This document summarizes a research project that evaluated the impact of a leadership development and practice improvement initiative in nursing homes in Northern Ireland. The initiative included a leadership support program and practice development subgroups. Focus groups with 15 nursing home managers found that the initiative helped managers develop leadership skills, improve staff development and relationships with relatives. It also led to specific practice changes like increased resident involvement and community connections. Overall, the research found the initiative improved quality of life for residents, relatives and staff.

1. ulster.ac.uk
Supporting leadership and practice
development in care homes results
in wellbeing for residents
Prof Assumpta Ryan- Project Lead
Mrs Sarah Penney – Project Manager

2. The need to act now!
• Demographics – an ageing population.
• Changes in family size and structure, immigration, divorce, role of
women in society.
• Chronic illness and dementia - 48,000 approx. people living with
Dementia in Ireland (Cahill & Pierce 2013)
• 80% of care home residents will have dementia or memory difficulty
(Alzheimer’s UK, 2013).
• Over 22,000 beds in the private and voluntary nursing home sector
in Ireland, accounting for more than 80% of the country's long-term
care beds (NHI 2016). Over 16,000 care home beds in Northern
Ireland (DHSSPS, 2014).

3. • Training in some homes meets mandatory requirements
only.
• Work poorly remunerated, physically and emotionally
challenging, low morale, staff turnover is high.
• Move to a care home result of necessity rather than
choice.
• A time of conflicting emotion for older people and their
families.
• Need to improve leadership and care provision in this
sector.

4. My Home Life
• My Home Life (MHL) aims to delivers positive change in
care homes for older people.
• Aimed at improving quality of life for people living, dying,
visiting and working in care homes.
• Originated in England in 2006 by the National Care
Forum and Help the Aged in collaboration with City
University…..Wales 2008, Scotland 2012, NI 2014.
• Achieved by supporting managers to develop their
leadership skills through a programme of action learning.

5. My Home Life NI
Implemented in NI with a new approach
• Leadership support programme strand
• Practice development strand new

6. Leadership Support Strand
• 4 day workshop
• followed by a cycle of 8 monthly action learning
sessions.
• delivered by trained MHL facilitators.
• Each LSP cohort comprises of sixteen participants
who meet as a group for the 4-day workshops
and who subsequently work in two smaller
groups (n=8) for the action learning component
of the programme (MHL 2015)

7. Practice development
• In addition to ALS participant's also formed 4
subgroups
• Each subgroup focused on one theme
• Reviewed current research
• Developed initiatives around the theme to
improve practice

8. An Msc Research project

9. Method
Qualitative focus groups were used to explore the views of
care home managers on
• the impact of the practice development initiative
• their leadership skills
• professional development.
Focus groups were conducted at the beginning and end
point of the project.

10. The initial focus groups were held after the leadership
programme workshops which were held over 4 days at the
beginning of the project.

11. The Sample
Fifteen care home managers
The homes included a mix of large and small, nursing and
residential homes of different ownership arrangements
(corporate, family owned, not for profit) across urban and
rural areas.

12. Analysis
The focus groups were digitally recorded and then fully
transcribed. They were then analysed using Colaizzi’s
(1978) approach

13. The initial focus groups
3 Main Themes
• Developing an insight
• Transitions for relatives
• Aspirations for staff

14. Developing an insight
We need time to look outside the box’, ‘away from the
distractions, demands and challenges
‘This is a more collaborative approach that I would never of
done before’

15. Transitions for Relatives
I am so much more conscious now of relatives feelings
‘I need to speak to these people [relatives], you know with
them not at them.”

16. Aspirations for Staff
‘I am now giving them the power to lead things and change
things’ to develop better relationships with residents. ‘I find
myself becoming more aware of how staff are relating to
residents’
The biggest thing for me so far is relationship centred care’
‘it was like a light bulb moment for me, I thought yes, this is
what we are doing and need to be doing’.
(Manager 1, focus group 1a)

17. Aspirations for staff
Recognition of terminology used in care homes
• Feeders
• Doubles
• Wanderers
Its ‘a lack of understanding [among their staff] that needs to
change’
(Manager 6 focus group 1a)

18. At the end of the
project

19. Themes
• Leaders not managers
• Developing Staff
• Developing Relationships with Relatives
• Practice Development

20. Leaders not Managers
I allowed myself to develop relationships more with the
staff’ (Manager 4 focus group 2a)
‘It’s nice to feel a bit more secure in yourself’
(Manager 3 focus group 2a)
‘my staff would say I involve them more’ I am more open to
suggestions’ I allow them more time to have that lightbulb
moment’ (Manager 10 focus group 2a)

21. Developing Staff
they are advocating for our residents now’,
‘they question me now because they know they can’,
‘they are taking ownership’
‘outcomes are changing’

22. Relationships with Relatives
‘It really is the little things that are making a difference,
we’ve found a way to make those things happen, and count’
(Manager 12 focus group 2a)

23. Practice Development
The subgroups enabled us to
‘produce significant changes’ (Manager 14 focus group 2a)
it helps build a better relationship with residents’
(Manager 2 focus group 2b)

24. Examples of PD Initiatives
• This is Me – Now
• A day in the life
• Decision trees
• FaN’s & Youth Volunteers

25. Measurement Tools
‘Yourself as a Leader’ (Dewar, 2014)
‘Assessment of Work Environment Schedule AWES’ (Nolan
et al., 1998)
completed by the 15 care home managers,

26. Assessment of Work Environment Schedule
I currently get a positive sense of personal achievement from my work
There is a good spirit of cooperation between staff
Staff can try new ideas without criticism
My staff are congratulated when they do things well
I am congratulated when I do things well
The amount of work I am given to do is realistic
There is a positive feeling of morale among my staff
I feel that I have the management and leadership skills required to undertake
an effective role
I have a positive quality of life
The quality of life of my residents is positive
I am content with the quality of interaction that staff have with residents

27. Key Findings
• Managers had all developed new ways to cope in what is
an extremely demanding role
• A focus on the language that was used
• Managers were able to clearly demonstrate changes that
occurred not only in themselves but in their staff and
relationships with relatives and residents.

28. Relatives
Relatives became an integral part of daily approaches and
were included in every one of the specific PD initiatives
completed within this project.

29. Residents
Shared decisions
Community links
Transitions
Dignity & identity

30. Staff
Managers also developed a sense of importance in helping
staff connect with residents on a more personal level and
helped staff move away from the traditional task orientated
approach

31. Outcomes & Benefit's
• Improves quality of life for care home residents, relatives and staff.
• Supports the government agenda as outlined in key documents.
• All stakeholders working in partnership towards a common goal.
• Develops a stable, reflective and confident workforce ready to meet
the demands of our aging population

32. Care homes have the potential to be an increasingly
valuable asset to our communities and to be perceived
as a positive lifestyle choice when care cannot be
provided at home.

33. Thank You to an amazing group of Managers