Exploring the experience of volunteers and paid staff in hospices, using LEGO® Serious Play®

Liz Dixon is a senior lecturer at the University of Huddersfield. Liz has a keen interest in palliative care and the work of the hospice movement. She has enjoyed a long association with a local hospice, and serves on the hospice board of directors. She recently spoke at the NCVO conference about her doctoral research with hospice volunteers.

I wanted to find out more about the hospice where I am a trustee, particularly:

• the experiences of hospice volunteers
• how volunteers work with paid professionals
• how the organisation shapes the experiences of volunteers.

I have learned a lot from observing, shadowing and interviewing volunteers and staff to find out more about the work they do. But, facilitating groups of four to six people to build LEGO® models to represent their individual and collective experiences gave me entirely new insights. The groups were based on the principles of LEGO® Serious Play® (LSP).

I recently presented a paper at the 2016 VSSN Conference about my doctoral research in this area.

Why participatory research is different

The LEGO® models are used as a focus for conversation and discussion, and to explore the nature of the volunteer role and relationships of volunteers and paid staff in the hospice. Interviews, focus groups and questionnaires also collect qualitative data but ask that people produce instant descriptions of what they’re thinking or feeling – this is hard to do. The LEGO® sessions help people to open up and develop their ideas leading to more detailed responses.

Windows into ideas and experiences

The models that people build provide useful windows into their ideas and experiences, which they share and discuss with the rest of the group. For example: the volunteer role or the relationship between the volunteer and the paid staff.

The groups have also done some joint models, giving them the opportunity to discuss aspects of the research questions together, and to consider:

• how volunteers might feature in the future development of the hospice
• opportunities and barriers for extending provision of hospice services, using volunteers
• perceived and actual risks in using volunteers within the hospice.

Advantages

LSP provides individual responses, like you would get from interviews but also the kind of group interactions that you’d get in a focus group.

My experience was that it gives people time to think before they respond, and they are usually encouraged by doing something new. Most participants seem to enjoy the ‘return to childhood’ and the opportunity to play, while discussing some important and interesting ideas.

Hearing the responses of other participants has led to discussions about how the hospice can use volunteers even more effectively to develop its services in the future.

Challenges

I needed to ‘sell’ the idea to participants, to explain it to them before they would usually agree to take part. Photographs of previous sessions helped though! Not everyone thrived in the group, the same way as some are uncomfortable in an interview or focus group.

Some people also wrestled with seeing themselves as ‘not creative’, and they sometimes started worrying that ‘style and the look’ might be more important than content and meaning.

Even though LSP sessions are usually fun and ‘playful’, the nature of hospice work meant that emotions did sometimes come to the surface during the conversations and discussions. I needed to be sensitive to that and supportive of everyone involved.

What you need to get started

• Time and space – the sessions last at least 1.5 hours, and finding a suitable room isn’t always easy
• Practice – it takes time and a few attempts to get good at running LSP sessions
• A supportive environment – the nature of the work means that the private becomes public: It is important to give people the time and confidence to feel all their contributions and ideas are valued.

What we found out

The symbiotic relationships between volunteers and paid staff

People used ‘gems’, ‘gifts’ ‘backbone’ and ‘treasure’ as metaphors.

A tower of strength supporting us and bringing time and generosity. They want to come…they’re a right tonic.

– Volunteer Co-ordinator

It’s the little things… you don’t realise how good they are until they’re not there… they do such  a good job so when they’re not there… they’re just part of what’s normal… and they do give you a lift.

– IPU Nurse

Support and development

It’s our responsibility that we are seen to be supportive… it is your family isn’t it? There’s nothing more satisfying than seeing a volunteer striding round the hospice like it’s their home… like they belong here. What a difference the hospice can make to them and how they flourish. We see such a massive change in some volunteers.

– IPU Staff nurse

I mean I think it rescued me in a way, and I think, you know, I think it does for a lot of people.  But oh yeah, I mean they’ll have to take me out in my box, you know, but yeah, if I can keep trundling in.

– Volunteer Receptionist

Challenging or negative aspects of the relationships between staff and volunteers

Occasionally we do have some volunteers that need more managing than others. Sometimes they want to get too involved… management side of things and want to know a bit too much… so I do find some volunteers challenging, same as staff really.

– Day Hospice nurse

Managing volunteers

• ‘Messy to manage’
• Volunteers, unlike paid staff can to an extent ‘work’ on their own terms in relation to: availability, time, ways of working, and can say ‘no’.
• Fitting volunteering in with other commitments such as: holidays, family and work which in some cases take priority.
• Volunteers can have agency and arguably be more difficult to ‘control’ which requires sensitivity, tolerance and more creative approaches to management from individual staff and managers who cannot naturally assume conformity and compliance from volunteers.

Final thoughts

Like other hospices, this one has evolved. It is recognised as a centre of highly specialised practice and expertise and at the same time is increasingly subjected to the same regulatory and inspection processes as NHS and other providers of health and care.

With the increasing influence of adjacent sectors there is a danger of the potential loss of independence, what some hospices regard as their ‘soul’. The LSP sessions, used with other more traditional approaches, are helping to shine a light on the challenges but above all the great benefits that volunteers bring to an organisation.

The Senior Fundraising Manager, when asked ‘What would the hospice be like without volunteers?’ captured that in her response: 

Beige. It’d be boring. Sometimes my job would be a lot easier. I could be firmer with paid staff and they’d be in every day – but it would be a much sadder place. The extra sparkle – we’d lose so much.