The success of our research work relies on an ability to create safe environments for people to speak openly and honestly, without fear of judgement or reprisal.
Head of Health and Care, Jessie Cunnett, spoke to us to share her thoughts on why this is such an important consideration and some of the approaches we’ve taken in recent projects.
Why is it so important to create safe spaces for complex conversations about health and care?
At Traverse, we are dedicated to making a positive contribution to the health and care system by engaging people in research and enquiry about health and wellness in the context of wider social values. This means we often need to encourage people to speak openly about divisive topics or sensitive issues.
For people to fully engage in those discussions with us, they absolutely need to feel safe, know that they can bring their whole selves to the table and believe that they won’t be judged for sharing their honest opinions. This is particularly important when we’re conducting research around health inequalities as the people we’re speaking to may already feel marginalised to some extent and that their voices have not or will not be listened to.
What principles do you apply to make sure you’re offering a safe environment?
There are numerous factors to take into account when attempting to create a safe environment and we tend to apply the ‘safe uncertainty’ model, first articulated by family therapist Barry Mason. It is a four-quadrant model, much like Johari’s window, with four axes: safe, unsafe, certain, uncertain. These lead to four positions: unsafe uncertainty, safe certainty, unsafe certainty and safe uncertainty.
We aim to create a sense of safe uncertainty in our research sessions. In a nutshell, this is because we recognise that we are asking people to talk about often sensitive, personal subjects which can create a sense of uncertainty. Therefore, it is vital that we make sure participants feel they can trust us, they understand the purpose, rules and parameters of the activity, as well as knowing any practical pieces of information such as how long it will last and whether they’ll get a break. This feeling of safety then allows people to feel comfortable discussing more uncertain and controversial topics and consider one another’s views more openly.
Can you share an example of this in practice?
A good example is when we were asked by the Department of Health and Social Care (DHSC) to set up and develop a patient reference group (PRG) to support and inform the government’s response to the First Do No Harm review.
A key theme of the review was that patients and families were not heard or listened to. It was also apparent that there was a lack of trust towards those in positions of authority within the healthcare system. The PRG members had all had highly traumatic and deeply personal experiences and so we simply had to create a secure, neutral environment where every voice was heard and valued equally to build trust and confidence.
We did this by bringing in highly skilled facilitators, having a member of the group co-chair alongside me, and supporting the group to establish their own terms of reference and rules of engagement. Ultimately this meant that the group were able to carefully explore the review in depth over a six-week period and agree on objective recommendations. We then supported them to create their own report containing these recommendations which was submitted to Parliament by the DHSC.
Is there an alternative to group discussion for subjects where views are likely to be highly polarised?
Absolutely. We’ve applied the safe uncertainty principle to focus groups and in setting up an innovative online platform for anonymised discussion. In the VacciNation project, we were commissioned by Healthwatch England to talk to people from the African, Bangladeshi, Caribbean, and Pakistani communities, who lacked confidence in the COVID-19 vaccine, to understand more about the triggers of vaccine hesitancy.
Conscious of how polarised this subject is and the vast spectrum of individual views, we chose to use an online platform where participants could respond to questions and activities set by our researchers using an anonymous profile and in isolation from other participants. This allowed them to be completely honest in explaining how they felt about the vaccine without fear of judgement on a topic that is often lacking in nuance in group conversation, particularly on social media. Their valuable feedback has gone on to inform government policy about how they communicate about vaccination with different groups.
Similarly, the Cass Review, which looks at how to develop and improve the services provided by the NHS to children and young people who are questioning their gender identity, commissioned us to create an online multi-professional research panel. In this project, it was really important to hear the full range of views to help develop a clear understanding of the current issues healthcare professionals were experiencing. Again, this meant that it was vital to create a safe space for participants to respond to our questions and activities candidly and honestly, before playing back key themes – rather than personal opinions – to the group for further exploration and discussion.
How does lived experience inform the way safe spaces are created?
That’s something we’re making great strides in, in partnership with REBLE (Research Enabled by Lived Experience), the lived experience advisory panel we set up in February 2021.Together, we’ve got big plans to co-design great research and engagement activities that authentically shares power with people with lived experience and sets the standard for co-production in research.
REBLE and Traverse have worked hard to establish a space to work together that is safe and have developed a set of guidelines that become our actions not our words. The guidelines include the need for good and respectful relationships, built on sharing and bringing our whole selves to the group, recognising it takes time, reflection and acceptance to establish this connection.
We invest time at the start of the process to make sure we include everyone. We think about timing, our relationships, the pace and the language we use. We create a safe and supportive space to be courageous, to take risks and to do things differently. We don’t shy away from challenging and uncomfortable conversations, experiences or topics.
We constantly try to reflect and then review how we connect with each other. We remember the emotional impact this work can have on us. Our individual skills, lived experience and wisdom are all valued equally. We spread and share our learning, aiming for the best we can in ourselves and our work. Everyone gets recognised and paid for their work.
If you would like to find out more about how Traverse can help your organisation to create safe spaces for complex health and care conversations, please get in touch with Jessie on: email@example.com
Jessie will be attending NHS ConfedExpo on 15-16 June.