A manager’s experience of the care home lab

You may wonder why I have started with a picture of an elephant. For me the analogy “You can’t eat an elephant in one bite, it takes many small bites to eat one” is how I have come to view implementation of Positive Personal Outcomes.

As a manager I thought we were providing or trying to provide positive outcomes for our residents, meeting their needs, treating residents as individuals; like you or maybe not this is what I thought. I have since attended talks/training on Talking Points, started to hear words like JIT (Joint Improvement Team), Iriss — no, not the flower but, as Rhiann has explained, the Institute for Research and Innovation in Social Services.

The more I heard the more aware I became of how little I knew; how was I going to implement the changes in the nursing home.

Then last year I received an e mail from Robert Telfer, Scottish Care, informing me about the reshaping care for individuals which was looking at enhanced outcomes for individuals receiving care and support from independent providers. This led to conversations between Iriss (that flower again) in the shape of Rhiann who planted the seed of positives outcomes in my mind; leaving me to consider how can I make it grow and flourish.

Oh this is easy I thought I will attend a few talks on personal outcomes, gathering the information, get it right and hey how difficult can it be! Train it out to staff, easy?

Not really

I now had a great big elephant in a garden of weeds and one small flower slowly growing in the corner (if you’re confused well trust me not half as confused as I was)

We were picked to test out a concept around communication. I knew the reshaping program was pushing for an outcomes approach but I had limited experience and confidence in this area; this was our challenge?

I am also very aware of importance changing the culture within the nursing home, moving away from needs led care to positive outcomes. In my view, improved communication was the key.

The co-design sessions were good as right from the start everyone became aware this was new learning for us all, new learning I liked this description as we weren’t being trained we were learning new or alternative ways to communicate, albeit that I was the manager the staff quickly realised I was learning along with them. This allowed the group to relax and not worry about saying something I might think was wrong.

Rhiann enlisted the help of two more gardeners Gordon Dunbar and Linsay Graham from the Joint Improvement Team, what I learned from them was I was a fixer, trying to find solutions to problems, not thinking about the personal outcome for the resident.

A light was switched on and I had just nibbled a piece of the elephant. Positive personal outcomes for me was a change in thinking, looking at how we communicate with each other and to recognise what we want to achieve from it, not about fixing things but to understand the why and how we can improve the quality of life for residents living in the home.

The lab opened my eyes working with our residents listening to how they feel living in a care home affects them, hearing the simple things that matter to them, being able to eat when they want, staying up to watch the football are just two examples of what is important to them.

The challenge for us all in the care sector over the next few years and yes it will take years to do this right, this is not a quick fix, is to introduce the new learning to all our staff, for staff to think about the person and what the outcome for the resident should be, not what we as carers think it should be.

Positive Outcomes for all who live in a nursing/care home is what we all strive to achieve, how we get there will be different for each home, being able to balance one residents positive outcome against the impact on others living in the care home.

Food for thought

I have a resident living in the home who was a painter and decorator before he retired. When he was admitted to the home he was very flat, unresponsive, wasn’t walking needing full assistance with all aspects of his personal care. We reviewed his medication and in consultation with the family and GP some of it was stopped or reduced, he now walks independently, is eating much better, engaging with staff, he is also stripping the paper of the walls in the corridor, when asked to stop or distracted away from doing this he becomes agitated, angry at not being allowed to do what he has always done in the past.

When left to strip the paper he is calmer, eats better and appears happier as he has something to do; a positive outcome for this man.

The other side of this is, his action impacts on the environment his fellow residents live in, the hallway looks unkempt, visitors remark on this when coming into the home, what should we do?

At the moment the resident continues to strip the wallpaper, once the paper is removed we will paint the corridor encouraging the resident to participate. We will keep relatives and visitors informed of what is happening and how we are managing the situation. Once the hallway is painted we will then have to identify how we can engage the resident in similar activity promoting a continuing positive outcome for him.

I have been lucky as I was able to be involved in the lab, testing communication and how we communicate in a safe environment, the title of this presentation is “no failure in failing” this is very true, we have to keep on trying new things some of them will work some won’t but we will learn from what doesn’t.

The new learning continues in the nursing home the elephant will remain in the garden for a long period.

Good luck all!

A video of this talk filmed by a member of the audience is available here. 

Elephant photo by Yathin S Krishnappa via Wikimedia Commons, CC-BY-SA 3.0.