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Values Based Reflective Practice (VBRP®)

National Handbook for Best Practice

Values Based Reflective PracticeNational Handbook for Best Practice

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Foreword 3

Introducing Values Based Reflective Practice (VBRP®) 4

What is VBRP®? 4When to use/when NOT to use VBRP® 6

Key Dimensions of VBRP® (KD) 7

KD 1.1 Three Levels of Seeing 8KD 1.2 NAVVY 7KD 1.3 MAP (Motivation, Actual Practice, Potential Practice) 9KD 1.4 The Role of the VBRP® Facilitator 9

Who is who in VBRP® (WW) 11

National Roles WW 1.1 NHS Education for Scotland 11WW 1.2 Registered Trainers 11Local Roles WW 1.3 VBRP® Local Leads 12WW 1.4 Registered Facilitators 12

VBRP® Local Communities of Practice 13

VBRP® Resources 14

Promotional Materials (PM) 15

PM1 VBRP® Website 15PM2 VBRP® Banners 15PM3 VBRP® Postcard 16PM4 VBRP® in a Nutshell 17PM5 VBRP® Article for In-House Newsletter 18PM6 VBRP® and KSF 20

VBRP® Training: An Overview 24

Tasters (T) 25

T1 Introduction to VBRP® Taster Events 25T2 Structuring a Taster Event 26T3 Feedback from Taster Event 27

Essential Toolkit (ET) 28

Essential Toolkit: An Overview 28ET 1.1 Essential Toolkit: Processes 29ET 1.2 Learning Goals for Essential Toolkit 30


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Dynamics and Processes (DP) 31

Dynamics and Processes: An Overview 31DP 1.1 Dynamics and Processes: Processes 32DP 1.2 Dynamics and Processes: Information Sheet 33DP 1.3 Application Form 34DP 1.4 Learning Goals for Dynamics and Processes 34DP 1.5 Six Processes in VBRP®: Diagram 35DP 1.6 Six Processes: Some Pointers 36DP 1.7 Exploring Group Dynamics 40

Registration (R) 42

Registration: Overview 42R 1.1 Registration: Assessment Criteria 43R 1.2 VBRP® Facilitator Registration 55R 1.3 Renewal of Registration 55R 1.4 Application for Renewal of Registration 56R 1.5 Log of Practice Hours for Renewal Application 57

Continuing Professional Development (CPD) for Facilitators 58

CPD 1.1 Processes 58CPD 1.2 CPD and Ongoing Development as a Facilitator 59

Train the Trainers (TT) 60

Train the Trainers: An Overview 60TT 1.1 Train the Trainers: Processes 61TT 1.2 Train the Trainers Course 61TT 1.3 Trainers’ CPD 62

Evidence for VBRP® (EV) 63

EV 1.1 2014 Independent Research 63EV 1.2 2014 Executive Summary - FireCloud 64

Articles about VBRP® (ART) 66


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Foreword Welcome to the First Edition of the VBRP® Handbook for Best Practice.

This handbook has been developed by NHS Education for Scotland in collaboration with VBRP® national trainers and informed by board leads as a means of maintaining a national standard and consistency of approach to VBRP® and in ensuring excellence in the delivery of VBRP® training across NHSScotland.

The NHSScotland 20:20 vision for workforce document entitled “Everyone Matters” sets out the commitment of supporting the people who work in the health service in Scotland to meet the core values of care, compassion, dignity and respect, openness, honesty and responsibility, teamwork and quality in all that they do.

Staff continue to be widely recognised as being the most important resource in health and social care in Scotland. Ensuring and supporting staff wellbeing as well as developing staff members’ capacity to respond appropriately to the needs of patients and service users, makes good sense fiscally, and in terms of delivering safe, effective and person-centred care.

By offering a structured method designed to support staff working across health and social care to (re)connect with their core values and the motivation underpinning their work, VBRP® supports staff members to better manage their own wellbeing and resilience and to develop increased reflexivity in their practice.

Led by a trained facilitator, VBRP® enables staff to step out of their daily routine in order to take stock of what really matters in their work, to reflect on their practice and to learn from the wisdom of their peers.

Independently conducted research (as discussed in section EV1.2) reports that staff who have engaged in VBRP® experience:

• enhanced person-centred practice

• improved levels of communication and relationships with their colleagues

• enhanced wellbeing and fulfilment at work

We commend this resource to you.


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Introducing VBRP®What is Values Based Reflective Practice?The answer to that most fundamental of questions lies in the name and more explicitly in making every one of the four words in the title count.

Models of reflection abound within the caring professions but most value the work and the quality of the work over the worker. One of the distinctive hallmarks of VBRP® is that it values the worker who does the work and begins not by asking ‘what did you do?’, but rather ‘why do you do what you do?’ In other words, it takes as its starting point not what happened in the care setting in the recent past, but rather what motivates and drives the worker to come to work in the first place. What makes them tick? What made them want to be nurses, ambulance drivers, care assistants, administrators in the first place? It does this by asking staff to reflect on the ‘nugget of gold’ in the job that they do.

At root, these questions are all about the relationship between soul (motivation) and role (what you are required to do). As such VBRP® asks:

• When did your soul and role last meet?

• When did they last come together in the workplace and you found yourself acting from those deep values by which you live?

And:

• When in your work have your soul and role been divorced?

• When have you found yourself putting your values to one side in the name of efficiency, or to save time?

• When have you simply ‘done what you were told’ even though it didn’t sit well with your own, inner core?

• When was the gap between what you intended to do and what you actually did, bigger than you would want it to be?

And:

• What are you willing to do that would help to get yourself, your confidence, your practice, your soul, back on track again within the context of your professional role?

It is this dialogue between:

• motivation

• actual practice

• potential practice

that has a serious chance of re-humanising health and social care and recovering vocation. When someone is in touch with their core motivation (to make a difference; to treat others with compassion; to offer dignity where it is missing; to let someone know that they are not alone at a time of need), then it is pretty well nigh impossible to walk past a patient lying on a hospital trolley in a corridor without at least a smile; to tell someone to hurry up in the toilet or on the commode; to leave someone feeling ‘less than’, or to divorce what we call ‘work’ from what we call ‘being human’.


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One of the greatest joys of the first six years of VBRP®’s short life has been to see care staff rediscovering the power, energy and clarity of purpose that comes from reconnecting their professional role with their personal motivation, vision and soul, and of rediscovering that there is no contradiction whatsoever between:

• professional competence and emotional intelligence

• clinical knowledge and human wisdom

• complex care and personal wholeheartedness

In summary:

Values Based Reflective Practice is about the re-humanising of health and social care through the recovery of, and dialogue between, personal and organisational vocation.


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When to use/when not to use VBRP®VBRP® is suitable for: VBRP® should not be used for:

Reflecting on the ordinary everyday experience of providing care

This is exactly what VBRP® was created for: to enable staff to reflect on the past (the care they have delivered), in the present (within a group), in order to ensure quality care in the future.

Critical Incident Debriefing

Reason: The likelihood of reawakening trauma is very great and requires a different skill set. Facilitators should not accept such invitations and refer on to those with specialist skills in this area.

Reviewing Clinical Care Services

Example: We have been running this outpatient podiatry service for three months:• Whose needs has it met?• What has it revealed about our abilities/

capabilities as a team?• Whose voices have we gathered and how?• What has been valued/overvalued/

undervalued?• What does it say about our clinical team?

Fixing Dysfunctional Teams

Reason: VBRP® facilitators should be wary of being asked to apply VBRP® methodology to heal longstanding disputes or poor communication within teams. Although noticing and wondering may appear to offer a degree of containment and safety for these tricky conversations, the NAVVY tool is likely to bring long buried enmities out from below the surface with the risk of intensifying rather than healing the situation. Facilitators should resist such invitations and refer on to those with mediation skills.

Responding to Operational Proposals

Example: ‘The Board has suggested we refocus from fixing what is broken in acute care to fostering resilience and wellbeing in local communities. In today’s meeting you are asked to say what you notice and wonder about the plans before you, as we work through the NAVVY tool. At the end of today’s meeting we will then ask what we have individually and collectively realised from engaging in this reflection together.’

Doing the Job of a Manager

VBRP® honours every voice and values each and every person. Facilitators should be wary and resist invitations to use VBRP® as a management tool to whip people into line or deliver some managerial message to a group of staff.

Reflecting on feedback, concerns and complaints

VBRP® can offer staff a safe and boundaried space (behind closed doors) to consider both what went well, and what went less well in some aspects of care or delivery of service which has been brought to their attention. The Three Levels of Seeing can be used as ground rules for group engagement (ie no finger wagging, blame or advice giving). NAVVY can widen the horizons of exploration to consider the issues that have been highlighted within a broader context.

Delivering Clinical Supervision

Whereas VBRP® facilitators can very usefully hold a space conducive to reflection and transformative learning, when what is needed (either developmentally by participants or by the professional codes of practice governing a registered practitioner) is the expert guidance or performance assessment of someone senior within that profession, VBRP® facilitators should not accept the invitation to run VBRP® groups in lieu of clinical supervision. In such cases VBRP® may complement but not replace clinical supervision.


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Key Dimensions of VBRP®KD 1.1 Tool One: The Three Levels of SeeingIt is important that trainers help participants understand the role of, and insistence upon, the Three Levels of Seeing in VBRP®. Unlike professions such as counselling in which group supervision is deeply embedded in the culture, many in health and social care will be unaccustomed to laying their work open to the eyes of others. Conscious that group reflection ‘involves high levels of commitment to the task’ and ‘a reasonable level of trust’,1 VBRP® needs:

• to be safe

• to incrementally build up rather than presume the presence of trust, and

• a style of facilitation that is sensitised to the presence of fear and resistance.2

Prior experience in the early days of group reflective practice repeatedly showed that without clearly agreed guidelines, group members were prone to spend the time moaning or offering advice rather than reflecting upon the issue before them. We were also minded to diminish as far as we could, the possibility of staff with varying lengths of service using knowledge as power over each other. Finally, we wanted to discourage participants from analysing each other and ‘playing the therapist’ by diagnosing each other’s problems, offering interpretations or prescribing solutions.

With these factors in mind we chose to use the ‘Three Levels of Seeing’ which are present in the Greek account of the Resurrection of Jesus in the Gospel of St John chapter 20. Although this model of seeing – which traces the journey from the obvious through growing curiosity to insight and perception – originates in a Christian text, as a model for seeing it works perfectly well for people of other or no religious faith.

The first level of seeing focuses on what you see or notice, that is, the obvious.

The second level of seeing is concerned with the kind of seeing that arouses curiosity, makes you turn something over in your mind or wonder about.

The third level of seeing implies that moment when the penny drops and you realise or perceive something.

The Three Levels of Seeing are deceptively simple but require some effort. Feedback from VBRP® participants suggests that the discipline of restricting responses to what they notice, wonder, or realise has provided the safety for presenters to entrust their work to their peers, given participants a clear sense of what is expected of them and given facilitators a watching brief for holding the group. Above all it has placed insight where it belongs – that is, with the presenter – since no one can perceive or realise anything for another person but only for themselves.

1 D. Boud, “Relocating Reflection in the Context of Practice,” in Bradbury et al, Beyond Reflective Practice, pp. 35–36. 2 Cf. Boud, “Relocating”; Leach and Paterson, Pastoral Supervision; Z. Fund, “Effects of Communities of Reflecting

Peers on Student-teacher Development – Including In-depth Case Studies,” Teachers and Teaching, 16.6 (2010), pp. 679–701.


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KD 1.2 Tool Two: NAVVYVery often when faced with a practice dilemma, staff are prone to jump from the issue that has arisen to the application of a solution, without pausing to thoroughly explore the issues that might lie within the ‘issue’, or to critically consider factors that might lie within the proposed ‘solution’.

The purpose of the NAVVY tool is to create a space between ‘issue’ and ‘solution’ through creating a space for reflecting in a more intentional and thorough manner than people’s default responses might suggest.

The NAVVY Tool asks five questions of any situation:

Needs

• Whose needs are being met?

• Whose needs are left unmet?

• Whose needs have not been considered in a particular situation or line of action?

Abilities

• To what abilities or capabilities does the situation draw attention? (This question includes issues of competence, human resources, skills etc. Do those involved have the abilities or capabilities to enact change?)

Voices

• Who/what has a voice in the situation and who/what is silent or silenced? (This question includes the voices of those immediately involved but also the voice of professional bodies, strategy, policy, ethics etc.)

Values

• What is being valued here?

• What is being overvalued or undervalued in this situation?

• Where is value being placed e.g. where it does not belong etc.?

• If there are competing values at work in the situation, how are these being managed?

You

• What does the situation have to say about you, the individual worker?

• What does the situation have to say about you, the team?

• What does the situation have to say about the wider context in which practitioners find themselves (the collective ‘you’ of the NHS or the care agency)?

These five questions are not intended to be pursued in a linear fashion but rather to act as a guide to care staff when faced with disorienting practice dilemmas. Thus, one situation may draw attention to issues of needs and voice, whereas another might shine the spotlight on abilities. Whatever the variance in practice, without attention to some aspect of NAVVY, reflective practice cannot be deemed values-based.


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KD 1.3 Tool Three: M A PValues-based reflective practice attends to three aspects of the practice:

M the motivational

A the actual

P the potential

The Motivational aspect asks:

• What brought you into the caring profession?

• What is it that underpins your work as a nurse, midwife, counsellor, care assistant etc.?

• What difference do you want to make to the world?

The Actual aspect asks:

• How has your motivation (for example to offer compassionate person-centred care) played out in recent weeks?

• Where and what has enabled you to do what you set out to do?

• Where have you noticed a gap between what you aspire to do (motivation) and what you actually do?

The Potential aspect asks:

• In the light of your motivation for practice and what you actually do, how would you like your practice to be in the future?

• What first steps can you take to enable that desire to come to fruition?

• What are your dreams for your role, your team, your service?

KD 1.4 The Roles of the VBRP® Facilitator To get the best out of group reflective time, a gentle but clear steer from the facilitator is required. Without this, the group is likely to wander aimlessly and lose focus and energy. The facilitator has three roles:

Administrator

• books a room

• circulates time and venue of meeting

• protects that room from interruption by phone, pager, callers at the door etc.

• ensures that someone is bringing a verbatim/case study to the session or comes prepared themselves to get work into the room

• ensures that sessions begin and end on time

• attends to time within the session

• ensures that any written materials (verbatim, case studies) are passed back to the presenter before the group ends

If the administrative task is bypassed, there is a risk that the session will limp along, ramble or never really get going.


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Group facilitator

• acts as host

• is responsible for creating a hospitable environment

• creates, maintains, intentionally uses, monitors and chooses a space conducive to learning through reflection

• attends to boundaries (i.e. the space is for reflection, not for therapy, advice, problem solving, line management, appraisal etc)

• attends to what is happening in the group (and not only to the person presenting); this includes attention to group dynamics, collusion and avoidance, parallel process, intrapersonal and interpersonal tensions

If attention to the group is neglected the session may default at best into pastoral care of an individual in the presence of an audience, or at worst an advice shop which overwhelms and silences an individual who brought an issue for reflection.

Reflective practitioner

• elicits from the presenter the focus of the reflection (i.e. What is it you want to focus on? What do you want to gain from this exploration?)

• monitors that all interventions/avenues of enquiry serve that focus

• keeps group on track

• ensures that all aspects of the reflection are attended to

• invites reflection on values (whose needs are met? what does the situation say about abilities? what does it say about me/us? what is valued, undervalued, overvalued? where does power lie?)

• elicits from the presenter and from group members what learning has occurred and how this will impact on future practice (i.e. makes a bridge from reflecting upon past action to future action)

If the reflective task is bypassed the session is likely to lose focus, go around in circles, dissolve into discussion and have little bearing on future practice.


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Who is Who in VBRP®?National RolesWW 1.1 NHS Education for Scotland (NES)VBRP® is a national initiative created, designed and owned by NHS Education for Scotland (NES). The intellectual property of VBRP® and all materials belongs to NES. The acronym VBRP® is trademarked and subject to law.

To protect the integrity of the product, only those trained, registered and authorised by NES can use the term VBRP® and call themselves facilitators or trainers.

NES

• creates, reviews and disseminates the VBRP® materials

• administers Essential Toolkit, Dynamics and Processes, and Train the Trainer courses

• oversees the national register of VBRP® facilitators

• manages and owns the VBRP® website www.vbrp.scot.nhs.uk

WW 1.2 Registered VBRP® TrainersOnly those who have successfully undergone VBRP® Train the Trainer courses, and are NES recognised trainers, can deliver VBRP® training. Others may assist in a trainee capacity. NES will not recognise any course run by non-registered trainer(s) and participants will automatically be disqualified from practising as registered facilitators.


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Local RolesWW 1.3 VBRP® Local LeadAs a national initiative delivered locally, the VBRP® Local Lead is a key role in the delivery and development of VBRP®. The role of the Local Lead is to:

• champion VBRP® within the local health and social care community

• ensure that VBRP® is accurately presented at all times

• safeguard VBRP® from being asked to do what it cannot and should not do (i.e. solve manager’s problems, deal with dysfunctional teams etc.)

• be the link person and and point of contact between NES and the local context

• submit an annual report to NES (a proforma will be available)

• coordinate a local VBRP® community of practice (see on next page)

• maintain an awareness and record of local registered and trainee facilitators

• act as mentor and coach to trainee facilitators within the local area

• liaise with the national VBRP® team regarding VBRP® specific continuing professional development opportunities

• keep local information on the national website up to date

While Local Leads are free to delegate some of these tasks to registered facilitators, the responsibility for oversight remains with them.

WW 1.4 Registered VBRP® FacilitatorsRegistered VBRP® Facilitators may:

• facilitate VBRP® sessions

• facilitate reflective meetings in which the VBRP® tools are used

• lead VBRP® taster events following consultation with the local VBRP® Lead (see the section on taster events for more details)


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VBRP® Local Communities of PracticeVBRP® Communities of Practice are local networks where those involved in VBRP® meet together to:

• welcome those who are working towards facilitator registration

• share best practice

• build confidence and experience in facilitation

• encourage and support each other as peers

• engage in CPD

• consider local issues which might benefit from a VBRP® approach

It is expected that communities of practice would meet at least quarterly for ninety minutes to two hours. Within that time groups might:

• welcome new trainees

• share any update from NES VBRP® national team

• exchange news of what is happening with VBRP® locally

• engage in at least one session of VBRP® on VBRP® (i.e. where the work brought is the work of facilitating a group)

• focus on one aspect of facilitation per meeting (i.e. reporting or reflecting; managing overbearing personalities in a group; role clarity and authority)

In addition, two of the group’s meetings in each calendar year should be dedicated to CPD issues. These could be organised entirely internally or by negotiation with a neighbouring team for example. Input could be offered by face-to-face presentation, or by video conferencing or skype.


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VBRP® ResourcesThe website can be found at www.vbrp.scot.nhs.uk It is structured as follows:

Website• calendar

• Community of Practice

• resources for Facilitators and Trainers

• VBRP® Leads contact details

Calendar• training dates (NES and local)

• CPD dates

• Communities of Practice

Online Community of Practice• NES point of contact

• contact point

• meeting dates/venues

Facilitators Area• resources (video clips, stories for tasters, etc.)

• templates (CPD, record keeping, etc.)

Trainers Area• resources (course books, materials)

• templates of observation reports


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Promotional Materials To enable local VBRP® leads and registered facilitators to promote VBRP® in the local setting, a number of promotional materials have been created by the national team, as well as by facilitators in local areas. Some examples follow.

PM 1 VBRP® WebsiteThe website can be found at www.vbrp.scot.nhs.uk

The site offers a central point of contact and information resource for people who want to know more about VBRP®, what it is and what it can be used for. Local contact details for NHS board areas are offered, together with current training and CPD opportunities.

PM 2 VBRP® BannersPop up banners were produced in 2017 and distributed to every board. In NHS Fife the banner is permanently on display in the Sanctuary area at Queen Margaret Hospital and in NHS Golden Jubilee it stands in the corridor outside the Spiritual Care Department for all to see. Think about displaying your banner in a prominent position together with local contact details or leaflets for those who want to know more.


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PM 3 VBRP® PostcardThese handy sized postcards, which are available from NES, are a quick and informative way to bring VBRP® to the attention of your staff:

Supporting staff wellbeing and equipping staff to provide person-centred care

VBRP® offers practical tools to support health and social care staff to deliver the best possible person-centred care. It offers a safe and boundaried space in which to reflect in a supportive and creative environment.

Impact evaluation on VBRP® participation demonstrates:

· Enhanced person-centred practice· Improved communication and enriched relationships with colleagues· Promotion of wellbeing and fulfilment at work

Training is available across Scotland

Find out what’s happening locally:www.vbrp.scot.nhs.uk · [email protected]


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PM 4 VBRP® in a NutshellValues Based Reflective Practice attends to:

Three aspects of the practitioner

M the motivational

A the actual

P the potential

Three forms of inquiry/levels of seeing:

1. What do you see or notice? Observation without interpretation

2. What do you wonder, question or are curious about? Turning things over in your mind or in the group

3. What do you realise or perceive? Moments of insight when the penny drops and connections are made

Five dimensions of practice:

N whose needs are met; whose needs are overlooked?

A what abilities/capabilities are at work?

V what voices are present/absent, included/excluded?

V what is being valued/undervalued/overvalued?

Y what does the situation reveal about you?

Five characteristics of the group process

F Facilitated - not a free for all

I Intentional - purpose is reflection not discussion

R Responsive - what happens is directed towards a different future

S Structured - uses a transparent framework from arrival to departure

T Trustworthy - Three Levels of Seeing enable safety; evidence supports clinical impact

‘Reflective practitioners have three characteristics: they are open-minded, responsible and wholehearted.’3

How does it work in practice?

VBRP® can be used for reflection IN action (ward rounds, team meetings, planning/audit of services; responding to feedback and complaints etc.) as well as for reflection ON action.

When used to reflect ON action:

• trained facilitator gathers a group of practitioners from a team/unit

3 Dewey, J. (1933), How we Think, Buffalo NY: Prometheus (originally published 1910).


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• member of staff (presenter) relates a professional scenario from their own practice that they would value exploring with the group

• group responds by naming what they notice or wonder about the scenario

• presenter is completely free to accept or reject what has been said by group

• the key questions are explored – Needs? Abilities? Values? Voices? You?

• facilitator invites presenter to name what they wish to carry into their future practice (the bridge)

• group ends with each member of the group identifying one professional resonance for their own practice

• group goes back to work!

Evidence of Impact

VBRP Outcomes - 2014 Independent Research

Impact on professional practice

Impact on wellbeing and engagement at work

Impact on communication and relationships at work

Increased self awareness

Increased ability to reflect in the moment

Increased professional confidence

More trusting leadership styles

Enhanced professional practise

Staff feel more motivated

Enhanced job satisfaction

Reduction in stress

Ability to work in a values- based way

More attentive to the unspoken and what might be missed

Better communication among staff, better handovers

Enhanced staff relationships

Staff more able to embed NHS policies re patient self-management and person-centred care

FireCloud Consultancy, 2014

PM 5 In-house newsletterSource: Suzanne Lake, Practice Educator, NHS Forth Valley

Learning from experience to improve what we do.

NHS Forth Valley Maternity Services recently introduced the use of Values Based Reflective Practice (VBRP®) to help enhance the staff and patient experience. Reflective practice; analysing actions with the aim of improving professional practice, is already a familiar concept within midwifery practice. VBRP® is an extension of individual reflection, using group reflection to explore practice issues. Five key questions are at the heart of the exploration:

• Whose needs are being met?

• What does this situation say about abilities and capabilities?

• Who or what has a voice in this situation?

• What is being valued here?

• What does it say about us as professionals?


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The VBRP® model has been developed by NHS Education for Scotland. As well as the key questions, the model uses the 3 levels of seeing (noticing, wondering and realising) to guide reflection. These tools can be used to reflect on a variety of situations such as case presentations, work reviews or service development proposals.

Research shows that by reflecting on practice, practitioners are :

• more likely to provide safe, effective, person-centred care

• in touch with the values that underpin their work

• happier and more fulfilled at work

• more equipped to respond to the pressures and demands of patient care

• more resilient

Reflective practice can transform a practitioner of habit (the regular, repeated acting out of ingrained values, attitudes and behaviours) into one who is able to respond creatively and competently no matter what the situation or the need. Whilst habit leads to a basic level of competence, professional wisdom developed through reflective insight and awareness enables practitioners to adapt to the rapidly changing context of clinical practice whilst continuing to put patients and their families at the centre of care. Developing flexibility in the workforce helps build resilience against the inevitable challenges we face in the NHS.

VBRP® helps practitioners at all levels recognise the power of influence they have to make a difference within their working environment. Such sense of empowerment is associated with increased motivation and positive levels of satisfaction at work.

VBRP® can help build a connect between personal and organisational values, attitudes and behaviours. It is a well known concept that if staff believe in the value of their working activity they are more likely to be fulfilled by their work.

Why not take a little time just now to reflect on your values and practice...Motivation/best intentions

• What is the nugget of gold within your profession? Actual practice

• What are you proud of in your own professional practice in the last few weeks? Quality Improvement

• What aspect of your work would you like to develop, improve upon or do in a safer, more effective or person-centred way?

For further information on VBRP® visit www.vbrp.scot.nhs.uk


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PM6 VBRP® and KSF The NHS Knowledge and Skills Framework (KSF) identifies the knowledge, skills, learning and development that staff need to do their job well. The KSF is a broad framework which supports a fair and consistent approach to Personal Development Planning and Review known as PDP&R in short.

The principles of PDP&R using the KSF are based on effective leadership and good people management – it is about treating all staff fairly and equitably. In turn, individual members of staff are expected to develop and apply their knowledge and skills to meet the demands of their post and to work safely and effectively.

VBRP® maps against the KSF in a number of ways as indicated in the following tables.

FACILITATORS

Knowledge and Skills Framework for VBRP® Facilitator NHS KSF Outline (Foundation Level)

NHS KSF Dimensions Needed for post? Notes Level for post

1 2 3 4

Core Dimensions - relates to all NHS posts

1. Communication Y X

2. Personal and people development

Y X

3. Health, safety and security Y X

4. Service improvement Y X

5. Quality Y X

6. Equality and diversity Y X

Specific Dimensions

General

G1

Learning and development

Y X


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Knowledge and Skills Framework Mapping for VBRP® Facilitator NHS KSF Outline

Knowledge/skill demonstrated

KSF dimensions Level for foundation facilitator (gateway)

Level for practiced facilitator (fully developed)

The VBRP® Reflective Cycle

Getting people into the room

Getting work into the room

Tools for responding

Eliciting a focus

Tracking the focus

Exploring the focus

Bridging and closing the session

Core 1 – Communication

Core 2 – Personal and people development

Core 3 – Health, safety and security

Core 4 – Service improvement

Core 5 – Quality

Core 6 – Equality and Diversity

General 1 – Learning and Development

3

3

3

3

3

3

2

4

4

4

4

4

4

3

Ability to hold role authority Core 1, 2

General 1

3, 3

2

4, 4

3

Ability to hold group process Core 1, 2, 3, 4, 5, 6

General 1

3, 3, 3, 3, 3, 3

2

4, 4, 4, 4, 4, 4

3

Working with unconscious processes

Core 1, 2, 3

General 1

3, 3, 3

2

4, 4, 4

3

Working with group dynamics Core 1, 2, 3, 4, 6

General 1

3, 3, 3, 3, 3

2

4, 4, 4, 4, 4

3

Articulating the purpose of VBRP® to colleagues

Core 1 2 2

Ability to facilitate reflection on motivation, ability and potential (MAP)

Core 1, 2, 3, 4, 5

General 1

3, 3, 3, 3, 3

2

4, 4, 4, 4, 4

3

Ability to facilitate reflection on values (NAVVY)

Core 1, 2, 3, 4, 5, 6

General 1

3, 3, 3, 3, 3, 3

2

4, 4, 4, 4, 4, 4

3

Setting up and facilitating a VBRP® group

Core 1, 2, 3, 4, 5, 6

General 1

3, 3, 3, 3, 3, 3

2

4, 4, 4, 4, 4, 4

3


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PARTICIPANTS

Knowledge and Skills Framework for VBRP® Participant NHS KSF outline (fully developed)

NHS KSF Dimensions Needed for post? Notes Level for post

1 2 3 4

Core Dimensions - relates to all NHS posts

1. Communication Y X

2. Personal and people development

Y X

3. Health, safety and security Y X

4. Service improvement Y X

5. Quality Y X

6. Equality and diversity Y X

Specific Dimensions

General

G1

Learning and development

Y X


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Knowledge and Skills Framework Mapping for VBRP® Participant

Knowledge/skill demonstrated

KSF dimensions Level for foundation facilitator (gateway)

Level for practiced facilitator (fully developed)

Participating in the VBRP® reflective cycle

Core 1 – Communication

Core 2 – Personal and people development

Core 3 – Health, safety and security

Core 4 – Service improvement

Core 5 – Quality

Core 6 – Equality and Diversity

General 1 – Learning and Development

2

2

2

2

2

2

1

3

3

3

3

3

3

2


Core 1 1 1

Ability to reflect on motivation, ability and potential (MAP)

Core 1, 2, 3, 4, 5

General 1

2, 2, 2, 2, 2

1

3, 3, 3, 3, 3

2

Ability to reflect on values (NAVVY)

Core 1, 2, 3, 4, 5, 6

General 1

2, 2, 2, 2, 2, 2

1

3, 3, 3, 3, 3, 3

2


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VBRP® Training: An OverviewThe following table indicates the relationship between the different facets of VBRP® training.

Taster Event Essential Toolkit Dynamics and Processes

Train the Trainer

Who is it for? Anyone committed to values-based care

Health and social care staff who can use the tools to enhance work based practice

Health and social care staff whose role requires them to facilitate group meetings, processes, audits etc.

Experienced VBRP® facilitators with proven ability to facilitate learning

Admission Open to all Open to all health and social care staff (paid and unpaid)

Application Form

Reference from line manager committing to practice post training

Application Form – including an assurance in writing from line manager of being released to deliver training

Assessment Conversation

Pre-requirements None None Completion of ET Registered VBRP® facilitator status with a minimum log of 20 facilitated sessions

Duration Variable 2 days at 6 hours per day

2 days at 6 hours per day

Preparatory reading and reflection

4 days at 6 hours per day

Shadowing with an established trainer


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TastersT1 Introduction to VBRP® Taster EventsVBRP® taster events can only be delivered by registered facilitators after consultation with the local VBRP® lead. The reason for this restriction is two-fold:

1. to ensure that VBRP® is accurately presented by those who have shown they know it well

2. to safeguard VBRP® from being asked to do what it cannot and should not do (i.e. solve manager’s problems, deal with dysfunctional teams etc.)

Experience over the years has shown that people come to VBRP® taster events for a variety of reasons.

Managers and those with clinical responsibility often come looking to be persuaded that releasing staff from clinical/care responsibilities to take part in VBRP® sessions offers ‘value for money’. As such they might want to know about:

• the correlation between reflection and improved clinical outcomes

• how facilitated group reflective practice relates to clinical supervision

• how VBRP® can contribute to their managerial targets

Care/Clinical Staff often come wanting to know what benefit they will derive from structured reflection rather than just getting on with the job. Experience has shown that when taster sessions include an element of revisiting the personal motivation that brought them into the caring professions, a natural connection is made between past (motivation) present (actual practice) and future (the quality of care they wish to offer).

The key to deciding how to structure a taster session lies in knowing your audience and anticipating the role VBRP® could play in their task list (managers) or support needs (care/clinical staff).

Remember that a taster is not a three course meal. Rather, give people enough to whet their appetite and to want to explore participating in an Essential Toolkit training. If you give all your tools away in a 1-2 hour session you may (however unintentionally) give people the sense that they are ready to practice without any further training with all the risks that entails.

Remember too that people learn in different ways and that novelty does not necessarily lead to improved wisdom. Whatever tools or methods you use to showcase VBRP®, remember to keep the focus on reflection and not on gimmicks. If people remember using picture postcards, or toys, but cannot tell you or themselves why they used them, you have missed the point.

In designing a taster, many of the materials in Section P – Promotional Materials – will be of use to you.


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T2 Structuring a Taster Session• Brief round of Introductions 5 minutes

• Presentation of the key ideas behind VBRP® 15 minutes

o Why a values-base for clinical/care work

o Three Levels of Seeing

o NAVVY

• Demonstration of tools in use 15 minutes

• Feedback from observers 15 minutes

• Plenary discussion and information about training 10 minutes

60 minutes


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T3 Feedback from Taster EventsFor optional local use only. Not to be submitted to VBRP® central administration.

Date VenueWhat is your job title?

Please circle the sector you work in?

Primary Care

Acute Care

Mental Health

Care Home

Other please

indicate

Previous Experience of VBRP®Today was my first encounter with Values-Based Reflective Practice

Yes No

I have been introduced to VBRP® in another context (i.e. national event etc.)

Yes No

Practical ApplicabilityHow useful are the VBRP® tools you have learned about today for your practice?

Very relevant Possibly relevant I don’t know Not relevant

Could you see yourself using the VBRP® tools in your workplace? Yes No

If so please tell us in what way

Future Training Would you be interested in further VBRP® training? Yes No

If you want to be kept in touch about VBRP® please give your email address. Thanks for your feedback!


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Essential Toolkit: An OverviewEssential Toolkit

Who is it for? Health and social care staff who can use the tools to enhance work-based practice

Admission Open to all health and social care staff (paid and unpaid)

Pre-requirements None

Duration 2 days at 6 hours per day

Learning Focus

• Knowledge Understanding reflective practice in general and Values Based Reflective Practice in particular

• Skills Ability to use Three Levels of Seeing (Tool One) and NAVVY (Tool Two)

• Experience To reflect on personal motivation in light of actual and future practice

To experience VBRP® for self

Following this course participants may/may not

MAY reflect on their own practice using the tools

MAY participate more fully in a group or meeting facilitated by a registered facilitator where the tools are used to reflect on past or future practice

MAY NOT call themselves VBRP® facilitators

MAY NOT facilitate meetings or groups which require training and skills in handling group dynamics

Assignment To articulate the purpose and role of VBRP® to other care staff

Exit Award None. Certificate of Attendance (12 hours) available from NES upon request


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ET 1.1 Essential Toolkit: Process

Registration

• if NES organised, all registration is via [email protected]

• if locally organised, booking is via trainer (sign-in sheet is sent to NES after Day two of training has been completed)

• NES sends email confirming place

• NES booking form and location managed by NES

• list of attendees provided to trainer

Course Delivery

• trainer to make clear that this only enables use of VBRP® tools and techniques

• standard NES course delivered by trainer, as per Trainer Handbook

Post-Course

• trainer emails sign-in sheets to NES and register is updated

• evaluation link sent to attendees the day after training is completed

• NES emails Community of Practice information to the attendees

• standard Certificate of Attendance made available upon request

• NES sends breakdown of attendees to each VBRP® Lead on a yearly basis (including 3rd sector staff in their geographical area)

Register • NES updates register


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ET 1.2 Learning Goals for Essential Toolkit 1. To create a community of learning

• VBRP® values relationality over transaction. What, do we as a training group need to attend to in order to ensure that the space will be safe, boundaried, hospitable and conducive to learning?

2. To introduce VBRP®

• What is reflective practice?

• Why reflect on practice?

• What distinguishes VBRP® from reflective practice?

• What evidence do we have of the impact VBRP® has on practice?

3. To explore Three Levels of Seeing and responding

• Outline the Three Levels of Seeing.

• Why do we use these rather than allow a ‘free for all’ mode of responding?

• Practice using noticing, wondering, and realising.

4. To explore a framework for values-based reflection

• Outline NAVVY.

• Give examples of each of the questions (needs, abilities, values etc.).

• Offer an opportunity to apply NAVVY (e.g. to a newspaper article or video of patient feedback etc.).

5. To experience the VBRP® approach first hand

• participants are offered an opportunity either to take part in/observe a live VBRP® session, or

• to see the tools in practice through facilitated modelling.


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Dynamics and Processes: An Overview

Dynamics and Processes

Who is it for? Health and social care staff (paid and unpaid) whose role requires them to facilitate group meetings, processes, service audits, reflective practice opportunities etc.

Admission All health and social care staff who facilitate groups.

Pre-requirements Completion of Essential Toolkit ideally within past 12 months. If in doubt check with local VBRP® Lead.

NES application form.

Reference from line manager committing to practice post training.

Duration 2 days at 6 hours per day.

Learning Focus

• Knowledge • Group Processes

• Group Dynamics

• Structure of a VBRP® session

• Skills • skills of facilitation

• skills of getting work into the room

• skills of enabling exploration

• skills of group management

• Experience • experience of presenting material to others for reflection

• experience of facilitating others’ work within a reflective group

• experience of being coached and receiving feedback

• experience of offering feedback to others

Assignment Learning file/log evidencing awareness of VBRP® tools, group dynamics and reflective processes


• MAY facilitate reflective space for health and social care staff under supervision

• MAY join the local VBRP® Community of Practice

• MAY work towards registration as a VBRP® Facilitator

• MAY receive two hours of coaching prior to assessment for registration. Trainees responsible for the request.

Exit Award Upon request, Certificate of Attendance (12 hours).


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DP 1.1 Dynamics and Processes: Process

Registration

• all DP courses administered by NES

• applicants must have completed ET ideally within past 12 months. If in doubt check with local VBRP® Lead

• NES must check that all sections of the form are completed and processed accordingly

Course Delivery

• standard course delivered as per Trainer Handbook

• DP Day 1

• DP Day 2

• trainer explains registration process and CPD requirements

Post-Course

• trainer sends sign-in sheets to [email protected]

• on request, NES issues certificate of attendance (note: be clear that this does not mean registered to facilitate)

• NES emails evaluation link

• trainer offers two hours of coaching pre-observation

• trainer emails training pack (including Learning File/Log and VBRP® Leads’ details) to attendees

Register • NES updates register

Registered Facilitator

• trainer informs NES after successful observation

• NES writes to new facilitator to confirm they are now a registered facilitator, with the date for their re-registration. The relevant VBRP® Lead will be cc’d in to let them know there is a newly registered facilitator in their area

• registration is valid for one year

• registration is conditional on maintaining practice - this includes facilitating six VBRP® sessions annually and attending two CPD events


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DP 1.2 Dynamics and Processes Information SheetDynamics and Processes Training for VBRP® Facilitators What is Values Based Reflective Practice?

Values Based Reflective Practice is an intentional way of reflecting on past practice, in the present, in order to improve practice in the future. The aim of VBRP® is to help staff deliver the care they came into the service to provide. VBRP® promotes person-centred care, engages in dialogue between personal and organisational values, attitudes and behaviours, enhances staff fulfilment and turns history (what we have done) into learning. Ultimately, its goal is to improve the care provided to patients and service users.

What are the training aims?

• to consolidate existing skills in using the VBRP® Essential Toolkit

• to increase abilities to work with group processes and dynamics

• to foster facilitation skills

• to deepen self-awareness and reflexivity as practitioners

Admissions and Recruitment Criteria

Applications for training are welcomed from practitioners working in health and social care who have completed VBRP® Essential Toolkit Training. For continuity of learning, training ideally should have been completed within the past 12 months. Application forms require to be completed both by the participant and by their line manager. Applicants who are unable to demonstrate sufficient reflective capacity will be encouraged to deepen their familiarity with VBRP® as group participants in their local context and to apply for training no sooner than six months after initial application. Admission to training does not imply suitability as a facilitator.

Attendance Requirements and Absences

The course requires 100% attendance. Given the short length of the course, missing a session automatically disqualifies a participant from continuing.

Facilitator Training Process

• Essential Toolkit Day 1 Assignment - purpose of VBRP®

• Essential Toolkit Day 2 Assignment - case study

• Dynamics and Processes Application

Acceptance on to course

• Dynamics and Processes Day 1 Assignment – reflection on unconscious processes

• Dynamics and Processes Day 2


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• Post Training

Building up a log of six facilitated sessions

Peer feedback

Coaching/Tutorial x 2 (optional)

Observed session

Process account of observed session

Trainer(s) final assessment

Facilitator registration

DP 1.3 Application FormA copy of the application form can be accessed at: www.knowledge.scot.nhs.uk/vbrp/what’s-on.aspx

DP 1.4 Learning Goals for Dynamics and Processes1. To establish a peer learning community

• Modelling a new group beginning will implicitly teach the training group key lessons about what they need to attend to when facilitating groups where not everyone may know each other.

2. To consolidate prior learning

• Dynamics and Processes is built on the premise that participants are:

o reflexive people for whom work-based reflection is a natural and ongoing commitment and who can clearly articulate the purposes of reflective practice

• Participants should have a strong awareness and familiarity with:

o the Three Levels of Seeing, NAVVY and MAP

3. To explore the role of the group facilitator

• The administrative role, the facilitative (group management) role, the reflective enabler role

4. To outline the structure of the reflective session

• hospitality (getting self and group into the room)

• getting work in the room

• eliciting the focus for exploration

• exploring the focus

• tracking and monitoring the focus

• bridging and enacting

• reviewing and closing the session


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5. To explore dynamics in group work (Lencioni)

• issues of trust

• handling of difference

• negotiating commitment

• mutual accountability

• achieving a result

6. To practice facilitating VBRP®

7. Facilitating with coaching and feedback

DP 1.5 The Six processes in a VBRP® Session4

4 Leach, J and Paterson, M, 2015. Pastoral Supervision: A Handbook, London: SCM

Hosting and Containing

environment getting self &

participants into the room

Tracking and Monitoring

keeping on trackrefocusing

watching time

Reviewing and Closingreminder of

confidentialitynext session

end

Bridging and Enacting

for presenterfor group

Exploring and Imagining

noticing and wondering

Eliciting and Focusing

getting work into room

eliciting a focus


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DP 1.6 VBRP® Process: some pointersWhat follows are some suggestions mapped against each of the six processes.

NB: The best interventions will be the ones you create yourself through reflection on your practice.

Process One: Hosting and ContainingPre-session creating a physical environment conducive to learning and trust:

• enough seats for everyone

• room temperature

• lines of visibility

• audibility

• protected and uninterrupted space (door sign ‘room in use’)

Getting self into the room

• being ready and able to facilitate a space for others

• parking one’s own material outside the session

• taking time to be centred, grounded and psychologically not just physically present

• being there to greet people on arrival

• being clear about the role

• articulating briefly and clearly why group has met

• establishing basic ground rules as necessary

Getting the group into the room

• taking a moment of silence to arrive

• paying attention to breathing to become present to this moment

• using an exercise from mindfulness to leave things behind and be here now

• imaginatively inviting people to leave whatever is burdening them in a box by the door to be collected on exit

• asking people to look at their shoes and note where they have been today and then to indicate a willingness to be truly present by placing their feet in those shoes firmly on the ground

• in a large room people could be invited to move around the room slowly and when they are ready to begin, take a seat in the circle

Process Two: Eliciting and FocusingWhen people come to VBRP® already knowing what the issue they want to work on is you will not need most of the suggestions here which are offered to try and get work into the room.


Employing an opening question to get work into the room such as:


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• ‘Thinking back over the last few weeks at work, what has tugged at your mind or your heart that you would like to reflect on here today?’ Or,

• ‘Of all the things that have happened in your work since we last met, what immediately springs to mind today?’

Using six minute journaling with a carefully chosen opening phrase such as:

• ‘The thing about work right now is …..’ or, ‘The thing I would love to develop at work is …’

• Lay out small world materials and invite people to choose something that speaks to them of where they are right now as a practitioner.

• Lay out visual image cards and ask people to choose something which speaks of the practitioner they would like to be…

Eliciting a focus for exploring the work

Why are you bringing that here?

• i.e. to a reflection group rather than to, for example your line manager, HR, staff support service, a counsellor etc.

Why are you bringing it today?

• Is there something that makes the issue very topical and timely? Or,

• Is there something about this group that makes it doable today?

What are you looking for in bringing that issue here today?

• Guidance; exploration; validation; discharge of feelings; nothing, just wanted you to know ….?

• What is the nub of the issue you are telling us about?

• Of all the things you have heard yourself say to us, what are the key words?

• Where is the energy in this issue?

• Where is the eye of the storm?

Process Three: Exploring and Imagining Having established what the presenter wants the group to focus on and what they are looking for in exploring it, the facilitator has a range of interventions to enable exploration.

Verbal narration

• What do we need to know in order to help you find what you are looking for?

• What do you notice within yourself as you tell us this story?

• If you had a magic wand what would you want to happen?

Group responses

• What do you (the group) notice about what you have been told?

• What do you (the group) wonder about what you have heard?

Communication by impact on the group

• What do you notice about yourselves as you have listened (e.g. I feel bored; I feel puzzled; I can’t quite get a grasp of the story; I am itching to get the matter resolved; I really want to rescue; I feel stuck; I feel tongue tied…)


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Presenter - does any of what you have heard from the group resonate with you? (i.e. the Third Level of Seeing?) The response to this last question from the presenter enables him or her to refocus the issue or the direction of the exploratory session.

Process Four: Tracking and MonitoringTracking focus

• What are you getting so far from this exploration?

• Are we addressing the real issue or skirting round the edges?

• Are you any nearer to the heart of the issue?

Tracking Time

• Just want you to know that we are a third of the way through the time we have together today…

• … Half the way through…

• … Three quarters of the way through…

• We are going to have to stop this part of the session in about 5 minutes.

Tracking insight

• Where are you now with the issue you brought today?

• Are you finding anything from what is being offered to you?

• Has today opened up any alternative ways of thinking about the issue?

Process Five: Bridging and EnactingThe whole purpose of reflecting on action (past) is to inform action in the future. The bridge from reflection back to action is therefore crucial and time must be given to it.

Bridging for the Presenter

When someone has clearly found insight that they did not have before the session began, the tasks of bridging and enacting will be significantly easier than when someone appears to be just as stuck as when they began.

In situations when insight (third level of seeing ‘I realise’) is present:

• Can you say in your own words what you are taking away from this session?

• Can you tell us and yourself what you intend to do with the insight you have gained?

• How can you internalise or hang on to the insight you have gained today?

• Can you give it a name, or capture it in an image or metaphor?

• If the insight involves an action, you might ask the person to say how and by when they intend to follow it up.

In situations where a person is not really able to say what insight they have gained from exploring the issue here (i.e. unable to say what they realise):

• Has today opened up any other ways of looking at the issue?

• Has today offered you some support even though you don’t have any answers?


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• What could support you as you go back to that situation?

• I hope when you go back to that situation you can at least remember that the six people in this group care about you and are supporting you etc.

• Is there anything that would help you hold on to our support….?

Closing for the Presenter

Whether the presenter has experienced a moment of insight or revelation - or has not made any progress whatsoever, it is crucial that the facilitator delineates that their work is now done and that the rest of the session focuses on the group and not on them.

One way of indicating this is for the facilitator to remove eye contact from the presenter and to focus their attention entirely on the group.

Process Six: Reviewing and ClosingReviewing the session in terms of what it puts group members in touch with vis-a-vis their own practice is a key moment in VBRP® and must not be skipped over or rushed due to inattention to time keeping. Based on the premise that when one person reflects aloud, the whole group reflects, this moment in the session invites group members to name what they will take away for their practice from the group reflection. NB: this is not an invitation to start the session all over again, far less to swap stories or anecdotes. Facilitators are minded to find a form of words which clearly indicates what is and what is not being invited at this point in the VBRP® session. Here is an example:

• ‘[Joan’s/John’s] work is over but as you prepare to leave here today, what will you take back to your own practice?’

Facilitators should neither comment themselves on what people say nor allow discussion or commentary between group members. Remember we are in the closing stages of the group and not in the exploratory phase.

To end, facilitators should:

• remind the group that what was said here stays here

• intimate the date and time of the next meeting

• enable a transition back to work in whatever way time and circumstances allow


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DP 1.7 Exploring Group Dynamics Source: Patrick LencioniEvery team or group has its own emergent or established group culture, some aspects of which are conducive to learning and some of which mitigate against learning. The issues that Patrick Lencioni outlines are very pertinent to the facilitation of VBRP® in a group setting.

These diagrams5 summarise the heart of Lencioni’s teaching.

1. For a group to function trust is required. Without it the group will never get going and has no chance whatsoever of achieving the results it sets itself. In the context of VBRP®, facilitators should never presume the presence of trust in the group they are about to facilitate but rather consider how everything they do might engender or discourage trust. In practice this means paying attention to how the VBRP® session was set up. With regard to the participants – are they there by choice or have they been coerced into being present; is the session timely and welcome or another thing to squeeze into an overstretched day; do they have good will or animosity towards each other; are there dual relationships within the group (line managers, staff they manage etc.) and what is the pre-history of this group? With regard to the facilitator – what has s/he done to engender trust i.e. was due notice given of the time and date and venue of the meeting? Is the room hospitable or unwelcoming? Can people see and hear each other easily? What attention did the facilitator pay to hospitality in welcoming people and putting them at their ease on arrival etc.?

2. Moving up Lencioni’s pyramid of functionality, how a group handles differences and whether these can be embraced without having to turn into conflicts, will require careful monitoring. VBRP® facilitators would do well to expect differences within the group and plan strategies for handling them, rather than being surprised when they manifest themselves and then have to think on the spot. Some common differences in VBRP® groups include differences in age, gender, role,

5 Lencioni, P, 2002. The Five Dysfunctions of a Team, Wiley

Inattention to results

Avoidance of accountability

Lack of commitment

Fear of conflict

Absence of trust

Results

Accountability

Commitment

Conflict

Trust

Vs

Functional Group Dysfunctional Group


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professional experience, personal and professional confidence and self-esteem. People come to VBRP® with differing experiences (positive and negative) of other groups they have been in. VBRP® is a work-based activity which takes place in work time and in the work venue, and some will come expecting a different character of meeting (e.g. seminar; discussion; planning meeting; debrief etc.). The biggest difference facilitators should plan for is in the capacity for insight and in willingness to change future practice. Ignoring the differences in the group is one way of ensuring that conflict will arise and that the goal – to engender values-based reflection – is unlikely to be achieved.

3. Lencioni’s third dimension of functional groups – commitment – arises when a group moves from being a series of individual ‘I’s’ to being able to say ‘we’. In VBRP®, facilitators need to actively work at eliciting whatever the group holds in common as a uniting force and catalyst for working together. A group that is able to explicitly acknowledge, for example, a shared commitment to gold standard service for every patient in every encounter with the NHS, is well on its way to being committed and open to anything. This will hopefully lead to that commitment becoming not only an aspiration, but a reality. This third and middle stage in Lencioni’s scheme is pivotal to the group achieving its values-based goals. Facilitators would do well to consider what the reflective group can say ‘we’ to and intentionally build on that.

4. Accountability in any group’s life is that stage when people with sufficient trust in each other (stage one), who have embraced their differences rather than allow them to fester unacknowledged until they turn into conflicts (stage two), account for the progress they are making in achieving their shared commitments (stage three). In a parallel manner, facilitators are encouraged to monitor the ways in which an ongoing VBRP® group moves into greater honesty and transparency in bringing aspects of practice to the group for reflection.

5. Lencioni places ‘results’ at the pinnacle of his functional group pyramid and stresses that this will only be achieved if attention has been duly paid to the preceding stages. It is worth noting that VBRP® facilitators might unwittingly go into a VBRP® session with results in mind – for example, that by the end of the session the practitioners will have reconnected with their personal motivation (M), reflected on their actual practice (A), and found a way to turn their potential into committed future practice (P). Group members, on the other hand, may arrive implicitly or explicitly checking out who is there and whether the space will be safe or threatening, supportive or critical etc. Working towards some sense of shared commitment – the midway hinge point of Lencioni’s scheme – offers an invaluable directional pointer for trainers.

6.

Results

Accountability

Commitment

Conflict

Trust

VBRP Tool One

The Three Levels of Seeing

exists to enable group members to:

• build trust

• overcome differences/conflicts

VBRP Tool Two NAVVY

exists to enable group members to:

• foster commitment and accountability for what can be done individually and together to

• achieve the desired result or goal


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VBRP® Registration: An OverviewThe following table indicates the requirements for registration as a VBRP® facilitator.

Essential Toolkit Dynamics & Processes

Post Training (after completion of DP)

Attendance at training

100% attendance 100% attendance Evidenced in VBRP® learning file/log

Assignment Articulation of purpose of VBRP®

Process account of a VBRP® session

Evidenced in VBRP® learning file/log

Practice hours Minimum log of 6 hours of facilitating VBRP®, 1 session should be observed

Community of practice

Evidence of regular participation in local VBRP® community of practice

Line manager assurance

Commitment from manager assuring availability to facilitate post registration

Assessment for registration

Observation by a VBRP® registered trainer

Completed learning file/log

Assessment options

1. Registered facilitator

2. Working towards registration with coaching

3. Retrain

To maintain registration

Evidence regular participation in local VBRP® community of practice

Evidence of participation at two VBRP® CPD events per year

Evidence of both to be submitted using pro-forma to VBRP® Lead

VBRP® Lead informs NES of re-registration eligibility


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R 1.1 Registration Assessment Criteria Applicants for facilitator registration will be assessed by:

• written evidence they submit in their learning file/log (Components 1-5 below)

• what is observed (Component 6)

• what comes out in reflective dialogue following the final observed session (Component 7)

The seven components are:

Component One Articulating the purpose of VBRP®

Component Two A process account of a VBRP® session

Component Three 360 degree assessment (self, peer, assessor)

Component Four Log of facilitation provided

Component Five Record of coaching received

Component Six Observed Session for VBRP® Facilitator Registration

Component Seven Reflective dialogue post final observed session

Applicants are required to pass all seven components to achieve facilitator registration.

Component One – Articulating the purpose of VBRP®In no more than 250 words articulate the purpose of VBRP® to a care services manager.

This exercise formed the assignment in Essential Toolkit training. Trainees are welcome to present their original response to the assignment alongside any modifications they have made as their learning and reflection deepened.

Please date both articulations.

Component Two – A process account of a VBRP® sessionApplicants are required to submit a process account of a session of VBRP® that they have personally facilitated evidencing their awareness of all the aspects listed in the following example. A blank pro forma may be downloaded at www.vbrp.scot.nhs.uk

Context

Palliative Care Unit in a large acute hospital.

Group

Members of the MDT who meet voluntarily for reflection every six weeks. Membership varies according to shifts and ability to get off the ward.

My role

I am chaplain in the hospital but do not work on a day-to-day basis in this Unit. Mary (see ‘Getting work into the room’ on next page) my colleague is chaplain here and facilitates VBRP® for my wards and vice versa.


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Environment

The group meets around a table in a small teaching room within the Unit. We try not to be interrupted but this doesn’t always happen as pagers go off, phones ring and other staff sometimes need to retrieve things from the room. From within the room we can hear patients’ buzzers going off and staff conversations in the corridor. I know this is not ideal but I feel helpless to stop it.

Creating an hospitable environment

I tidied up the room as best I could, cleared the table and placed a small cloth with four seascapes on it in the centre of the table.


I began by asking people to take a moment to let go of what they had just been doing and to park whatever was in their minds, knowing that they will return to it later. I then asked them to focus on the images on the table and let their mind travel to a seaside memory and draw energy from it. I then invited people to name what they would draw from being at the sea right now. ‘Peace’, ‘perspective’, ‘calm’, ‘a sense of ebb and flow’ were among the words used. We then began the session proper.


In this group, people volunteer in advance to bring an issue for reflection. They are free to present in any way they wish. At the end of the last session Mary, chaplain to the Unit, said she would bring an issue. Today she arrived with a short half page of scripted dialogue (verbatim) printed out for everyone to follow. I invited members of the group to read the verbatim aloud.

Eliciting a Focus

Once the verbatim had been read aloud I asked Mary what she hoped to gain from bringing these snapshots of patient encounters to the group for exploration today. Mary said she wanted to get a handle on why she felt so overwhelmingly tired at the end of those visits.

Exploring the Focus

Using the Three Levels of Seeing, I invited members of the group to say what they had seen/noticed, wondered about or turned over in their minds from what they had heard.

Paul (social worker) noticed (1st level of seeing) that each encounter ended with Mary saying ‘I’ll see you later’ or ‘I’ll pop in tomorrow’. He wondered (2nd level of seeing) if this was her customary way of ending a bedside visit. Linda (physio) picked up on this and said she was curious to know (2nd level of seeing) whether there was something particular about these three patients or about Mary herself on that day. Mary looked surprised. She had been focusing on the stilted dialogue in each encounter and on how she felt unusually lost for words, but hadn’t reflected on the patients as a group or on how she was in herself prior to going in to visit them. She certainly hadn’t noticed how she had brought each visit to a close. Jane, (student doctor on placement) expressed a curiosity (2nd level of seeing) as to how many people died in the hospice each week. ‘Too many’, Mary exclaimed and with that her eyes filled up and she buried her head in her hands.

Tracking the Focus

I called for a pause and invited Mary to take some time for herself. After several minutes, she spoke of realizing (3rd level of seeing) just how worn down she was becoming by the accumulation of death after death and how on that day, because of a worry about tests her husband was undergoing, she had been feeling particularly ‘raw’ and had wanted to protect herself.

I was conscious that Mary’s work-life and home-life were now in the room and felt that she might feel


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exposed by what had just happened. I asked her if she wanted to draw things to a close at this point or continue. She said she wanted to continue.

Reminding her that she had begun the session wanting to explore why she felt a sense of overwhelming tiredness, I wondered (2nd level of seeing) if she was any nearer to answering her own question.

She then spoke of ‘getting it’ (3rd level of seeing) since the personal and the professional were so closely entwined. When asked how she now felt about the visits, Mary began to berate herself for having ‘short changed’ her patients by worries from her home life.

At this stage, various members of the group tried to rescue her. I gently used my role authority to restate that the purpose of the meeting was reflection and not problem solving.

Bridge for the presenter

I asked Mary how she would take the insight gained in the room out the door and into her work. She identified two support systems which were in place for her and a weekend off that she was looking forward to spending with close friends. I closed the work for Mary at this point and invited her to sit with her own thoughts and feelings while the group came to a close.

Bridge for the group

I invited members of the group to briefly name the resonances for their own work that the verbatim had stirred in them. At first they were unable to extricate themselves from empathic generalisations along the lines of ‘I’ve been there too’. But gradually the group moved towards naming one thing they would take into their practice as a result of the reflection.

Closing the session

I closed the session by reminding people of the date, time and venue of the next meeting and asking for a volunteer to present something for reflection.

Reflection after the session (feelings, thoughts, self-assessment)

I suddenly felt overwhelmingly tired. I noticed that my shoulders and neck had been stiff for the last hour and wanted to shake myself down. It had been a very cathartic session for Mary but seeing her break down in tears threw me and left me wobbly. I too wanted to rescue her and had to remind myself to stay in role as the group facilitator. On reflection, I think there was a parallel process going on throughout the whole session between my tiredness and Mary’s tiredness i.e. having to hold it all together when there are things going on in my life too. I was so busy trying to keep it all together for Mary and the group, that I didn’t notice this parallel process running through the whole session. Overall though I think I managed the session fairly well and stuck to my administrative, facilitator and reflective roles.

Process Account Proforma Context in which the VBRP® session took place

Briefly indicate the context i.e. an ongoing regular group/a group called together for a particular reason etc.

Group

Briefly describe the make up of the group.


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Your relationship with the group

Are you part of the group? An external facilitator?

Physical Environment

Briefly describe the physical environment in which the group met.

Creating an hospitable environment

Briefly outline how you attended to creating an hospitable atmosphere conducive to learning.


What did you do to enable the transition into the reflective space?


Briefly outline how you did this.

Eliciting a Focus

Account for how you did this.

Exploring the Focus

How did you facilitate exploration?

Tracking the Focus

Give examples of your tracking within the session.

Bridge for the presenter

How did you facilitate the bridge for the presenter?

Bridge for the group

How did you facilitate a bridge for the group members?

Closing the session

How did you close?

Refection after the session

Briefly offer a reflection on feelings, thoughts and self-assessment after the session.

Learning

Briefly indicate anything this session taught you about facilitating VBRP®.


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Component Three – 360 degree assessment (self, peer, assessor)VBRP® Training – Knowledge and Skills

Name Peer

Assessor

Evidence Self-assessment Comment

Peer Comment Tutor Comment


(Minimum of three examples)

Able/Skilled Able/Skilled N/A


(Minimum of three examples)

Able/Skilled Able/Skilled Able/Skilled

Tools for responding

(outline the model and say why we use it)

Able/Skilled N/A Able/Skilled

Eliciting a focus

Give examples of trigger questions


Tracking the focus

Give examples of trigger questions


Exploring the focus

Name at least three ways of exploring the issue in a group session


Closing the Session

Outline some ways of doing this



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Working with Dynamics in Facilitating Reflective Practice



Ability to hold role authority

Give example(s) from your practice


Ability to hold group process

Give example(s) from your practice


Working with unconscious processes

Example(s) from your own practice


Working with group dynamics




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Other Dimensions of Facilitating




Briefly state why VBRP®


Ability to facilitate reflection on values


Application of NAVVY model of reflection:

Whose Needs are being met in this encounter?

What does this encounter say about the presenter’s Abilities?

Whose Voices are being heard/silenced/ignored?

What does this encounter say about Values? (e.g. what/who was valued, undervalued, overvalued in this situation?)

What does this say about ‘You’ – (the presenter) in the workplace?

General ability to recognise and facilitate reflection on values.


Final assessment KnowledgeSkills/GiftsStrengthsTo be developed


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Component Four – Log of facilitation providedUsing this proforma (which can be downloaded at www.vbrp.scot.nhs.uk) please document the hours you accrue as a Facilitator.

Date Group Number of Group Members

Practice context of Group Members

Session Duration

Running Total Hours

25/09/13 Community Health Visitors

7 Community Nursing

1 Hour 1 Hour

Signed by Facilitator Date

Signed by VBRP® Lead Date


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Component Five – Record of coaching receivedTrainees are offered two coaching sessions by a registered Trainer between the end of Dynamics and Processes and being observed for registration.

The purpose of the coaching sessions is to offer bespoke mentoring and not to recap on course learning. Trainees are responsible for requesting help when and as they need it.

The following record of coaching should be completed and included in the learning file.

Trainee Name VBRP® Coach Name Date

Area(s) for which trainee seeks coaching

1.

2.

3.

Strengths identified Areas to work on

Coach’s assessment of trainee’s readiness for final assessment

1. Ready 2. Not yet ready

Signed Trainee Date

Signed VBRP® Coach Date


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Component Six – Observed Session for VBRP® Facilitator Registration

Name of Applicant Name of Assessor

Date Context

1. Portfolio of Evidence Assessor’s comments on portfolio

Observed Session 2.1 Ability to Structure the Session: The Six Processes

Evidenced Partly evidenced

Not evidenced

Creating an environment conducive to reflectionGetting self into the room



Eliciting a focus

Exploring the focus

Tracking and Monitoring

Bridging and Enacting

Reviewing and Closing

Assessor’s comments


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Observed Session 2.2 Facilitation Skills


Not evidenced

Ability to clarify purpose of meetingAbility to hold role authority

Ability to enable a group to participate fullyAssessor’s comments

Observed Session 2.3 Values-Based Approach


Not evidenced

Ability to keep the reflection values-basedAssessor’s comments


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Observed Session 2.4 Group Dynamics


Not evidenced

Ability to foster trust in group

Ability to work across differencesAbility to work with resistance or reticence Ability to achieve commitment to an agreed purpose Ability to work with group dynamics Assessor’s comments

Final Assessment

Ready for Registration

Working towards Registration

Recommended to Retrain

Assessor’s comments

Signed (Assessor) Date

Signed (Applicant) Date

Please submit this Assessment Report to [email protected]


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Component Seven - Reflective dialogue post final observed sessionThe purpose of this final component in the VBRP® registration process is to allow trainee facilitators to show their reflexive abilities. Irrespective of how the observed session goes, facilitators are required to evidence their ability to reflect upon the immediate experience and demonstrate awareness of dynamics that were happening within themselves as they facilitated, within the group as it worked through the material and within the story itself.

There is no set formula for this dialogue.

R 1.2 VBRP® Facilitator RegistrationUpon receipt of the assessor’s report, NES will inform successful facilitators that their name has been added to the register. Registration lasts for one year, after which those who wish to renew their registration are asked to complete the following proforma (R1.4).

R 1.3 Renewal of Facilitator Registration Registration lasts for one year.

To be eligible for renewal of registration, VBRP® facilitators must:

• maintain their practice by facilitating at least 6 VBRP® sessions a year

• maintain their CPD by attending at least 2 CPD events each year

• submit an annual log of practice to the local VBRP® Lead


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R 1.4 Application for Renewal of RegistrationName

Work address

Email address

Date of last registration

Log of VBRP® sessions (please attach using proforma at R 1.5)

Briefly outline how you are using VBRP® in your workplace

Briefly account for your participation in your local VBRP® Community of Practice

Briefly evidence your participation in two VBRP® specific CPD events

Are there any other CPD events/activities that you would like to be considered

eg writing about VBRP® for an in-house journal; giving a presentation on VBRP® to colleagues …

Signed Date

Please submit this form to your local VBRP® Lead


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R 1.5 Log of Practice Hours for Renewal of RegistrationUsing this proforma (which can be downloaded at www.vbrp.scot.nhs.uk), please document the hours you have accrued as a Facilitator. This form should be sent in alongside the Application for the Renewal of Registration (R 1.4).

Date Group Number of Group Members

Practice context of Group Members

Session Duration

Running Total Hours

25/09/13 Community Health Visitors

7 Community Nursing

1 Hour 1 Hour

Signed by Facilitator Date

Signed by VBRP® Lead Date


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CPD and Re-registration for Facilitators

CPD 1.1 Process

Call to CPD• VBRP® Lead sets up two CPD sessions per year via the local CoP, and

notifies NES of these

• NES advertises CoP CPD events on the VBRP® website

CPD Session

• CPD session includes at least two VBRP® sessions for particpants to use the VBRP® model in order to reflect on VBRP® practice

• CPD sessions are for facilitators and trainee facilitators

• VBRP® Lead keeps an attendance list of who attends CPD sessions

Maintainance of Registration

• Facilitators must maintain their practice by facilitating at least six VBRP® sessions a year

• Facilitators must maintain their CPD by attending at least two CPD events each year

• Facilitators must complete a re-registration application and an annual log of practice, and submit it to the VBRP® Lead

• VBRP® Lead confirms with NES the names of Facilitators who meet the criteria for re-registration


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CPD 1.2 CPD and Ongoing DevelopmentContinuing professional development for VBRP® facilitators happens in a number of ways:

• through personal reflection

• through participation in the local VBRP® community of practice

• through mentoring, coaching and supervision

• through VBRP® specific CPD events

Ongoing reflection on the experience of facilitation

This could be intuitive and free flowing in style as a facilitator notices, wonders and realises what happened in a session they have just facilitated, or it could be more structured using, for example, the headings for the process account outlined in section R 1.1, Component 2.

Local Community of Practice

These have been established across Scotland and provide a supportive space for facilitators to develop their skills and confidence and to test drive new initiatives or uses for VBRP®.

Mentoring, Coaching and Supervision

Moving from conscious incompetence to unconscious competence takes time and experience. Having a mentor is invaluable especially in the early days of facilitation. Being able to identify a specific area that needs attention and further development gives a focus to the coaching sessions which follow initial training pre-registration. Holding and containing others is no easy task and can leave its imprint on our minds and our hearts. Working with others from time to time can trigger our own sore spots. Reflecting on those things in supervision (or within VBRP® sessions on VBRP®), can offer us some of the quality of support and ‘holding’ which we offer others through the VBRP® process, and can enable us to find greater freedom to remain present with those things which are difficult in our work.

Organised CPD events

The national VBRP® delivery team – in dialogue with the local VBRP® Lead – are committed to offering CPD opportunities across Scotland. All registered facilitators are required to participate in two VBRP® specific CPD events per year in order to maintain their registration.


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Train the Trainer: An Overview

Train the Trainer

Who is it for? Experienced registered VBRP® facilitators who:• can demonstrate high levels of reflexivity• have the capacity to facilitate learning• exude an hospitable attitude conducive to enabling others

to learn

Admission Application FormAssurance in writing from line manager of being released to deliver trainingAssessment Conversation

Pre-requirements Registered VBRP® facilitator status with a minimum log of 20 facilitated sessions Preparatory reading and reflection

Duration 4 days at 6 hours per dayShadowing with an established trainer outside of course

Learning Focus

• Knowledge Philosophy behind VBRP®Variety of pedagogical methods and learning styleTheoretical grasp of group dynamics

• Skills Skills of group hosting and containingSkills of delivering training materialsSkills of adapting materials to fit group’s needs

• Experience Making self available as a primary learning resource for othersCreating a learner-focused experience Drawing on own practice as a rich pool in training

Post course Keeping a reflective training logCo-training with a registered trainer on two Essential Toolkits and ideally two Dynamics and Processes


MAY under supervision co-train with a registered facilitator until signed off as registered trainers

Exit Award Certificate of Attendance (24 hours)National trainer registration


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TT 1.1 Train the Trainer: Process

Application Process

• Dates advertised to registered facilitators

• Application forms that meet the criteria will be considered

• Application forms must be signed off by the applicant’s line manager

Course Delivery

• Trainer allocated to dates - four day course - established trainers from the ‘Trainers Group’ deliver the training

• Training delivered to NES standards and specification

• Training to include curriculum design and delivery, course content and training methods consistent with the values of VBRP®

Post-Course

• Trainees to co-train on two Essential Toolkit and ideally two Dynamics and Processes cohorts with registered trainers

• Trainees to submit reflective training log

• Trainees to be signed off by supervising trainer

Registration as Tariners

• NES to register new trainers

• NES to monitor ongoing practice and CPD for trainers


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TT 1.2 Train the Trainer CourseThis course is currently being developed and will be piloted in the Autumn of 2017.

A separate handbook will be created containing:

• application form

• pedagogical principles

• course curriculum

• reflective training log

• record of mentoring

TT 1.3 Trainers’ CPD: Process

Call to CPD• NES setup 1 CPD day per year

• NES emails trainers annually

CPD Day

• NES arranges attendees list

• NES arranges location

• Each CPD day includes some teaching practice/demonstration

• Course leader confirms who attended on the day with NES


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Evidence for VBRP®VBRP® facilitators are often asked for the hard evidence that supports the capacity of VBRP® to:

• enhance practice

• positively impact on working relationships

• help staff re-connect with their core values

In the six years since VBRP® came into being two studies have been independently undertaken.

EV 1.1 2014 Independent Research Study – FireCloud A second study was conducted by FireCloud in 2014 and yielded the following findings:

VBRP® Outcomes - 2014 Independent Research

Impact on professional practice

Impact on wellbeing and engagement at work

Impact on communication and relationships at work

Increased self awareness

Increased ability to reflect in the moment

Increased professional confidence

More trusting leadership styles

Enhanced professional practise

Staff feel more motivated

Enhanced job satisfaction

Reduction in stress

Ability to work in a values-based way

More attentive to the unspoken and what might be missed

Better communication among staff, better handovers

Enhanced staff relationships

Staff more able to embed NHS policies re patient self-management and person-centred care

FireCloud Consultancy, 2014


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EV 1.2 2014 Executive Summary - FireCloudIn April 2014, Health and Social Care Chaplaincy within NHS Education for Scotland (NES) commissioned an independent study to evaluate the use of their Values Based Reflective Practice (VBRP®) initiative. The purpose of this research was to identify the emerging impact of VBRP® as delivered by the 40 chaplains and health and social care staff NES accredited as facilitators between February 2011 and April 2014. These facilitators now deliver VBRP® in their local health and social care settings in a variety of ways. This report presents the findings of 26 questionnaires and 9 individual semi-structured interviews conducted between May and July 2014 with facilitators drawn from cohorts one to six of the NES VBRP® training programme. Specifically the evaluation asked, what impact, if any, does Values Based Reflective Practice facilitation training have on:

a) staff practice

b) staff team relationships and communication

c) staff wellbeing and engagement at work

The evaluation found more than 186 VBRP® sessions were delivered across the NHS in Scotland by 23 VBRP® facilitators within the timeframe of this research; most commonly these were attended by between 4-8 NHS staff members. The contexts in which these VBRP® sessions took place were wide ranging and the various specialisms of health and social care staff attending was very broad.

The evaluation found seven key areas of impact reported by facilitators:

1. increased self-awareness and therefore an enhanced ability to reflect on practice at the point of care and be responsive to patient and staff needs in the moment

2. exposure to new skills and techniques in reflective practice, elements of which are usefully transferable to a range of professional experiences and settings

3. increased professional confidence and courage in terms of leadership, supervision, collaboration and decision-making

4. enhanced team relationships evidenced by deeper instances of trust, understanding, humour and challenge

5. a new and/or fuller ability to create a safe space for critical group reflection on challenging, and sometimes sensitive, professional experiences within the NHS

6. enhanced engagement with other organisational priorities such as patient safety, critical incident enquiry and staff appraisal processes

7. increased personal wellbeing, satisfaction and resilience as a result of remembering, recovering or reclaiming the motivation and desire to become NHS healthcare staff


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Further, the evaluation found areas for development within VBRP® including:

1. The need to articulate more clearly how VBRP® works in practice, the benefits to staff, how it links to other similar but different initiatives and how it fits within the context of the wider NHS

2. A feeling that VBRP® needs further work in terms of governance, infrastructure and support for it to be secure and reliable in its future development

Since this evaluation, two further training cohorts are complete and four more are underway. This gives a total of 95 trainees eligible for national registration at the time of print. Through them the potential impact of VBRP® continues to grow.

FireCloud, December 2014


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VBRP® Articles A series of articles about VBRP® or using its approach have been published including the following:

2011 Michael Paterson and Ewan Kelly article ‘Values-based Reflective Practice: A Method Developed in Scotland for Spiritual Care Practitioners’ in Practical Theology Vol 6 (1), which tells the story of how VBRP® came into being and how it migrated from being a theologically based activity in which only chaplains engaged to become the values-based approach that is now prevalent across Health and Social Care in Scotland. You can download the article here http://www.tandfonline.com/doi/abs/10.1179/pra.6.1.t815l2592549h478

2013 Ewan Kelly article ‘Translating theological Practice into Values Based Reflection: A Report from Scotland’ published in Reflective Practice: Formation and Supervision in Ministry, Vol 33 pp 245-256. You can download the article here journals.sfu.ca/rpfs/index.php/rpfs/article/download/282/281

2014 Michael Paterson’s series of three articles in the Journal of Health and Social Care Chaplaincy in which he uses NAVVY to offer values-based reflections on the changing face of healthcare chaplaincy. The articles are:

1. ‘Emerging paradigms in Health and Social care: Disorientation or Reorientation’. 2.1 https://journals.equinoxpub.com/index.php/HSCC/article/view/19762

2. ‘New Wine? New Wineskins? Values-based reflections on the changing face of Healthcare Chaplaincy’. 2.2 https://journals.equinoxpub.com/index.php/HSCC/article/view/26927

3. ‘When the Chaplain is ready the teacher will appear’ 3.1 http://www.academia.edu/13042317/When_the_chaplain_is_ready_the_teacher_will_appear_1

2016 Suzanne Bunniss’s article ‘Courageous Conversations: Values Based Reflective Practice (VBRP®) and the bridge between soul and role in Medical Education’ which relates VBRP® to the promises medical doctors take.

This resource may be made available, in full or summary form, in alternative formats and community languages. Please contact us on 0131 656 3200 or email [email protected] to

discuss how we can best meet your requirements.

NHS Education for ScotlandWestport 102West PortEdinburghEH3 9DN

www.nes.scot.nhs.uk

© NHS Education for Scotland 2017. You can copy or reproduce the information in this document for use within NHSScotland and for non-commercial educational purposes. Use of this document for commercial purposes is permitted only with the written permission of NES.

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