How can both people who use our service and colleagues influence our service?

One of the outcomes in the UK Care Quality Commission’s Essential Standards of Quality and Safety is:

“People who use services can influence how the service is run as they are given opportunities to take part in decision-making through general discussions with the provider, on an informal basis, as the person who uses services wishes – and through periodic surveys or gathering of their views”.

To comply with this (Click here for full details), most organisations do annual surveys of people they support and their families. Service user surveys (or equivalent) are required by regulators; however, surveys for people who use services are fraught with challenges. For example, how can you mitigate against the impact of people probably having fewer life experiences and lower expectations of services than the general population? How can you address the different ways that people communicate through a survey?

We think that Working Together For Change (WTFC) is a more powerful and effective way of gathering information than surveys. This still fits the requirement of ‘gathering of their views’, but without the challenges inherent in surveys.

WTFC is an 8 stage process that uses information from person-centred reviews, and is a way to learn about quality from people who use the service, without taking people’s time through surveys and focus groups. Providers are starting to use person-centred reviews as a way to hear everyone’s perspective of what is working and not working (thereby fulfilling the regulator’s expectation), and WTFC as a way to address together what is not working, celebrate what is working and build on this. This combines reviewing quality and improving quality, in a co-produced way, in line with person-centred values.

WTFC can, however, be just as easily used with information generated in discussions between managers and staff about their one-page profiles, replacing staff satisfaction questionnaires.

What would it be like if, in an appraisal situation, you looked at your one-page profile with your manager and said, ‘Here are the top two things that are working for me, the top two things that aren’t working for me so well, and the top two things that I’d like to see changed in the future’?

What if the manager then worked with you to start changing some of the things that weren’t working, and that information then went on into a WTFC day, with the same information from all staff, who would each be sharing their top two ‘working’, ‘not working’, and ‘important in the future’ comments?

Having identified the big common themes that are affecting many staff, it would then be possible to dig deeper into the reasons why things are working well or not working for staff members. This is done using a process called “5 whys”, which delves into the underlying issues behind the successes and challenges facing the organisation; if we look at what’s working and not working for staff, what are the causes for that? What are the things that are causing that, so that we can then treat the cause rather than just the symptom, and what would success look like from the staff’s perspective? And from that, we can generate actions that feed into the business plan of the organisation.

That is a much more powerful way to gather feedback from staff and really acting on it, rather than staff satisfaction questionnaires. One large organisation in the North West is starting to do this.

Here are some more examples of organisations using the WTFC process:


WTFC in schools paper

WTFC in hospitals paper


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Working Together For Change

An 8 stage process using person-centred themes to inform strategic change.