People tend not to follow advice unless it feels relevant and connected to their own reasons for change. The ‘Good Help’ report explains how crucial it is to tap into people’s personal motivations to achieve better outcomes.

A recent experience of my own as a patient brings to life the subtle differences between ‘good help’ and ‘bad help’. This short interaction is not obviously ‘bad’ and I chose it purposefully to highlight how small differences in language and behaviour can turn a helpful interaction into an unhelpful one, despite the best intentions of practitioners.

In spite of being a practitioner myself and having recently written a report on building confidence, in this interaction, I felt powerless and unsure about my care. It showed me how hard it can be to demand ‘good help’ and how the power of the system can override practitioners’ capacity to connect with patients. I found myself wanting four of the seven characteristics of ‘good help’ which were missing: 1. enabling language, 2. power sharing, 3. tailoring and 4. transparency.

Having worked in the NHS for several years I understand that certain processes need to be followed, for reasons of accountability, safety and efficacy. I also understand how the power of the system can override a more flexible and nuanced approach from practitioners. Even with these contextual factors in play, I believe this interaction could have involved more ‘good help’ principles as outlined above.

In fact, with some small tweaks to language and more equality in the relationship, the outcome of this interaction could have been quite different. Maybe I would have been persuaded that the extra appointment was of value to me or maybe we would have agreed together that it wasn’t necessary to book it in the first place. Either way, I would have left that interaction feeling more confident and in control of my health. Could these subtle but important relational aspects of care help to shed light on non-attendance rates in health and beyond?

I think a core part of what went wrong was a misalignment of purpose, represented in the diagram below. The midwife’s purpose (I am making an assumption) is to deliver the safest care possible to his patients, whereas my purpose is to have a healthy pregnancy whilst also being able to get on with other important things in my life, such as work. If purpose is misaligned and people disengage, there can be serious consequences for people’s care.

I do not want to convey ‘bad help’ as an issue for practitioners to address alone. There is a clear organisational role to make clear the level of clinical flexibility that practitioners can exercise. There is also a role at the level of the citizen and I have reflected on what I want to do differently as a citizen if a similar situation arises in the future:

1. Interrupt. This takes confidence, but I would like to be able to say ‘please can I interrupt because there is something I don’t understand’.
2. Express my feelings. I want to help practitioners understand what I am going through. If I am unsure about a decision I would like to say, ‘I feel a bit uncertain about this, do I have a choice about my treatment?’
3. Be honest. Rather than leave an interaction and go against what has been recommended, I will try to be honest and explain the decision I have reached in the moment. This also takes confidence.

‘Good help’ and ‘bad help’ are on a spectrum and there is no clear line between them. I have come to realise that one of the biggest challenges we face when trying to mainstream ‘good help’ will be the established cultures of help - in particular, shifting and sharing power between help givers and help recipients. We will be exploring the cultural aspects of power in our upcoming People Powered Health conference on 2 May 2018.

Esther Flanagan is leading a breakout session on Good Help at the Future of People Powered Health on 2 May 2018. Read more about the event and join the conversation on Twitter #peoplepoweredhealth