"How can we improve performance?", NHS conference in Cambridge, May 2001 The task of leading improvement in the public services is a difficult one. People expected to "deliver" a huge agenda and an overwhelming number of targets, yet how do you know something has improved as a result of your actions if results are numerical and abstract? This was the subject of a discussion that used a new faciliation technique called Visual Dialogue to draw out peoples experiences around learning how to imporve "Improving perfomance", from an NHS conference in Cambridge, May 2001, 100cmx 70 cm, watercolour I was recently engaged by the NHS as a visual facilitator. The occasion was a conference that was essentially a forum for sharing stories of successes that had occurred since the introduction of the last NHS Modernisation Plan. Six hundred managers and staff attended. I was asked to create a picture that would capture the essence of such success, as a vehicle for reflection and celebration of the experiences of those involved. The style of the conference was similar to a knowledge fair; a large informal space filled with booths and displays of various initiatives and projects about recent innovation in health care delivery. Participants were free to choose to whom they talked and what they talked about. I was positioned in a booth, available to draw and interview anyone who happened by. Some passersby were attracted to the pictures I was sketching from the first informal conversations that took place. I acted as facilitator, asking participants to share their experiences of which I immediately drew up on a large piece of paper. As a picture took shape it became a catalyst for further dialogue. [My line of questioning was in the style of Appreciative Inquiry, tapping into what gives people engery and life.] It soon became apparent that many participants had insufficient information about how well their unit, trust, or facility was performing. Consequently, they were finding it difficult to recognize and define success. As this theme developed, it evolved into further discussions with other participants on how to improve feedback mechanisms to provide staff with a clearer and more meaningful assessment of the quality of their unit’s performance. The main insight to come out of the informal discussions I facilitated was that informal feedback from close colleagues is the most benficial for personal learning, innovation and performance enhancement…" its nice to be told you made a difference..I always feel valued and appreciated and it gives me more meaning at work".."informal feedback? We all need it, and actively seek it out"…"formal feedback mechanisms don’t seem to reflect the hard work I do!" I captured the day’s discussion in a large, colourful picture that we used a few weeks later during a review of the event. The visual output was used to focus and generate further discussion by engaging the review group's attention. Group members were thus able to quickly grasp the main issues and focus on relevant elements. Such an exercise demonstrates how visually structuring complex and difficult issues can provide a space in which fresh perspectives can emerge that allow groups to see things in a new light. One great advantage of visualising the themes that emerge is that an image can be a powerful focusing aid. Images help people to quickly grasp the core material and concentrate on relevant issues, providing symbolic encapsulation of complex and difficult concepts. Visual dialogue is a valuable tool for enriching the quality of any group discussion, capturing themes in a way that keeps the conversation moving. The result, almost inevitably, is a more useful outcome.