Small steps and trusting in the reason why: 10 years of Bridges
As Bridges celebrates its 10th Birthday year, our Founder and CEO Professor Fiona Jones shares the story of how Bridges was formed, and reflects on the journey to where we are today, with all its challenges and successes.
What do you do on day 1 in the life of a new social enterprise?
We had the beginnings of a concept that we knew would make a difference; a way of working that put people with lived experience and those that support them at the heart of everything. We wanted to build this into training for healthcare teams and co-designed books for people with different conditions. We had started down a path with the lofty plan to make an impact. But a life working in the public sector had not prepared me or any of us for what we needed to do to make Bridges work. There’s nothing wrong with an unrealistic goal though!
One issue we faced was describing what Bridges was. From our research we knew when it felt right, when a practitioner said they had been surprised by a patient’s ideas or they felt relieved they didn’t need to hold all the answers. The seminal work of Albert Bandura’s Social Cognition Theory had always been there, with self-efficacy a solid thread throughout our work. We knew the profound effect of believing in your own capabilities and how confidence can build as well as drain away, and the power of a feeling of success. By pulling together our strands of experience, theory, stories, and research, we started to shape our workshops and resources, and to share, connect and talk about this approach. Meeting deep thinkers like Professor Paul Batalden and reflecting on sentiments like this below also helped…
‘When a trusted health professional explores a patient’s need, a relationship is formed […]Patient and professional are held together by knowledge, skill, habit, and a willingness to be vulnerable. Trustworthiness, respect, and trust make this relationship possible. Both parties bring their knowledge, skill, and habits to the service making task. A willingness to be vulnerable arises from being fully present and able to fully engage another person’
‘Willingness to be vulnerable’ has been pivotal, much more than we realised at first. As Bridges grew, and more healthcare practitioners and teams went through their training, we heard how it was possible to build capacity by sharing expertise, and this in turn liberated practitioners from the feeling they needed to fix and hold all the answers. We were pragmatic, flexible and different, and rode the wave as personalised care became embedded into healthcare policy. We were in the thick of things when co-design was accepted as a methodology to authentically innovate. This confirmed our beliefs that when power and control shifted in a relationship everyone would benefit.
Defining Self-Management Differently
And then there was the word ‘self-management’. Secretly we didn’t like it, we knew it could come across as ‘DIY’, or ‘being left on your own’. So, we started to define it differently. By asking questions about ‘what good self-management support sounded like or felt like’. And asking, ‘what really is a good outcome?’ We learnt that it’s not always about following advice or achieving a change in an outcome measure. But it can be hearing someone say how they have worked out their way around a problem and realise they are needing less support than they first thought. Some key moments stand out; like when the individual living with stroke asked the therapists ‘When are you lot off then?’ or a woman with long Covid telling us ‘I now feel like I have a new identity, I am in control of my symptoms rather than the other way around, I’ve reinvented myself…a bit like Madonna’. Or when a practitioner quietly reflected on what she had heard in a first workshop and said, ‘Bridges is like listening to understand rather than listening to respond’.
As we struggled to describe self-management, we gradually realised that less is more. The simpler the language, the more people connect, and it’s our job to create a space in all our interactions, dialogue, processes, and team culture for that to happen. From the many healthcare teams, we have worked with, two new words emerged: ‘Bridgey’ and ‘Bridged’. Practitioners started reflecting on when they had been ‘Bridged’ and described it as when a colleague had really listened to them and felt supported to think of a way around a problem, not just told what they should be doing. We now refer to the word self-management less and less, static definitions are just not that important anymore. We ask practitioners how they will keep Bridges going when they have little time or are short staffed and we have been amazed by their creativity. They build Bridges language into their practice, processes, and ways of working with each other. Often, they say, “We are going to be more Bridgey from the first interaction with a patient” and everyone just knows what this means.
The ripple effect of Bridges
10 years on, we can now describe Bridges more easily. We have a set of core principles, language, and descriptors of what good personalised self-management support looks and sounds like. We also understand more fully that the impact of using Bridges is like a ripple effect, so that when a practitioner establishes a trusting and open relationship with a patient or their colleague, then things change, and outcomes improve. We have also learnt a huge amount in the last 10 years about how teams can sustain this way of working so it becomes ‘normalised’ into their practice. Right now as we publish this blog, as many as 10,000 practitioners across the UK, and EU have benefitted from the Bridges approach. They are listening to what’s important, making space for ideas, following the patient, looking for small victories, asking about hopes and fears and encouraging first steps, talking about things not goals, interested in how people feel and not only giving their advice and using ‘Bridgey’ language in all their interactions with patients. Overall being more coach and less teacher/manager.
Bridges started with a step, but we are still only part way over the Bridge, we have harnessed the collective experience and expertise of 100s of people living with different long-term conditions most recently those with long Covid, Cancer and joint pain. We have more than 150 Bridges champions, 10 different codesigned books and are still supported by an incredible group of clinical and lived experience associates as well as St George’s University London and Kingston University, as our loyal partners. We believe that if we use our language to explore, share, connect, and exchange ideas it gives energy, and it importantly can save time, by enabling healthcare teams to focus on what really matters most. This is critical at a time when practitioners are expected to do more and more with less and less. This blog marks out our 10th anniversary as not only a reflection of what we have done, but also what we are doing now in this 10th year and what plan to do over the next 10 years. Look out for some insightful, reflective, and Bridgey sounding blogs over the coming months. We promise not to stand still, always reflect and trust in this way of being.
