How to engineer change

To identify whether the existing culture within your care home enables activity, use the following questions: 

For residents, relatives and staff, what are: 

• Three wishes you have for the home? 
• Three things the home does well? 
• Three ideas to improve the residents’ experience of life in the home? 

Once you have identified people's aspirations within the care home, you need to ask the following questions: Does it need a new culture? If there is more than one culture, and can the cultures be integrated to achieve the best possible fit or can two cultures sit alongside each other to achieve an acceptable balance? (Child et al 2005).^[1]

Exploring culture can also help to evaluate what the organisation is doing well, and provide a baseline to build on. The next step is to decide areas for improvement and to: 

• Define appropriate quality standards to work towards 
• Agree actions to meet these standards 
• Establish monitoring to ensure quality is maintained.

For these steps to work, it is important to understand the needs, fears and motivations of staff at all levels and establish improvement activities. Therefore, the agreed actions should: 

• Include clear measures and accountability. 
• Highlight benefits for residents and rewards/benefits for staff. 
• Utilise motivators for staff. 
• Be supported by procedures and the environment. 

(There are examples of action plans under ‘Measuring quality’).

The following questions may help to get ideas on how to move forward in creating a new active culture within the home.

For residents, what are: 

• Three ways you are supported to do activities? 
• Three things you would like support to be able to do? 

For relatives, what are:

• Three things you would like to see your relative supported to do? 
• Three ways you might like to be involved in the life of the home? 

For staff, what are:

• Three ways you support residents to engage in activity? 
• Three things you would like to do to support residents to engage in activity?

References

1. Child J, Faulkner D, Tallman S (2005) Cooperative strategy: managing alliances, networks and joint ventures. Oxford: Oxford University Press.

To establish a positive activity culture: 

• Be aware of current legislation, policies and guidance in relation to dignity, choice and staying active. 
• Review the service’s current policies and procedures and the environment of the home – do they support activity? 
• Support the activity coordinator and grant them status and a degree of authority. An acknowledgment of the importance of this coordinating role sends a message to all team members about activity being essential to the experience of the residents’ daily life. 
• Encourage the role of other staff through including enabling activity within everyone’s job description and making enabling activity a fixed agenda item in staff meetings, supervision sessions and staff appraisals. Any ideas need to be recorded as part of an action plan with a measurable outcome, date for completion, and named responsibility. 
• Design in-service training that promotes discussion to allow staff to share ideas, encourage each other and challenge existing practice. 
• Encourage staff to feel able to contribute ideas and suggestions to the activity programme and progress new ways of working. 
• Review existing supervision arrangements. Regular supervision for staff can guide them on best ways of working, offer support, outline their responsibilities and manage risk. It can be carried out on an individual, group or peer basis. Supervision supports the process of change by giving staff the opportunities to ask: What am I doing well? What areas do I need to develop? What can I do differently? How can I make changes?

It is important to recruit the right staff: people who believe that it is everyone’s responsibility to support residents to make choices and to be fully involved in the life of the home. 

• Understand the beliefs and roles of all team members and identify each team member’s strengths and motivators. 
• Include enabling activity within everyone’s job description. 
• Develop team-working skills to facilitate cooperation from others and good working relationships with other members of the team. 
• Encourage staff to think of possible solutions to barriers they perceive or encounter. 
• Encourage ideas and creativity in all levels of staff. If staff have a particular interest or set of skills, work with them to consider how they can use them for the benefit of the residents. 
• Review the environment and current procedures – do they support activity? 
• Active participation in daily life needs to be discussed regularly – what is working well, what is not, the barriers, possible solutions and new ideas. For example: consider making enabling activity a fixed agenda item in staff meetings, supervision sessions and staff appraisals, or hold regular meetings with staff, residents and relatives with activity as an agenda item. 
• Establish a suggestion book or box and actively explore proposals. 

Forming a support system for staff groups 

Change can be welcome, but it may cause some staff members to become anxious and resistant. One way to support and involve staff is to establish a structure that offers processes they can use, such as meetings and checklists. This will encourage shared responsibility, the exchange of ideas, and tackling problems and barriers. 

Ideas for establishing a support system 

• Hold regular meetings for staff. 
• Consider the time and frequency of meetings: who should be involved, when and where they should take place, and what should be covered. 
• Establish ground rules of confidentiality. 
• Develop a framework to include: 

1. Behaviour – ‘I have a problem’. 
2. Effect – ‘I find it difficult to make tea, run activities and when doing both...’ 
3. Feelings – ‘I am worried about leaving the residents unattended, how can we deal with this?’ 
4. Space to ask questions – provide fertile ground for people to come up with solutions. 

• Evaluate the usefulness of the meeting and plan the next one. 
• Hold a special meeting to discuss any stress points in the organisation that are preventing progress, and work out ways of providing help. 
• Draw up a ‘help list’ for all possible problems, indicating who to turn to for help and which resources to draw upon. 
• In stressful times, hold a short wind-down meeting at the close of each shift to tackle work/communication difficulties and stressful situations.