1. Understand the theory and principles that
underpin outcome based practice.
1.1 - Explain
‘outcome based practice’
In 1990 health
care providers had just began to discover what appeared to be a very powerful
tool for reducing variation in patient care practices - clinical paths. A
clinical path includes descriptions of key events that, if performed by
caregivers as described, are expected to produce the most desirable outcomes
for patients with specific conditions or procedures. By the late 1990s,
caregivers started to question the benefits of clinical paths. Organizations
reported problems integrating the pathway document into patient records, thus
dampening caregiver enthusiasm for using the pathway. Physicians, nurse, and
other clinicians found the pathways difficult to apply to all patient
populations. A variety of factors may be causing clinical paths to look like yesterday’s
failed solution, when in fact the lessons learned during years of pathway
development are being put to good use in many organizations.
Today
caregivers are adopting outcomes-based practice methods to achieve desired
patient care goals. Outcomes-based practice (sometimes called outcomes
management) involves a combination of teamwork, continuous quality improvement,
and process and outcome measurement. These collaborative multidisciplinary
efforts build on the pathway development work of the 1990s. It’s quite likely
that outcomes-based practice would not have been possible if caregivers hadn’t
learned how to work together while designing clinical paths. All of those
multidisciplinary meetings to develop paths were not a waste of time!
1.2 - Critically
review approaches to outcome based practice.
Outcome based care is about putting the person at the
centre of the care service, and not prescribing a standard service to everyone.
[ It is about delivering meaningful outcomes to every individual and helping
people to lead more fulfilling lives. Outcome based care requires careful
planning, which involves working with the people who use our services to help
them identify and achieve the things they want to do. Delivered well, outcome
based care increases interest and motivation and creates the enthusiasm needed
to support people to lead a more fulfilling life.
1.3 - Analyse
the effect of legislation and policy on outcome based practice.
Analysis may involve qualitative, quantitative or a
combination of both methods. When describing program activities or experiences,
qualitative analysis is appropriate. Quantitative analysis is used when trying
to assess policy outcomes and impacts.
1.4 - Explain how outcome based practice can result
in positive changes in individuals’ lives.
An
outcomes-based approach encourages us all to focus on the difference that we
make and not just the inputs or processes over which we have control. Success for the Government and its Public
Bodies is about impact and it is right that we should be judged by tangible
improvements in the things that matter to the people of Scotland. Government is
therefore committed to an outcomes based approach and will work with Public
Bodies to: Align activity to connect
explicitly to the Government's over-arching purpose of sustainable economic
growth through the National Performance Framework Scotland Performs. Better integrate activities with local
government, with other Public Bodies, and in partnership with the third sector
and private sector, to deliver the Government's Purpose Targets and National
Outcomes. The current development of Single Outcome Agreements (SOAs) with
community planning partnerships, under the leadership of local authorities,
offers a significant opportunity for Public Bodies which are delivering local
services to help achieve this locally. Focus activity and spend on achieving
real and lasting benefits for people and as such minimise the time and expense
on associated tasks which do not support this purpose. Create the conditions to
release innovation and creativity to deliver better outcomes.
2. Be able
to lead practice that promotes social, emotional, cultural, spiritual and
intellectual well-being.
2.1 - Explain the psychological basis for
well-being.
Psychological
models of mental health, quintessentially, emphasise the key role of a Healthy,
loving, supportive, connected childhood in producing well-adjusted adults. It must clearly be a key policy aim to
protect children from abuse, to identify children at risk from abuse, and to
help address any problems resulting from abuse at the earliest possible stage.
We therefore fully and unequivocally support the emphasis in ‘New Horizons’ and
elsewhere on the importance of a healthy start in life. As elsewhere,
investment in positive policies to support parents, families and communities
will pay dividends in terms of a healthy adult population. When specialised
care in needed, a well-being focused approach should be used within services to
address a child’s or young person’s physical and psychological needs.
2.2 - Promote a culture among the workforce of
considering all aspects of individuals’ well-being in day to day practice.
The
implementation of The Wellbeing and Performance Strategy requires an Agenda for
Action.
The
purpose of this agenda is to embed into the organisation a culture, attitudes
and daily behaviours that result in high levels of wellbeing amongst all staff
(managers and employees) and will produce the high level performance dividend
that can be measured as lower sickness absence, staff turnover, presenteeism
and HR/Manager time on conflicts, disputes, tribunals and other features of
presenteeism.
The
agenda items also improve involvement, innovation, energy, motivation,
engagement, commitment, trust, all of which lead to greater profit/flexible
budget, market share, innovation and improved reputation and resilience.
The Agenda
items are:
ü
Engage top management in the
Wellbeing and Performance Agenda.
Senior management influences the behaviours of those below them, and
senior management set the tone for the organisation.
The culture of the organisation is heavily determined by the
personalities and characteristics of senior managers, and their own
determination in promulgating a wellbeing and performance culture. This will
normally necessitate the champions of wellbeing and performance to raise
awareness of the arguments, and issues relating to wellbeing.
ü
Undertake an analysis of the
current levels of wellbeing and performance.
A survey of staff provides the benchmark against which the effect of
various wellbeing initiatives can be measured. A year on year assessment of
progress can be made, and those initiatives which show least impact can be
dropped in favour of those with greatest impact.
Various surveys exist with different purposes. At the least, all
organisations that employ 5 or more people are obliged to demonstrate they
comply with the Health and Safety Management Standards. More comprehensive
surveys examine the health and wellbeing of staff, the quality of working lives
of staff, the intention to leave or stay amongst staff, and the assessment of
the organisation in relation to commitment, trust and engagement.
The results of a survey provide the information to focus attention
of specific actions that are needed to build and sustain a culture of Wellbeing
and Performance.
ü
Establish a steering group.
Many organisations are made up of different divisions and
departments, with different purposes. They will have different managers and
perform differently. In order to promote a wellbeing and performance culture,
it may be necessary to establish a steering group to oversee and take
responsibility for this project. A steering group needs to have decision makers
on it, as there will be decisions about resource allocation that will be
necessary.
ü
Develop a strategic framework
for action.
A strategic
framework provides the focus for action, and a map against which progress can
be routinely measured. A suggested framework embraces
a)
Promoting wellbeing and
performance and the prevention of risks of psychological distress and other forms
of ill health and accidents.
b)
Preventing deterioration amongst
those who suffer distress.
c)
Restoring those with
psychological distress back to their normal level of performance and beyond.
d)
Supporting those with chronic
conditions and sustaining wellbeing and performance.
In addition,
a strategy will need to consider the services and training required to
implement a wellbeing and performance programme. Suggested topics are
Behaviour, Wellbeing programmes and services, Structure, Culture, Resilience
and tolerance.
ü
Build a culture for wellbeing
and performance.
The culture of the organisation embraces the features that influence
how people behave.
In building a culture of wellbeing and performance the features need
to be those that promote commitment, trust, engagement and a strong
psychological contract – the idiosyncratic unwritten contract that individuals
have between themselves and their organisation based on personal notions of
fairness. Most psychological contracts are based on the behaviour that managers
and employees exhibit towards each other that denote trust, value, and
reliance, where each party engages fully with each other and builds trust
between them.
For this to happen, the context in which behaviour takes place needs
to promote values that accord with the values of the employee.
ü
Develop the ethics and
behaviours that produce wellbeing and performance.
The behaviours that managers need to demonstrate are those that
build and sustain trust, commitment and staff engagement. These behaviours are
the building blocks for a Wellbeing and Performance culture. The headlines are
in the diagram.
Ø
Attentiveness
F
Politeness.
F
Courtesy
F
Personal communication
F
The Use of Body language
F
Addressing needs
F
Empathy
Ø
Intellectual flexibility
F
Emotional intelligence
F
Negotiation
F
Sharing
Ø
Reliability
F
Honesty
F
Clarity
F
Fairness
Resolving conflicts Encouraging contribution, these behaviours can
be developed in every manager and staff member using Corporate Cognitive
Behaviour Therapy (CCBT) approaches, in a coaching or group workshop setting. This
involves replacing ambivalent attitudes about people at work with positive
thoughts that promote the benefits of positive interaction, and the benefits
that accrue from gaining commitment, trust and engagement between staff and
managers.
ü
Take the actions that produce
wellbeing and effective performance.
The actions required from managers who wish to implement the
Wellbeing and Performance Agenda are divided into the classical purposes of
management. They are:
Ø
Decision making - Justification
for decisions based on appropriateness, evidence, experience, timeliness and
feasibility.
Ø
Direction - Providing direction
based on analysis and with committed ambition.
Ø
Co-ordination - Integration of
the mosaic of available resources to achieve a declared aim.
These classical purposes of management normally form the basic
training for managers. There are technical and psychological aspects in their
application to practice. The psychological aspect embraces the ability to
follow the ‘Just a Minute Model’ of performance, that seeks to ensure that
actions are taken without hesitation, deviation or repetition, and that the
decisions are appropriate, efficacious, effective and efficient.
This requires intense concentration by managers, and is the
principal benefit arising from a Wellbeing and Performance strategy, and a
Positive Work Culture.
ü
Strengthen personal resilience.
Resilience is the capacity to tolerate excessive demands and
stresses without experiencing personal stress.
Resilience is about the maintenance of person control in adverse
situations, combined with the capacity to control the responses of others to
oneself in these situations.
Resilience is based on individual attitudes towards an adverse
event. Attitudes are developed from conditioning throughout life, combined with
personal experiences that have either built or reduced self-esteem (depending
on one’s capacity to cope with the situation), combined with a decision to be
motivated to overcome and tolerate an adverse event or not.
Most people have built a degree of resilience, simply through the
process of experiencing challenges and rising to them successfully. However,
there are some established adverse events that pose a risk to individuals. Many
of these arise in the workplace. A substantial number of people are not
prepared for these challenges and find them difficult to tolerate, causing a
lowering in performance, reduction in motivation, and the possibility of
significant distress.
Training in building the capacity for resilience is an important aspect
of the Wellbeing and Performance Agenda.
ü
Implement change management
utilising the Managers Code of Conduct.
This is a method of change that uses a Manager’s Code that all
managers are expected to follow. The Code is based on the principles of a Positive
Work Culture and the link between wellbeing and performance.
2.3 - Review the extent to which systems and
processes promote individual well-being.
In this day and
age of individualised, person-centred service provision, effectively promoting
and maintaining well-being and choice for people who use services, presents
many-headed challenges for service providers, especially frontline staff. From
their waking moments to bedtime as well as throughout the night, providers of
adult social care, especially frontline staff, have a social and legal
responsibility to ensure that the needs of individuals who use services are
being continually met.
It is important
to note that a key challenge for staff to effectively promote and enhance the
well-being of service-users, is in understanding and accepting that it is both
a process and outcome involving service-users and frontline staff. Thus it
requires presence of mind, careful consideration and monitoring and evaluation
by service providers in order to maximise the quality of life of the vulnerable
people who they care for and support.
The importance of
well-being and the availability of choices is unsurprisingly a common thread
which runs throughout the Essential Standards of Quality and Safety outlined by
the Care Quality Commission, and involves meeting the needs and aspirations of
service-users.
Let us consider
well-being and choice touching on a few examples during a hypothetical day in
the life of a service-user.
The timing,
approach and manner in which a service-user is supported to get out of bed
impacts on their well-being. Knocking, waiting to be invited in and offering
the person choices such as whether or not they are ready to get out of bed and
if they are, how they would like to proceed, may make the person feel
respected. This may even be the case when the service-user has an established
routine.
A key challenge
for service providers is to ensure continuity of care, so that staff who are
familiar with the needs of the service-user are also those who care for and
support them.
Effective
communication is also important in promoting well-being and choice, as it
fosters mutual understanding, which is at the core of the process to facilitate
desired outcomes. Achieving this is however fraught with pitfalls, including
limited or non-existent knowledge of the best way or means to communicate with
individuals.
Inappropriate or
poor communication also manifests itself in various ways such as making
critical comments about service-users who are within ear shot or chatting with
colleagues and excluding the service-user from conversations. This becomes more
obvious when temporary staff such as different agency workers who are not
properly inducted are called upon on a regular basis to care for and support
people they have not met before.
Respecting the
privacy of service-users is also key in maintaining the well-being of the
individual. Thus, invading personal spaces such as barging into bathrooms,
bedrooms or quiet areas especially when there is a perceived ‘emergency’ does
little to foster well-being. Staff may also unconsciously speak loudly in the
presence of others when talking to individuals about things the service-user
may wish to keep private. Issues of confidentiality in all its forms must also
be maintained in order to facilitate the well-being of individual
service-users.
Personal care
such as bathing, toileting and managing continence presents its own challenges
for frontline staff in their bid to promote, the well-being of service-users
who require this level of support. Privacy and dignity is always linked to the
well-being of individuals.
Another aspect of
the service-user’s day which is often taken for granted by staff is nutritional
care. It is generally accepted and a well-documented fact that mealtime is
among the highlights of a service-user’s day. It is therefore an activity, when
managed properly, which improves the quality of the day for the individual.
The challenge is
for staff to ensure that meals are provided to individuals when and where they
want it, and not only at set times when it is convenient for the
service-provider. Furthermore, offering a wide range of food choices becomes a
logistical nightmare for providers, especially when catering for more than a
handful of individuals. Offering the appropriate cutlery and crockery for the
individual service-user is also very important to promoting well-being.
Service-users may
wish to feed themselves, rather than be fed by staff in what may sometimes be
undignified ways. The only inhibiting factors may be the lack of non-slip table mats,
especially modified cutlery and the use of ‘pseudo-bowls’ instead of flat
plates to reduce spillage, promote independent eating and make mealtimes an
enjoyable experience. Regular input from a dietician may also help to ensure
that meals are of nutritional value.
Another area
worthy of note is that of healthcare and a particular ‘typical’ scenario which
springs to mind. A service-user has an appointment with the GP and is supported
by staff to attend. The doctor completely ignores the patient and talks to the
staff about the patient’s symptoms as though the service-user is not present.
No physical examination of the person is made even though required. This
attitude of some healthcare professionals seems to be just like this when
dealing with patients with learning disabilities. In such cases GPs need to be
reminded that they too are subject to the requirements of the Health and Social
Care Act 2008, and are expected to follow the Essential Standards of Quality
and Safety when dealing with service-users.
It appears that
due to the limited or scanty knowledge that some General Practitioner’s
(especially locums) may have about certain conditions that fall within the
broad spectrum of learning disabilities, there is consequently a perceived
reluctance to engage with such patients even when no communication difficulties
exist. It is the writer’s view that this attitude is another subtle dimension
of health inequality which needs to be addressed whenever it arises.
Promoting the
well-being and choice of the service-user may also be achieved in the
development of everyday living skills. This may involve staff offering
practical assistance to carry out household tasks. It is key however, to use
simple tools such as an Everyday Living Skills Inventory (ELSI) form to
accurately chart progress. (This may be found in the QCS Management System).
Choice is always
inextricably linked to the making of decisions and suggests that at least two
options/a range of options/limited alternatives exist, and that the choice is
made independently. However in practice this is hardly ever the case. Thus the
use of independent advocates is of crucial significance in the quest to promote
and maintain well-being and choice for service-users in different care
settings.
3. Be able
to lead practice that promotes individuals’ health.
3.1 - Demonstrate the effective use of resources to
promote good health and healthy choices in all aspects of the provision.
It is estimated
that illness at work costs UK employers £12.2 billion a year, as a result of
sick days taken. Whatever the cause of ill health, it is in the interests of
the organisation to support an employee’s return to work wherever possible.
Health issues can
not only affect the individuals concerned but can also have a detrimental
effect on the wider workforce and the organisation’s performance. Organisations
should be aware of possible problems and be confident that they have the
background knowledge and policies in place to deal with them.
According to
research recently conducted by the Institute: “The Quality of Working Life
2007”, 42 per cent of managers reported that sickness rates in their
organisation had increased over the last year. 67 per cent of managers who
suffered ill health reported that it had affected their productivity levels.
There appears to be an emerging trend that absence and sickness rates are on
the increase and there is a high degree of ill health that does not necessarily
translate into days off but appears to be affecting motivation levels.
This guide seeks
to raise awareness of health and well-being issues, the effects on
organisations, strategies for dealing with ill health and suggests how a policy
may be implemented.
3.2 - Use appropriate methods to meet the health
needs of individuals.
The uses of epidemiology and other methods in defining
health service needs and in policy development
ü
Participatory needs assessment.
ü
Formulation and interpretation of measures of
utilisation and performance.
ü
Measures of supply and demand.
ü
Study design for assessing effectiveness,
efficiency and acceptability of services including measures of structure,
process, service quality, and outcome of health care.
ü
Measures of health status, quality of life and
health care.
ü
Population health outcome indicators.
ü
Deprivation measures.
ü
Principles of evaluation, including quality
assessment and quality assurance.
ü
Equity in health care.
ü
Clinical audit.
ü
Confidential enquiry processes.
ü
The use of Delphi methods.
ü
Economic evaluation.
ü
Appropriateness and adequacy of services and
their acceptability to consumers and providers.
ü
Epidemiological basis for preventive strategies.
ü
Health and environmental impact assessment.
ü
Health Care Evaluation Frameworks.
3.3 - Implement practice and protocols for
involving appropriate professional health care expertise for individuals.
All clients
are entitled to good standards of practice and care from their practitioners in
counselling and psychotherapy. Good standards of practice and care require
professional competence; good relationships with clients and colleagues; and
commitment to and observance of professional ethics.
Ø
Good quality of care
F
Good quality of care requires
competently delivered services that meet the client's needs by practitioners
who are appropriately supported and accountable.
F
Practitioners should give
careful consideration to the limitations of their training and experience and
work within these limits, taking advantage of available professional support.
If work with clients requires the provision of additional services operating in
parallel with counselling or psychotherapy, the availability of such services
ought to be taken into account, as their absence may constitute a significant
limitation.
F
Good practice involves
clarifying and agreeing the rights and responsibilities of both the
practitioner and client at appropriate points in their working relationship.
F
Dual relationships arise when
the practitioner has two or more kinds of relationship concurrently with a
client, for example client and trainee, acquaintance and client, colleague and
supervisee. The existence of a dual relationship with a client is seldom
neutral and can have a powerful beneficial or detrimental impact that may not
always be easily foreseeable. For these reasons practitioners are required to
consider the implications of entering into dual relationships with clients, to
avoid entering into relationships that are likely to be detrimental to clients,
and to be readily accountable to clients and colleagues for any dual
relationships that occur.
F
Practitioners are encouraged to
keep appropriate records of their work with clients unless there are adequate
reasons for not keeping any records. All records should be accurate, respectful
of clients and colleagues and protected from unauthorised disclosure.
Practitioners should take into account their responsibilities and their
clients' rights under data protection legislation and any other legal
requirements.
F
All counsellors,
psychotherapists, trainers and supervisors are required to have regular and
on-going formal supervision/consultative support for their work in accordance
with professional requirements. Managers, researchers and providers of
counselling skills are strongly encouraged to review their need for
professional and personal support and to obtain appropriate services for
themselves.
F
Regularly monitoring and
reviewing one's work is essential to maintaining good practice. It is important
to be open to, and conscientious in considering, feedback from colleagues,
appraisals and assessments. Responding constructively to feedback helps to
advance practice.
F
A commitment to good practice
requires practitioners to keep up to date with the latest knowledge and respond
to changing circumstances. They should consider carefully their own need for continuing
professional development and engage in appropriate educational activities.
F
Working with young people
requires specific ethical awareness and competence. The practitioner is
required to consider and assess the balance between young people's dependence
on adults and carers and their progressive development towards acting independently.
Working with children and young people requires careful consideration of issues
concerning their capacity to give consent to receiving any service
independently of someone with parental responsibilities and the management of
confidences disclosed by clients.
3.4 - Develop a plan to ensure the workforce has
the necessary training to recognise individual health care needs.
As we do not have a specific document
that pinpoints the specific training needed to meet the needs of an individual
service user, I created the ‘Internal
Training’ document. The document has a simple format and focuses on three
main questions:
1. What are the needs of the individual?
2. What training would staff need to meet these needs effectively?
3. Are the allocated staff team sufficiently trained to meet these
needs?
I decided that just because staff have
some level of basic training does not mean they are fully competent to support
the needs of the individual, therefore, I have used a number system. By grading
a staff member on each subject allows us to highlight where they need further
training, level 1 shows that the staff are not competent and need further
training whereas level 3 shows staff are more than competent to meet the needs
of the individual. The document I have created will be reviewed and amended as
often as any changes take place to the care team, if the individual’s needs
change then this will be documented and further training introduced where
necessary.
Any specific support issues that require
a great deal of expertise will be initially assessed by an appropriate
professional, this may be one of the following:
F Occupational Therapist
F District Nurse
F Clinical
F Psychiatrist
F GP
F Community Psychiatric Nurse
F Social Worker
When expert
advice is given regarding the support needs of the individual this will be
documented within the care plan for support staff to read, a sign off sheet
will be introduced to ensure all staff members have read the advice given. If
any treatment requires specialist or trained staff, the existing staff team
will be assessed performing the actions by the relevant professional, the staff
member will be signed off as proof off competency.
It is
important that all specialist care is regularly assessed by the management or a sufficiently trained
professional, this will make it possible to see any changing needs of an
individual and of any further training staff may need.
4. Be able
to lead inclusive provision that gives individuals’ choice and control over the
outcomes they want to achieve.
4.1 - Explain the necessary steps in order for
individuals to have choice and control over decisions.
Ø Informed choice
An informed choice means that a person has the information and
support to think the choice through and to understand what the reasonably
expected consequences may be of making that choice. It is important to remember
that too much information can be oppressive and individuals have differing
needs in relation to how information is presented to them. Professionals and
organisations must be able to demonstrate that they have taken these individual
needs into account.
Enabling people to make informed choices does not mean the local
authority or provider organisation should abdicate its responsibility to ensure
people have a good quality of life. For example if a person „chooses‟ to stay
in bed all day, every day, the local authority or provider organisation has a
responsibility to explore what is happening and respond to this appropriately,
working to ensure that the individual fully understands the consequences of
their decision. It is not acceptable to simply accept such a decision at face
value if this would put the individual at significant risk, as acts of omission
can be considered to be abusive.
Ø
Duty of care
Duty of care requires everyone to „take reasonable care to avoid
acts or omissions which you can reasonably foresee would be likely to injure
your neighbour‟.
Donoghue (or M‟Alister) v Stevenson ([1932] “You must take
reasonable care to avoid acts or omissions which you can reasonably foresee
would be likely to injure your neighbour. Who, then, in law, is my neighbour?
The answer seems to be —persons who are so closely and directly affected by my
act that I ought reasonably to have them in contemplation as being so affected
when I am directing my mind to the acts or omissions that are called in
question.” (26 May 1932, Lord Atkin)
Within this duty there is a responsibility to enable people to make
informed choices and decisions as well as to take steps to minimise foreseeable
risks, in liaison with the person and others who know and care about them.
Person you are supporting can make a decision with or without
support, the process of risk assessing is advisory in nature rather than
something which the individual is required to adhere to.
In the event that there appears to be a clear risk that an
individual will be harmed, or at risk of harm, or where there is a risk that
they may harm another, then local adult protection / safeguarding procedures
should be referred to. There may in some circumstances be a requirement to
break confidentiality and act to report and intervene in such instances.
The duty of care requires you to consider the consequences of your
acts and omissions and to ensure that those acts and/or omissions do not give
rise to a foreseeable risk of injury to any other person. Clearly, one is not
expected to guarantee the safety of others; one is expected to act reasonably.
Ø
Statutory Duty
In addition to a
common law duty of care, the local authority has a statutory duty under the NHS
and Community Care Act 1990 to assess people’s needs and to decide what
services are called for. It decides whether services are called for by applying
an eligibility system called “fair access to care”.
People are
eligible for help if the local authority believes there is a sufficiently high
risk to their independence. If there is, it must arrange for services to meet
their needs. Most commonly this involves provision of services in people’s own
homes under the Chronically Sick and Disabled Persons Act 1970 , or of
residential accommodation under the National Assistance Act 1948.
Ø
Communication
It is important
to involve people in decisions even when they do not use speech as their main
means of communication. Person centred planning techniques point us towards
many ways of listening to people in different ways other than relying on what
they actually say, using tools such as learning logs, communication charts and
supported decision making agreements, and these should all be utilised if we
are to demonstrate that we have truly attempted to communicate effectively with
an individual.
It is also
imperative that professionals and organisations ensure that the views of others
who know and care about the person are invited and taken into account in any
decision making process, without these taking precedence over the individual’s
views and wishes. Where we are supporting people who have complex communication
needs, person centred approaches are essential to ensure people’s involvement
in decisions which affect their lives.
Ø Health
and safety issues
Bb It is
sometimes the case that a service culture can be seen to put safety at all
costs above all other considerations, including people’s rights to make
informed decisions and live their lives in ways which work for them. It is a
failure if professionals and organisations do not take account of the risks to
people’s health and wellbeing of not taking a risk, as well as those associated
with taking the risk.
This policy does
not replace or ignore existing health and safety policies and if you are in any
doubt about supporting the positive risk in relation to health and safety
issues, it is responsible to stop, think and discuss with others before
proceeding. This process must not, however, be used as an excuse to
unreasonably delay a course of action which an individual is choosing, nor be
used to subtly dissuade people from wanting to try new things.
The process of
assessing risk needs to be timely, inclusive and well documented. Where it is
helpful in delivering support to an individual and positively managing situations which contain
risk, then there may be a need for this to be written into a specific “risk
assessment” document. Summary A service-led approach to risk management can
compromise individual’s rights to make choices and take risks. Often concerns
about minimising and attempting to eliminate risks are in the interests of the
organisation, but not necessarily in the interests of the person they are
attempting to support. This policy framework is designed to change the focus of
risk management to one where the person is at the centre of all discussions, is
enabled more fully to self-direct their support where able, and is supported in
ways which are clearly in their best interests where they are unable to do so
for themselves.
4.2 - Manage resources so that individuals can
achieve positive outcomes.
To achieve positive outcomes for
individual’s means managing resources to ensure the service systems and
processes are geared to this aim. As a consequence, all aspects of the care
process need to be considered in relation to outcomes.
Ø Performance
Management
Setting
performance standards, observing and providing feedback, and conducting
appraisals enables you to achieve the best results through managing employee
performance.
To begin the
process, you and the employee will collaborate on the development of
performance standards. You will develop a performance plan that directs the
employee's efforts toward achieving specific results, to support organizational
growth as well as the employee's professional growth. Discuss goals and
objectives throughout the year, providing a framework to ensure employees
achieve results through coaching and mutual feedback. At the end of the rating
period, you will appraise the employee's performance against existing
standards, and establish new goals together for the next rating period.
As the
immediate supervisor, you play an important role; your closest interaction with
the employee occurs at this level. Performance expectations are the basis for
appraising employee performance. Written performance standards let you compare
the employee's performance with mutually understood expectations and minimize
ambiguity in providing feedback.
Having
performance standards is not a new concept; standards exist whether or not they
are discussed or put in writing. When you observe an employee's performance,
you usually make a judgment about whether that performance is acceptable. How
do you decide what's acceptable and what's unacceptable performance? The answer
to this question is the first step in establishing written standards.
Standards
identify a baseline for measuring performance. From performance standards,
supervisors can provide specific feedback describing the gap between expected
and actual performance.
Ø
Effective performance standards:
F
Serve as an objective basis for communicating
about performance.
F
Enable the employee to differentiate between
acceptable and unacceptable results
F
Increase job satisfaction because employees know
when tasks are performed well
F
Inform new employees of your expectations about
job performance
F
Encourage an open and trusting relationship with
employees
4.3 - Monitor and evaluate progress towards the
achievement of outcomes.
Monitoring is the systematic
gathering and analysing of information that will help measure progress on an
aspect of your project. Ongoing checks
against progress over time may include monitoring water quality in a catchment
or monetary expenditure against the project budget. Monitoring is not evaluation as such but is
usually a critical part of your evaluation process and should therefore be included
at your project planning stage.
Before undertaking any monitoring it is
important to consider:
Ø Why you want to monitor.
Keeping records and monitoring activities helps people see progress
and builds a sense of achievement.
Records can be useful and even essential when promoting the group or
applying for funding.
Monitoring also has significance for the wider field of
conservation. Ecosystem monitoring is
not a fully developed science, so any work undertaken by your group has the
potential to contribute to the refinement of measures of ecosystem health.
Ø What you will monitor.
The following
list of questions will help you decide on your monitoring objectives:
F
What information will help us
make informed decisions? What will help us know that our project/group is on
track?
F
What’s the appropriate scale
for monitoring e.g. catchment, district, reserve boundary, whole forest or
whole ecosystem?
F
What are our timeframes for
monitoring e.g. days, months or years?
F
Do we need input from other
groups or agencies?
Ø Key features of effective monitoring
Monitoring can be
considered to be effective when:
F
Scientifically valid techniques are used.
F
Aspects relevant to your project are measured.
F
It’s carried out regularly and consistently.
F
Accurate records are kept.
F
It is used as part of your evaluation to support
or adjust project goals and actions.
Once evaluation data has been
gathered and analysed, remember to check your conclusions against your goals
and objectives. Make sure you put your
results into practice - take them on board and use them to influence how you
work!
4.4 - Develop a plan to ensure the workforce has
the necessary training to support individuals to achieve outcomes.
Developing a plan to ensure that
our staff are appropriately trained to use an outcome based approach in their
practice starts from and understanding of the needs of individuals using the
service. The finding from ‘In Control’ and similar projects based on
personalisation can provide ideas that perform practice.
Ø
Developing the strategy
Primarily, a
workforce development task group was launched whose role was to develop the
strategy and evaluate the process and outcomes for both service users and
staff. The methodology included investigating the gaps and effectiveness of
current training provision and methods of delivery, current partnerships,
recruitment and retention issues and the necessary skill mix for potentially
new roles and integrated services. A cross sector survey of front line staff
was also attempted with limited response, which is indicative to the on-going challenge
of engaging independent organisations.
However, to
continue meeting the changing needs of people with learning disabilities, staff
with the right qualities must be employed and then assisted to develop their
knowledge and skills. This requires a high standard of induction, training,
education opportunities and a commitment to life-long learning across all
sectors and is fundamental to the effectiveness of the strategy.
Ø The
strategy
The workforce
strategy plan supports a co-ordinated approach to the evaluation of training
and development, ensuring that all local providers, service users and staff
have an opportunity to participate. It sets out what actions need to be
undertaken in the coming year and actual training activities over the next five
years.
The training
activities will begin with frontline staff and managers, rippling out to those
working in mainstream services. It is envisaged that this will impact on the
wider community, eradicating any lingering prejudice.
Ø
Valuing People
Bb Valuing
People is the first white paper since ‘Better Services for the Mentally
Handicapped, which was produced 30 years ago, leading to the closure of large
institutions and the development of community services.
Valuing People is
a strategy to further improve the lives of people with learning disabilities
and their families through the promotion of four key principles, which are
legal and civil rights, independence, choice and inclusion. Each of these
principles is embedded within eleven main objectives that make up the strategy.
The sub-objectives state that all
new entrants to learning disability care services must be registered with the
Learning Disability Awards Framework, 50% of the workforce must have achieved
at least NVQ level 2 by 2005 and local workforce plans must be developed, which
reflect the current training requirements and illustrate future actions to
develop staff across all sectors.
4.5 - Implement systems and processes for recording
the identification, progress and achievement of outcomes.
Effectively recording the
progress towards the achievement of outcomes for individuals’ means having a
system that is able to track the processes that contribute to that goal.
Ø Recording outcomes: the critical link between engagement and
improvement
Recording is
an essential task in human services. It helps to focus the work of staff and
supports effective partnership and planning with people who use services. When
adopting an outcomes focused approach, practitioners should be encouraged to
use recording as an analytical tool and as a way of clarifying the purpose of
their interventions. In addition to its role in supporting values and
principles of professional practice, recording ensures that there is a
documented account of work undertaken. It supports continuity when there is a
change of staff and provides a means for managers to monitor work. It becomes a
major source of evidence when there are critical incidents or enquiries.
Recording is also necessary for planning, monitoring and reviewing progress, at
individual, service, organisational and locality levels. Over the past five
years in Scotland, work has progressed on developing an approach to outcomes
based working called Talking Points. Recording has been identified as one of
three key elements essential to maximising the benefits of an outcomes
approach. The diagram below shows the interactivity between the three key
elements.
The recording
of the outcomes following assessment and planning and review the use of that
collated information for a range of purposes including planning, commissioning,
accountability and performance improvement The relationship between the three
elements is not linear, but is best understood as a circuit. To complete the
circuit, the collated information can be reported back to staff who gain
improved understanding of how they influence outcomes, and how the information
can be used to improve services, which in turn can influence recording.
5. Be able to manage effective working partnerships with carers, families
and significant others to achieve positive outcomes.
5.1 - Analyse the importance of effective working
relationships with carers, families and significant others for the achievement
of positive outcomes.
Carers
play an important role in many service users’ lives. They are often the people
who know the service user best and can be an invaluable source of information
and support. Carers might be best positioned to provide the help needed to
achieve the best possible outcomes for the service user. In this section we
will examine the role of carers and the benefits of working closely with them,
for the benefit of care professionals, service users and carers themselves.
Ø Improved outcomes for service users
F
Increasing the knowledge,
confidence and understanding of significant others in dealing with the service
user’s mental health problems, and their own feelings and anxieties regarding
the situation, has been shown to aid to service user recovery.
Ø
Access to useful carer knowledge
F
Information sharing can work two ways – not only
do carers require information from you, the clinical team can also learn from
family and friends experience and knowledge. It is worth emphasising that
listening to carers, or accepting information from them does not constitute a
breach of confidentiality.
Whatever the status of the current family / friend
relationships, these individuals may have information to help you understand
the case history of the service user. Over the longer term, engaged informal
carers get used to reading signs of relapse, assisting with medication
compliance or suggesting different ways to support the service user. Their
involvement can be helpful for the clinical team and this will be more effective
if the informal caring role is noticeably valued and respected by us and our
colleagues.
5.2 - Implement systems, procedures and practices
that engage carers, families and significant others.
Ø
There are several factors that influence
approach to engaging with carers:
F
Carers have their own needs that are often
overlooked.
F
The caring role can be demanding and result in
the carer experiencing ill-health.
F
Carers can have limited social networks and this
can affect their access to friends and services to meet their own needs.
F
The death of a carer can result in a crisis in
the life of the cared-for individual.
5.3 - Use appropriate approaches to address
conflicts and dilemmas that may arise between individuals, staff and carers,
families and significant others.
In our care work we mostly work
with children and young people who may not have the ability to judge what is
good for them and what is not. In those cases it is our responsibility and job
as individuals and as a team to provide them what we judge is best for them. In
some other cases they have the skills to get involved in the decisions and this
can lead to conflicts and dilemmas.
Potential conflicts between the service user
and the care worker in our job role can arise from disagreeing in certain questions
e.g. what is healthy to eat, what is not, what is more important when having a
meal: quality or quantity, what activities or forms of entertainment (films,
songs, etc.) are age-appropriate and/or mentally and emotionally adequate and
so on.
If a conflict arises, I can never
force a learner to do or not to do things unless the law or the School Policy
allows me to (for example if they want to watch an age-inappropriate film, but
in these cases I always have to refer to my line manager). What I can do if a
conflict in these questions arises between me and the learner is to provide all
the information about the risk carried by their decisions in a supportive,
encouraging way, and then let them make their own choices. Every time when a
conflict arises I should record what actions were taken to provide every source
for the learner to make their own decision and what choice they made. I always
should seek for advice at my line manager.
5.4 - Explain how legislation and regulation
influence working relationships with carers, families and significant others.
In the 1990s there was an
increasing realisation that carers’ needs were ignored. This led to the Carers
(Recognition and Services) Act (1995). There has been a series of initiatives
to highlight the central role carers play in the lives of individuals and
emphasise their importance. This has now led to the recognition that carers
constitute a ‘third frontier’ in care delivery, whose contribution is estimated
at approximately £70 billion.
5.5 - Implement safe and confidential recording
systems and processes to provide effective information sharing and recording.
Confidentiality is about who
knows what about whom. In service it involves monitoring who has access to
information, what is written about people, and what information is passed on to
external agencies.
There are many different
approaches to confidentiality within the sector and there remains some
confusion about confidentiality. Clients and staff need to be clear about the
limits to confidentiality. In other words, under what circumstances staff will
pass information to others without the expressed permission of the client.
Organisations collect and hold a
lot of information about clients in order to provide effective support. Much of
this information will be of a sensitive and personal nature. It is therefore
not surprising that some clients feel very uneasy about disclosing information.
They will only be reassured if they are confident that the information will be
treated confidentially.
Unfortunately, there is scope for
misunderstanding between staff and clients over what confidentiality means and
the limits to it.
It is important, therefore, that
all service providers have a confidentiality policy that addresses:
F What
the organisation means by “confidentiality” and why it is important.
F What
information will be collected
F How
it will be recorded
F Who
will have access to it
F How
will it be used
F Informed
consent – how clients will be asked for consent
F Sharing
of information within the organisation
F Sharing
of information outside the organisation
F Circumstances
in which information may be shared without the client’s express consent
F Security
of electronically stored data (e.g. against hacking)
Ø Principles:
Some practitioners prefer to refer to the 'professional
use of information'. This is to say that information on an individual of a
personal nature is (only) disclosed where it is important professionally to do
so, in order to provide a better, more joined-up service or to minimise and be
aware of risks.
Confidentiality generally means information is kept
within the project. This means that information given to one member of staff
may be shared with other members of staff. Where the provider has several
projects, the policy may state that confidentiality is within the organisation.
The policy should set out under what conditions staff
will share information outside the organisation without the consent of the
client. This may involve situations where not divulging information will create
serious risk to the client or someone else, or where the provider is obliged to
divulge the information by law to the police or other agency. Providers should
be proactive in working with the local police to ensure mutual understanding
about confidentiality and legal requirements. Clients should be aware of how
information will be disclosed to the police.
The policy should be clear on staff responsibility around
handling personal information to keeping records up-to-date. For example, staff
need to be mindful of the environment in which they are collecting, receiving
or viewing sensitive information. Letters, records, and files (both paper and
electronic) should not be written or left where people without authority can
see them. Confidential telephone calls should be conducted in private.
References
Ø
Performance Management
Ø
Employee health and well-being
Ø
Health and Safety Executive
Ø
Scottish Centre for Healthy Working Lives
Ø
Health at work
Ø
Code of Practice 2005
Ø
Valuing People (A New Strategy for Learning
Disability for the 21st Century)
Ø
Recording with care
Ø
Staff support and supervision for outcomes based
working
Ø
Diploma in Leadership for Health and Social Care
Level 5 – By Nelson Thornes.
Absolutely agree with the importance of managing health and social care practices for positive outcomes. It's a topic close to my heart. Recently, I've been looking into NDIS plan management services to better understand how to optimize support structures. If anyone has practical insights or tips on navigating these services, please share.
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