Liaise Loddon: Driving Up Quality Code
Baseline self-assessment and organisational intervention plan
In responding to the Driving Up Quality Code (DUQC) initiative, the Directors of Liaise Loddon decided to focus upon practice leadership and behavioural management. Liaise Loddon, provides a service focussed on supporting people with autism who present significant challenges. We commissioned Roy Deveau to support our work. Roy is one of few experienced frontline managers to have conducted published research into practice leadership, during his study at the Tizard centre. We conducted a survey of staff’s views on their daily experience of practice leadership/management and managing challenging behaviour. The idea of practice leadership (part of two of the five key requirements for good practice described in the DUQCwas introduced into intellectual disabilities by Professor Jim Mansell in the context of trying to support community placements for the most challenging people being discharged from hospitals in the late 1980s. Mansell et al. (1994) commented:
Perhaps the most difficult part of the interventions was redefining the role of house managers and patch managers as primarily concerned with “practice leadership” rather than administration. (p. 276)
The staff questionnaire was provided, analysed and feedback provided by Roy at ‘arms length’ from the Liaise senior management team.
The staff survey asked staff about their experiences of:
- leadership and management,
- perceptions of challenging behaviour e.g. of personal confidence and effectiveness in managing the challenging behaviours experienced,
- experience of general work satisfaction, work stress,
- use of physical & non-physical interventions and views on the BSP they work with,
- preparation for, coordination and recognition/reward of their work,
- wider organisation’s management approach and focus for their work.
This report summarises the staff survey, analysis of BSP and concludes with recommendations for organisational development within Liaise Loddon.
The staff questionnaire and procedure
The questionnaires were completed anonymously to enhance honest responses and response rates. Questionnaires were delivered in individual envelopes and distributed to staff and the envelopes collected by the service manager. Overall results are described here. Results at individual service level were used in feedback sessions to service managers concerned.
Results
The overall response rate was 53%. Fifty seven completed questionnaires were received from potential participants of 109 staff (Support Workers, Senior Support Workers, Shift Leaders and Specialist Workers).
Participant’s General characteristics
Twenty seven participants were male, 29 female. Their average age was 33 years and length of current employment 1.9 years with 29 employed less than one year and only 7 employed for over 5 years. The job roles of staff responding was, Support Workers (31), Senior Support Workers (11), Night Support Workers (6), Shift Leaders (6) and Specialist Workers (2). Fifty one participants worked fulltime. Days absent, none: 17, 1-5: 26, 6-15: 9 over 15: 2.
Where available, comparison scores with similar organisations are provided with the results below. The comparison organisations can be regarded as being high quality services.
Practice leadership & Management
The PL measure was devised for the context of implementing Active Support (AS). PL was defined as the development and maintenance of good staff support for service users through managers: spending time observing staff work, providing feedback and modelling good practice, providing staff with regular one-to-one supervision, and team meetings focussed upon improving service user engagement in meaningful activities and relationships. Using this definition, greater PL is associated with better implementation of AS (Beadle-Brown et al., 2009) and better staff experiences when working with people who challenge (Deveau & McGill, 2014).
The PL measure used in this staff survey had 16 items, some items were scored on a five point scale e.g. “Does your line manager give you constructive feedback in supervision on how you support service users? and “ In a typical team meeting which of the following do you discuss: paperwork records and admin, supporting service users to participate in activity, health care and safety of service users, housework and smooth running of the home. The results expressed as a percentage of the total score gave an average of 76.3% for Liaise. This compares well with other comparable survey results available. For example, a national charitable provider, produced a mean percentage of 41% of which the authors commented that overall very little practice leadership appeared to be provided and a smaller, self-selected sample, of ‘good’ practice leaders produced a mean total PL score of 67.7% (Deveau & McGill, 2014).
These high PL results were derived from the general provision of ‘meaningful and useful’ individual supervision and team meetings which had ‘supporting service users to participate in activities’ as a focus and often the main focus. For example, 83% of participants said they attended supervision either monthly or more often than six monthly and for team meetings 92% of participants did so. Team meetings and supervision were reported as meaningful and useful by three quarters of staff participants.
Like other PL survey results, less certainty was evident on what may be regarded as a very significant element of PL i.e. staff’s practice being observed and being given supportive and corrective feedback on their practice. For example, the item ‘How often does your direct line manager spend time watching how you support service users’ has a five point response scale from ‘more than once a week’ through to ‘less than monthly’. Unlike the high scoring team meeting and supervision responses, participants scored evenly across this scale and most frequently at the either extreme, 14 staff ticked ‘more than once a week’ and 11 ‘less than monthly’. Although involving service users in activities was the most frequent indicated focus for staff being watched (20 participants) a significant minority of 9 participants indicated they ‘don’t know’ why they are being watched. The related item ‘When they watch you work do they show you how to work well with the service user you support’ although 25 participants ticked ‘always’, 6 ticked ‘rarely’ and 5 ‘never’. It should be noted that no accepted practices or training exists for frontline managers observing their staff’s practice and giving feedback, unlike the situation for team meetings and individual supervision.
Table 1. Supportive and Developmental Leadership for Liaise Loddon and comparison
Liaise / Deveau & McGill 2014Supportive leadership / 4.0 / 3.6
Developmental leadership / 4.1 / 3.8
Supportive and developmental leadership is scored on a five point scale and higher scores indicate better staff experiences of supportive/developmental leadership and developmental leadership is more strongly associated with PL than is supportive leadership. For the three developmental leadership items, between 78% - 87% staff agreed or strongly agreed with these e.g. “My manager encourages staff to improve their job-related skills”.
Wider organisational management focus
Whilst the PL and Supportive/Developmental Leadership measures assess staff experience of frontline management and leadership. Research on implementation of Active Support suggests that good implementation is best achieved when the whole organisation from the top leadership down is seen as being involved and interested in staff focussing upon service user engagement in meaningful activities.
Two approaches were taken to assessing this aspect of staff experience at Liaise.Firstly, indirect measures of staff experience and secondly more directly about the frequency and focus of senior manager visits to services.Five items examined the organisation’s performance were scored on a five point scale with lower scores indicate better staff experiences. The overall mean score of 3.4 indicates that staff don’t always experience a clear organisational focus upon service user engagement. For example, 75% (n=43) of participants, agreed or strongly agreed, with the statement “Management is more interested in smooth running than in helping service users engage in meaningful activity?” and 81% (n=46) staff, agreed or strongly agreed, with “ Managers don’t get involved much in how we support service users?”. The results for general items of overall organisation focus may not fully reflect the work of the ESSL team, which may not be perceived by staff as part of the senior management structure.
Other questions focussed more directly upon senior managers direct input within services and their focus e.g. “when was the last time a ‘senior’ manager visited the service”, what was this manager’s work role and what was the purpose of their visit. Seventy nine percent (n=41) of participants said a senior manager visit had occurred in the last month, 15% (n=8) said they didn’t know. The most frequent visitor was the Area Manager and the overall purpose of visits, from the list provided was: staffing issues (4 staff) observing how staff engage with the people we support (20 staff) admin and paperwork (18 staff) consulting staff and the people we support (3 staff) and 10 staff said they don’t know.
The more positive organisational focus indicated in the more direct questions is somewhat counter to responses to the more general items.
Impact of leadership & managementupon staff experiences
Various measures in the survey were used to examine the impact of the PL and management upon staff.
Overall job satisfaction
Three broad measures of overall satisfaction included: likelihood of leaving current employment within the next 12 months, participants overall job satisfaction and experiences of job related teamwork, see Table 3.
Table 3. Measures of selected overall job satisfaction for Liaise Loddon and comparisons
Liaise Loddonmean scores / Deveau & McGill (2014) mean scores
Teamwork (5 items) / 1.8 / 1.9
Likelihood of leaving / 3.8
Overall job satisfaction / 4.1
Note: all items scored on a (1-5) five point scale. For Teamwork lower scores and for likelihood of leaving & overall job satisfaction higher scores = better staff experiences
Teamwork has been shown to be associated with high PL (Deveau & McGill, 2014). On the Teamwork measure Liaise Loddon demonstrated scores similar to that shown by other good services. For example, on the three items asking staff how well they experience working with their colleagues e.g. “Do your co-workers help you with your work” 74% (n=42) of staff recorded “always” or “usually” and a maximum of 2 staff recorded “rarely” or “never”.
Likelihood of leaving has a scale from “very likely” to “very unlikely” i.e. the average score of 3.8 shows that staff feel they are unlikely to leave their job in the next twelve months. 36 staff said they were “quite unlikely” or “very unlikely” to leave in the next 12 months. The item on overall job satisfaction has a scale, from “very dissatisfied” to “very satisfied” i.e. the average score of 4.1 shows that staff are generally “quite satisfied” or “very satisfied” with their job overall, 6 staff indicated they were “slightly dissatisfied” or “very dissatisfied”. Conclusion, the overall job satisfaction on these measures shows that in general: staff feel satisfied with their job, experience good team work and appear settled and are unlikely to leave in the next twelve months.
Staff stress and burnout
Many staff surveys use measures of staff perceived stress and burnout, which is associated with working with people with challenging behaviour, poor support from colleagues and especially, immediate managers. Less experience of stress and burnout is also associated with PL style of frontline management (Deveau & McGill, 2014).
Seven items examined staff experience of stress and burnout. These items are scored on a five point scale, with high scores indicating better staff experiences. The overall average score of 3.5 indicates moderate stress levels are experienced by Liaise Loddon staff. For example, “Is your work emotionally exhausting” 6 staff recorded “to a very high degree”, 7 recorded “to a high degree”, 13 recorded “somewhat”, 21 recorded “a little” and 6 recorded “not at all”. The item “Do you feel worn out at the end of the working day” 9 staff recorded “always”, 6 recorded “often”, 25 recorded “sometimes”, 6 recorded “seldom” and 7 recorded “never”. These results are similar or indicate lower stress than other staff surveys of perceived stress and burnout using similar measures. The very low numbers of staff experiencing the more serious stress is commensurate with staff being engaged and committed to a demanding work role rather than overwhelmed by it.
Staff experience of the organisation of and preparation and incentive of their work
Three questions asked staff about how well they feel their work is coordinated, whether their work is recognised and rewarded and whether they have the right preparation for their work, see Table 2. Each of the eleven items is scored on a five point scale with lower scores indicating better staff experiences.
Table 4. Mean scores for how staff feel about various aspects of their work
Question / Liaise Loddon, mean scoreHow well is your work coordinated(4 items) / 1.7
Do you have the right preparation for your work (3 items) / 1.8
Is your work recognised and rewarded (4 items) / 2.5
Overall results for Liaise Loddon show that staff generally feel that their work is well coordinated, well prepared for it and somewhat more balanced in their views on whether this work is recognised and rewarded by managers who focus upon service user’s experience. The recognition/reward question has 4 items. Of these, one stands out as contributing to the lower average score i.e. “My manager only gives me feedback when I have done something wrong” 46% (n=26) staff “strongly agreed” or “agreed” with this statement. The research evidence on staff feedback demonstrates the effectiveness of providing positive feedback for good staff performance, which is observed, and ‘corrective’ feedback for staff performance managers feel should be improved. Achieving a balance between these two elements of feedback is important.
Staff perceptions of severity of the challenging behaviours they work with, their feelings about the most severe behaviour and working with therelated BSP and the physical/non physical methods employed to manage CB experienced.
One question asked staff to ‘think about the person you support that provides you with the greatest challenge and indicate from a list of ten common challenging behaviours if the behaviour is shown and if shown the severity of the behaviour on scale of 1= minimal problem to 5 = serious problem. Table 5 clearly shows, as with other staff surveys, that the main three challenges were felt to be aggression, self-injurious behaviour and destruction.
Table 5 staff views on the presence and severity of challenging behaviour for a person they support
Challenging behaviour / Behaviour = serious problem (n of responses) / Behaviour = absent or minimal problem (n of responses) / Mean score(1=minimal & 5 = serious problem)
Aggression / 13 / 12 / 3.1
SIB / 20 / 8 / 3.5
Social disruption / 8 / 20 / 2.5
Temper tantrums / 9 / 19 / 2.5
Physical disruption / 8 / 11 / 3.0
Destructive behaviour / 16 / 18 / 3.0
Non-compliant / 10 / 19 / 2.7
Rituals / 4 / 31 / 3.5
Stereotype / 5 / 24 / 2.1
Sleep problems / 8 / 25 / 2.2
Staff perceptions of behaviour support plans (BSP)
Recent research has been conducted upon the quality and effectiveness of BSP and recent government guidance upon the positive management of challenging behaviour has also recommended that organisations should audit the quality of BSP. Staff were asked to relate eleven items about various aspects of the BSP to the person they thought about for the question above, on a five point scale from “not at all” to “very well or very much” with higher scores indicating more effective BSP from staff perspective. This question wasn’t answered as fully as others with 16 staff missing these items.
The overall average for these eleven items was 3.9 (the majority of responses were in the “well or much” and “very well or very much” categories) indicating that Liaise Loddon staff feel positively about the BSP they work with. For example, three items ask if the BSP is clear on what staff should do, are they comfortable with what they should do and do they feel well prepared and trained to implement the BSP. Adding all staff responses to these three items, gives a total of 122 staff responses, of these 93% were in the “well or much” and “very well or very much” categories and only 7.4% of responses were in the “not much” or “can’t tell” categories. Two items focussed upon how well staff feel they have been involved in helping develop the BSP and in monitoring and reviewing the effectiveness of the BSP indicated somewhat less positive experiences indicating that a significant group of staff feel that they were not involved in developing and monitoring BSP they work with. Although the overall staff responses to these two items was still generally positive these responses were less positive than to the other BSP items.