Motivating sustainable change

12 September 2011

At NPC we’re all about impact, and we’re always keen to hear from frontline charities about what they think makes their work effective. This guest blog comes from Marion Janner, Director of the charity Bright, which runs the Star Wards project to help staff on mental health wards deliver excellent inpatient care, and is funded by one of NPC’s clients. Marion talks about the importance of motivation in making the charity’s work effective.

Hello. What motivated you to start reading this blog? For most of us, the task of motivating ourselves and others is a perpetual, but perhaps subterranean element in our working and personal lives. I certainly grapple with this, in my dual career of being chief executive of a charity, Bright, and full-time manager of my mental illness. Following my stint in 2005 as a detained patient at St Ann’s hospital, Tottenham, I set up and now run the Star Wards project. We help mental health ward staff genuinely want to engage more effectively with patients, and provide them with practical resources to achieve this. This of course means understanding and responding to what’s currently most important to the 600 wards who are members, to patients’ views and to our other sector colleagues, our trustees and (much loved) funders.

My summer holiday culminated in an unexpected but voluntary and highly beneficial 5 days back at St Ann’s, giving me the chance to review what staff, and patients, find makes us actively want to do something. When I was a mere nipper of a campaigner, I was convinced by the influence and persuasion school of social change, and swotted up on these techniques. They are thoroughly employed on mental health wards, partly because of concerns about patients’ capacity to make ‘reasonable’ decisions, and also to enable 12 acutely ill strangers locked up together to form an instant (sort of ‘pop-up’) community. An obvious example is staff trying to persuade patients to take medication which many know will produce side-effects that for them are worse than the symptoms. And patients are energetic in trying to influence staff, especially in relation to trying to see a doctor, usually to negotiate for temporary leave and/or to get back home.

The trouble with trying to influence someone, is that it often relies on convincing them that, basically, you are right and they are wrong. Or it can feel like that, which tends to inflate division rather than create compromise. And persuasion too easily morphs into actual or perceived coercion. Most patients on my ward were sectioned, but all of us were required to forfeit much of our autonomy and choices – very willingly on my part, as I no longer felt able to manage my own self-destructiveness. But each of us, in highly variant ways, were very protective of our residual, potential self-determination. And any hint of coercion went down very badly!

Conversely, nurturing people’s internal motivation not only feels much more kosher, but is much more likely to be effective in sparking sustainable changes in behaviour. For patients, it might be about providing reassurance that kids, pets, bills etc will be OK if we stay a bit longer in hospital. And for staff, that they do have the professional skills, personal qualities and organisational support to effectively manage these negotiations with us.

Star Wards uses an unswervingly appreciative inquiry approach, focusing on what is going right with mental health inpatient care. The content and tone of our resources help staff feel appreciated and confident, usually resulting in a rise in morale, then in energy, motivation, engagement and creativity. This is accompanied by a parallel positive process for patients, who are given the time, support and confidence to regain our daily living skills and self-esteem. Extrinsic motivation (eg pay) certainly incentivises ward staff to turn up for their shifts. But only intrinsic motivation can result in the sorts of extremes of compassion, understanding and tolerance that staff are able to generate, day in, day out, in a highly complex and stressful environment.

My summer break at St Ann’s reinforced my view that staff and patients flourish when we have confidence in ourselves and are trusting and optimistic of each other. Charities are distinctive and appreciated for being independent (at least of the state), non-judgemental, supportive, practical. All these qualities are highly conducive to tuning into what motivates our clients, partners, funders and trustees, and providing services which harness this eagerness to do well.