Grand ideas

I recently filled in an application to speak at an event about children in Care. The form asked me to summarise in a limited number of characters what I would bring to the table as a speaker. I wrote:

We have collected BERRI data on the psychological needs of over a thousand children in residential children’s homes over the last five years, and surveyed and trained over a thousand residential care staff to provide care that is tailored to those needs. We can present what this data shows us, and how we have used it to improve the services that are offered, and commissioning decisions made about children. For example, we have learnt that the level of challenge presented varies remarkably little by age or gender, though the types of needs are slightly different. Some types of needs (eg behaviour, risk) are affected much more by proximal stressors (eg exclusions from school, gang involvement, substance misuse, sexual exploitation) whilst others (eg relationships) are affected more by historic adversity and the nature of early attachment experiences. We can present how staff variables (demographic factors, burnout, empathy, ability to formulate) affect the care they deliver, and how the price and types of services commissioned relate to the needs of the child and the impact they make on the life of the child – if at all!

The government spend a billion pounds a year on these 7000 children, and we have good evidence that by better targeting the psychological needs of individual children they can improve outcomes whilst saving costs.

It struck me when I looked at that paragraph that this was simultaneously a grandiose claim and underselling the potential of the systems we have developed*. I think that tension between over and under-selling what we can do reflects one of the big challenges of being an entrepreneur – seeing the potential, whilst being realistic about the frustratingly slow steps it takes to achieve it. I can see so much that we can achieve, and the way that collecting the right data can help put children’s needs in the heart of commissioning decisions, improving outcomes whilst saving substantial amounts of money but it is very hard to get this information in front of the right people. I’ve tried to speak to politicians, policy makers, experts in the field, commissioners, clinicians, funders and the media. I’ve spoken at conferences, written a book, contributed to policy documents, delivered service improvement programmes in major providers in the sector, I’ve even given evidence before a select committee. But because I try to answer the questions that are asked, I don’t always get the chance to promote the products and services that we provide. And it isn’t my personality to aggressively sell what we do.

Looking back, I think that I believed that if you work out a better way to do something, a technique that saves time or money or improves outcomes for people, then once people knew about it then it would start to gain traction until it became the established way of doing things. I figured that was how we had progressed from horse-drawn carts to steam engines, cars and now electric vehicles, or from papyrus to paper to typewriters to computers to the plethora of voice-activated, photo-capturing, text and graphic app laden smartphones – finding iteratively better ways to solve problems. I knew that sometimes there were two simultaneous steps forward that competed (like VHS and Betamax) and that variables like marketing, networks and budget could influence the choice, but I generally thought that the best solutions would win through. Maybe it is my left-leaning political bias or my hippy upbringing, but I think in my heart I have held onto a naive idea of fairness in which everyone should be motivated to solve social problems, and people should be rewarded for their effort and insight.

I suppose the concept that we live in something of a meritocracy is quite a widespread belief, and entrenched in western cultures, that good ideas will surface and the best people will rise to positions of power. That’s taken a bit of a crushing for me over recent years, as I’ve seen the covert influence of the super-rich and we’ve had several prominent examples of terrible people rising to the top of systems that have failed to keep up with social and technological change, but somehow I am still hoping for the system to right itself, because it feels like society should be a functional meritocracy.

I think it is particularly well articulated in the USA, because they started as a nation of immigrants who created their own society. To quote the American Declaration of Independence, “all men are created equal”, are entitled to “the pursuit of happiness” and will rise to their natural position in society. That sounds like a fair way to run a country, but of course the reality has never quite matched the headlines, given the theft of land and resources from native peoples, the decimation of the natural environment and the evils of the slave trade. But somehow the myth of the American Dream has persisted. First described by James Truslow Adams in 1931, it describes a culture where anyone, regardless of where they were born or what class they were born into, can attain their own version of success in a society where upward mobility is possible for everyone. The American Dream is achieved through sacrifice, risk-taking, and hard work, rather than by chance or the privilege of your pre-existing connections. In Adams’ words it is:

a dream of social order in which each man and each woman shall be able to attain to the fullest stature of which they are innately capable, and be recognized by others for what they are, regardless of the fortuitous circumstances of birth or position

Whilst I can see so many places where people are not starting the race from the same starting line, because of geography, race, gender, religion, socio-economic adversity, sexuality, age, or so many other variables I have clung on to my optimism that if you can work out a solution to a big social problem, or have an idea that can really work to make life easier (and/or make lots of money), then it should be possible to gain traction with it, get key people to support you, and get it to happen. The reality is that so many people who think of themselves as examples of a working meritocracy have in fact been handed a huge head start by their privilege. As we joked the other day on Twitter, all the wrong people have imposter syndrome because it is mutually exclusive with entitlement. It seems that private schools in particular train people to expect to be leaders and wielders of power, as we see in the preponderance of Prime Ministers educated in Eton (and in the irritating arrogance of Lottie Lion and Ryan-Mark in the recent series of the Apprentice). Having attended an ordinary comprehensive, and never having been aware of any negative repercussions of my gender or heritage, it has been quite eye-opening to see that maybe the playing field isn’t as level as it appears, even for someone ostensibly white and middle class**.

One figure that has stayed with me is that of all the money invested into fledgling businesses in the UK, 89% is given to all male founder groups, 10% to founder groups containing men and women, and just 1% to all female founders. I couldn’t find any UK numbers, but the figures look even worse if we consider race, with black women only receiving 0.0006% of the of the $424.7 billion that has been invested into startups globally between 2009 and 2017 by venture capitalists. Those white men probably think they simply have better ideas, but the evidence doesn’t support that, whilst the statistics say they are 89 times more likely to be funded than all female groups, whilst a white male entrepreneur is thousands of times more likely to be funded than a black woman, and will have the confidence to ask for much larger sums of money. Only 34 black women have raised more than a million dollars of investment in the last decade. This doesn’t reflect the quality of the idea or the work ethic of the individuals involved (as meaningfully empowered women on boards increase corporate social responsibility and may have a positive impact on the profitability of the business, and diversity increases profitability). It reflects the stereotype of what the (predominantly white male) funders think successful entrepreneurs look like – and they imagine young geeks from silicon valley who are predominantly white and almost always male. And that sucks.

It might also explain why men in suits with glossy patter are able to sell systems they have pulled out of the air for eight times what we charge for properly evidenced tools that do the same job better. Or maybe that’s just a coincidence. But whether or not the playing field is flat isn’t something I can solve alone, and it is unlikely to be resolved within the timescale that is critical for me to make a success of my business and to maximise the impact I can make on the lives of vulnerable children. That means that, despite how discouraging it is to realise that we are not living in a meritocracy where the strength of the idea is enough to sell it to those who matter, I need to find ways to shout louder, communicate what we do better, and get our message in front of the right people.

Because we are tantalisingly close to having all the data we need to understand the critical variables at play in the psychological wellbeing of children and young people in Care, and which placements and services can help to address them. We have an exciting partnership growing with a group of local authority commissioners that will couple our data with commissioning data, and we are applying for grants to help us to gather and analyse that data across much wider samples. We are also scaling up the previous project we did looking at whether BERRI can help to identify suitable candidates to “step down” from high tariff residential settings into family placements with individualised packages of support. These larger scale projects mean that we will be able to show that the model works, at both the human and financial levels. And with a little bit more momentum we can start making the difference I know we are capable of. The trick is hanging onto the vision of what is possible and celebrating what we have already achieved, whilst having the realism to put in the graft that will get us there. I need to keep pushing upwards for longer than I ever imagined, in the hope of reaching the fabled sunlight of easier progress – even if so many variables skew us away from the meritocracy that I imagined.

 

*I think that’s why I used the pronoun “we” and shared credit with my team, even when I was asked to describe myself as a speaker, rather than taking full credit on my own. This transpires to be a common female trait, and part of the double bind for women where being assertive is seen as aggressive whilst being collaborative is seen as lacking leadership. In fact, many words are used exclusively towards women and highlight how pervasive these biases about women in leadership roles are.

**albeit a second generation immigrant to the UK, with Jewish heritage

What to do when you can’t do it all

There was an interesting little discussion on the forum this week about the perceived pressure to do everything, and to do it all right now. That fits with the concept of the insecure overachiever that is actively sought out for certain high demand jobs (and was the topic of a recent radio 4 show) and also the concept of Imposter Syndrome, where you constantly feel like a fraud who might be found out and identified as inadequate for the job. There is a widely perpetuated narrative in modern society that people should be willing to work longer and harder, and there is always a mythical person who is doing more than you. Whether that is more revision before exams, or more prep for their clinical application or assessment day, or more voluntary work, or managing to juggle more things in their working week, it always makes you feel a bit guilty and inadequate no matter how much you are doing or how hard you are trying. The truth is we are in a profession where demand for our services will always exceed supply. The early stages of the clinical psychology career path are competitive, and there are lots of people who claim impossible workloads and huge amounts of experience that can make you feel like you’ll never measure up. So how do we tackle this pressure to do more?

There are probably lots of layers to the answer. Some are political, as this culture springs from job insecurity, underfunding, and the focus on attaining wealth and status – so the ideal is to change the game, rather than trying to win a game that is rigged against us. Another layer is to communicate with others and band together, as this undermines our personal insecurities that see it as our own personal failings, and allows us to normalise our experiences and work together to resolve the systemic issues that underlie them. But even at a personal level, there are things that we can do.

So this blog is about my top ten suggestions to tackle that feeling of having too many plates spinning and not enough time, and the cognitive distortions that maintain the belief that we should do more. I’m not saying I’ve got all the answers, or that that I’ve resolved all these issues in my own life. Far from it! I’ve mentioned many times that I’m not a good role model in this regard. I think I am a bit of a workaholic, and whilst other people say I’ve achieved a lot, I always feel like there is more I could/should be doing. However, the things that have started to help me change my own patterns are:

1) Know when you are taking on too much. Having had a minor car accident, the physical repercussions made me cut down my work to a more manageable level. They remain a good reminder if I’m overdoing things, as I get aches and pains in my ear/jaw and shoulder. Obviously, I’d not recommend having an accident as a self-care strategy to others! The bit worth sharing is to be aware of your own physical and mental state, and to learn to recognise your own signs of stress as early as possible. Then you can be responsive to your own needs, and learn to stay within your own limits. It is also a good reminder to ensure that you build self-care and exercise into your routine.

2) Fit in friends and fun. Giving higher priority to the people and things you enjoy and are recharged by. We all need to have support networks, and family and friends need to be given enough time and priority in our lives to perform that role. I can’t persuade myself to “do less work” or to leave gaps in my diary, but I can put in commitments to the people and activities I value in my life that compete with work. I make it a personal rule that I finish work at 4pm on Mondays to take my kids to their swimming lesson and do my 30 lengths. Every evening the 7.00-8.30pm slot is time I always give to my kids’ bedtime routine, and 8.30-10.30pm is time I always spend with my husband. I’m also trying to cook with the kids twice a week, to fit in a creative activity each month and not to work on weekends. My advice is to start small, commit to something for at least a month and then build on good routines once they are established. Once in a while make time for fun or frivolous things like having a spa day, or sneaking out for a cinema or lunch date with my husband, or booking a holiday.

3) Sleep. No matter what else is going on, make sure to get enough sleep. For me that means eight hours per night. I’m a night owl, so I often work until the task is done, even if that means resuming work after everyone else in my house is asleep and working through until the small hours. Then I often have to get up and fulfil work commitments the following day. If I could stop doing those extra bits of work after everyone else is asleep and get a proper sleep routine where I sleep during the hours of darkness and get out into the sunlight more in the daytime, that would have positive knock-on effects on my energy levels, mood, appetite and attention span. You can see from the fact I’m drafting this post at 2am that I’m not managing that yet, but for now allowing myself to have at least one lie-in on the weekend is a lifesaver.

4) Use your time better. Stack commitments together with similar content, that involve particular colleagues or that you can do in particular locations. Get the right kit to do the job efficiently. Travel less. Use video chat rather than meeting in person. Minimise your commute, or use it for something relaxing like reading a novel or listening to music or audiobooks. See if you can work from home even if it is just a small proportion of your time. Work out what the blocks or bottlenecks are in your process, and how you can solve them, For me having templates of common reports and letters was one helpful step. According to where you are in the power structure, you can also look at how you can draw in support or what you can delegate to others.

5) Diarise the in between stuff. Don’t just fill your calendar with the face to face stuff and expect to fit in the admin and support tasks in the cracks, because they either escape into non-work time or don’t get done. If you have to write a report between appointments, give yourself a diary slot to do it in. Need to read the papers before a meeting? Book the hour beforehand for that task. Want to write up a paper? Diarise three days for it. Then make sure that you keep that time for that sole purpose. Book an admin slot at the beginning or end of each day, or a half day at the beginning or end of the week. Check out how much time you need and when you are most productive. If that is a time that is earlier or later than other people work, make sure that you take the time back somewhere else*.

6) Prioritise, then focus on the key tasks. Isolate yourself if you need to get something important or time critical done. Turn off your phone and your email alerts, ideally unplug from the internet, and prevent distractions. Then give it your full attention. Work out what is interrupting you, and then stop it so you can get work completed in one steady sprint, rather than having to come back to it again and again after dealing with phone calls, emails, other people interrupting, or diverting onto the internet. Deal with the quick stuff straight away. But then make yourself a task list and work down it. Prioritise the important stuff over the seemingly urgent but unimportant. Try to check email and messages at the beginning and end of the day, not every few minutes. When you need to get something done turn off social media, email alerts, etc. Turn your phone onto silent and then put it out of sight.

7) Clarify your goals, and how to reach them. Envisage where you are trying to get to, what the steps you need to take are, and what barriers are preventing you getting there. If you wanted to lose weight you could picture yourself thinner and see how it would play out in your life, then think about what you need to do to consume less calories or burn off more. Then see what is stopping you. You could identify that you aren’t getting to the gym if you go home from work first, or that you are always tempted when there is cake in the office, or buy unhealthy snacks when you don’t take a lunch to work. Once you recognise them, you can then make an informed choice, and if the benefits are worth the extra effort you then need to address the barriers. One of my goals is to make my business self-sufficient enough to continue even if I went off long-term sick, and could provide me an income in retirement. So I have been thinking about how to recruit and train others to sustain the business, and create products that can utilise my skills and knowledge without me having to deliver everything in person (eg can I train others to deliver training, deliver it as a webinar, or make videos of the training available to subscribers).

8) Get a better bubble. They say that we are the average of the five people we spend most time with, and whilst that isn’t a scientifically validated concept, I think that it has some merit to it. We are all normed by those we spend most time with, so I’ve actively chosen to seek out the company of people I admire and want to learn from, and who will challenge my assumptions and habits. More specifically, I’ve been trying to spend more time with other social entrepreneurs, rather than the long-term NHS, education and social care professionals I already know, so that I move away from the common assumptions of this kind of work, and can be more creative and less risk averse in how I look to create impact. You also need to enlist the support of the key people in your life so they reinforce your goals, rather than unwittingly draw you back into old habits.

9) Get reflective. Use your supervision, your trusted confidants or keep a journal. If you want to take it one step further, why not seek out therapy, or coaching, or personal development opportunities. Give yourself time to think and regroup, particularly after stressful or emotional experiences. As well as the benefit of some wonderful supervisors, I’ve had various coaches and mentors since I left the NHS, and I’ve attended various groups and training programmes. Each one has helped me understand myself better, and helped me to refine my plans to make them more likely to succeed. It is really good to take time outside the pressure of spinning all the plates to look at why you are spinning them, which are most important, and how they make you feel. It can help you to consider the pros and cons of different options, and to identify goals and actions.

10) Be kind to yourself. Remember that you need to attach your own oxygen mask before you can help others with theirs. Take time out when you need to, and find the things that replenish you. Be realistic about what is possible or what you have capacity for, and learn to say no to unreasonable demands. Don’t be too self-critical. Seek out and remember the positive feedback, and the things you have already achieved. Take the time to note the positives and be grateful.

And above all: Enjoy the journey. There is no rush to get to the destination. Dance whilst the music is playing.

 

*with the agreement of your manager, of course.