I went to the first day of the Association of Family Therapy & Systemic Practice (AFT – link to the AFT website here) annual conference in Brighton last week, and heard two impressive plenary presentations. The first, by Karen Partridge, introduced me to the idea of constructive awkwardness.

In her abstract entitled “Evolve or die! A cautionary tale from beyond the grave of the great auk”, Karen referred to the real great auk, a flightless bird which became extinct in the 19th century. On a trip to Iceland earlier this year we saw a monument on the Reykjanes peninsula commemorating the last great auks, killed on Eldey island, so this caught my attention. When I read her abstract it made me think about the NHS as an auk, the need for the NHS to evolve or die, and the question of whether the NHS is being killed by those (politicians) who don’t understand its worth.

The talk, however, took me in another direction. Thanks to Karen I’ve downloaded Naylor’s doctoral thesis onto my ipad (read it here). Constructive awkwardness involves confronting or challenging whilst keeping relationships intact (see page 5 ). “The constructively awkward practitioner is capable of collaboration and compliance in pursuit of a shared primary task and putting the benefits of membership that such commitment generates at risk by their commitment to dissent.” (Page 27) There’s a figure too that positions constructive awkwardness between pussy-footing and sledge- hammering. Naylor writes about how people self-authorise to be constructively awkward, and about situations where they might be silenced or even be seen as destructively awkward. I wonder how this fits with whistle-blowing? There’s a phrase he uses about a culture that “values belonging over questioning”, and I suspect that’s how a lot of staff in hard pressed front line NHS jobs feel when they see lack of staff or excessive demand impacting on patient care – that the culture isn’t open to questions or concerns and that to raise them is somehow a betrayal of the organisation. So how is it that some people take on the responsibility to ask uncomfortable questions? And how do we nurture, support and develop constructive awkwardness?

A second phrase that’s captured my imagination and interest is professional curiosity. I first came across it in a Domestic Homicide Review report, where the author suggested that health and social care professionals lacked “professional curiosity”: they should have sought more information about events and people. Curiosity is a stance in systemic therapy and it’s probably not what killed the cat (see Alistair Reid’s poem here: “only the curious/ have if they live a tale/ worth telling at all”).

So what is professional curiosity? I think it’s about not taking things at face value, but instead questioning, being curious and trying to understand. It’s about not accepting the first answer (maybe not the second or third either) but instead probing for what lies underneath. For me there are another two important factors in professional curiosity. One is a genuine interest in and desire to understand the person/ patient/ family and their situation or concerns. The second is learning. The professionally curious person wants to learn and isn’t afraid to admit they might not know or they could be wrong. They are open to possibilities that they themselves may not have seen or considered. Without this I’ve seen healthcare professionals back themselves into a corner because they think they know (and can’t admit that they don’t).

So I think there are big overlaps between these two concepts: being prepared to question rather than being blinded or silenced by others or the obvious; and risking being seen as not knowing, wrong or even foolish. In relation to health and social care, underlying both these approaches is a fundamental abiding commitment to care.