Co-production in action: Welsh Ambulance Service NHS Trust

James Moore of the Welsh Ambulance Service NHS Trust (WAST) has kindly shared with us the redesign that WAST has been going through and which has been shortlisted for an award. It centres on creating adult-adult and coach-creator relationships with colleagues, partners and patients – and leads on to an invitation to get involved.  Read on!

Transactional Analysis and the Drama Triangle:
Change our behaviours and we change patient outcomes!

We all have choices as to what state we’re in and, therefore, how we behave. We have 3 different states that we can be in: parental (nurturing & controlling), adult and child (adapted & natural). Our reactions are based on our learnt behaviours, many come directly from childhood.

We can play in all the states and there are consequences of being in one state too much or too little. Our individual behaviours in each state are most likely to have been learnt from childhood, but recognising these, gives us a chance to choose the best state and behaviours.

Telling someone what to do ultimately gets 2 answers back: a child-like response (compliance or resistance) or a returned parental response (I’m more right than you)… this can rapidly slip into childlike behaviours from both people. Treating each other as adults and with equal respect releases potential and ensures that both parties are “ok”. (NB: positional power is often a barrier to this).

The drama triangle plays out every day. It’s really damaging as everyone ultimately becomes a victim. Public services tend to attract rescuers, who need victims, but we give worse services as a result.

Be it controlling or nurturing parental behaviour, we can change what we do. Ultimately, the development for many of us means trusting other people and letting go. We can still influence, but we can do it through constructive challenging and true coaching by asking questions and not rescuing someone or telling them what to do.

Work on Values and 360* recruitment

Over the last 2 years, the Trust has moved from using selection processes to assess not just what a candidate does, but also how and why they do it with a view to understanding what values and principles candidates work by and whether they can work to our Trust’s principles. This has proved to be successful.

To move this on further, we wanted to develop approaches which really build on the “wisdom of crowds” and move the organisation even closer to genuine co-creation and co-production and away from “parent-child” and “rescuer-victim” relationships.

We have decided to encourage every single stakeholder in our Trust to join selection events to help provide feedback on what they noticed about candidates and how they made them feel during the selection processes. We also have invited any colleague to facilitate the corporate inductions.

Importantly, we have developed a selection and induction facilitation personal development workshop for anyone wanting to be part of the events. Being involved in these events is a pre-requisite of being part of assessing others.

. Increased engagement from stakeholders: “power is where decisions are made”, so encouraging individuals to make real decisions, they have become far more engaged with the Trust.
. Willing participation at events because individuals are choosing to be there themselves
. Reinforcement of the Organisational Design and culture through the approach
. Deliberate challenge of parent-child/manager-staff power, and moves relationships to adult-adult states

. Few, if any! Some discomfort from Senior Leaders, but this is actually helpful!

An invitation: Decide who works in WAST!

What’s our goal?
We want to ensure that our future colleagues are able to do their jobs well in both what they do, but also in how they do it. This means, all our colleagues must be able to:
. Connect well with others especially patients, colleagues & partners
. Notice their impact on others and be able to change how they do things to get the best possible outcomes
. Live the values and principles of our Staff Charter

What are we doing?
We are ensuring that we have lots of different people able to be part of choosing who are our future colleagues. They’ll do this in group discussions with each candidate on a real subject.
Anyone interested in/involved with the Trust (e.g. patient, partner or current colleague) is encouraged become a selection assessor. To help them with this, we are providing some training to help notice behaviours and someone’s impact on them.
We will continue to help our current colleagues to develop the above behaviours and, of course, develop their knowledge and skills so that what they do continuously gets better.

Why are we doing this?
We know that how people do things is often as important as what someone does. As we all work with lots of different people, it’s really important to get different perspectives on behaviours.
Also, if we’ve been part of making a decision, we will own it, so we’ll want to make sure it works.

What’s your role?
Your role is crucial, as you will notice the behaviour of candidates in real group discussions and notice how they make you feel. As you are unique, how each candidate makes you feel through their behaviour is vital to help make the best possible selection decision.
We’ll support you with some training so that you can reflect on the behaviours we’re trying to encourage and noticing the impact of someone else’s behaviour in group activities. This is a requirement for anyone who is part of a selecting our future staff.
After this, you will be part of a group of assessors and you’ll be asked to be part of selection events locally to you whenever you can.

What do you need to do next?
We have training events set up across Wales during 2014, so you’ll need to arrange to come to one locally to you by contacting or 07725 786971.

James Moore is Assistant Director, Organisational Design & Development and  can be contacted at