Awakening to human centered interaction. Dialogue with Sofia Kjellström

Hilary: My dialogue with Sofia is part of  our blog thread on liberating the Ivory Tower leading us to our AR+ Chalmers Gathering in March 2019.  Dr. Sofia Kjellström is an action researching  Professor of Welfare and Social Sciences at Jönköping U. in Sweden.

Sofia,  Let’s start with a big question. What is holding your attention these days?

Sofia: What I do right now is connected to making transformations happen and using more adult development to support that. I want to integrate this perspective more in our education about improvement and leadership.We have also started a center for co-production as we educate healthcare and social care professionals.

Hilary What is co-production in your healthcare context?

Sofia For us it’s about healthcare personnel working with patients and co-producing better health outcomes with the patients. It is when care is both designed and delivered together with patients. That requires a transformation of healthcare!

Hilary Healthcare is interesting from an action research perspective. It’s so complex. In most industrialized countries we have systems designed for clinics with doctor focus. I see an analogy with education which is designed for universities with a professor focus.Both are very costly.  Neither is focused on end user experience, the patient or the student.  So it’s a big revolution when it starts to change. I was so impressed by that change in the work of healthcare action researchers, led by Svante Lifvergren. Also in Sweden! [the interested reader may read about this healthcare transformation in the AR+ Cookbook].

Sofia I wonder how we can transform things too. I have not been in a position of having power but I’m moving into that kind of role, and I want to use that to share “power with” people. We like “interactive” research in Sweden. It’s a bit closer to action research than conventional research. We always want to involve the practitioners. But now we’re moving into a different phase where we really want to connect with patients more deeply at all stages of research and education. So that relates very well to action research.

Hilary Not to sound like a Swede-o-fan, but I do think the Scandinavian context is particularly advanced with regard to rethinking power relationships. I see it in the gender relations which I believe are so fundamental to how we experience power from childhood. And generally I see this egalitarianism as a prerequisite for  doing good action research. So we might say in Sweden you have this cultural advantage. And you’re now linking that with adult development processes. What have you found is best when talking to “normal” people, be it students or healthcare workers or patients, who don’t have a background in thinking about growth and development beyond childhood?

Sofia I suggest that there are three levels of living our life. We can be dependent. When we are young, we depend on others to tell us what to do or be. I point out that such dependency can and often does  continue in life, such as when people have not clarified their own purpose. Then there is the independent and self-authoring mode which we may develop as we age. And then there are still later stages of adult development. The research tells us that it’s about 10% of the population who can balance well the places that allow for purposeful life and collaboration with new people. It’s this inter-independent way of interacting that is an essential mindset for co-production I believe. Knowing about these three modes is very helpful for understanding people’s thinking and action. So that’s what I tell my students to start.

Hilary: How do you encourage them to take on more responsibility for their own development? When we’re young it happens almost naturally. But by adulthood it does seem that 90% of people do not advance much beyond what our culture defines as successful. Today that’s to have the material success. This does not offer a sustainable vision of what it is to be a good human being.

Sofia: I think we have a responsibility to design education so that student reach their highest potential so to speak, and there is much work to do there. I hope to connect at AR + conference with people interested in that. But also closely tied with the insight that everyone should be respected for wherever they are. It’s not always about vertical development.  But we certainly could teach about the developmental dimension more.

Hilary:  What have you found encourages your students efforts?

Sofia: I sometimes gives personal examples from my life. For example, learning to take responsibility for emotions. My story is from when I was home with my first newborn. Reflecting back on that period I could see that I was depressed. I was waiting for my husband to come home by five.  By 5.30 I was already upset and then I blamed him for my emotions on arriving. Which didn’t help. But then I began to observe this pattern. I saw that the irritation was not really caused by or dependent on him, rather it was due to my interpretation of the situation. So that was a helpful shift. And I tried to do something like “ breathe deeply.” Which was pretty bad initially, but after a while I got better at it. And now I share this personal story with students and most recognize similar situations in their lives. That can be quite mind blowing for students. They’re, oh really, so it is possible to have negative feelings towards others and then bring those feelings as an object of inquiry for myself. To turn things around so to speak. That allows people to have the feelings as opposed to the feelings having them. It’s still painful but there is more freedom for those involved. Therefore it’s part of the movement into greater independence, of growing up as an adult.

Hilary:  Compelling teaching example! Linking that to what we call “liberating the ivory tower” mentality we could say that as an educator you’re speaking from your experience to students’ experience. After all everyone gets a bit depressed. Though I know the Swedes seem to excel at that. Too many Bergman movies perhaps?

Sofia: It’s hard. Most of us, myself included, were educated in traditional style with lectures. When I changed into a being a teacher I wanted to do something new. I was really thinking, oh my God, I have no role models. I have to imagine it all by myself. People should be able to come alive a little bit more in education.

Hilary And many of the changes for livening things up are cosmetic, right? The old system is so deeply familiar. We’re flipping classrooms, using case methodology, moving the chairs on the Titanic, if you know that expression. These are great ideas, and they are helpful. But it still feels status quo in terms of outcomes. There is not so much transformation for students, or patients, as they are yet not invited to contact their own experience, with their own purpose.

Sofia: What I’ve done has been small scale. Showing parts of yourself is radical in a way as a teacher. Like the story of when I learned to take responsibility for emotions, I also shared about crying at work. The students really appreciated that. Wow, it is possible to talk about vulnerability!. Most people have cried or came close at work, but it’s not something that we talk about.

Hilary:  Your sharing brings more of reality into the classroom, after all your students are learning about healthcare workplaces. People cry there. It’s a very rich life world. And I know that so many physicians, but nurses too are suffering from burn out. It’s a bit of a catastrophe looming for our societies. Simply allowing people to be a little more real helps. So that is a nice example of not being unconsciously dependent on what is typically “allowed” or not allowed at work. You bring more dimensionality by bringing more of your own personal narratives. Within reason of course we know they also have to learn content too.

Sofia It’s a good question to live into. If we say that we’re interested in transformation, then what does transformation really look like? There is some sense that it can’t just be the way it’s always been and yet we don’t quite know what’s next.

Hilary: Well, let’s talk a bit about the upcoming gathering in Chalmers, March 2019.  I hope that lots of people will be there who are themselves leading with different elements of what we could call transformative action oriented research. We want to have a loose enough label, but also be clear we are interested in transforming knowledge creation in education, in social improvement projects… everywhere. As my colleague Steve Waddell points out, these people haven’t yet been organized into a community. The Chalmers effort is one effort to do that. Perhaps we can see each other as role models. I agree we have so few. And we need a sense of community and learning with each other. We’ve been too alone, right? I want to cry now too! I get depressed when I see how action researchers work is often devalued.

Sofia: Yeah. I am looking forward to connecting to people, finding people that do similar things is key. Those people can be role models, help find inspiration. We enjoy a food for thought to get inspired. From that we take it another step to workshops or work together. I know you are thinking about a virtual university … Sounds interesting!

Hilary: And there’ll be people there who have no interest in healthcare per se. And vice versa. We can do a live experiment with a live case. We’ll have fishbowls, e.g., on the transformation of universities in the Philippines and in Germany and  Canada. What’s common here is the entire system is concerned with having key stakeholders, patients, students be involved with their own systems transformation. With action research. So I think that could be very interesting. What do you think?

Sofia: I am excited at the idea of participating and co-creating a conference in an unconventional form.

Hilary:  Yes, It’s all connected to a larger umbrella concern of the evolution of a more sustainable society. We need new healthcare and education systems. And everything else too on our warming planet. And we need to bring it about at the the same time that we are inside the current systems. Something akin to cooking for 12 guests while having your kitchen renovated. That metaphor scares me!

Sofia: I have been personally very much involved with sustainability for a very long time. I started the network at my university. Feels good to reconnect with that agenda. I hear when you talk that you see it all as integrated: research and education, healthcare and sustainability. And sometimes I feel that we have too many departments. We separate research and education.

Hilary:  Yeah. I find that that’s very common everywhere. It’s part of modernity and the specialization and silo. The Scandinavian context does seem very hopeful though. Of course we can’t do everything. Society works in part because of specialization. But we have gone too far. And in all action research, including my own, there’s always something missing! We just need to be choiceful about it. When we’re just doing it, like there’s no other way to do it, be it healthcare or learning, that’s what I think is the problem. Perhaps, you could help organize researcher-educator-action researchers around adult development. That feels like a key thing we need in the great transition to a more sustainable world. As you said, co-producing knowledge is best done by people who can really practice collaboration.

Sofia: This idea that in traditional research and education, life is somehow is separate from us. It’s a bit insane. So bringing in a more personal piece often feels like a radical move.

Hilary: Radical and needed. I really want to see some organizing around adult development. I think the official term is constructive adult development, or people call it vertical development too. We have this huge technological advance in our societies. Even in third world countries now people have smartphones. And yet human awareness, or consciousness, whatever we want to call it, has remained pretty much stagnant since our Savannah ancestors. It doesn’t help that the scientific method has no place for addressing the benefits of adding increased awareness. A bit like Einstein said i’d say it may help us find solutions at a different level of mind than created them. Well, I hope that this gives us some sense of what we might do together.

Sofia:  Like for our students in care and social work. we tell them to be person centered but we teach only in a one size fits all model. We want to be more tailor-made and that’s also related to adult development.

Hilary: I like that term. How to help students become patient centric?

Sofia: Yeah, it pays off too. We have a great example here in Jönköping of coproduction with self-hemodialysis. In 2005 a young engineer asked his nurse to teach him to set up and run the hemodialysis he needed. Later other patients wanted to join. A learning system for patients to manage their self-dialysis emerged. It became a new unit and an innovative co-productive way of working was created. This provided control to patients’ lives. So that’s the radical opportunity. The follow on action research will have to keep track of the numbers, before and after, and do the cost benefit analysis.

Hilary I’m impressed by such a radical move to transform how things are usually done. Very impressive. You see I admire Sweden. By the way I loved your idea of having us do a collective Swedish dance together. I hope it won’t be too difficult. Or embarrassing!

Sofia: It’s actually one to have at huge parties, and it is just to follow along. When I was local leader in a youth organization, we did this kind of dance. You need 50 to 70 people, so if we want to have that one evening…

Hilary: That’s great. Yeah. And then I believe we’ll have somebody else who can do a little yoga maybe in the morning. I’d love to intersperse all these embodied practices to keep us alert. So many of us will be jetlagged. Maybe sit out the dance?!

Sofia: Maybe the families could enjoy it too? Are you bringing your daughter?

Hilary:  Great suggestion. So it’ll feel a little bit festive. I think that’d be good. And here’s my last request for you is to think beyond the meeting. So if you come and you make that investment of your time and effort, what is it you want? I ask because I believe that if we’re all clear with each other it’ll make it easier to figure out some kind of organizing of efforts after the meeting too.

Sofia: So maybe before then we start. At conventional conferences people send in abstracts of their presentations and we read in advance to find interesting stuff. What if all participants for the Chalmers Gathering send in ”abstracts” about themselves, their work and future ambitions. We each read the abstract and  identify interesting people in advance. Maybe when we register we can do that – we can share our interest. Personal & something about your organization etc. If we get that a week before we can skim through. So we know a little bit more about people and who they are.

Hilary: Yeah, I love that. And then there’s also the “autumn zoom teas” we are planning. We’ll have small groups getting to know one another. There will be a Gathering Stewards team. I think it’ll all really come alive when we start to talk with each other. I know it has for me in talking with you and others about coming to Chalmers. So thank you!

Sofia: That’s great! Thank you.

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