions can be followed up and those who didn’t attend can see what was discussed.
The Word From the Ward
“We start each day on our Lodges with a coffee morning at 10.30, here the day begins and we plan together what we will do. Two days a week we cook our main meal on the Lodges (very busy acute lodges), this involves planning together, shopping, budgeting and cooking. The whole ambience of the lodges changes and it’s a days activity that everyone is encouraged to join. At the weekend we make tea with a smaller budget and a lot of creativity – this in itself creates fun and the need for imagination. But again it’s a whole process and involves everyone. While we have coffee mornings every morning, every Monday morning we have a community meeting (all three Lodges attend) where members of the independent forum (service users and carers) attend. They promote the forum, take views, ideas back to the forum and provide independent ears should anyone want to talk to them.”
“We use a whiteboard during our community meeting to take the minutes of the meeting, this includes any agenda items (in black) and any responses or newly raised issues (in blue). This allows any patients who attend the latter part of the meeting to read up on the issues that have already been raised, they can then contribute where they feel they want to. Almost like a pick & mix community meeting for late arrivals!”
- At our community meetings all the ward attended and we would discuss any issues there were with rules. It helped me feel included in ward life rather than dictated to about it.
- Being able to talk about the ward dynamics is essential because for that period of time – it is your home!
- Ward life was certainly a roller-coaster. That was why getting together as a group in the morning and evening helped contain the day’s events – be they good or bad.
- When the whole ward gets together and you each have a turn to speak, it is a huge responsibility and one that makes me feel good.
- I really enjoyed going to our ward community meeting. It gave me a chance to air my views and ideas about the ward. The staff really listened and respected what I said.
- When the whole ward comes together as one I feel like all the broken pieces of me have joined back together, even if only for a bit.
- When I first came in I went to a ward meeting. I was so scared and didn’t know what was expected of me on the ward. Other patients introduced themselves to me and that made me feel better.
- Each day the staff used to say what they were looking forward to for that day and what they had enjoyed the day before. It helped us all feel connected and empowered as a group.
- Going to community meetings helped me break the habit of isolating myself and I got to know other patients.
- We all used to go round in a circle each morning and say something positive about the person next to us. It really helped those who struggled with self esteem. Somehow it was easier to speak when being nice about someone else.
- We all had to find our voices and we all had to go at our own pace.
- At the community meetings other patients talk about how they are near discharge and feeling better. It reminds me that I will also leave when the time is right.
- I take the minutes at ward community meetings and then type them up.
- When we have group meetings on the ward it helps the general level of understanding and tolerance.
- We were actively encouraged to constructively challenge something we were uncomfortable with in community meetings. We chaired them and set out the agenda. The lessons I learnt from this has helped me in my life away from hospital as well.
- Every time I attend the community meeting I feel more and more a sense of belonging and support.
- Seeing someone so distressed they need to be heavily medicated is terrifying. We have the opportunity to talk about it when it happens as a special meeting is held specifically to ‘hold’ the raised anxieties of the rest of the group.
A little note from Marion Janner (founder of Star Wards)
Here’s a pretty typical community meeting agenda on one of our Trust wards:
- Welcomes, especially new patients, staff and visitors
- Introductions – either simply names or more of a ‘check-in’ where each person says how they’re currently feeling
- At this stage, and/or at end of meeting, an ice-breaker exercise can be appreciated, whether a ‘thought for the day’ (there are lots of great books of inspirational thoughts and quotes), a word game, a physical activity or maybe even a joke.
- Recap on purpose of meeting, agenda items, ground meetings
- Action notes and developments from last meeting. (In practice, it can be better and more informal not to have notes of daily meetings typed up and circulated. Action notes are, however, important if meetings are only happening weekly to make sure that patients’ views are being acted on. Much more on all this in Idea #45 Patient Involvement.)
- Issues that people want to bring up. If possible, this happens by going round the circle so that everyone gets the chance to contribute.
- Plans for the day
- Wrapping up, giving people the chance to add their views (especially if they haven’t so far) – and thanking everyone for participating