Talking a little, learning a lot

As we have been shaping our ideas about relationship centred design we have been talking a little and learning a lot. Here’s a couple of reflections on our learning so far. We will be sharing more over the next few weeks.


Words shape ideas and ideas drive action. It is therefore important that we think about language very carefully. In a world of transactions the word ‘relationships’ has many meanings. Clearly, although I may use the same word, the relationship which I have with my bank is entirely different from the relationship which I have with my son.

The ‘circles of support’ model – which originated in the social care sector in Canada and spread to the UK in the 1980s – might be useful here. It helps us to segment the different types of relationships we have, but also invites us to think about what these relationships have in common, and how a relationship might migrate from one segment to another.

Different types of relationships


Though the boundaries are porous, we likely experience relationships differently depending on which segment they fall in. But we believe that relationships – real relationships – should all share some fundamental characteristics.

Do these characteristics seem right to you? What are we missing?

We’re more likely to associate these characteristics with the relationships that we have with friends and loved ones. However, we believe that our relationships with the individuals and organisations that we participate with and exchange with can be strengthened by embracing these characteristics more deliberately.

In the real world, the relationships we have in the sphere of exchange often fall somewhere between a transaction and a real relationship, sometimes by design but often by chance. I talked in the last blog about the hospital staff working with my dad – some of whom formed a relationship, some didn’t:

Case study

The doctor sits on the bed, takes my elderly father’s hand between her own, looks him in the eye and says “good morning Dennis.” He looks up. He listens. He smiles. Most of all he takes notice, he cooperates in his own care. Not an hour later a nurse appears, lifts his arm and begins to take his blood pressure. Not a word. “I’m not dead yet” he says without moving. He refuses lunch.

I saw how my Dad cooperated in his own care with the doctor and not with the nurse. At the same time I noticed how every member of staff – cleaners, doctors, nurses – all repeatedly applied the disinfectant to their hands from the dispenser on the wall. This didn’t just happen; the behaviour change had been designed. Then it had been taught and reinforced until it became habitual. We know that “the beneficial effects of a good patient-clinician relationship on healthcare outcomes are of similar magnitude to many well-established medical treatments” [source]. Relationships should be no more randomly or inconsistently prioritised than high standards of cleanliness and hygiene.

Wide field, common core

Scarcely a day goes by when we aren’t encountering someone new, so it is obvious that a large and diverse range of organisations are interested in relationships. Of the people we’ve spoken with so far, here are some of the areas they represent:

There’s something in the idea of relationships adding value that resonates with a diverse group of people. Each are interested in a different end, but see relationships as being a means to that end.
We want to understand more about what these ends are. What’s the business case for investing in relationships? What’s the social case?

Two cases for working on relationships

Through our conversations, some broad outcomes of a relationship-centred approach have emerged. At one end of the spectrum, befriending schemes are tackling loneliness. Here, the activity is usually about meeting an acute need and relationships are an end in themselves. At the other end of the spectrum, schools and hospitals and businesses are primarily interested in educational achievement, healthcare and selling more products, each seeing relationships as a means to these ends. In between the two, other organisations focus on individual wellbeing or community cohesion or a combination of all these objectives, but equally recognise relationships as the central operating principle.

The spectrum of benefits for a relationships-centred approach

Does this way of thinking about the field make sense to you? What are we missing?

At first glance, this is a very big and thoroughly mixed bag of organisations and interests. However, although the entry points are different, all have an interest in building and sustaining real relationships. It is wide field with a common core. Considered from this perspective, we can see opportunities to build from the sum of the parts; to learn from one another; to develop a shared narrative; and ultimately to influence the long-term trajectory of policy and practice across the sectors. In recent weeks, we have spoken to some organisations that have identified strongly with one bubble but seen little or no connection with the others. Maybe there are good reasons for that or maybe these are missed opportunities.

Case study

I think of two local street parties run last summer as part of the Jo Cox Foundation Great Get Together. Both would have ticked ‘social cohesion’ as their primary purpose and both appeared to attract a diverse crowd. However the first drew almost entirely on a parent network that had begun at an NCT group, developed through the parent toddler years and was now flourishing at Primary school. Nothing wrong with that of course but missing a trick when compared to the second group who, from similar beginnings, door knocked throughout the neighbourhood personally inviting neighbours they didn’t know and then knocking again on the day to meet and collect. The primary interest in social cohesion had been expanded to embrace also the most isolated.

Connecting some or all the bubbles with good design may not work in every context but we think it could work in any context, i.e. in hospitals or businesses or local authority services. Take the school, for instance, that starts thinking about relationships in the classroom as a way of improving SATs results. How children support one another, how they relate to the teacher and how families are engaged all influences learning. Pressed for time and necessarily focused on Ofsted ratings, this is, at first, the school’s single purpose. However, done thoughtfully, it might also embrace in the process children who have struggled to make friends or mix groups across cultural or ethnic divides.

Understanding the range of organisations with an interest in relationships, and understanding better how they do what they do, can help us to also understand what else we might achieve. Importantly, we think this has to be – and can be – about spending time and money differently, not costing more. In fact we are building this stringent requirement into the relationship-centred design considerations that we’re developing. We hope that these considerations will be a broad and open entry point to thinking about a relationship-centred approach.

If you would like to be involved in co-designing these considerations or to know more about this project, or if you have any other comments or suggestions, do please get in touch. We would love to hear from you!