HOW LEADERSHIP STIMULATED INNOVATION AND CONTINOUS IMPROVEMENT FOR EXCELLENCE IN PERSON CENTRED CARE
Personalisation of care has been in the press and the focus of many health care professionals for some time now but the theory, practice gap is as wide as ever with many RNs unable to identify what true, high quality personalised care looks like. Long term residential care, often funded by the NHS, is uniquely placed to change this and with an enabled work force this often-neglected branch of nursing can, through guided culture change, easily become a leading light in developing and sustaining personalisation of care. Given the complexity of care homes and scope of provision service providers, managers, leaders and senior staff at all levels of operation need to reach common understandings supported by evidence bases about what person centred outcomes look like from the separate but interdependent perspectives of the central player, the resident, the staff/practitioners and the relatives.
What we did
For the last 2-3 years we have been working with a Surrey care home to support transformational culture change in the delivery of demonstrable person centred outcomes and relationship activated care which we have been excited about as they have gone from strength to strength developing a systematic incremental programme of continuous improvement, and now moving towards a learning care home model. The main changes occurred after staff had attended a couple of our courses, ‘Therapeutic conversational skills for people with dementia’ and ‘ Involving Relatives Purposefully’.
Subsequently the manager who wanted to develop his skills and practice in how to lead and support of culture change in a sustainable way attended a Prime Minister Challenge funded in Surrey. Surrey County Council commissioned the 360 Forward team to deliver a 5 day management and leadership course for care home managers based on the 360 Standard Framework. It focused on leading and managing person centred cultures, with a particular focus on dementia. This resulted in projects with specific action plans resulting in observable and measurable outcomes. This particular family run nursing home used our triangulated in- house surveys with observations for ‘relationship activated care’ to identify what was working well and what could be improved from the resident, staff and relative experience perspective. It was accompanied by a learning programme that was delivered by the team leader, supported by the manager.
On the follow up session of the leadership and management culture change programme the manager reported:
‘We have pioneered a systematic culture change. leading to the enhanced wellbeing of all of our service users and their relatives and friends. It has also led to greater job satisfaction in all of our staff with a reduced absentee rate and a higher productivity and enthusiasm’
The initial stage was to audit our care home based on the outcomes and wellbeing of residents, relatives and staff. During this audit we also sought the opinion of visiting professionals. We recognised that any change in culture needed to have the support of senior management if it were to be maintained and therefore senior managers and frontline leaders attended training focussing on personalisation and culture. This training included intensive work on nurturing the relationship triangle and of recognising the importance of long term reciprocal relationships and the development of an enabling culture through the implementation of the 360 Standard Framework with a focus upon meaningful activity.
One of the most important elements of this training was in gaining the understanding of how senior managers can often be a barrier to change through an autocratic hierarchical leadership style. Developing all staff and enabling residents and their families to have an equal role within the home is a successful model for change and requires a skilled multi-faceted approach by managers who can exhibit a light touch approach when possible which in turn promotes confidence and trust and breeds a culture and service that is constantly striving to improve through reflection.
- Manager, Broome Park Nursing Home
This care home implemented some great initiatives and the challenge is how this can be sustained and supported by facilitative leadership that empowers staff. The new Kings Fund Report Caring for Change.
Compassionate leaders nurture a culture of compassion, risk taking, involvement and belonging. They have a profound effect on clinical effectiveness, patient safety, patient experience, efficiency of use of resources, health, wellbeing and staff engagement, and the extent of innovation loosened within the system.
Compassionate leaders actively listen, pay attention, withhold judgement, clarify, summarise, reflect and share in turn, geared towards insight and making empathetic connections.
Staff are more likely to make suggestions pro-actively and embark on real problem solving as they feel listened to and their perspective is appreciated.
Taking thoughtful and intelligent action to help means doing something about it – staff then feel listened to, so, it’s not just talk but action that makes the difference.
Top down leadership is the most ineffective in healthcare organisations. Management enabling is key to compassionate cultures and the 360 SF is an exemplar of what a compassionate leadership looks like in practice.