Delivering Dignity in North Lancashire
Final Report
By Dr Laurence Clark
August 2015
Table of Contents
Introduction 3
Evaluation 5
Appreciative Inquiry 6
Coaching and Mentoring 7
Welcome Values 11
Conclusions 21
Recommendations 23
Appendix 1: Definitions of Dignity 24
Appendix 2: Delivering Dignity Audit Survey 29
Appendix 3: Workshop Dates 56
Introduction
As part of the “Delivering Dignity in North Lancashire” agenda, this project looked at how to improve standards in the care and support of older people. Lancashire County Council and the Clinical Commissioning Groups in North Lancashire worked together to raise awareness of dignity and embed a person-centred ethos across all settings.
Pathways Associates were commissioned to deliver this initiative. A number of distinct pieces of work were delivered:
· An overview of the various definitions and understandings of dignity in relation to health and social care (included in appendix 1).
· An audit questionnaire around person-centred approaches which was sent to all providers of care and support services to older people in North Lancashire. The providers’ responses are included in appendix 2.
· A Delivering Dignity Launch Event which was held at Kirkland and Catterall Memorial Hall on 16 July 2013. It was attended by a total of 25 representatives from providers (although 31 booked to come).
· Four Appreciative Inquiry (AI) sessions have been delivered, although more were planned and subsequently cancelled due to poor take-up. Appreciative Inquiry “begins by identifying what is positive and connecting to it in ways that heighten energy and vision for change.…AI recognizes that every organization is an open system that depends on its human capital to bring its vision and purpose to life… The outcome of an AI initiative is a long-term positive change in the organization… AI is important because it works to bring the whole organization together to build upon its positive core.”[1] The project delivered AI sessions with 2 providers, Unlimited Care Ltd (4 people with staff) and ARC Community Care (10 people with families). It also worked with 2 coaches who then ran an AI event in their own organisations with support.
· Three coaching and mentoring cohorts were established. Each cohort attended a series of 6 monthly half-day sessions which explored coaching tools and person-centred approaches to bringing better outcomes for older people. Participants were expected to sign up for all the 6 sessions and co-deliver a small workshop with the focus on the continued development of dignity with the lead coach. Sessions were aimed at managers / owners / supervisors to enable them to develop dignity through team meetings and supervision. Across the 3 cohorts a total of 20 people registered their interest and 14 attended. Please see appendix 3 for workshop dates.
· A series of 3 Welcome Values workshops were delivered. The Welcome Values project recruits, trains and supports people who use services, family carers and staff from care providers to visit other people who use services and assess the quality of the care and support they receive. Providers who attended these workshops were the Lancashire In-house Provider, Lake View Nursing Home, Hill Croft Nursing Home and Care Watch Morecambe. A total of 8 people completed the workshops and a further 6 people were visited as part of the reviews. Please see appendix 3 for workshop dates.
· An end-of-project celebratory event was organised and subsequently cancelled due to poor take-up.
Evaluation
This evaluation will focus on identifying outcomes and positive changes as a result of the project for providers, the local authority and people who use services. In addition, it will identify potential future work to improve the delivery of dignity and person-centred approaches in Lancashire.
This is a summative evaluation taking place after the project has been completed. Information was gathered using the following qualitative methods:
· Examination of the notes from workshops and other relevant meetings, in addition to the project delivery action plan.
· A one-to-one interview with a participant on the Welcome Values workshops.
· A bespoke written questionnaire completed by both of the workshop facilitators.
· A written questionnaire which identified outcomes from the project distributed via the website Survey Monkey. A total of 7 participants completed this questionnaire.
It proved extremely difficult to get participants to complete the evaluation questionnaire. Nevertheless a total of 10 out of the 63 people (including workshop leaders) who participated took part in this evaluation. None of the people who participated took part in the Appreciative Inquiry. Six of the people had participated in coaching and mentoring sessions; and four had participated in Welcome Values workshops.
Appreciative Inquiry
None of the people who participated in the evaluation process took part in the Appreciative Inquiry (AI) workshops. However the workshop facilitator offered some insight into these sessions in their responses to the questionnaire.
Appreciative Inquiry enabled staff to meet with older people and family carers and learn from their perspective what matters, what’s working and how they want to move forward being included as a valued partner. The project would have been more beneficial if it had been able to engage more local people and local services. There was a pause in delivering the AI sessions in an attempt to refocus and generate involvement. With more time the facilitator said that would have continued to consistently offer AI as an approach to include older people, there needed to be more of this really.
Older people told the facilitator that they had never done anything like this which highlighted that this inclusive way of working in partnership with people and families is not embedded in these services.
Coaching and Mentoring
Aims and Objectives
The aims of the coaching and mentoring sessions were:
· to enable managers and supervisors to undertake structured, productive sessions with their teams using coaching and mentoring tools
· to provide greater understanding, motivation and encourage commitment to person-centred principles that support dignity in older people’s services
· to enable managers and supervisors to work in partnership with their teams to deliver dignity in care to older people and their supporters
By the end of the 6 sessions participants should be able to:
· Value the uniqueness of every individual
· Uphold the responsibility to shape care and support around each individual in a meaningful way from the person’s perspective.
· Address issues of communication across different partnerships, communicating and listening to individual’s preferred communication styles.
· Understand how an individual’s dignity can be affected.
· Recognise and challenge when dignity may be at risk.
· Be able to develop workplace cultures that actively promote dignity for everyone.
· Be able to use coaching skills in supervision and team meetings in order to create positive actions that have an impact for older people and their families.
· Develop skilled approaches to finding creative solutions.
Feedback from participants
Asked what new skills they had acquired as a result of the workshops, one participant cited “a variety of tools for solution-focussed problem solving.” Another person said:
“I learnt new skills in coaching the staff team, understanding them better and sharing information as part of appreciative inquiry.”
The facilitator also concurred that participants had learnt variety of new skills:
“Feedback was that the sessions helped learn new skills and confidence to make sure the people they support are at the centre of what they do, also, offered some solutions that we don’t do as frequently as we should because we focus on risk and systems that aren’t about people.”
When asked how the workshops could be improved, 3 people said they were just right and could not think of any improvements:
“The workshops were excellent. Pauline delivered the information with passion and engaged me in all aspects.”
Feedback to the facilitator indicated that the groups did not want the sessions to end and wanted more of them.
Others found the lack of commitment from fellow participants to be a problem:
“There were very few attendees at any of the sessions which meant that there was little sharing of ideas. Times, dates and venues of workshops were not well publicised... It would have been useful to know if the sessions were viable beforehand as some had to travel long distances but there was only 1 other candidate attending.”
“I signed up for the course with Pauline Doyle… Not Pauline’s fault but the course was a non-starter [as] candidates did not turn up; no commitment. For future I suggest a deposit with a refund when completed, as my time was wasted as well as Pauline’s.”
Participants were asked what values they thought were important to people when they are using services. They listed dignity, being treated with respect, being “people-centred”, compassion, empathy, excellence, being listened to, having a voice, having choice and control and having ownership.
In terms of how the project had supported their own personal development, participants said:
“I can implement changes I may need to make within my job role.”
“I have a few tools to use.”
“I have a better understanding of sharing information appropriately and listening to others.”
However one participant was less than positive:
“There is always something to learn, however I do not feel that my learning was great in relation to the amount of time I spent travelling and on the course.”
Positive outcomes for respective services identified by participants include being able to provide person-centred care, being able to support the development of other team members to work through issues and having the tools and understanding to keep driving dignity forward. Positive outcomes for the people who use services were identified by participants as having all their needs met in a respectful and dignified manner and feeling that they have a voice and are more actively listened to.
When asked what further action needs to be taken to improve the delivery of dignity to older people in Lancashire who use services, one participant said more people need to do these workshops.
Conclusions
From people’s responses to the questionnaire, there is clear evidence that participants learnt to creatively solve problems and shape care and support around each individual in a meaningful way. Participants said they had a better understanding of how to communicate and listen to individual’s preferred communication styles. There is also evidence of how a person’s dignity can be affected and how and when to challenge when dignity may be at risk. In addition, positive outcomes identified include the ability to use coaching skills in supervision and team meetings.
However it must also be noted that these workshops were hampered considerably by poor attendance and a lack of commitment.
Welcome Values
Aims and Objectives
The Welcome Values project recruits, trains and supports people who use services, family carers and staff from care providers to visit other people who use services and assess the quality of the care and support they receive. The assessments focus on:
“…evidence from provider organisations that they and their staff actively seek to welcome people’s friends and extended families into their environment, and where people have no friends and family, that effort is made to support people develop such relationships. We will be looking for the kind of evidence that we value as humans – how it felt, how it smelt, whether people looked happy and contented, whether people were bored and not well supported etc. These are the kind of standards that all of us would want for ourselves and the people we love – do staff think about supporting someone to get changed if their top is dirty or they have food round their mouth etc.? This kind of gentle support makes the most difference and, if it is in place, people are at less risk of being dehumanised to the point where abuse becomes more likely to happen.” (Pathways Associates, 2012)
The results are then fed back to the providers who have the opportunity to respond and make positive changes to provision.
The process has been run a number of times across the UK with different providers. Learning disability providers include Castlebeck (now known as The Danshell Group) across England and Scotland, PossAbilities CIC (Heywood/Rochdale), Shared Approach (Lancashire), Integrate (Lancashire), Castle Support Living Ltd (Lancashire) and SLC Paragon (Lancashire). However this was the first time the project had been run with older people’s services.
The aim of the project was to effect positive changes to the quality of local care services for older people.
The objectives of the project were:
1. To develop a set of standards for services around dignity, respect and community participation in collaboration with older people, family carers and service providers.
2. To train a group of older people, family carers and service providers to carry out reviews.
3. To review local services for older people against these standards through volunteer self-advocates and family carers visiting services.
4. To develop friendships, relationships and community participation for people who use services.
During a Welcome Values review, a team of stakeholders are supported by one or more facilitators to carry out visits to a sample of people who use a particular service over a 12 month period. A stakeholder can be a person who uses services, family member or member of staff from a provider.
At the first workshop the group come together to learn how to conduct a review and collectively come up with a set of values by which the services will be evaluated. Each member of the team then spends time visiting one person who uses a particular service, ideally carrying out four visits including one in the evening visit and one at the weekend.
At the next workshop they discuss what they have found and whether the standards are being met. Support is available at the workshop and in between workshops via phone and email from the facilitator(s).
At the third workshop they write action plans for both themselves and the provider to help them work towards achieving the values for that particular service.
During the process used in the Delivering Dignity in Lancashire project, workshops 2 and 3 were combined.
The final half-day workshop is a celebration event where participants assess progress and revisit the action plans. They also make a return visit at the end of the review to discuss their findings with the person and the provider and end the formal process. In order to achieve on-going progress the process may be repeated over and over again.
The review process is planned and organised by the facilitator(s) with a commissioner / provider manager and/or project team. Mentoring of key personnel during the process ensures sustainability after the first review has been completed. The cyclical nature of the process is outlined in diagram below: