Thinking a lot about the nature of the task (and it is a paradoxical one) of standing in front of a team (that usually already has a great deal of expertise) and suggesting to them ways that they may wish to change their understanding and practice... so as to get better.
We bang on about the need to support self efficacy in teams (as in our patients), but tell 'em what to do... well, not quite: part of our method is to avoid trying to generate teams that are badged as "AMBIT teams" - but instead to offer AMBIT as a platform upon which local teams can find space to develop and share their own locally-developed and locally-tested expertise, in a "fecund mix" of evidence based practice, and their own hard-won practice-based evidence. This might be seen as a bit tricksy in one way, as our manual "template" (upon which we hope they'll write and show their improvements and tricks and techniques)is pretty big, even overwhelming...
Part of it requires a shift towards an outcomes-focused approach - does this stuff make a difference in the direction I want it to (or more importantly that my patients want)? So then the challenge is not just to show a team some neat and satisfying ideas and tricks, but to make a difference to their outcomes, and more than that, to establish patterns of behaviour that are sustainable. That last sentence is a double-entendre - but not in a saucy way. The behaviour change made by a team can be sustainable or not (i.e. does the team keep doing it?) but also, the method of working can make a team sustainable or not (i.e. do the workers burn out, get sick, get bored?)
We figure that the people that WRITE the manuals are generally the best at FOLLOWING them, too, but that there is also this stuff called evidence out there, that is better than benign eclecticism and safer than the lonely visionary; hence the different layers of content in tiddlymanuals or tiddlyspace - the capacity for one person's (or team's) wiki to include the content of another one's, and then to overwrite pages written by others - to create my own local version, without in any way affecting the pages that the original author wrote, and still curates.
We have recently been invited to write a paper for the journal Attachment and Human Development and we are thinking about help-seeking behaviours a lot, and how might a treatment manual act as a kind of place to turn to for help. Look at how Google have managed it! A locally-adapted tiddlymanual might act a bit like that - a place that people turn to, if a better "secure base" isn't available.
Our developing hypothesis is not to suggest that a bit of wikification can or should ever replace a great supervisor or experienced colleague, but that in the absence of that person, people might turn to a great looking manual that "delivers the goods" predictably... but in the same way that we are able to "scribble" over our parents and other attachment figures (in the privacy of our own minds we can, and usually do, hold our own ideas about what our parents reveal of themselves) we can also "scribble " over the core manual - hold our own ideas about it, if you like... and just as this makes our parent/attachment figure recognisable, familiar, safe to us, so - we hope - our wiki-adaptations help to make the manual feel recgnisable, familiar and safe.
