Organisational culture and workforce development for improved dementia services

The Declare Your Care campaign found around 7 million people who accessed health and care services in the last five years had concerns but had not raised them for reasons such as

• not knowing how to give such feedback
• fearing being perceived as a 'trouble maker'
• believing that speaking up would not make any difference

(research for CQC published in February 2019)

It also found that when people did speak up improvements were made in many cases (infographic). This may suggest that how people using services perceive their values and culture influence whether they share their experiences in ways that enable services to improve.

Caring cultures value people's experiences

'The experience we deliver for patients and their families will only ever improve when an entire organisation or health and social care system examines and re-creates its culture, leadership, service user engagement, staff engagement and measurement systems in order to improve service experience.'

(Sam Hudson Head of Experience and Engagement NHS Institute p8 Patient Experience: Guidance and Support)

You can find more free resources on improving workplace culture on the Foundation of Nursing Studies website. 

Julie Unwin's 2018 report on Kindness, emotions and human relationships: the blind spot in public policy, argues that the answers to how to meet everyone's needs in times when statutory services are so stretched, include those to be found by looking carefully at the role of emotions, and kindness in public policy. Communities looking to be kind, through Dementia Friends and collaborative initiatives such as Dementia-Friendly Communities may more likely actively include and involve people with dementia and their carers, enabling them to live well and delaying the need for them to access statutory services.

Making an impact

Neither data, or caring about people, on their own can bring about change. 

Bringing about change requires organisational culture to value impact and embed behaviours.

Key beliefs and behaviours to embed are for staff to:

• be curious about what the service is achieving and how it could become even better
• believe in the value of learning from the experience of people with dementia and their carers
• be able and willing to record feedback or observations from people affected by dementia.

Don't expect immediate results.

• New ways of working take time to implement and the full impact of change may take time to become reflected in service data and evaluation.
• The investment you make, may well help you to save time and resources overall, by helping you to identify how and why to improve.

Champion and communicate why service user experience is everyone's business.

Make sure all staff understand why it's important to measure the experience of people affected by dementia effectively - the benefits it can bring to people's quality of life, and benefits it can bring to staff roles and services too. Without this buy-in, it will be difficult to implement a useful approach.

• Senior management foster a culture of continuous improvement by using evidence to inform decision making.
• Middle management design meaningful processes and disseminate guidance
• Front-line staff follow processes to collect high quality data. 

Get staff into good habits about measuring experience

Approach this in the same way that you normally approach service design. For example, have an appointed member of staff responsible for delivery, perhaps with support of a working group, including people living with dementia, and, where appropriate, carers, friends and family of people living with dementia too.

If you are working in a large or complex organisation consider how to communicate new processes to dispersed and front-line staff to ensure you develop consistent approaches between services and locations, while taking account of people's diverse personal needs too.

Ensure staff have access to any necessary learning and development

Addressing concerns that as many as 1 in 3 staff in care homes have no dementia training, the NICE Guideline (NG97, June 2018) underlines the importance of training and development for staff.  It says:

• 'Care and support providers should provide all staff with training in person-centred and outcome-focused care for people living with dementia, which should include:

  • understanding the signs and symptoms of dementia, and the changes to expect as the condition progresses

  • understanding the person as an individual, and their life story

  • respecting the person's individual identity, sexuality and culture

  • understanding the needs of the person and their family members or carers.

• 'Care providers should provide additional face-to-face training and mentoring to staff who deliver care and support to people living with dementia. This should include:...how to monitor and respond to the lived experience of people living with dementia, including adapting communication styles.'
• 'Consider giving carers and/or family members the opportunity to attend and take part in staff dementia training sessions.'

Note: If you commissioned an external organisation to support with measurement, you may be able to get staff training included in your agreement.

Useful links

Blog from the King's Fund - challenges to bringing about inclusive culture, and tips for encouraging learning from lots of different perspectives.

Courses for learning how to measure experience

Future learn offers short courses including free courses on why experience matters and qualitative research. It may be possible to upgrade these  and use the course completion as credit towards a postgraduate qualification.

MRS Evidence Matters courses - topics include questionnaire and infographic design.

Nuffield Department of Physical Health Sciences short courses - topics are about qualitative research methods, including online as well as traditional methods.

Social Research Association courses - topics include visual representation of data and infographic design, qualitative data analysis, write-up, and evaluation of impact.

E-learning

Dementia awareness e-learning course (free): SCIE

Mental Capacity Act (2005) (free): SCIE

Tools for making staff more dementia-aware

Dementia Friends sessions

​NHS Gloucestershire Clinical Commissioning Group ('CCG) have made Dementia Friends sessions an integral part of their training programme. Joint Commissioning Manager, Helen Vaughan, told us that Dementia Friends sessions run side by side with the CCG's training programme in the county.  The CCG have also included what Dementia Friends have done locally in their reports to ensure that they are not regarded as a stand alone campaign, but lead to embedding change in the county.

Dementia Champions can make a difference in care homes