‘Appreciative Inquiry’ the way forward for SocialCare change management

This post is to show how Appreciative Inquiry (AI) can support positive changes in the health and social care market. For those readers unfamiliar with AI please take the time to check out the work of David Cooperider, including – Appreciative Inquiry: A positive Revolution in Change

This post is around recent work that I have been undertaking in turning around a residential/nursing home rated as ‘requires improvement’ from the Care Quality Commission and needing change from local authority and health professionals involved in order to deliver the quality care service expected of an excellent care home provider.

Now before I utilise this post to show how AI is a positive tool to use in achieving desired outcomes, improving goals set and further developing best practice of service delivery, I must say that AI can be used in various different ways of working – including change management, future developments of new service projects and changing cultures of employment, for example.

So back to this post..…….

VCS took on this project off the back of providing an initial comprehensive audit/visit including findings, potential actions and outcomes for the provider in achieving positive changes to become more compliant with regulatory organisations – Positive Change Management

After speaking at length with the owners of the service (1 of which I had previous and current work with) I was able to highlight how AI would support the radical change needed in service delivery to create a service that was safe, meaningful and directly support individual led delivery of care for all people, families/relatives, employees and professionals accessing the service/home.

AI is explained as being a “Collective action designed to evolve the vision and will of a group, an organisation or as a society as a whole” (David Cooperider). For me, understanding how AI can support best practice achievement in health and social care is as follows:

“It’s an energy focus to progress development and delivery through positivity and specifically an awareness of the care service being acknowledged as an organic living entity”

Potential to sound a little scary for traditional corporate management types I am sure, but stay with me. Can I show you how this looks in practice? Well firstly I would love to take you and your business/service through it personally so please get in touch (Contact link) and for these who need more let me continue………

The main function and/or lead focus for AI is the 4D cycle, which is a set of prompts from which you can explore and nurture ideas and new thoughts in order to gain a collective approach on how you are to change and/or develop the outcomes you are looking for.

So again let me return to the example of my recent support of residential/nursing home in turnaround using AI. Using the 4D cycle it looked in simple terms like this:

1D – DISCOVERY: Appreciating and Valuing the here and now to better understand the home, its residents, its employees and its service delivery, whilst gaining a vital platform on which to ‘build new’ and ‘develop existing’ ways of quality person centred care. Prompts include: “What gives the service its life?”, “Describe and highlight the best of what it is and what it does”.

2D – DREAM: Envisioning what an achievable gold standard of personalised quality care supports would look like and how it would be delivered and received by individuals accessing, employees working and relatives/professionals/local community being involved with. Prompts include: “What might it be?”, “Describe or picture the image/model of what the local area is calling for”.

3D – DESIGN: Constructing the future service and how that will be in practice moving forward. Prompts include: “How can it be?”, “Determining the ideal model needed to create and/or develop reaching the gold standard identified”.

4D – DESTINY: Sustaining the developed service in order for it to continue to organically grow and evolve to meet the changing needs of care and people in need of care in the future. Prompts include: “What will it be?”, “Describe or picture the learning, empowerment and continuous improvement that would show sustainability in the future”.

So what has it achieved for the home and service? Well as we stand now the home is in a much safer and secure position; its delivery of care is acknowledged by all professionals involved as greatly improved; residents and relatives have stated how much of an improvement has been noted (shown within a recent HealthWatch visit which received a score of 4.6 out of 5); staff turnover has drastically reduced and retention is greater improved; and finally the home are awaiting the Care Quality Commissions return to complete a comprehensive report into changes made.

David Cooperider explains “Every organisation has something that works right, things that give it life, when it’s most alive, effective, successful and connected in healthy ways to its stakeholders and communities”

For me in the way I use AI in supporting social care organisations and providers is to understand its organic state then identify what is positive, and connect it in ways that intensify energy, vision and positively create actions for real individual person centred changes in care delivery.

I would love for people to follow this up with comments and I would also like the opportunity to speak directly to you and your organisation on how I and VCS can positively support your services.

Till then take care and remember,

“With hope and belief there are no limitations”

Stephen

A new way to start thinking

I’ve wanted to write this post for a long time and I hope I can do it justice, so please keep with it. I would also love to have your feedback on the content once you’ve had a chance to read through so please click the comments box and add to the discussions, thank you.

This post is all around how for me there is need to explore a different focus to create and develop a whole community involved, connected social care service that lives seamlessly within the communities we live in.

A couple of years ago now I was fortunate enough to be involved in a really innovative project that was brought together by likeminded individuals under the guise of the “Good Enterprise Lab” https://www.edgehill.ac.uk/ice/2014/03/05/good-enterprise-lab-real-change-enterprise/  that was held within the Edge Hill University complex  with a special nod to the creator Andres Roberts http://andresroberts.com/

Now this post is not to go into the finer points of the work undertaken, however I’d like to highlight a couple of the really positive elements experienced including:

  • From the start people involved didn’t focus on where they were from in terms of job role, however following the positive conversations, focussed on what skills and attributes they wanted to contribute to the ideas created
  • The use of person centred approaches, asset based community development and appreciative inquiry in order to develop those innovative ideas
  • The total negation of the focus of money and/or higher management decision and policy leads in the progress of the project

What I’d also add is that the whole project from my perspective and involvement started to unravel as many of these projects do (in my experience) when people in higher positions got more involved to steer the focus of aims to access funding streams. This then became the single focus of actions and outcomes to take instead of the positive innovative social care ideas – a totally contradictory approach to the positive work that was undertaken in the first place.

Now I am not trying to start an anti-establishment, rebellious thinking, free funded movement (or am I?). What I am interested to initiate, explore and would love to hear from other likeminded individuals about is; can the positive work started in the ‘Good Enterprise Lab’ be used to further nurture social care community ideas without fear of cost, funding or higher position management led focus?

Thus for this to be further explored and developed in such a way that the ‘contract/funded rule book’ is out the window and we create a foundation of the following:

  • Likeminded individuals working together, from all different backgrounds but a common goal to make a difference, to explore ideas and creativity in the health/social care sector
  • A pooling and exploration of existing positive streams/services/projects that could come together or be enhanced to create a collective positive stable wellbeing project in itself
  • The re-appropriation of existing services that don’t specifically look at achieving outcomes of health/social care inequalities, however with a little tweaking could be supported in achieving those goals
  • A chance to change the very way in which planned changes to community health and social care is looked at to a more community driven citizenship owned, ‘what a community needs’ led health and social care provision

I am not saying that this project would require you to down all existing tools and work in order to make happen.  What I am saying though is, ‘wouldn’t it be wonderful?’ …  are you not just the slightest bit curious to see what could happen if focus is slightly shifted and the community itself as well as the people living and existing within it are those in the ascendency to create, develop and nurture unrestricted social care and health led communities to live in?

I would love to hear from likeminded people and maybe this could be the starting point of the future thinkers in social care to develop and nurture a different focus on how to achieve positive wellbeing for all across local communities.

Thank you for taking the time to read this post and I look forward to the journey it may well take us on,

Till next time remember,

“With hope and belief there are no limitations”

Stephen

PS thank you to my lovely daughter for letting me use her lovely photo in the featured image 🙂

The positivity in Co-connected communities

I’ve had the pleasure this week of spending a little time away from the day to day running of VCS and get away with the family for a recharging break.

Alongside plenty of walking in the marvellous North Eastern countryside I’ve also been able to indulge in another passion neglected somewhat on normal working weeks, that of reading.

Now during this break I’ve enjoyed reading several books including this little quirky number “Fish Bowl” by Bradley Somer

  
Now without giving away too much of the story it’s set following a short time in the lives of a 27 storey residential block and the inhabitants lives lived during the period of a goldfish falling the distance of the 27 storeys to the ground – you have to read to understand 😀

What struck me with this book however is also follows a long held approach I use in my work and life, that on all levels we are as a society all co-connected in some way. Indeed the author in their acknowledgements says “…proving that no single person lives his or her own life; we live each other’s together.”

In supporting social care providers I truly value the approach of co-connection and how each service can work with the assets its holds and the quality assets that are in and around that locality to create a co-joined support network that works together for the benefit of all. 

I have to be careful to state here that this is not a reliance on others in being co-connected however a more mutually working together that comes from unstanding co-connection and how we are all living our lives together even if we don’t immediately understand its direct impact.

From the most obvious areas – collective health professionals and carers all coming together to deliver care services to individuals in need of personalised support, with each person playing their part in the collective whole to reach a positive outcome for others….

To less obvious areas – the local butchers and/or greengrocers taking local dementia friendly awareness sessions in order to better understand their changing customer group more and provide a co-connected provision of products and service with their local residential/nursing homes to support the continued business framework of a local community…

There are many more ways that this co-connected approach can be explored and I urge you dear reader to check out Cormac Russell and the  Nuture Development team to see those in positive action

And please if you see or image any further ideas then please feel free to comment below,

Till next time remember “with hope and belief there are no limitations

Stephen

Thank You!

The votes are in and have been independently verified and I am pleased to announce the following:

2015/2016 April to April has been Valued Care Solutions best and most successful on record.

VCS continues to grow from strength to strength in supporting a wide range of health and social care businesses and organisations the length and breadth of the country. Always to ensure they are providing quality person centred supports alongside high standard governance and management supports.

For this I would like to take the opportunity to say –

image

Thank you to:

  • All the businesses I have worked with this year
  • All the people I have met and connected with along the way
  • All the connections I have made in social media land

And finally and most important of all Thank You to my amazing wife and children who always give me 110% support in all that I do.

I couldn’t do it without you all 😀

So here’s to another fabulous year ahead and to changing the face of social care provision for the better!

Till next time, take care and remember

“With Hope and Belief there are No Limitations”

Stephen

 

Manager – “When do I get a supervision?”

Hello again dear reader I hope the past week has been a good one with plenty of opportunity and positive well-being for all.

So week 3 of these blogs brings me to a topic that has become very familiar in discussions but not so familiar when asking a manager “has yours been done or not?”

What am I talking about well I am talking about “Supervision and Appraisal” specifically for Care Home/Provider Managers and their management team.

I have had lots of experience over the years of working with care providers both residential and domiciliary and have often audited and monitored their supervision, appraisal and development of the staffing team. Now undertaking these audits normally show that the home and/or service is on top of employment supervision/development with all staff being supported with scheduled supervisions and annual appraisals, all written and recorded for inspectors to see on nicely defined matrices.

“HOWEVER” something that I have experienced a lot in my working and has again cropped up this week with a client is, who undertakes the supervision and appraisal of the manager and the management team in charge at the home/service.

“OFTEN” have I found that managers have been left to arrange their own supervisions with responsible persons/owners and if this gets forgotten about or through all the work that goes into being a manager it happens to be put on the back-burner it is left and the manager goes for months even years without their own supervision and/or development being appraised by the home/service owner.

Now in extreme cases, including a recent residential home turnaround project I have been involved, what happens is the standard of the home/service drops and due to not carrying out regular supervision/appraisals of the manager in charge the responsible person/owner only finds out about issues when they are at critical stage.

As an associate member of the Chartered Management Institute I advocate wholeheartedly in holding regular supervisions and appraisals with managers of home/services to ensure that management development is high on your agenda as well as moving to resolve issues that may occur at a low/local level before becoming critical.

I hope this blog has nudged you if your or your managers supervision is long overdue

And indeed if you feel that this is something that you need assistance with or would like to discuss the possibility of assistance then please get in touch with myself and I would be more than happy to offer VCS  supervision/appraisal supports.

As always please feel free to leave a comment and our experience on this subject and till next blog take care,

Stephen

 

Covert medication & DoLS

Well week 2 into this new weekly blog, oh how that week has flown by dear reader!

So this weeks interesting issue that was discussed at length was all about ‘Covert Medication’ and the implications of ‘Deprivation of Liberty Safeguards’ (DoLS).

Now before I start I have to state I am not an authority on this subject and will always state in all things DoLS –

“If in doubt ALWAYS contact your local DoLS team for clarification on the issue presenting”

and for those reading who deliver support with DoLS and/or the Mental Capacity Act involved will understand there are still a myriad of grey areas when it comes to this subject – “what is and what isn’t” – what I hope to provide in this blog is the benefit of the advice I give, have gained and some pointers for you to consider.

The question that started the whole discussion off was:

Do I need a DoLS for administering covert medication where the person involved lacks capacity?

I must admit my first response was “If it is covert and the person involved lacks capacity to understand the reasons/action taken even after formal support to understand and fully retain the information, then the answer would be YES!”

However it then got me thinking was I fully right in that assumption so I gathered some further information asked a few close connections with further insights into DoLS and MCA and was able to reach the following conclusion.

You do indeed need a DoLS for administering covert medication when the covert medication is either used as a controlling and/or sedative medication.

For those medications that are NOT classed as controlling and/or a sedative then a ‘Best Interest’ meeting and agreement should be used in conjunction with a GP or Pharmacist sign off

So how did I arrive at those statement. Well after consulting the Mental Capacity Act 2005 which includes the Deprivation of Liberty Safeguards and checking with the current advice listed on the NICE guidelines for managing medications in care homes – link, as well as my connections in conversation it was semi-clear the difference between needing (DoLS authorisation) and not needing (Agreed Best Interest) lies in the nature of the medication and what it was being prescribed for.  

And to put it in a form of a flow chart was the best way I could then let the care homes I am working with understand my finding:

Covert_medication_DoLS

Finally I must refer again to the statement made earlier in the blog –

If in doubt contact your local DoLS team for clarification on covert medication issue!

So there goes week 2 of these blogs I hope again this has either assisted you or got you thinking about the subject and with all my blogs I welcome your comments on the subject matter and/or blogs you wish to see in the future.

I thank you for reading and till the next blog, take care

Stephen

MPLC Movie Licence for Care Homes

As described here is the 1st in the list of Valued Care Solutions weekly blogs highlighting an area or issue I have encountered during my working week.

And the honour of the 1st blog goes to The Motion Picture Licensing Company (MPLC)  and a care homes need for having a licence to show DVD’s and downloads of films which have been bought or rented for the homes use as detailed within the Copyright, Designs and Patents Act 1988.

This came about following a recent visit to a care home who asked the question to myself

“Do we need to have this licence? as we only ever show films in a communal lounge and its their home after all”.

Simple answer to this one was YES however as with everything that you are certain of you have that little feeling deep in the recesses of your brain that says

“Are you sure, I mean really sure”

So I contacted the very helpful MPLC who where more than happy to assist and give their confirmation of the need for all care and nursing homes to have a licence to show films within the communal areas giving me the following FAQ information:

Q: Is a communal lounge area in a care home not a domestic, home environment?

A: No. There are a number of factors that dictate that a screening of a film in a care or nursing home is a public screening for the purposes of the Act and include:

  • Residents normally do not have a domestic or private relationship with each other. They do not live in the same residence because they are part of the same family or have private ties.
  • Residents are in the scheme independently from each other. Each resident is there as an individual member of the public to benefit from services offered by the scheme.
  • Residents pay for their accommodation and included within the price are various benefits offered by the scheme, which include communal activities that are available, such as the screening of film. Showing a film in a communal lounge of a scheme is an additional activity offered at the scheme.
  • Generally the audience in the communal lounge comprise of people who may not normally choose to watch film together.
  • Generally the size of the audience would be much larger than a normal domestic situation.

Whilst I was speaking to the MPLC I also asked about what would it mean for a care home if they decided to ignore the licence and carry on their practice and the answer was very interesting indeed:

Q: What are the penalties for screening films without the licence?

A: The Copyright, Designs and Patents Act in §107 prescribes damages for infringement of copyright that may subject you to substantial fines and penalties, including criminal penalties of up to a £5,000 fine and/or up to six months imprisonment. In addition, Section 97(2) of the act allows the court to consider the flagrancy of the infringement and any benefit, in order to award additional damages.

So do you as a manager, your activities coordinator or any of your staff use DVD’s and downloads of films as part of the residents activities programme in your home?

If the answer is yes then I would suggest a quick telephone call  or email to the MPLC to support your home and ensure you are compliant with the law:

Q: How can I contact MPLC?

e: healthcareuk@mplc.com

t: 01323 432163

w: www.mplcuk.com

Thank you for taking the time to read the 1st in this series of weekly blogs and I would finally like to thank David Taylor from MPLC for the use of information and links contained within this blog.

Take care till the next blog!

Stephen