Values-driven practice (explained using Quilt Theory).

If you are wondering what values-driven practice might look like, or what Quilt Theory is, and how these apply ideas to social work (or mental health nursing and any sort of people work) then this blog is worth a read. Quilt Theory, as a construct that explains how health and social care practitioners attune to, and use, their values in their work is a new theory. Brand Spanking New. As in it-popped-into-my-head-at 4am-this-morning new!

Let me explain…

This week, I had the honour of being invited by Siobhan Maclean and the Social Work Student Connect team to speak at a webinar about my book, He Died Waiting. The topic was ‘Values-driven social work practice: applying the lessons from He Died Waiting’. I was a bit nervous and I had a few technical glitches that meant for portions of my talk I couldn’t see all of my prompts. So, I missed a few things that I had intended to say. Writing this feels like a bit like finishing off one of the quilts I make. Sometimes, I think I am done and then I notice places where I have missed a few stitches or some embellishment is needed.

In He Died Waiting, a story about my eldest son Tim who died waiting for a mental health appointment, I talk about quilts quite a lot. There are passages about the quilt I made for Tim and some sections where I describe how I made memory quilts for the people who Tim loved and who loved him. This was a therapeutic process for me and I write about the importance of sewing as a way of managing overwhelming emotions. I used photos of some quilts mentioned in my book to illustrate my presentation.

We social workers go on a lot about values. But how much do we really understand about how our own interact with the professional and organisational values we are obliged to comply with? This is something that students grapple with. I was not surprised by last night’s responses to the question, ‘what are social work values?:

- Compassion and empathy

- Honesty

- Integrity

- Reliability

- Non-judgemental

- Empowering

- Social justice

- and so on...

These all fall under values we might own as our personal or professional values. We can quite glibly say them. But do we really own them? Can we ever be non-judgemental? As we go about our work how empowering are we? I think we all, including me, fall short quite often. In part this is because we don’t pause and reflect and unpick what these concepts mean to us in enough depth. This is where Quilt Theory – trust me you are going to love this- offers a way of understanding.

If Quilt Theory is an overarching macro-theory, we need to recognise that there are different sub-theories. Just as Behavioural Theory has sub-theories such as Operant Conditioning or Social Learning Theory, so Quilt Theory has different, but related, ones. In, applying Quilt Theory to values I have identified the following:

- Personal values: these are the values/quilts that belong just to us. They are unique and might have been with us since childhood, maybe even passed down through generations of the family, or they could more recently acquired. We might wrap ourselves in them to feel warm and comfortable. Or we might have them stored in a cupboard. If they are in a private space, only we may see them. But they could be proudly on display. Some might be worn and damaged. They might have been lovingly repaired. Or discarded. Most of us are like ‘scrappy quilts’ (my favourite kind) that are made from whatever materials we have. Like our life experiences, these might be made up from pretty, bright, sparkly, dull, mundane, or downright ugly pieces but together they form a beautiful whole. Our personal values make perfect sense to us as a way of explaining things.

- Professional values: These have prescribed characteristics and represent a shared understanding of what a quilt should be. They might have set ‘block’ patterns, colour palettes, or methods of construction. In the quilting world we recognise different types (wholecloth, strippy, sampler, pinwheel etc). Often a group of quilters learnt from each other and a particular style is associated with a place (eg Durham strippy, Baltimore, or English paper pieced). Similarly, different professions have their own criteria. Social work values/quilts are based on ethical principles (think organic or ethically sourced materials here) and laid out according to the BASW code. Nursing professional values/quilts might look similar to social work but they have distinct differences. For example, the NMC code specifically mentions compassion and kindness. Professional values/quilts should be aspirational – the ones we work towards acquiring through our professional training and reflection. I think an aspiration for social work values would be to adopt compassion and kindness into its code.

- Organisational values: These are like functional, mass-produced quilts. They might look good from a distance but up close the stitching will be regulated and the materials might feel stiff. Each organisation will have its brand colours and design. These quilts are more likely to be functional, efficient, and value-for-money rather than cosy comforters. In some of the environments that we work in the quilts are not quilts at all but scratchy grey blankets that our leaders call a quilt. We might not like these values/quilts but we must use them if our organisation require us to. We might not pay enough attention organisational values but we should because they sets the context of our practice.

- Service-user values: Just as we have our personal values the people who we serve will have theirs. These might, or might not, look like ours. Service-user values/quilts could have deep cultural significance that we might not understand. For example, Welsh quilts look very similar to Amish quilts in their use of colour blocks and heavily stitched patterns but Amish quilts reflect religious beliefs. They are distinctly different. I love Japanese Boro quilts. These are randomly stitched layers of fabrics (traditionally made by poor people as a way of creating quilts for warmth out of worn and discarded fabric remnants). Some people see just tatters but I see resilience, ingenuity, and love. As professionals, we might look at a service-user’s values/quilt and think it needs repairing or replacing. We might cover theirs with our own personal or professional ones and potentially stifle people with our good intentions. We could be asking them to discard a treasured quilt that has brought them a sense of comfort and safety for many years. I’m thinking here about how many of us had ‘quilties’ as children that we adored. Even when they became grey and stinky rags it would cause distress if they were removed or washed. Too often we ignore or over-rule service-user values/quilts.

Now I shall apply Quilt Theory to understand the differences between values-based and values-driven practice.

Quilts are typically made with three layers that are joined together by stitches. The top may be plain or a made of patchwork. A plain quilt top without its layers is just a piece of material. A patchwork top without its layers is all show and no substance – flip it over and all the raw edges are visible. If we take our values to have layers they might look like this:

- A top layer that is on display. The values we are happy to show to the world or that others can see.

- A foundation or base layer, that is only seen if we turn it over. This might be as beautiful as the top or it could be messy. But if it is looked at through reflection, it is easy to see what values might underpinning our practice.

- A middle layer (the batting or padding) where all the tangled threads and raw edges are enclosed. Here lurk the values that we know about that we do not wish others to see, or those that we are not aware of. Sometimes, I accidentally catch up some detritus from the sewing room floor, or even pins, into this layer. However, it is this part we cannot see that provides warmth and we might discover hidden treasures within. I would suggest our deeper emotions dwell here. We might need to unpick a section of our values/quilt to see what is inside and maybe remove something that shouldn’t be there. This might mean we have to repair a section where the seams have been ripped open.

These layers might joined by simple stitching or by complex stitched patterns. This mirrors the way we weave theory through our practice.

In my view, values-based practice is like a well-constructed basic quilt. For decades I have talked about the importance of values-based practice. I aspire to be informed about, and by, my values. I would liken this to a quilt I made of patchwork squares from Tim’s clothing. Each square represents a different aspect of my values in a regular pattern. It has great meaning for me, it is fit for purpose, and it forms a visual reminder. I can sit on it as a foundation to practice from. Sometimes I cover myself in my values/quilt to justify my position. But maybe I am just hiding under it?

I have only recently started thinking more about values-driven practice. This has more direction and suggests a deep sense of purpose. By committing to values-driven practice, I have to make difficult decisions about any conflicts between my personal, professional, and organisational values. My values then are not an underpinning or covering layer, they set my course. They direct my life and career choices. Values-driven practice looks more like a quilt I made for Tim’s cousin (in the photo). It has all the same elements as the first quilt, and shares some of the same fabrics, but it has a more obvious focus and is more easily recognisable to others as a quilt that is expressing love.

So, taking Quilt Theory as a basis for understanding how your values drive your practice, consider the following questions:

What is your purpose? Think about which values inform what you are trying to, or must, do. So much of the *care* Tim received followed an organisational purpose of targets and repeat assessments that didn’t lead to treatment. What he needed was a quilt he could become familiar with, one that offered warmth and safety. What he got was more like a foil ‘blanket’ that temporarily prevented hypothermia but wasn’t going to work long-term.

How will you see the beauty? Try and appreciate the individuality of people and recognise their strengths. Tim’s files missed the point of him. His beauty and worth were totally missing. He was described as a series of his deficits and shortcomings. Viewed as a heap of rags rather than a finely crafted Boro quilt.

Will you look beneath the layers? This requires a commitment to reflexivity and to being prepared to unpick and repair where necessary. Are there values you need to re-evaluate or maybe even cut out and replace? In my view carefully repaired quilts reflect that they are worth working on. Can you see beneath the layers of other peoples’ values/quilts?

Quilt Theory is a whimsical invention, not a peer reviewed theory based on research evidence, but an analogy that might help you remember to think about your values . Hopefully my musings have been thought provoking.

My final point is to say we can learn from quilters. They are a kind bunch. They share ideas and materials, often work together, and thoroughly enjoy teaching their craft to others or gifting their creations. A value, that I treasure most, is kindness. When we operate out of kindness we value people and make better decisions. Being kind to the people who need to use services might mean we have to challenge systems and professionals sometimes. It does not mean being fluffy about injustice, poor practice, or abuse. We need to be kind to ourselves, to our colleagues, to the people we serve. And

let's support each other to take kindness with us as we progress through our careers and lives.