Evaluation of the Cumbria County Council
Dementia Focussed Performance Management Programme
April 2012
Background
The ‘Dementia Focussed Performance Management Programme’ was commissioned by Care Sector Alliance Cumbria (CSAC) and delivered to thirteen senior care managers and care home managersfrom ten dementia care/nursing homes in west Cumbria. The course comprised seven modules and ran between January and February 2012. The modules covered [1] organisation communication and leadership, [2] dementia care, [3] managing change positively, [4] person centred thinking, [5] conflict in teams, [6] staff motivation and [7] supervision. The course was designed to improve organisational performance and contract compliance and was informed by an audit of Adult Social Care compliance reports which was undertaken by CSAC. Potential participants were also consulted as to the demand for the Programme prior to its commencement. Some participants attended the course on the recommendation of the Adult Social Care Contracts Team.
Methods
The evaluation was carried out by a researcher from the Social Care Workforce Research Unit at King’s College London. A focus group was carried out with participants attending the final day of the Programme (n=8). Participants who had missed the final day of the training were followed up for interview at a later date (n=4). The focus group and the interviews employed the topic guide shown in Appendix 1. A brief telephone interview was conducted with one participant (n=1) who had signed-up for the course but who did not attend to find out the reasons why.
A seven point (0-6) Likert Scale was also administered pre and post Programme delivery to explore performance improvement across each module domain (communication skills, present knowledge of dementia care, skills in managing change, promoting person centred values, managing conflict in the workplace, motivating staff, supervision skills). This was completed by 12 participants.
A separate end of programme report was also produced by the Programme leaders.
Summary of Findings
Most participants said that they enjoyed the Programme and that theyfound it useful.What was especiallyappreciated was the opportunityit afforded forlearning from colleagues.
The venue was considered to be inaccessible given its geographical location a long way from many participants’ workplaces.
The aims and objectives of the Programme were not clearly explained at the outset. Many participants had assumed that the Programme was going to be wholly dementia focussed and were surprised that a large part of the content was focussed on generic management training applicable toall social care settings.
The management training itself was considered to betoo basic or low level and perhaps more suited to participants new to management. While some participants felt it was useful to have a ‘refresher course’ other more experienced managers felt strongly that it was not a good use of their time. Overall, the mix of dementiatraining with basic management training was perceived not to have worked well.
Despite these issues the majority of participants felt that the Programme enabled them to reflect upon and change some aspects of their management practice. Impacts were noted particularly at the level of improved confidence and feeling more skilful in communicating with staff.The Likert Scale demonstrated an average 0.6 improvement across each of the seven domains.
Many impacts were also reported at the level of improving dementia care. One participant described how on recommendation of the Programme she had introduced coloured toilet seats to the care home where she worked. Another participant implemented changes to information provided to residents and families.“We have implemented quite a few things form the training... and when you get feedback from your staff to say it’s working- that’s fantastic”
Participants made a number of suggestions as to how the Programme could be improved for the future:
There is a need to ensure greater commitment to continuing professional development within the sector so that adequate staff cover is provided when managers/staff are on training. Lack of adequate cover led to a high number of participants missing sessions. Participants would have liked to receive course materials where they had missed a session.
There is a need for performance improvement initiatives to target all levels of an organisation rather than focussing exclusively on care home managers. Participants described the difficulties they faced in keeping their staff motivated and engaged in the process of continuous quality improvement:“It’s not that we need some more of [this training] but that [our front line staff]need some of it to... May be not at this level but something which gives them some self awareness about how they [can] affect the running of the home. Because then they could see where all these big decisions come from and that it is not just coming from their manager sitting in their office”
Programme content needs to be mindful that care home managers have only limited scope to implement change (for example to care planning and supervision practices) without approval from their senior managers.
Participants described how they are often subject to conflicting advice as regard what constitutes ‘best practice’. This is especially the case with regard to ‘care plans’ where each CQC inspector has very different expectations. Clearer guidance on practice standards would be welcomed. “I think we can see now that we are all in the same boat – it’s not just our home... You get an inspector coming in saying “[Those] care plans are no good - I want them rewritten”. But from talking here we are all in the same boat. We are not on our own”
Participants felt that they would benefit most from more tailored support around what are perceived to be the most challenging aspects of dementia care management practice.It would be important to scope these issues first and then to design any performance improvement programme around this.Examples of challenges noted in the evaluation include:
“Working in dementia care is very emotional and challenging for staff – how can we adapt our supervision practices to reflect that?”
“We will just be getting ourselves on the right track and [the requirement to make another practice or procedural change comes] along and knocks [the staff] and then it’s trying to motivate them again”
“Teams can be doing great things but then one of the more disruptive members of staff will disrupt them and can spoil the whole team – managing team dynamics.”
“[When you] have done a lot of this training before, you become quite self-aware, but you are going in managing people who are not at that level, they have not got that level of self awareness and that’s the toughie ... They have never been asked questions about their values - all that stuff that [this kind of training] opens our eyes too...
“I think it’s very hard to turn a nursing home around. If you go into a home and there is lots of issues you have got to have nerves of steel to go in there to take [the staff] on. It can be very challenging”
Some participants felt thatmanagement training alone would not be adequate in addressing these challenges and that there was a need for more participatory and collegiatestyles of learning, for example employing a mentorship scheme orsetting up a Forum where managers could get together to share experiences and exchange ideas. It was acknowledged that staffing constraints and the competitive nature of the care home sectormay represent significant barriers to achieving this.
Recommendations
The evaluation findings were presented and discussed with the Programme Leaders and the Workforce Development Manager. The following recommendations are made to the CSAC Board in the light of this.
- Dementia training may be better delivered as a ‘stand alone’ programme and commissioned from dedicated/specialist providers
- To identify the most appropriate means of addressing performance related issues in dementia care management it is suggested that a small scale scoping exercise is undertaken in partnership with those who attended the above Programme. This could be run as a participatory style event (in one afternoon session) in which participants consider a number of‘Turn Around’ simulations. Simulations are case study vignettes which might for example profile a failing care home – with different events unfolding during the course of the session which participants are expected to respond to.
- The overall aim of the exercise would be to allow CSAC (1) to identify ‘management challenges’ from a number of different standpoints, (2) the extent to which it is possible to address these issues through the development of more collegiate working (learning from peers) and (3) where more advanced/specialist (potentially interdisciplinary) management training may be required. In considering how to develop more collegiate working, this event might also function as a taster session for a dementia care managers’ ‘Community of Practice’.
Dr Michelle Cornes &
Professor Jill Manthorpe
Social Care Workforce Research Unit
King’s College London
Tel: 01931 713123