The "Messy Middle": Where personalisation really happens

Personalised care can sound like a big idea. But often, it begins with something very simple: listening to someone, being curious about their life, and asking what they need rather than assuming we already know.

That message runs throughout a fascinating podcast conversation between Alison from the It’s All About People team and Lisa Richer, founder of neurodiversity consultancy Journey to Bloom in Maryland, USA.

Drawing on her personal, parental, and professional experience of neurodiversity, Lisa explores what it really means to meet people where they are.

Despite working thousands of miles apart and within very different systems, Lisa and Alison discover a striking amount of common ground: the importance of relationships, strengths, curiosity, courage, collaboration and creating space for people to be themselves.

Meet people where they really are

One of the strongest themes in Lisa and Alison's conversation is the idea of meeting people where they are.

That means much more than bringing services physically closer to people. As Alison points out, moving an appointment from a hospital to a village hall does not automatically make care personalised. We need to understand the person themselves: what matters to them, what they need, and what is happening in their life.

Lisa makes the same point when talking about neurodiversity. Two people may share the same diagnosis, but their experiences, strengths, and needs can be very different.

“Each of us shows up in our own unique way.”

She argues that personalised approaches recognise this individuality rather than trying to fit people neatly into categories. Systems and processes may be designed to help, but they can become barriers when they stop professionals responding flexibly to the person in front of them.

For personalised care, the starting point therefore has to be the individual, not the service, pathway, or process.

A diagnosis can inform us, but it should never define someone

The conversation also explores the complicated relationship we can have with labels.

A diagnosis can be enormously valuable. It can help someone understand themselves, explain experiences they may have struggled with for years and open the door to appropriate support. But problems arise when other people begin to see the diagnosis before they see the person.

Lisa captures this beautifully:

“Diagnoses inform, they do not define.”

She talks about understanding and owning her own ADHD, including recognising where it affects her executive functioning. The important question becomes not simply "What diagnosis does somebody have?, but "What does this mean for this particular person, and how can we work with them?"

That is a fundamentally strengths-based approach. Rather than reducing someone to what they cannot do, it recognises their knowledge of themselves, their capabilities and the different ways they experience and navigate the world.

Curiosity and kindness can change conversations

Getting personalised care right does not mean professionals must always have the perfect words. In fact, the podcast conversation suggests that worrying too much about saying the wrong thing can sometimes stop us having important conversations at all.

During the podcast, Alison openly acknowledges being unsure about the right language to use around neurodiversity. Lisa sees value in that openness because Alison is curious, compassionate, and willing to learn.

“You showed vulnerability. You showed the courage to be open and honest.”

Lisa's advice is refreshingly straightforward: ask people. If you are unsure how somebody prefers to describe themselves, or what they would like you to know, create the space for them to tell you.

This shifts the balance of a conversation. Instead of the professional being expected to know everything, both people bring something valuable. One brings professional knowledge; the other brings expertise in their own life.

Personalisation grows from bringing those different forms of knowledge together.

Being heard, seen and not judged

Sometimes what a person needs is surprisingly simple.

Lisa shares the story of visiting a friend who had experienced significant illness, trauma, and bereavement. They planned to have lunch together, but her friend realised she needed to rest. Rather than abandoning the visit altogether, she felt able to say what she actually needed: for Lisa to collect lunch, give her some space and then come back.

Lisa celebrated her friend for being able to express that need. But crucially, she recognises that it took both of them: one person needed to feel able to speak honestly and the other needed to be ready to listen.

Reflecting on what people want from health and care, Lisa says:

“They want to be heard, seen and not judged.”

Alison connects this directly with personalised care. Curiosity, kindness, courage, and open conversation should not be reserved for friendships; they should be part of health and care relationships too.

Start with people, not the solution

Perhaps one of the most powerful ideas in the conversation is Lisa's description of the “Messy Middle”.

Health and care systems understandably want plans, actions, and solutions. But genuinely personalised and strengths-based approaches require us to resist jumping too quickly to the answer.

Lisa explains:

“If you come with an already created action plan, then you're not doing what we're describing here.”

Why? Because the solution has already been decided before everyone has been heard.

Alison draws a direct parallel with co-production. Asking people to comment on something that has effectively already been decided is very different from beginning with an open mind and creating something together.

The messy middle is the space where people listen, explore different perspectives, challenge assumptions, and sometimes admit they do not yet know the answer. It may feel uncomfortable, but that is often where meaningful change begins.

Build on people's strengths - and be brave enough to change

A strengths-based approach is not about ignoring challenges. It is about recognising that people, families and communities bring knowledge, experience, relationships, ideas and capabilities that can help create solutions.

That requires collaboration rather than professionals simply doing things to or for people.

Lisa argues that real strategy happens in the messy middle:

“It happens when you're connecting and coming together to co-create something.”

That also requires courage. Lisa shares examples from education where change only began because people were prepared to raise concerns, listen, and challenge established ways of working. One voice encouraged another, and gradually people began to recognise that things could be different.

For health and care, there is an important lesson here. Listening is only meaningful if we are prepared to do something with what we hear.

Personalised care therefore requires not only compassionate conversations, but systems with enough flexibility and courage to respond.

Relationships are the golden thread

Across the conversation, one theme keeps returning: relationships.

Whether we are talking about neurodiversity, health, education, bereavement, or navigating complicated services, people need relationships built on trust.

Lisa describes collaboration as essential if we are genuinely going to meet people where they are and find solutions together.

Alison sums up many of the qualities needed: curiosity, kindness, understanding, and bravery.

These are not complicated interventions. They are human behaviours. Yet they can transform how somebody experiences a service, from feeling processed by a system to feeling that somebody has genuinely listened and understood.

Conclusion: personalisation happens in the Messy Middle

Lisa and Alison may be separated by an ocean and work within very different systems, but their conversation shows how universal these ideas are.

Personalised, strengths-based care begins by recognising that every person is different. It means seeing beyond labels, understanding what matters, listening without judgement and recognising the strengths and expertise people already have.

It also means accepting some uncertainty. We will not always have the perfect words. We will sometimes make mistakes. And we may need to challenge processes that make sense on paper but do not work for the people using them.

That is why the “messy middle” matters. It is the place where professionals, people, families and communities can come together without pretending that one person already has all the answers.

As Lisa says at the end of the conversation:

“It's all about people, no matter where we are in the world.”

And perhaps that is the simplest definition of personalised care: see the person, listen to them, recognise what they bring, and work alongside them to find what works.