Tag Archives: healthcare

Playing with numbers

I am often mindful of the need to criticize the quality of leadership and management in health and social care services; particularly the obsession with numbers, the tick-box mentality, and the blind faith placed in targets for driving change and daily practice across services. I am surely not a lone voice in this critique, but is it valid or just a reaction against the sound of the pips squeaking?

I do believe that an absence of targets or defined outcomes, and a failure to establish high standards for provision of services only leads to inconsistencies between practitioners and teams… what is often referred to as a postcode lottery. Service users don’t deserve to be on the receiving end of either stressed out practitioners fearful of constant criticism, or laid-back practitioners doing their own thing. Audit and regulation have a place, but surely they need to be clearly joined up to practice, not existing in a vacuum somewhat disconnected from the realities within which good practice has to operate.

The ever-growing chasm between person-centred practice and business-focused managerialism does little to promote a culture of organizational collaboration that may encourage a more engaging form of audit and regulation across services. My solution would be to eliminate most of the current audit requirements imposed on practitioners and teams, particularly that which they experience as wholly time-consuming and unhelpful. So far so good, say the practitioners amongst you; please do share your thoughts, but read on before you do…

Over the last 12 years, through the Practice Based Evidence initiative, I have been developing tools designed specifically for use by practitioners and teams. These tools have flexible uses: personal reflection, individual supervision, team development and team evaluation. Used diligently they should be able to provide a host of qualitative and quantitative data, which in turn should offer useful feedback to practitioners and teams for practice development purposes.

Updated Risk Resource (2013)
Updated Risk Resource (2013)

The Risk Decision-Making publication includes examples of these tools, and a specific example of data emerging from their use in a specific organization to help identify good practice and priorities for further development.

So, the sting in this tail is that practitioners and teams need to own the processes of audit and regulation if they are to reflect and develop good practice. For those auditors and managers fearful of losing their jobs if Practice Based Evidence emerged as the norm, you could always make use of the data to tick your boxes; better still, you could prioritise your time more effectively by getting in and alongside practitioners and teams to support a quality revolution. You might then be in a stronger position to challenge and inform the thinking of the inter-galactic warlords from distant planets a.k.a. commissioners, Department of Health, Care Quality Commission.

Podcast Episode 045: A Place for Carers

TheStrengthsRevolution_albumart_2-2In this episode the focus is on informal unpaid carers in the health and social care system. Who carers are, and the roles they perform, are honoured as amazing strengths that can be relied upon. However, the role comes with burdens and pressures, and services have not been so quick to see carers as a priority for the vital support they need.

The focus for this episode was triggered through reading an article by Nicci Gerrard in the Observer newspaper (UK Sunday broadsheet). She was reflecting on her father’s experiences of dementia, and more specifically on the damaging effect of a hospital admission on his ability to function independently. It is not a way of blaming staff or the service, but more a reality check on how the demands of an ageing population are overloading the existing service.

John’s Campaign has been established to promote greater access for carers on to hospital wards, particularly to continue supporting their loved ones who have succumbed to dementia. The costs are very minimal and the benefits for patients, carers and staff are very significant. Good practice in this issue exists in small pockets, but the challenge of the campaign is for best practice to become standard practice everywhere.

To access the full content of this episode click on the links to iTunes and Sound Cloud (or go to Stitcher Radio):

https://itunes.apple.com/gb/podcast/strengths-revolution-steve/id867043694

https://itunes.apple.com/gb/podcast/045-a-place-for-carers/id867043694?i=334927346&mt=2

“To care for those who once cared for us is one of the highest honors.” [Tia Walker].

“I am sickened that the government thinks my value is so low when actually carers save the government billions.” [Anonymous carer survey response].

Values-Based Practice

TheStrengthsRevolution_albumart_1In 2013 Oxleas NHS Foundation Trust, in south-east London, commissioned a piece of work from Practice Based Evidence and the Mental Health Foundation to explore ways in which ‘values-based practice’ can be practiced and evidenced more in the day-to-day work with service users and carers within the Adult Mental Health Directorate. So far, the programme has engaged with six pilot teams and produced a set of draft guidelines. In 2014 the programme explore innovative ways of implementing the ideas, and spreading ideas to staff in other directorates.

Now in 2015 the programme draws to a close with a focus on a specific group of people, explored elsewhere in a few podcast episodes, the team and ward managers. These are seen by the programme developers as the key people for embodying and promoting the culture change needed within teams in order to implement refined approaches to the day-to-day challenges of working with peoples strengths and focusing on person-centred values in practice rather than just words in policies and mission statements.

WHY FOCUS ON VALUES-BASED PRACTICE?

They influence everything we think, decide and do in day-to-day practice, though often in a more sub-conscious way rather than overt statements and discussions. Good practice is not about adhering to one set of right values, we should respect and embrace values diversity. Values can be very personal, professional or organisational statements, but the focus here is on the values that underpin the day-to-day language of focusing on the needs and priorities of the individual service user. Practitioners need to be supported to be able to work where values of the service user, organisation, or professional may differ or conflict.  A recent high profile report in the UK highlights the need to put this approach to values-based practice into context:

Francis Report into Stafford Hospital “People must always come before numbers. Individual patients and their treatment are what really matters. Statistics, benchmarks and action plans are tools not ends in themselves. They should not come before patients and their experiences. This is what must be remembered by all those who design and implement policy for the NHS.” Excerpt from press release statement by Robert Francis QC in Stafford (5/2/13).

One product of the overall programme has been the development of brief practical guidelines linking together values and principles, working with strengths, positive risk-taking, and the role of person-centred care planning. A modified version of these can be accessed on request through The Strengths Revolution blog.

Podcast Episode 016: Risk Taking v Risk Aversion

TheStrengthsRevolution_albumart_2-2Are we risk takers or are we generally more conservative in our risk decision making, more risk averse? There is no blanket answer to this question for any of us, as there are different situations and circumstances that influence us in different ways.

Health and Social Care service practitioners may become more risk averse in particular situations, and some will be more risk averse depending on their own experiences. When is it ok to be risk averse? When it is the clearly reasoned decision based on careful consideration of the information available to us.

Risk decisions will be part of everyday experiences within health and social care services across all sectors e.g. mental health, learning disability or older persons services. The same principles apply to all of us in our personal lives, when we are confronted with situations that require a difficult decision.

For the full content of this episode click on the links to iTunes and Sound Cloud (or go to Stitcher Radio):

https://itunes.apple.com/gb/podcast/strengths-revolution-steve/id867043694

https://itunes.apple.com/gb/podcast/016-risk-taking-v-risk-aversion/id867043694?i=316511320&mt=2

“There is a short window at the beginning of one’s professional life when it is comparatively easy to take big risks. Make the most of that time, before circumstances make you risk averse.” [Joshua Foer].