Robert Stephenson

Putting care into the actual running of a care provider, Part 5

Putting care into the actual running of a care provider: Concrete practices to implement
When I wrote about Morriss House and CUN, I want to highlight my mention of the “feel” these organisations spin off when you encounter them.

This may seem somewhat unscientific and an aside from the goals of “keeping someone alive” but if you think from a patient or care recipient’s view, a large part of their experience in a health or social care setting will likely be this “feel”. As emotional human beings, this is so important. If a person is in a hospital and can get well in either, but feels genuinely cared for in one but not in the other, where do you think the person would want to stay? This is not rocket science but unfortunately for England’s health and social care sectors, it is often approached as if it is. Looking at the four model organisations in this article series, I hope the solution is obvious by now: the change, the source of providing excellent care with compassion must start with the management of health and social care organisations.

We must instill care and compassion into the way we run our organisations. We must manage with humility and compassion as this helps stimulate an overall culture of compassion from which staff are better able to provide care with excellence and compassion. No matter how many white papers, laws, and regulations are written to promote dignity in care, they will all have been written in vain if the management of health and social care organisations do not themselves expound care and dignity in the way we conduct ourselves. It is simply untenable to ask your staff to be compassionate if you yourself are not treating your staff with compassion.

Model Practices for Care Organisations
Below are some concrete care organisational practices which are exhibited by the model organisations in this article series that your organisation can implement, as they already are at Penrose Care.

Overall, there is a recurring theme across the “model organisations” covered in this article series: treat your staff with dignity and respect and they in turn will be more likely to put excellence in their work, including treating others with dignity and respect.

Safeguard your employees from temporary organisational setbacks: in a society used to “cyclical redundancies”, how about just avoiding them? As Victorinox has demonstrated, it is fitting and right for the owners of an organisation to absorb the bulk of the pain of temporary setbacks to the extent possible. By doing this, a large amount of stress from your workforce is removed. As what is worse than to go into work everyday not knowing if you will be there tomorrow? In care, a sense of job security among the workforce is so important as we would expect the workforce to be providing a sense of security to patients and care recipients. Although health and social care is generally considered non-cyclical this is not purely true. A cyclical downturn in public tax revenues could result in pressures on health and social care budgets. A weak jobs market could lead to individuals deferring elective procedures. Periods of poor investment returns could impair abilities to privately-procure health and/or social care. In addition, organisational specific events such as the sudden loss of block or other large contracts could be serious short-term setbacks.

If a total transformation is necessary, ensure your organisation is sufficiently conservatively financed to do so in ways which mitigate the negative impacts on staff: As Coloplast has demonstrated, an organisation should limit its usage of debt to give it sufficient breathing room to adjust to difficulties, particularly should they turn out to be structural vs temporary. With such breathing room, staff reductions can be done in ways that limit negative impacts on those losing their jobs through such measures as early retirement, generous redundancy packages, and/or position transfers within the organisation. This is particularly important given the structural challenges facing England’s health and social care system as it struggles with an ageing population. It is further relevant given the high debt levels of some of the larger care organisations in England.

Management and frontline staff compensation divergence should be within reason: At Victorinox, senior management compensation is capped at 5x the pay of an average worker. This to me sounds incredibly sensible, as it is easy to conceive how the culture of an organisation could be engulfed in animosity if workers in are living in poverty while a manager lives in riches. Such a culture is not conducive to providing excellent care with compassion. Recent data from Skills for Care suggests an average care worker in London is paid c £7.10/hour. With c 57.8% (“Time to Care”, Unison, Oct 2012, p19) not being paid their travel time between care recipients’ homes which is c 19% of an average care worker’s work time (“… UK domiciliary care sector”, UKHCA, Sep 2012, p8), this implies many London care workers are effectively paid £5.75/hour which is below the national minimum wage for those 21 and above. The reality that there are certain care organisations that pay their staff such abusive wages while managers/owners live luxuriously is nothing short of outrageous. Local Authorities that commission care work that is priced in ways that force such abusive workforce practices should be reviewed by the Central Government. Firstly, care staff should be paid a decent wage as a minimum and in my view, this is at least the Living Wage. Secondly, care staff must be paid for their travel time between care recipients’ homes – this is just common decency. Thirdly, sensible management compensation caps such as that in force at Victorinox should be encouraged.

Management should manage with humility: Morriss House’s shift manager doing the dishes underlies this model practice. Humility is essential to instilling compassion in an organisation as it is a concrete expression of a belief that we are all humans, equal in dignity and deserving of respect. Staff that feel they are genuinely respected are more likely to have high morale and be in a disposition conducive to providing excellent care with compassion.

Management should to the extent possible, be willing to and be trained in performing the tasks assigned to frontline staff: this is not possible in all settings. Of course, a hospital manager that is not a heart surgeon should by no means try to perform a heart bypass! But this is not necessary, the manager can work alongside the cafeteria staff one day to help prepare the food and tea. Or how about cleaning the toilets from time to time? Why not? Such practices may seem inane but they again, demonstrate humility which helps cultivate a culture of compassion and dignity in an organisation.

Management must remember that each patient or care recipient is an important individual deserving of respect and should be provided the time necessary to receive care with dignity: this is a practice which is incredibly fundamental at CUN and the benefits are evident – patients receive incredible health care in a warm and secure environment. Within social care, a concrete practice is providing sufficient time to a care worker to perform his/her tasks without rushing. As such, personal care appointments in home care allocated at 15 minutes or less should be done away with. In addition, to the extent possible, a care recipient should have stability in their care worker as a care worker that knows a care recipient well is best able to provide care which is comfortable and best customised to the care recipient’s specific needs. In addition, a care recipient should be familiarised with their “back up” care workers ahead of time to avoid unnerving situations where an unfamiliar person shows up at their home.

No detail in care should be overlooked by a manager: At CUN, one can immediately notice the incredible thought and care that goes into cleaning and interior design. Further, CUN has incredibly amazing food – the best food I have ever had at a healthcare organisation. As such, it is an organisation that strives to address the little details in care to help ensure patients receive excellent care. Care organisations should adopt a similar mindset. For instance, reviewing the ingredients of your food and drink? Are there better quality ingredients or drinks you could procure at the same price or could your organisation afford to spend a bit more on food and drink quality? Is your service setting clean? In the case of home care, is your staff sufficiently trained to help ensure a care recipient’s home is properly cleaned and well maintained? These may seem like little details but as CUN demonstrates, when you imbue the little details with excellence, the end result is an overall service which is imbued with incredibly superior quality.

Together, we can transform health and social care in England
Raising the bar in the health and social care sectors is possible and I hope this article series helps inspire other health and social care managers to instill care in the actual running of their organisations. I am under no illusion that every health and social care organisation will be willing to change the status quo, but this is where governments, regulators, patients and care recipients can also help.

Government institutions such as the NHS and Local Authorities and regulators such as the CQC can help by assisting organisations that put in place concrete practices to promote excellence in care with compassion. Patients and care recipients can help by using care organisations dedicated to being centres of excellence and avoiding those not serious about improving the health and social care sectors.

It will be challenging and may take many, many years, but I am hopeful that by working together, organisations and individuals committed to fundamentally transforming the UK’s health and social care sectors for the better can indeed do so, for the benefits of the millions alive today and our posterity that come after us.

Link to Part 4 of the article series

End of article series, Putting care ino the actual running of a care provider

Robert Stephenson-Padron is Penrose Care’s managing director. Prior to founding Penrose Care in 2012 with Dr. Matthew Knight, Mr. Stephenson-Padron was a healthcare equity research analyst at Merrill Lynch in London. Prior to joining Merrill Lynch in in 2010, Mr. Stephenson-Padron was a healthcare equity research analyst at Barclays Capital, also based in London. From 2003-2008, Mr. Stephenson-Padron was a research assistant to epidemiologist Prof. Alison Galvani of Yale University.

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