Not a one-size-fits-all approach: effectively supporting practitioners’ reflective practice

“Mentoring in complex clinical settings is an effective approach to learning and development because there’s so much to take on: intellectually, mentally and physically. But there’s no one-size-fits-all framework - for mentor nor mentee - and that’s why incorporating reflective practice can be really valuable, especially when there are opportunities to share and reflect together.”

Conni Rosewarne, Music Programme Manager, Royal Brompton & Harefield NHS Foundation Trust.

What’s the story?

Established in 2002, rb&hArts is the designated arts team for Royal Brompton & Harefield NHS Foundation Trust. We provide a range of creative opportunities for patients, their families and staff to enhance the patient experience and improve wellbeing. Our core music programme includes the longest running Singing for Lung Health programme in the UK: Singing for Breathing; the Musicians in Residence live music programme for adult inpatients on wards and hospital bays; and Vocal Beats, a participatory singing and beatboxing programme for paediatric and young adult inpatients, funded by Youth Music.

The rb&hArts Musicians in Healthcare Mentoring Programme grew organically from our work across all these programmes, and aims to diversify the creative skillset of our team of musician freelancers, develop capacity in the industry to deliver high quality participatory music activities in clinical settings, and actively share our learning and expertise of working in these settings. This case study mainly focuses on the first round of the programme (2018-19), but draws from some learning from the second phase of the project (2020), which took place mostly online.

How does the programme work?

The mentoring programme aims to address the gap in arts and health provision for young people, and responds to the huge desire from early career musicians to work in healthcare settings. The opportunity to participate as mentees is advertised via professional arts and health networks. A recruitment panel (including the rb&hArts Head of Arts and Project Assistant, the Vocal Beats lead musician and representation from partners Sound Connections) select candidates from a CV and cover letter. Musicians recruited for the 2018-19 programme included two guitarists, two flutists and a percussionist, with prior experience working in primary schools, special schools, refugee centres and music colleges, but looking to establish skills and experience working in arts and health clinical settings.

Once participants are selected, the programme begins with a detailed induction, which covers what we do as an arts team, what arts and health is (as much as it can be defined), and the theoretical underpinnings of inclusive music practice. Mentees become members of the trust, receive an honorary contract, an NHS DBS and occupational health check, training in infection control and information governance, and a bursary of £400 to cover expenses. We also offer each of the mentee musicians an individual developmental needs assessment. Each of the mentees initially shadows every musician delivering activity across the core music programme, before selecting one mentor musician (who are also paid for this time) to shadow more closely. In total, this equates to 40 hours (or approximately two weeks) of one-to-one mentoring in total. The programme concludes with a debrief session with mentees to allow for reflection, feedback and signposting to future opportunities.

Mentoring in arts and health settings

Complex clinical settings are really difficult to navigate, but they are especially difficult to step into for the first time. There’s so much to take on: intellectually, mentally and physically. It requires a fairly intensive learning process, which you can’t do through theory alone. There’s a real nuance to the practice, a lot of which is founded on the effective development of relationships with patients and staff on hospital wards. You have to acknowledge you’re in their space, which requires a certain amount of emotional intelligence to navigate. It’s also quite hard work! It’s physically demanding walking around all the time, you have to get to know hospital spaces, you have to get to know the people there, and you have to become acquainted with the conditions. You have to understand infection control. You have to understand information governance. You’re also probably going to be in circumstances with people who are very unwell - including children - and some of them may well die. That comes with its own set of real challenges, and there is a need for real emotional and mental support, as well as direct supervision, in any kind of clinical work in healthcare settings.

That’s why the main focus of the programme is centred around giving mentees real, ‘on-the-ground’ experience. The kind of one-to-one mentoring we offer gives the mentee musicians an opportunity to explore their ideas and hone their craft in that context alongside a mentor musician who is experienced working and developing their own practice in healthcare settings. As 2018-19 mentee Lila describes, it was an opportunity to “experiment with new techniques and ideas in a safe and supportive environment”, building confidence in an otherwise unfamiliar environment. Nicola points out this gradual process enabled them “to respond to situations more appropriately, and eventually start to take initiative as my confidence increased”.

Mentoring programmes can afford different modes of learning, incorporating theory and practice. But as it is not a ‘one-size-fits-all’ model of learning and development, reflective practice is crucial. At the end of the programme, we ask mentees to write reflective essays, based on their notes made after each session throughout the programme. These combine ‘in the moment’, first-hand accounts, stories and learning recorded during their time on the wards, with more reflective analysis on, for example, the broader social or emotional value of music in health and wellbeing contexts. It is fairly common practice in some areas of clinical practice (e.g. respiratory physio), as you’re learning all the time, but I believe everyone in arts and health should be using reflective practice. By writing your experiences down - by finding a way to get them out of your head - it enables you to process and explore them further.

What’s the learning?

Be sure to establish a clear framework for supporting reflective practice.

When we first developed the programme with the aim to develop individual practitioners’ practice, we knew the reflective practice aspect had to be mainly directed by the mentees themselves. After all, we can’t tell them what their development will look like; we can only give them the parameters that it has to happen within. So at the first meeting when we started the programme, we said to everyone: ‘do some reflective practice after your sessions’, ‘just go and reflect’. Understandably, the mentees were like ‘what are you talking about?’ We realised we needed to be much clearer and more explicit about what we expected from them. In addition to the regular contact they were getting with their mentors, we needed to be more hands on in supporting them through this process.

Luckily our lead musician for Vocal Beats, Heather McClelland, had done a lot of work in this area and created a set of initial questions for each mentee to respond to at the end of each of their sessions. These were quite basic questions, or prompts, to help evaluate music interventions that the mentees observed such as: ‘Who was there? What activity did you do? What techniques did you use? What do you think went well? What didn’t go so well? How did you notice the participant respond? How do you feel now?’ We asked each mentee to note down their answers to these questions after every session.

After the first phase of the project, we built on this to create a more comprehensive reflective practice toolkit for mentees [see pdf download for details], which asks them to set further goals and intentions, to reflect on what existing tools and skills they have already as well as where they want to develop and get to by the end of the programme. Over the course of the programme, participants were able to build up a clearer picture of their development, and this informed their reflective essays at the end of the project.

Prompt participants to be open about failure and use it as an opportunity for growth.

The aim of these reflective exercises is to give musicians the permission to admit when things didn’t quite got the way they wanted, or expected. This can be quite a hard to thing to do, especially if you’re working in an unfamiliar environment for the first time; there can be a lot of pressure. Our mentees appreciate they’re being offered the unique opportunity to work with patients in a hospital and consequently feel more pressure for things to be ‘amazing’ all the time. By actively providing them with the framework and language to reflect when things don’t go to plan, we reinforce the idea that failing is part of developing confidence in working in clinical settings, and often requires responding to things ‘in-the-moment’.

While individual learning is key, sharing and reflecting together helps to consolidate that learning and feel part of a shared endeavour.

While mentees said they felt supported by the rb&hArts team and their mentors on the whole, some of the mentees fed back that the programme could feel like ‘a solo journey’ and suggested that they would have liked more opportunities to meet together as a group. In future, we aim to organise more group mentee sessions as a space to discuss their experiences - either formally with a facilitator or informally at regular intervals - and support one another throughout the process.

Opportunities to share experiences are just as important for the mentor musicians and the music leader team. In fact, as Aiden remarks in their project essay, the diverse nature of working in healthcare settings meant that “the musicians I was shadowing often remarked about how little they knew of what each other were doing”. We’ve trialled facilitating regular musician meetups on Zoom across the pandemic. Overall I think people have appreciated the opportunity to talk together as professionals, not just work in silos, and to recognise themselves within a wider project. Of course this can be difficult to facilitate (even online!) given everyone’s busy timetables, but that’s why it’s important to plan these sessions into the programme from the start, to ensure we can make the most out of the time we have together.

You need to ensure that you create a really robust infrastructure that embeds that space for reflective practice and supervision into the fabric of the programme, from the outset.

This is significant learning for us on this project, which we’ve only really learnt by doing it. Projects like this are always so much bigger than they first seem. So in terms of capacity, you have to make sure you’ve got enough money in your budget for external supervision, and to pay people for their time to attend reflective practice sessions. This has to be included in practitioner fees from the outset. It’s both time and resource-intensive, but crucial.

Invest time and resource in training mentors too.

You can’t just say ‘please go and mentor some people’. You have to really interrogate what that means specifically for the project and the specific groups of people you are working with, and then provide the adequate training and space in order for that to happen effectively. Through the independent evaluation of the programme, we know mentors valued opportunity to share and articulate their skills with a diverse array of early career musicians, with different skillsets. “Acting as a mentor helped me solidify my own knowledge and gain more confidence in my practice” one of the core musicians mentors suggested, “it was a great opportunity for me to critique my own work as well as the mentees, evaluating how my practice is most beneficial to participants.” Nevertheless, it became clear that some of our mentors were more comfortable with leading debrief sessions than others. We identified a real need to get some tailored training on what mentoring looks like, what it entails, and how the mentors can incorporate their own reflective practice.

Expect reflective practice to impact all areas of activity.

We’re encouraging and supporting reflective practice with all our practitioners involved in delivering projects and we have started to roll out the use of our reflective practice toolkit to other parts of our programme. From a practical delivery perspective, facilitating this reflective space has contributed to the evaluation of the project as a whole, highlighting areas of the programme we can develop and improve. A key outcome of this has been more collaboration with clinical staff, as we are proactive in creating spaces for discussions and able to listen to contributions from them on key aspects of delivery. We encourage anyone who applies to the programme to read the mentee’s reflective essays and they now enter the programme ready to consider what they would like to go and try, or get out of the programme, giving them a sense of what kinds of experiences to expect. This approach has not just been beneficial for our participants, but has directly informed our activity across the programme, and will no doubt continue to be a crucial component of future iterations.

Case study written by Conni Rosewarne, Music Programme Manager, Royal Brompton & Harefield NHS Foundation Trust.

Edited by Emma McDowell, University of Leeds, on behalf of the Centre for Cultural Value.