Relationship Activated Care: The 360 Standard Framework Defining and Transforming Care Cultures

1. Relationship Activated Care: The 360 Standard FrameworkDefining and Transforming Care Cultures Patricia Duff OBE, MSc, BA, RN, RM, PGCEA Rosemary Hurtley MSc, Dip COT, FRSA Using measurable outcome standards to exemplify and protect Human Rights in care settings Rosemary Hurtley MSc, Dip COT, FRSA Royal College of Medicine, Summer School 2013

2. 360 Forward provides : Diagnostic assessment Consultancy, education, coaching & training services Working with managers and staff at all levels Health and social care Our aim is to establish dynamic, sustainable person centred cultures in their organisations in line with the philosophy and principles of The360 Standard Framework. Patricia Duff OBE, MSc, BA, RN, RM, PGCEA Rosemary Hurtley MSc, Dip COT, FRSA

3. What is the 360 Standard Framework? A diagnostic assessment framework that shows care organisations how to establish and maintain person-centred cultures from the perspective of the cared for person, their families and carers An outcomes based practice development framework for achieving continuous improvement

4. Defining and Transforming the Care Experience

5. Assessment Framework – Residents' Measures • Receiving person-centred care • Opportunities for social/occupational activity • Influencing meals and drink • Meeting spiritual needs • Resolving concerns and complaints

6. Staff and Relatives’ Measures Relative measures Staff measures 1. Finding the work fulfilling 1. Welcoming ambience of the home 2. Having time to deliver good care 2. Communicating with staff and managers 3. Equipped to do the job 3. Being fully informed 4. Feeling valued as a staff member 4. Seeking to resolve concerns and complaints 5. Contributing to the care of the family member and the community of the home

7. Managers making it happen • Enabling /facilitative management style - clear channels of communication, positive relationship building, collaboration with other professionals and agencies • Pivotal leadership role in change management • Operational management • Practice development • Quality improvement • Business planning

8. Example : Resident Standard 3:1The resident has a choice of culturally acceptable food and drink that meet his/her dietary requirements Structure Process Outcome

10. Characteristics of the 360 Standard Framework • Delivers continuous quality improvement and demonstrates measurable change • Involves the cared-for person, relatives and staff • A Standard of excellence in relationship activated care for person-centred outcomes • Underpins all other service and practice standards • Incorporates evidence from research and empirical studies • Diagnostic with measurable outcomes

11. 1 - Client Decision Routes : The 10 Step Cycle 2 - Preparing and Planning 3 - Data Collection 4 - Data Analysis 5 - Feedback

12. Why is the 360 Standard Framework important to the NHS? • Good patient outcomes - Create a patient-centred NHS • Quality Improvement - Focus on improving their experience and their health outcomes • Value added benefits: effectiveness and efficiency • Leadership and management enabling tools - Empower professionals – end top-down control

13. Work-based Learning Key topic areas For delivering quality compassionate care • Understanding ageism in society • Understanding chronic conditions and their effects on the person –identity, significance, continuity, purposefulness, belonging and being understood • Building positive relationships –the triangle • Specialist communication skills • Understanding transition, loss and adapting • Understanding and preventing institutionalisation • Inter professional co-operation and collaboration - INTEGRATION

14. The Elizabeth project Justine Cawley Independent Consultant Associate at Bucks New University

15. Background • Developing a career pathway for people working with older people • From apprenticeship to post-registration nursing • Mid Staffordshire and other incidents of unacceptable care • Over the years older people have been moved out of hospital into residential care and as a result the health input has diminished

16. The Structure of the pathway • Post apprenticeship course • Elizabeth practitioner – Foundation degree • Elizabeth Nurse – Post qualifying degree

17. Why is this needed? • Increase in complexity of care – dementia, long term conditions • Need to have higher standards in health and social care • No dedicated career pathway for older people • Need to give the sector and their staff more status and recognition

18. Issues in the sector • Societal • Organisational • Operational • Practice- knowledge, skills, behaviours • Lack of funding for socio-health nurse development • No career pathway to higher education qualification in care of older people

19. Why training is essential: 65% of people in hospital are over 65. 80% of people in care homes have dementia or cognitive impairment (Alzheimer’s Society, 2013) Residents of care homes have complex healthcare needs, reflecting multiple long-term conditions, significant disability and frailty.(BGS, 2011) All health and social care providers need training in the complex management of people with multiple long-term conditions (BGS, 2013) People living in a care home and suffering from dementia are more likely to go to hospital with avoidable conditions such as urinary infections.(CQC, 2012- Care Update) The social care model is central but insufficient to meet residents’ health needs.(BGS, 2011)

20. Impact • More young people coming into the Sector • A more educated and adaptable workforce • A career pathway that young people want to enter • Work based learning and an alternative to University • Less turnover of staff • More profitable sector • Happier staff • More career opportunities • More customer satisfaction

21. Enabling the Willis and Francis Report Recommendations • The culture of healthcare provider organisations is routinely assessed • More family and user involvement in education • Streamline communication skills to provide dignity for people with dementia, mental health and chronic disease • Flexible education programmes for nurses and carers, people and their families • Work-based learning • New status of nurse for older people (Francis Report)

22. Integration • Integration is essential if we are going to give older people the care they deserve. • Partnership is essential – Partnership which are equal • Social Care sector is very fragmented. • NHS have the money and Commissioners have the power • Social care have less qualified staff

23. Social Care Sector • Predominantly SMEs who are fighting to survive • High turnover of staff • Lack of awareness of partnership – lose staff to NHS • High drop-out rate with young people

24. Partnership and integration • Partnerships are sustainable • They are equal • They have good foundations and have identified core common goals • They have common training routes

25. Building Bridges Construction began in 1831 but the project was beset by political and financial difficulties. By 1843, with only the towers completed, the project was abandoned. The bridge was finally completed and opened in 1864.

26. Underpin foundations of the weaker side or use strengthening members across it Victorians great engineers and innovators We have to be a different sort of innovator by being builders of social structures that work and provide excellent care. Bridges and innovation

27. ‘ Thank you Rosemary Hurtley Rosemary@360fwd.com 01483 275555 Justine Cawley jca@consultant.com 07767 442136