‘My home is my castle’   It is about status, ownership,   privacy and identitywww.institute.nhs.uk | Assisting the NHS in ...
”Our home has become a way                                         of signalling who we are. The                          ...
Why is it, then, that when    people move into a care    home such considerations no    longer seem to apply?www.institute...
We are ambivalent about old age.            People are living longer            Number of older people is increasing      ...
Culture of Care   A reflection on how care   homes need to shift their   culture...from patronage to   engagementwww.insti...
www.institute.nhs.uk | Assisting the NHS in transforming healthcare
The next 30 minutes             Background on care homes             Insights & Creating change that sticks             Ex...
When you hear ‘care homes’     Scandals     Poor quality     Money grabbing     Less relevant     In decline     Is there ...
Speaking to someone                                                                      who considered whether           ...
Future projections of our ageing population       predict that older age groups are growing       much faster than the res...
How will the country care      for the growing amount of      older people?      Who will provide it?      Who will pay fo...
8 % of care is funded by the NHS                   41% privately by the individual                   51% by local Authorit...
Residents who will use care homes more                                                         in the future are said to h...
The care home of the future        will need to become a central        part care solutions. It must be        radically d...
Although there is a sense of crisis   that care service are reaching   breaking point, ageing presents   huge opportunitie...
From flexible care in your home to         the flexible use of a care home we         will need a variety of future scenar...
But, we will also need to                 mobilise existing resources.                 “We have recognised the need to    ...
Evidence suggests that the     culture of a care home     Evidence suggests that the culture of a care home directly     d...
Evidence suggests that the culture of a care home directly     affects the quality of life of those who live and work ther...
Creating small interventions which     Evidence suggests that the culture of a care home directly a                       ...
Froma‘patronage’     Evidence suggests that the culture of care home directly                                   to engagem...
What is important to   people in care homes?   Some key insightswww.institute.nhs.uk | Assisting the NHS in transforming h...
# 1 Feel safe and secure    Residents: safe and free from harm, pain and    discomfort, and know they receive competent an...
# 2 Have a sense of continuity    Residents: consistent care from the moment    they come into the care home, people to   ...
# 3 Feel like they belong    Residents: be able to form or maintain    meaningful relationships, be part of a    community...
# 4 Have a purpose    Residents: opportunities to engage in    purposeful activities which facilitate the    passing of ti...
# 5 Sense of achievement    Residents: feel they can make a    contribution and can meet meaningful    and valued goals.  ...
# 6 Feel valued & important    Residents: feel significant and valued    as a person. Feel like they matter.    Staff: fee...
As we continued our work to help         design for these needs, we learned         some important lessons about how      ...
Don’t try and force   cultural shift. Start small.www.institute.nhs.uk | Assisting the NHS in transforming healthcare
“One member of staff had                                                                      written that she likes line ...
Draw on the positive   aspects of culture.www.institute.nhs.uk | Assisting the NHS in transforming healthcare
By drawing on cultural                                                                      strengths we tapped into      ...
Involve people at all   levels. Work with and   within their cultures.www.institute.nhs.uk | Assisting the NHS in transfor...
We learned taking that                                                                 time to listen to people’s         ...
We developed a tool called                                                                      ‘My Story’ which gives car...
www.institute.nhs.uk | Assisting the NHS in transforming healthcare
Clear info                                                          ‘Expert’                               al             ...
Bob.             It was through the simple activity of listening to             relatives that staff was able to find out ...
My Storywww.institute.nhs.uk | Assisting the NHS in transforming healthcare
Improved communications during shift and handovers          Better relationships between staff, residents and relatives   ...
The framework                Measure                              Capture          Understand   Improvewww.institute.nhs.u...
Getting Startedwww.institute.nhs.uk | Assisting the NHS in transforming healthcare
Small change is ok.   But we need lots more of it.www.institute.nhs.uk | Assisting the NHS in transforming healthcare
Thanks.   julia.schaeper@institute.nhs.uk   @juliaschaeperwww.institute.nhs.uk | Assisting the NHS in transforming healthc...
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Culture of Care

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Transcript of "Culture of Care"

  1. 1. ‘My home is my castle’ It is about status, ownership, privacy and identitywww.institute.nhs.uk | Assisting the NHS in transforming healthcare
  2. 2. ”Our home has become a way of signalling who we are. The symbolic value of how we live has detached itself from the utility value of the past decades.” - Siv Raun Andersen, Anthropologist, 2004www.institute.nhs.uk | Assisting the NHS in transforming healthcare
  3. 3. Why is it, then, that when people move into a care home such considerations no longer seem to apply?www.institute.nhs.uk | Assisting the NHS in transforming healthcare
  4. 4. We are ambivalent about old age. People are living longer Number of older people is increasing Society has the means to prolong lifewww.institute.nhs.uk | Assisting the NHS in transforming healthcare
  5. 5. Culture of Care A reflection on how care homes need to shift their culture...from patronage to engagementwww.institute.nhs.uk | Assisting the NHS in transforming healthcare
  6. 6. www.institute.nhs.uk | Assisting the NHS in transforming healthcare
  7. 7. The next 30 minutes Background on care homes Insights & Creating change that sticks Example of what we are working onwww.institute.nhs.uk | Assisting the NHS in transforming healthcare
  8. 8. When you hear ‘care homes’ Scandals Poor quality Money grabbing Less relevant In decline Is there a viable future?www.institute.nhs.uk | Assisting the NHS in transforming healthcare
  9. 9. Speaking to someone who considered whether they would want to live in a care home: “I have a fear of living like this when I am old”www.institute.nhs.uk | Assisting the NHS in transforming healthcare
  10. 10. Future projections of our ageing population predict that older age groups are growing much faster than the rest of the population: By 2050, twice as many people aged over 85 and overall costs will increase fourfold. Future demand for long-term care services will grow rapidly: There are 400.000 residents in approx. 18.500 care homes now. By 2050, no of beds needed for elderly care is expected to double to just over a million.www.institute.nhs.uk | Assisting the NHS in transforming healthcare Source : National Care Association
  11. 11. How will the country care for the growing amount of older people? Who will provide it? Who will pay for it?www.institute.nhs.uk | Assisting the NHS in transforming healthcare
  12. 12. 8 % of care is funded by the NHS 41% privately by the individual 51% by local Authorities UK Councils are tightening their eligibility criteria and rationing social services to make ends meet. The great majority of people with low or moderate needs receive no support from Councils.www.institute.nhs.uk | Assisting the NHS in transforming healthcare Source : Laing & Buisson UK 2011
  13. 13. Residents who will use care homes more in the future are said to have ‘high levels of needs’: The average age of a resident is 85 years 75% are classified as “severely disabled” 70% have dementia 40 % are said to have depressions 66% have cognitive impairments They are a much older and frailer population than they were in the pastwww.institute.nhs.uk | Assisting the NHS in transforming healthcare Source : My Home Life
  14. 14. The care home of the future will need to become a central part care solutions. It must be radically different from current propositions and offer: Flexible care packages responding to personal needs; Affordable solutions to citizens and the state; Flexible use at the point of need.www.institute.nhs.uk | Assisting the NHS in transforming healthcare Image source : Hogewey
  15. 15. Although there is a sense of crisis that care service are reaching breaking point, ageing presents huge opportunities to develop new models of care outside of care homes (for people with low to moderate needs) which: Harness increased willingness of families & friends to provide informal care; Recognise that people due to medical advances can stay at home for longer.www.institute.nhs.uk | Assisting the NHS in transforming healthcare
  16. 16. From flexible care in your home to the flexible use of a care home we will need a variety of future scenarios...www.institute.nhs.uk | Assisting the NHS in transforming healthcare
  17. 17. But, we will also need to mobilise existing resources. “We have recognised the need to make improvements in our care home for a very long time but we have never been sure where to start and how to do it.” - Care Home Managerwww.institute.nhs.uk | Assisting the NHS in transforming healthcare
  18. 18. Evidence suggests that the culture of a care home Evidence suggests that the culture of a care home directly directly affects the quality affectsof those who live of those who live and work there of life the quality of life (Reed et al, 1997). A positive culture is characterised as one and work there. A positive where is characterised as one culture the ethos of care is centred on the individual, based on evidence of what care is for good care and continually where the ethos of makes effective within a changing health and social care context centred on the individual and (Manley et al, 2004). their relationships.www.institute.nhs.uk | Assisting the NHS in transforming healthcare Source : Reed et al, 1997 and Manley et al, 2004
  19. 19. Evidence suggests that the culture of a care home directly affects the quality of life of those who live and work there (Reed et al, 1997). A positive culture is characterised as one where the ethos of care is centred on the individual, based on evidence of what makes for good care and continually effective within a changing health and social care context (Manley et al, 2004).www.institute.nhs.uk | Assisting the NHS in transforming healthcare
  20. 20. Creating small interventions which Evidence suggests that the culture of a care home directly a help to build relationships and affects the quality of life ofcaring who liveMobilise existing those culture. and work there resources by valuing different (Reed et al, 1997). A positive culture is characterised as one perspectives and fostering creativity, where the ethos of care is centred on the individual, based on evidence of what makes for good care and continually within. learning and innovation from effective within a changing health and social care context (Manley et al, 2004).www.institute.nhs.uk | Assisting the NHS in transforming healthcare
  21. 21. Froma‘patronage’ Evidence suggests that the culture of care home directly to engagement. affects the quality of life of those who live and work there (Reed et al, 1997). A positive culture is characterised as one where the ethos of care is centred on the individual, based on evidence of what makes for good care and continually effective within a changing health and social care context (Manley et al, 2004).www.institute.nhs.uk | Assisting the NHS in transforming healthcare
  22. 22. What is important to people in care homes? Some key insightswww.institute.nhs.uk | Assisting the NHS in transforming healthcare
  23. 23. # 1 Feel safe and secure Residents: safe and free from harm, pain and discomfort, and know they receive competent and sensitive care. Staff: free from physical threat, abuse and criticism, and work in secure conditions of employment. Relatives: confident in care home staff’s ability to provide good care, and have access to support networks when required.www.institute.nhs.uk | Assisting the NHS in transforming healthcare
  24. 24. # 2 Have a sense of continuity Residents: consistent care from the moment they come into the care home, people to understand them as a person Staff: time and access to the stories & information that lies in people’s past, exposure to good role models and environments of care. Relatives: be able to maintain involved in the life of their relativewww.institute.nhs.uk | Assisting the NHS in transforming healthcare
  25. 25. # 3 Feel like they belong Residents: be able to form or maintain meaningful relationships, be part of a community or group, as desired. Staff: feel part of a team and recognised in their contributions. Relatives: be able to confide in trusted individuals to feel that you are not in this alone.www.institute.nhs.uk | Assisting the NHS in transforming healthcare
  26. 26. # 4 Have a purpose Residents: opportunities to engage in purposeful activities which facilitate the passing of time, and tie in with their personal interests and past. Staff: clear set of goals to which to aspire – individually and as a team. Relatives: feel involved and that that they are still part of the resident’s carewww.institute.nhs.uk | Assisting the NHS in transforming healthcare
  27. 27. # 5 Sense of achievement Residents: feel they can make a contribution and can meet meaningful and valued goals. Staff: be able to provide good care, feel satisfied with one’s efforts Relatives: need to know the care home ‘has done its best’ to provide the best possible care to their loved one.www.institute.nhs.uk | Assisting the NHS in transforming healthcare
  28. 28. # 6 Feel valued & important Residents: feel significant and valued as a person. Feel like they matter. Staff: feel like their efforts are valued and significant in the wider context. Relatives: need to feel that one’s caring efforts are welcome and appreciated.www.institute.nhs.uk | Assisting the NHS in transforming healthcare
  29. 29. As we continued our work to help design for these needs, we learned some important lessons about how to create cultural change that sticks:www.institute.nhs.uk | Assisting the NHS in transforming healthcare
  30. 30. Don’t try and force cultural shift. Start small.www.institute.nhs.uk | Assisting the NHS in transforming healthcare
  31. 31. “One member of staff had written that she likes line dancing, and one of the relatives came and asked her if she wanted to go with them!” Small interventions started to trigger significant behavioural changes - improved communications and increased confidence that making changes is not that difficult and that it can be fun toowww.institute.nhs.uk | Assisting the NHS in transforming healthcare
  32. 32. Draw on the positive aspects of culture.www.institute.nhs.uk | Assisting the NHS in transforming healthcare
  33. 33. By drawing on cultural strengths we tapped into the deep rooted concern about residents and their wellbeing and the desire from staff and relatives to get more involved in making improvements.www.institute.nhs.uk | Assisting the NHS in transforming healthcare
  34. 34. Involve people at all levels. Work with and within their cultures.www.institute.nhs.uk | Assisting the NHS in transforming healthcare
  35. 35. We learned taking that time to listen to people’s stories, opinions and experiences is what people found most helpful in order to create a more positive culture. It made them feel valued and important.www.institute.nhs.uk | Assisting the NHS in transforming healthcare
  36. 36. We developed a tool called ‘My Story’ which gives care home staff the time and encouragement they need to listen to someone’s stories and draw insights for making improvements.www.institute.nhs.uk | Assisting the NHS in transforming healthcare
  37. 37. www.institute.nhs.uk | Assisting the NHS in transforming healthcare
  38. 38. Clear info ‘Expert’ al relative package. On Emotion Pro vi din s n g a dvice services provided, transitio on what to think who works support. abo ut, w hat to there,who lives ives Assisting relat expect there, what to ition in t he trans bring, prices... process ‘Jo urney I nto ation Ca re’ convers ch Transition days. gath ering as mu Days where future as infor mation residents can get the possible on to know the care d p erson to be Flexible hours. surroundings for Where some people join Reintroduce daily activities before routines (washing, they become gardening - things residents? people used to do before coming to the care home)www.institute.nhs.uk | Assisting the NHS in transforming healthcare
  39. 39. Bob. It was through the simple activity of listening to relatives that staff was able to find out about Bob’s past routines. Bob wouldn’t stop his night time wanderings and eventually a member of staff came up with the idea to manage his behaviour by giving him a torch and clip board and getting him to come along on night time rounds, to check the security of windows and so on.www.institute.nhs.uk | Assisting the NHS in transforming healthcare
  40. 40. My Storywww.institute.nhs.uk | Assisting the NHS in transforming healthcare
  41. 41. Improved communications during shift and handovers Better relationships between staff, residents and relatives Increased confidence and ownership in making changes Sense of involvement Reduced ‘back-end’ work and increased time spent with residentswww.institute.nhs.uk | Assisting the NHS in transforming healthcare
  42. 42. The framework Measure Capture Understand Improvewww.institute.nhs.uk | Assisting the NHS in transforming healthcare
  43. 43. Getting Startedwww.institute.nhs.uk | Assisting the NHS in transforming healthcare
  44. 44. Small change is ok. But we need lots more of it.www.institute.nhs.uk | Assisting the NHS in transforming healthcare
  45. 45. Thanks. julia.schaeper@institute.nhs.uk @juliaschaeperwww.institute.nhs.uk | Assisting the NHS in transforming healthcare

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