The care home lab

Hosting a lab in a care home would not have been possible without the dedication, openness and experience of each person involved. Thank you for welcoming us into your world.

Context

Peacock care home is a 79 bed home in West Lothian that is interested in planning for the future. In 2014, Peacock care home was selected to participate in the care home lab as part of the joint Iriss and Scottish Care Fit for the Future Project. The home wanted to learn more about outcomes, and was particularly interested in using a safe space to explore what could support an outcomes focus to work in a residential setting.

The project’s wider engagement with care homes in West Lothian revealed that many wanted to improve and to begin a process of becoming more person-centred, but were not sure where to start. Following on the learning from other Iriss Labs, the project team decided that introducing the lab methodology in a care home context and sharing the learning might lead to increased innovation and creative working in the future.

The challenges and opportunities of delivering outcomes for people who live in care homes are well documented. The Joint Improvement Team tackled the question of outcomes in care homes with a year long pilot in the Borders. Other national programmes such as My Home Life have also been designed to support outcomes-focussed working and relationship based care. At a national level, the Taskforce for Residential Care(2014) produced recommendations that emphasised the importance of moving from task based support to more holistic person-centred care.

Who was involved?

The lab worked by bringing together a co-design group. Individual members of this group were recruited by the manager of the care home, who knew them best. The group comprised care staff, managers, residents and facilitators.

As a group, we felt the membership of the lab was not conducive to long-term embedding, and missed out on some key views. Please read more about this in the lessons learned section.

The care home lab

The care home lab took place over a full day. In the morning, we broke into groups of three (see figure) and each group had a facilitator who took responsibility for role playing as a resident in the scenario.

Each group had two scenarios to complete: with as much or as little support as they felt they needed. At the beginning of each scenario, the group chose an appropriate location (for example, the residents room, the conservatory, the games room) depending on the scenario.

Each group had a printed pause button, which they used to stop the scenario, ask questions or reflect on their conversation. For example, one member of a group hit the pause button and said “I notice I’m trying to fix this instead of listening, can I start again?”

At the end of scenario 1, the active member from each group was asked to pass on what they had learned to a member from another group. This was designed to make the members consider what information needs to be passed out from outcomes conversations.

Some groups involved all members in each scenario, whilst others had the third member as the observer. In some groups, multiple conversations were needed to thoroughly address the challenge of the scenario; for example, one staff member spent time observing a ‘resident’s’ response to music before working with that resident’s family member to discuss how music could be better incorporated in her support.

After the second scenario was completed and information was passed on, the group reflected briefly before heading to lunch. The afternoon was spent reflecting, evaluating and celebrating the group’s hard work.

What were the outcomes of the lab?

The structure of the lab changed over time due to the needs of the group. Our initial aim had been to spend our co-design sessions together developing tools to support outcomes and to test these tools in the lab setting. However, we spent more time than anticipated becoming comfortable with the concept of outcomes, and did not develop any tools in these sessions. Instead, we used the lab as a space to test out conversations and identify the gaps and opportunities that needed to be addressed to make outcomes work in this setting.

The lab offered an environment where everyone involved felt that they could learn and ‘try’ things differently. The lab was evaluated on the day and eight weeks later to understand what had changed due to the experience.

Participants in the group identified several positive outcomes from the lab including:

• An introduction to outcomes that was grounded in experience.
• A chance to share openly, with staff saying that hearing the opinions and experiences of family members and residents was particularly valuable.
• Improved sense of value in the care staff’s role: “It will definitely make me a better carer and make me approach things head on and that can only be a good thing for me and Peacock [care home].” Another member remarked that she had always known the job was more than “personal care, baths and meals” and that the lab reinforced her realisation that the job was about relationships with people.
• An appreciation of the little things: eight weeks after the initial lab, members of the group all reflected on meaningful moments they had taken the time to appreciate after the lab, such as watching a normally withdrawn man “light up” at football reminiscence and being in awe of how he knew the name of every team. They realised that he could remember all the names because of how important football was to him.
• Understanding of the barriers of current ways of working and habits that the group wanted to address such as information sharing, time management and prioritisation. Some people experienced this as overwhelming because they were aware of the long road ahead.

What worked?

• Bringing people together in an open, honest space. The space allowed for reflection and challenge for what was a very difficult subject.
• Working without hierarchy, the staff felt comforted that management was going through the same process as them, and even got some things wrong. “We were all equals, no rank within the lab.”
• Being flexible with the co-design process to make it relevant to the people involved.
• Having the real life scenarios from residents to use in the lab itself.
• Learning in situ meant real life interruptions and experience of managing multiple conversations and outcomes at once.

What would we do differently?

• The process could have been made clearer, particularly in the second co-design group. It would have been better to have a clearer vision of what was going to happen on the day of the lab.
• The lab could have built in some initial ‘reflection time’ as a group after scenario 1 to discuss, debate and offer up other suggestions before moving straight into a second scenario.
• The group could have had a wider range of representation including more family carers, a staff nurse and representation from domestic staff. However, more than one member wrote in evaluation that they valued the smaller group for its learning.

Lasting impact of the lab

Since the lab was completed several steps have been agreed to move forward:

• The group has visited a care home in the Borders which works in an outcomes-focussed way for guidance and inspiration.
• Individual carers now support smaller groups of residents to build more meaningful relationships.
• The manager implemented a ‘daily report book’ which has since been renamed the ‘positive outcomes book’ to capture observations, changes and conversations with residents.
• The group holds fortnightly feedback sessions to discuss how to implement an outcomes approach in the wider home.
• The group has shared learning and their action plan with residents, family members and staff.
• Peacock care home will be receiving ongoing support from the Personal Outcomes Partnership (POP) to develop their approach to outcomes.

Three Lessons Learned

• The membership of the co-design group is vital, not just for the quality for the lab but for embedding the learning beyond this. Eight weeks after the lab, the group was finding it challenging to champion outcomes without the buy-in of trained staff across all teams.
• The process should be flexible and tailored to meet the needs of the group you are working with.
• Building a robust action plan must be a priority in order to keep up the momentum after the lab has finished.

The Future

Iriss has also produced a ‘how-to’ guide for running experience labs with learning from our labs across other sectors.

The main points for running a lab include:

• Focus upon one experiential perspective
• Be able to explain what you want to test in one sentence
• Only involve people who have experience/knowledge of the situation you want to change
• Test this experience in a safe, live environment (or create an aspirational environment)
• Make time for personal and group reflection.

We hope that other care homes consider using the lab methodology and learning from this case study to implement a test of change in the setting.

“This will be a long road. It will have twists and curves, but we all have to keep in mind where we are going, and have the vision for the future.”
—Activities Manager

References

Cook, A., Dunbar, Gordon and Eastwood, K., JIT Action Group, Polding-Clyde, S., Social Care and Social Work Improvement Scotland (2011) Talking Points: Personal Outcomes Approach: Framework of Outcomes Important to People Living in Care Homes, JIT

Iriss (2014) How to Run an Experience Lab, Glasgow, Iriss

Iriss (2014) Working with outcomes: the practitioner experience and Exploring roles and boundaries: the prisoner and prison officer experience, Glasgow, Iriss

Iriss (2014) Why we like testing things, Glasgow, Fit For the Future Blog, Iriss

JIT (2011) Scottish Borders – Care Home Pilot

Taskforce for Residential Care (2014) Recommendations for the future of residential care for older people in scotland