Person-centred approach – training and development

Person-centred care should be at the heart of any health and social care provider’s approach to care. But how do we embed it into training and development? The person-centred approach framework released by Skills for Health, Skills for Care and Health Education England includes a section advising organisations on how to embed these approaches using training and development. The framework recommends a number of “underpinning principles” to guide an organisation’s approach to training and development on the topic.

Behaviour change

The most important of those principles is “behaviour change”. As with the whole idea of a person-centred approach, this concept is now fairly old, but its implications have still not been felt by a vast number of organisations in the sector, and indeed across all sectors. Unfortunately, the framework is frustratingly light on how behaviour can be changed in a positive way, reflecting only that it is more successful than “isolated training”. It does note, however, that any training geared towards changing behaviour will fail if the organisation’s structure and processes reward an old, habitual behaviours rather than reward the behaviours enshrined in the framework:

Development of capability must simultaneously be supported with the right processes, system and opportunity together with locally relevant incentives, which build those intrinsic and extrinsic motivations.

Behaviour change in training - Advantage Accreditation

Co-producing training

The framework also recommends that training is co-produced to a certain extent. This boils down to having the carer or even the service user contributing stories and reflections about their experiences during the course, or even during the planning of the course.

This shouldn’t be new to any good provider or trainer. A good trainer will seek to engage the people on the course, getting them to talk about how they can relate to content of the course and whether they can think back to any relevant experiences. A classic reflection exercise is ‘What would you have done differently?’, getting the learner to retrospectively apply their new learnings to a previous experience.

Again, the framework highlights that the best co-produced training will have people involved in the planning stage without them even knowing it, with HR processes that continuously seek feedback from service users and staff.

Reflective practice

Again, we are all familiar with the importance of getting members of the team to reflect on what is working, what isn’t working, and on the needs of others.

The challenge for many health and social care providers, of course, will be finding the time for members of staff (including managers) to engage in reflective practice. As resources become more stretched, it will become more and more difficult. One possible solution is to stress its importance during the induction period, to effectively train staff to continuously reflect ‘on the job’.

Continuous improvement

The framework focuses on the structural element of continuous improvement – of managers consistently providing feedback to staff. The framework does not mention, though, the significance of a continuous improvement culture. The best companies in industry that practice continuous improvement have it as part of their culture, running through everything they do, encompassing HR, finance, production and service delivery processes.

Achieving culture change, of course, is difficult to accomplish and can take a long period of time. It requires concentrated effort and the full support of senior leadership. As any continuous improvement organisation will tell you though – and this includes the likes of General Electric and Mitsubishi – it is well worth it.

Value-based approaches

This part of the framework primarily refers to recruitment and retention. Unfortunately, the section of the framework seems a little too aspirational. The news this week has been full of reports about the huge number of vacancies with the NHS, with retention proving as much of an issue as recruitment. This is compounded by applications from the EU dropping off significantly in anticipation of Brexit and the end of free movement. Even a brief perusal of any job site will tell you that care settings are also continuously recruiting in a sector renowned for its high staff turnover.

Increasingly, health and social care providers are taking what they can get. Recruiting on the grounds of values and outlook, as the framework advocates, is simply not possible for those who cannot afford to go and do it. The emphasis has to be on training and induction. This is helped by having a strong culture that new workers can be embedded in to quickly.

Methods for delivering training

The ‘narrative’ section of the framework does not elaborate on this principle much, although content further down in the document does by discussing “permitted time for e-learning”. As ever, the key is deciding which approach is most suited for each person and for each subject area. E-learning is often perfect for entry-level staff being trained in compliance topics where answers are often binary (i.e. yes or no, right or wrong). It may not be suitable for training that requires reflection and where judgement may be more subjective.

Conclusion

Although the framework raises some great points, it does feel a little too aspirational and abstract at times. Many health and social care providers will feel that it doesn’t account for challenges in recruitment and funding issues. If you take anything from the framework and this post, let it be these three points:

  • Culture, culture, culture: if behavioural change, continuous improvement and a person-centred approach are going to take hold, it needs to be embedded in your culture.
  • The method of training delivery needs to be suitable for the person and the subject area.
  • Train people to reflect on their work every day and ‘on the job’. This embeds it into their behaviour, and means they are doing it even if you can’t set aside specific time for them to do so.
Person-centred approaches - Advantage Accreditation

Person-centred approaches in healthcare

A new framework is being launched by Skills for Health, Skills for Care and Health Education England to put people-centred approaches at the heart of the health and social care sector.

The framework builds on a long-running trend to put people and their needs at the heart of health and social care, replacing the traditional top-down approach of yesteryear. Although to many this may seem like old news, there are still a number of health and social care settings who do not fully understand the implications of adopting a person-centred approach.

The framework, according to Skills for Health, was created by drawing on the experience and knowledge of professionals in the sector, and is designed to take person-centred principles and apply them to the current landscape. It is designed to help health and social care workers – or rather their managers, in reality – “put person-centred approaches into practice and to create sustained behavioural change”.

You can read the new framework here. As ever, although the thought must be applauded, drafting a framework and implementing that “sustained behavioural change” is the real challenge, and it isn’t clear from the framework how that is to be achieved in a realistic context. Much of the framework – as is clear in the central diagram – is based around conversations with service users. In health and social care settings where human resources are increasingly stretched, finding the time to have these conversations is easier mandated than done.

A more detailed analysis of the section on training and development will be posted shortly.

Old man and carer

Choosing the perfect care home

BBC News have published an article online today advising people on ‘how to choose the perfect care home‘. We liked the article because it included a checklist from Age UK on what to ask potential residential or nursing homes before you or your family member moves in.

The list is useful for providers though, too. Very often we focus on complex issues and forget the basics. This checklist is great for bringing us back down to earth, and ensuring we have the fundamentals of care right:

  • Can residents choose their daily routines?
  • Are senior staff on duty at all times?
  • What is the ratio of staff to residents?
  • What is the annual turnover of staff?
  • What dementia support is available?
  • Do GPs visit the home?
  • What is included in the fees?
  • What meals are provided?

Is DoLS set to be replaced?

This may have slipped under everyone’s radar. A report that received little attention in the news from the Law Commission has recommended scrapping the current Deprivation of Liberties Safeguards, which it describes as “in crisis”, and replacing them with a new Liberty Protection Safeguards system.

Although this may seem like semantics, the new system is notably less onerous that the current safeguards. Although this may prove much more beneficial to a courts system struggling to deal with the massive increase in DoLS cases since the 2014 Cheshire West ruling, some will highlight that it poses a risk to the vulnerable. One notable change is the scrapping of ‘best interests’ assessments for all cases.

Law Commissioner Nicolas Paines QC has argued, however, that the current system is failing families because of the backlogs it creates: “There are unnecessary costs and backlogs at every turn, and all too often family members are left without the support they need.

“The Deprivation of Liberty Safeguards were designed at a time when considerably fewer people were considered deprived of their liberty. Now they are failing those they were set up to protect.”

Read more about the changes here.

Old lady

New report shows the importance of basic skills

A number of news outlets are leading today with the news that the CQC has found that 32% of nursing homes in England and Wales are failing on safety:

Inspectors making unannounced visits to care homes found medicines being administered unsafely, alarm calls going unanswered and residents not getting help to eat or use the toilet. Some residents were found to have been woken up by night-shift care workers, washed and then put back to bed, apparently to make life easier for staff.

Training, recruitment and retention of skilled staff was cited by the CQC's chief inspector of adult social care, Andrea Sutcliffe, as one of the key causes for failed safety standards across the sector:

“Many of these homes are struggling to recruit and retain well-qualified nursing staff and that means that this is having an impact on delivering good services to people who have got very complex needs".

This shows that staff training is still a difficult issue for many facilities. It is likely that this is going to become a hot issue for the CQC over the coming months and years. 

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