Domain 1: Building on Expert Person-Centred Practice

What is Critical Companionship?

A critical companion can be any person committed to developing a supportive and challenging relationship for the purpose of mutual, experiential learning and inquiry based on being person-centred. A critical companion does not need to be in the same field, profession or specialism. It is often preferable that critical companions come from different perspectives as it is easier to ask questions about areas of work that are often taken for granted.

The aim of critical companionship is to enable mutual learning and empowerment through joint inquiry, to enhance professional practice and improve experience and outcomes for those both experiencing care and providing care by focussing on what matters to them. This is achieved through creating a safe, person centred, trusting relationship and environment for reflection, high support and high challenge to enhance mutual learning, growth and development so that everyone can thrive – the characteristics too of good learning cultures.

The framework is evidence based and was developed by Angie Titchen a physiotherapist who supported other health care professions to develop their own practice expertise as well as enabling others to learn, develop and improve in the workplace. The framework in Appendix 1 (below) is derived from the original evidence base but identifies the enablers that support critical companionship, the attributes that help you recognise what would be happening in a critical companionship relationship and the positive consequences for all. The symbol þ identifies the strategies that critical companions would use to support and enable others in their formal and informal learning, development and improvement activities.

Whist critical companionship is a sophisticated model, Michele Hardiman has teased out two steps towards becoming a critical companion first as a critical ally, and then as a critical friend.

Hardiman, M., (2017) “Using two models of work-place facilitation to create the conditions for development of a person-centred culture: A PAR Study” PhD Thesis (unpublished) Queen Margaret University Edinburgh. (The refined conceptual models are presented here).

As this thesis is not published, you can access the refined models more easily in Hardiman & Dewing (2019).

Hardiman, M., & Dewing, J. (2019). Using two models of workplace facilitation to create conditions for development of a person‐centred culture: A participatory action research study. Journal of Clinical Nursing, 28(15-16), 2769-2781 (This article shows the two final models in action in the workplace).

How is it different to mentorships and coaching?

Whilst some strategies used in critical companionship may be similar to coaching and mentorship. The main difference is that critical companionship focuses on:

· being person centred and knowing the person you are helping in their contexts. A critical companion brings who they are as a person, as well as a professional, to the relationship and their multiple ways of knowing.

· what matters to people

· providing and evaluating high support and high challenge

· commitment to mutual growth and learning for all

Critical Companionship for supporting multi-professional consultant practice in all its domains

Critical companionship as an approach would be expected to be at the heart of multi professional consultant practice as a way of being, knowing, doing and becoming in any kind of relationship to support others, their learning and their practice. Critical companionship embraces all multi-professional consultant practice domains and contexts from micro to meso and macro levels of the system. Such relationships have been demonstrated to be instrumental in achieving positive impact in care and services (See Akhtar et al, 2016) for people. For this reason, identifying a critical companion as a participant in a developmental programme is important, ideally one from within your own organisation and one external to it to focus on specific and or different development needs.

Choosing a Critical Companion

There are no criteria that need to be fulfilled except those commitments identified above combined with an interest in pursuing mutual interests and embarking on a journey of inquiry together. You may decide to draw on different critical companions for specific areas of development that you are interested in pursuing in your developmental journey based on your own self assessment. Critical companions would be able to help you to identify opportunities for growing expertise in various capabilities and consider the appropriate range of evidence sources required to demonstrate their achievement for your portfolio.

Commitment required as a critical companion

A single critical companion would not be expected to support more than 2 people at any one time and would normally negotiate with the participant what is mutually realistic in terms of frequency of meeting, length of time and also the medium too which could vary from virtual, face to face, informal and formal settings or all perspectives at different times?

Normally a critical companion would not be paid as this is a professional role but one that can also benefit the critical companion as well as the participant in the joint learning together as well as the skills developed.

Several resources are being developed to support both those who are critical companions and those learning to develop skills in being critical companions to continue on a journey of continuous learning.

Copyright to K. Manley. ©

References

Akhtar, M; Casha, JN; Ronder, J; Sakel, M; Wight , C and Manley K (2016) Leading the health service into the future: transforming the NHS through transforming ourselves. Original Practice Development and Research Volume 6, Issue 2, Article 5 http://www.fons.org/library/journal/volume6-issue2/article5

Hardiman M and Dewing J ( 2015) Critical Ally and Critical Friend: stepping stones to facilitating practice development International Practice Development Journal 4 (1) [3] http://www.fons.org/library/journal/volume4-issue1/article3

Titchen A (2003) Critical companionship: part 1. Nursing Standard, 18(9), 33-40.

Wright, J., & Titchen, A. (2003). Critical companionship part 2: Using the framework. Nursing Standard, 18(10), 33–38.

Titchen, A. (2001) Critical companionship: a conceptual framework for developing expertise. Chp 10 in Higgs, J. and Titchen, A. (2001) (Eds.) Practice Knowledge and Expertise in the Health Care Professions. pp 80-90. Oxford: Butterworth Heinemann.

Hardiman, M., & Dewing, J. (2019). Using two models of workplace facilitation to create conditions for development of a person‐centred culture: A participatory action research study. Journal of Clinical Nursing, 28(15-16), 2769-2781 (This article shows the two final models in action in the workplace).

V2.1 KM & AT 19 8 2

Resources

Click Here to view: "Starter References: Setting out on the Journey to Critical Companionship"

Here is the link to the NHS England Consultant Level Practice Resource:

https://advanced-practice.hee.nhs.uk/consultant/