Head psychologist Harold Sharples CEO explains the root causes and solutions to staff happiness.
CQE’s innovative system offers any care home leader the opportunity to make a significant difference in service quality whilst simultaneously providing the evidence needed to prove leadership and management strengths to CQC. The following paragraphs and exhibits positively address CQC’s KLOE statements and at the same time answer the all-important question: “How do you keep them safe?”. Combined with the ability to generate consistently safe rotas (see later in this document) CQE’s system can transform the nature and quality of any care providers’ care.
1. Whether they realise it or not, care leaders hold the keys to whether their operations are safe, effective, caring and responsive … or not.
The nature of any organisation’s day-to-day activities is a product of it’s culture. A Quality Caring Culture reliably and consistently delivers good caring. A poor quality uncaring culture will just as predictably deliver the opposite.
In care, building and maintaining the right culture is more crucial than building the right culture in any other organisation – because ‘care’ is quintessentially a human activity – care is not about doing a job and making ‘things’ – it’s much more than that – it’s about human expression and inter-relationships. The shared values and the shared habits of doing, thinking and inter-relating are pretty much all there is. Well-intentioned leadership is not enough … We need Well-Informed Leadership – founded on “Know-How”. All it takes to initiate KLOE hell is for a leader to recruit some uncaring carers. (Well-led – do you agree?) K5
2. Without a dependable and proven recruitment methodology, recruiting uncaring carers is far too likely an outcome. Uncaring carers are at best job-focused, and at worst completely careless. Uncaring carers and ignorance are the two commonest sources of unsafe practice in the industry. Uncaring carers are not motivated to learn, retain and practise how to deliver caring care. When those factors are combined haphazardly into weekly rotas – as they invariably are in the absence of a dependable and proven rota-building tool that routinely minimise the risks, it is inevitable that sooner or later, hitherto diligent colleagues will routinely see poor care being practised – and the uncaring carers getting away with it – perhaps even being encouraged by uncaring colleagues on the same shift. This doesn’t just result in reduced safety – it actually encourages it – and, in consequence, truly caring carers become disenchanted and demoralised with their organisation … and very often leave. (Safe – do you agree?) K1
3. Uncaring carers don’t just fail to deliver quality care, they aren’t even interested in learning how to improve. Unmotivated, undedicated and ineffectively trained carers destroy the very foundations on which a care culture thrives. Unchecked, workforces of uncaring carers just encourage the introduction of more uncaring carers – whether by recruitment and churn or through increased use of agency staff. As a consequence the organisation fails to develop a foundation of solid care experience. (Effective – do you agree?) K2
4. Care homes lacking a dependable and repeatable recruitment methodology cannot reliably prevent their working environments from becoming sub-optimised. Their outcomes are only made worse when rotas treat ‘risky’ carers as if they were ‘risk-free’. Perhaps this is why as many as 99% of UK care homes have had a resident abused by a carer. (Caring – do you agree?) K3
5. Notes 1 to 4 above describe the elements that all-too-often combine to build self-perpetuating and uncaring cultures. Uncaring carers that are uneducated, undeveloped and lacking in useful experience are quite incapable of delivering the care responses residents expect and deserve. (Responsive – do you agree?) K4
The Vicious Circle of Sickness and Absence and its debilitating cost is well known but to remind ourselves of the facts here’s some recent news editorial.
Here’s an extract from Magazine Care Home Provider
Increased agency costs contributed to a 3.1% drop in Four Seasons’ EBITDA (Company valuation) in 2017. Agency as a percentage of payroll for the business rose to 10.1%, compared with 8.0% in the year earlier.
Here’s an extract from carehome.co.uk. The nursing shortage crisis in care homes has led to the use of agency staff in care homes rising by over 55 per cent in just two years, according to a recent report.
In its report “The UK Nursing Workforce: Crisis or Opportunity”, specialist property advisers Christie + Co, claim that short-sighted workforce planning has resulted in the evolution of an ‘agency culture’ in health and social care over the past few years.
Christie + Co’s research revealed that an ‘agency culture’ has put huge financial pressures on care homes with the cost of agency staff typically exceeding the cost of regular staff by over 100 per cent on a per-hour basis.
Earlier this year, the CQC blamed poor care in care homes on a growing use of agency staff. They observed that continually changing rotas of agency staff often meant that warning signs of deteriorating health were missed.
Debbie Westhead, CQC’s deputy chief inspector of adult social care for the north said, “[One of the] few threads that run through the ‘inadequate’ inspection reports … is shortages of staff – and in particular – an insufficient number of registered nurses in nursing homes”. Agency culture: The report gives credence to her comments noting that the ‘agency culture’ has increased the cost of care whilst putting immense pressure of those providing it. ‘As a result, the risk that these pressures result in a deterioration in the quality of care is also real.
Thinking about health and social care as one system is absolutely essential for this’. Michael Hodges, director of Healthcare Consultancy at Christie + Co wants to see both policy makers and care home providers take action to address the problem, saying ‘those who fail to act now will feel the impact for years to come’. “The findings of our report highlight the need for innovation from operators, regulators and policy makers. “The announcement by the Government of an intention to place controls on payments to staffing agencies highlights the inefficiencies in workforce planning as detailed within our report.”
CQE IS AN OPPORTUNITY TO CREATE A VIRTUOUS CIRCLE
IT’S THE VIRTUOUS CIRCLE THAT DIMINISHES AGENCY, REDUCES SICKNESS AND ABSENCE AND CHURN WHILST CREATING RELIABLE ROTA DATA TO PROVIDE REPORTS AND DOCUMENTS FOR CQC – BUT MOST IMPORTANT OF ALL IS THAT IT MAKES CARE HOMES RELIABLY SAFE.
1. Whether they realise it or not, care leaders hold the keys to whether their operations are safe, effective, caring and responsive … or not.
The nature of any organisation’s day-to-day activities is a product of it’s culture. A Quality Caring Culture reliably and consistently delivers good caring. A poor quality uncaring culture will just as predictably deliver the opposite.
In care, building and maintaining the right culture is more crucial than building the right culture in any other organisation – because ‘care’ is quintessentially a human activity – care is not about doing a job and making ‘things’ – it’s much more than that – it’s about human expression and inter-relationships. The shared values and the shared habits of doing, thinking and inter-relating are pretty much all there is.
The first responsibility of a care leader is to ensure that the culture works FOR the organisation and the service users – and not against them. (K5: Well-led – right?)
2. In any care organisation, there is a spectrum of carers – ranging from truly caring carers who are care-focused to relatively uncaring carers who are at best job-focused. Uncaring carers and ignorance are the two largest sources of unsafe practice in the industry. By using CQE’s recruiting tool, we can consistently recruit a far greater proportion of caring carers than would otherwise be possible. Caring carers learn far more effectively than uncaring ones (see 3 below). When these factors are combined with the CQE rota-building tool, we can confidently and consistently deliver a far higher level of safety than we ever could before. ( K1: Safe – right?)
3. Caring carers enjoy delivering care and they enjoy learning how to do that effectively – and, in due course, more effectively. When people find learning enjoyable, their ability and capacity to learn improves. Motivated, dedicated and educated carers are the very foundations on which great care is built. By using the CQE recruitment tool we know that we are recruiting caring carers. Our carers’ ongoing development is our best guarantee of effectiveness. (K2: Effective – right?)
4. We recruit caring carers, we train them in how to deliver care, we retain them because the working environment is optimised when we build safe rotas consistently. Happy carers are easy to retain. Caring carers who are retained combine accumulated learning and experience with the care continuity that our residents value. With these measures, we are able to continually deliver and improve on our caring service. (K3: Caring- right?)
5. Notes 1 to 4 above describe the elements that we are embedding into our organisational culture on a daily basis. Caring carers who are educated, developed and retained develop a fund of experience to draw on as well as a network of mutual trust and support. We believe these elements are the vital ingredients that will make our culture the most responsive we can possibly make it. (K4: Responsive – right?)
BREAKING NEWS FROM CARE HOME PROFESSIONAL MAGAZINE Recruitment and retention key to care home turnabouts, CQC finds
We (at CQE) know that at the heart of every care organisation is a CARE QUALITY IMPROVEMENT ENGINE just waiting to be unleashed by its care leaders.
CQE have discovered that ANY care leader can unleash this engine in their own care setting by making three minor modifications to their routines.
FIRSTLY, by incorporating a 10-minute screen-based carer survey into their recruitment process ..
SECONDLY, by incorporating a once-quarterly carer survey into their monthly “housekeeping” routines …
And THIRDLY, by using survey outcomes in a simple rota-building tool to create reliable and safer shifts.
Incorporating these 3 simple modifications into their usual routine empowers care leaders to drive cultural change in their own care environments.
The benefits achieved are measured and tracked by the system and form an excellent foundation for reporting progress on KLOEs 1 through 5.
Once the modifications have been properly embedded within routines, leaders can expect to generate reports demonstrating improvements in: Carer Morale – Carer Happiness – Carer Pride… As well as …Reduced Sickness and Absence – Resulting in reduced dependence on agency carers; Improved carer focus on service users; Happier and more contented service users – with the added benefit of Managers with more time to lead!
There are many media headlines relating to organisations that are yet to forge a completely cohesive staff team – so it is not surprising that the use of agency is largely frowned upon by ourselves, regulators and investors alike. Agency use is a burden upon the industry for many reasons – not least, the obvious cost and consequent damaging effect on budgets. There are of course well known and, at the time, unavoidable reasons to use agency staff – such as the effect of churn, sickness and absence – or a sudden increase in service users – or when existing staff simply don’t or won’t pick up shifts at holiday times or cover staff who go absent without warning.
Whatever the reason, the use of agency has a negative effect on both residents and staff. If agency is used regularly, there will be a downturn in staff attitudes to their duties – which, in its turn will lower morale … finally resulting in creative sickness and absence and a failure of staff to respond to requests to pickup shifts. It is the way staff signal to management that there is no longer any joy in working with colleagues they cannot respect.
Care Quality Ecosystems has an immediate effect on staff because they become aware of a management resolve to change the status quo. This awareness is inescapable – because all carers are required to complete surveys on a regular basis: The idea of recruiting new staff who are also surveyed is acceptable – because their leaders tell them that any new recruits will be at least as good as the existing staff team. Consequently, staff stop seeing people get away with poor quality service … then, gradually, they begin to feel valued and secure … finally this trust develops into a holistic pride in their organisation.
That is the moment when staff begin to pick up shifts they would have previously turned down … for now they will start experiencing once again the joy that comes from delivering a great service … and the knowledge that their joy is shared by colleagues. The icing on the cake is the more appreciative and happy residents they will be working with.
The creation of Care Quality Ecosystems began a wave of change that resulted in safe rotas being created in a far shorter time than the old rotas: Speedily achieved because the rota-building tool allows rota safety to be visualised and changed until optimal.
Safe processes, in turn, breed confidence in the manager – who now enjoys more confidence, more time to lead … and less frustration with daily routines. This confidence then increasingly manifests itself in a new team spirit – born of the growing sense of responsibility, pride and mutual support.
This is the ecosystem at work. All the above directly impacts cost – as churn and agency gradually but dramatically fall away – as the new culture beds in.
Not quite so obviously, cultural change also brings with it a reduction in sickness and absence – one of the inevitable consequences of the stress induced when working in a team of people who don’t share a passion for delivering quality care.
The fact is, the safer an operation becomes, the more reliable the budgets, the staff … and, of course the subsequent inspections. All of which combines to make for happy and relaxed investors. The accumulated evidence demonstrates that CQE-driven Care & Service quality combine to deliver improved service user protection through a positive influence on carer behaviour and communications in residential environments that rely on shift-driven staff and carers.