Getting skin in the game- starting a provider organisation

Abhishek’s blog crystallised something that I had been feeling but had not been able to articulate as clearly as he did. Over the last two years I have been a coach on Seth Godin’s AltMBA. This means that I work closely with 20 students, with a co-coach, and comment on their ‘assignments’ known as prompts.

Abhishek, one of our students, began his first prompt with this:

I’m a big fan of Nassim Taleb. He often brings forth counterintuitive, non-conventional ideas with extremely convincing arguments. He introduced me to a concept known as ‘skin in the game’ – berating how most academics and consultants (me being one of them) did not have anything to lose for the ideas they propagated (me advising entrepreneurs on business strategy, without facing any potential downside of that strategy is one example). While this may be an extreme view, it hit a note with me.

It hit a note with me too.

Over the past twenty years, since leaving Occupational Therapy, I have worked as a trainer and consultant. Twenty years of projects, courses, conferences, and sharing what I have been trying and learning through twenty books. I have been immersed in a world of person-centred practices, one-page profiles, personalised care and support planning, personalisation, person-centred reviews and Working Together for Change. I feel like I have made offers of different ways of working, and helped to show what these could look like in practice.  I hope I have had a positive influence in some way.

Consultancy often feels like trying to make a contribution to (or ‘messing with’) other people’s projects.  Seth Godin says,

“There’s a difference between signing on to someone else’s project and starting your own…It’s yours, you own it. Might as well do something you are proud of, and something that matters, because it is your gig.’

Looking back, two of the most satisfying pieces of work I have done, were with Dimensions exploring Individual Service Funds, and working for two years with a care home, Bruce Lodge. They were satisfying because I proposed the idea and then worked directly with senior leaders and first line managers, we were intentionally crafting and testing new ways of working, and could see and record the impact this had on people’s lives, over time. We learned deeply, recorded and shared what we were doing through books and different media. I facilitated, contributed content knowledge and personally learned and developed. They were still in someone else’s organisation, someone else’s gig.

This September, now, I am starting my own project, and getting skin in the game in a new way. Over the last year I have been working with a series of pilot Wellbeing Teams. I have worked with other business owners, like Maddy and David in Love2Care, testing and learning together. I have learned that when it is someone else’s organisation, whether this is Dimensions, Bruce Lodge or Love2Care, where I am not responsible for their finances, their registration with CQC or reputation, naturally, there is only so far you can go. I have learned that to go to the edges of what I want to test and learn, the risks that I want to take, cannot be done with someone else’s organisation.

I am setting up a new provider, Wellbeing Teams, and I am going through the process of registering with CQC. I will personally be the Registered Manager, if CQC accept me after my interview in a weeks time. I am still part of H S A, and will still be speaking at conferences and working with the team towards the same vision. I now want to demonstrate, in practice, what one-page profiles, person-centred reviews, person-centred teams, care and support planning and Working Together for Change, can actually look like in teams supporting people living at home. My plan is to start in home care, and also look to supporting families and people with learning disabilities, and people using mental health services, as well as within primary care.

I will share what I am trying and learning, where I am failing and hopefully succeeding, through blogs and films.  This week I am getting ready for my CQC interview – it feels like revising for an A-level. I am scared and excited to finally get some skin in the game.