On the 1st of March, 2017, Iriss reconvened with the same group of care professionals from our last meeting in February. Everyone agreed that the last meeting had been productive and that all of the ground rules that had been set at the first meeting should be kept in place.
The first part of the workshop comprised of the challenging task of defining improvement.
At the end of the last meeting, participants were given the following activity:
We would like you to go back to your services and work with a group of people (which might comprise of people who use your service, staff, families, other management) to develop your own definition of improvement.
1) What would improvement look like to you?
2) What process would you follow to achieve it?
3) How would you know it was a success?
Approaches to the exercise varied. One person or group formed the questions into survey which they distributed. There were 11 responses, all from users of care services. The responses were limited; most were only a few words, with many omitting some questions. The first question tended to get responses to the effect of “making things better”. The responses to the second question were broadly themed around getting effective people or organisations to make the improvement happen. The answers to the final question mainly consisted of improvements being seen.
Another group reflected on an initiative in their own service. They agreed that improvement meant having a sense of purpose, and a system of monitoring progress, while creating a happy and safe home environment for their residents. With regard to processes, the group agreed that connecting with residents, internal staff and looking at other services would achieve improvement. Success would be measured by contented residents.
After a short discussion of this activity, participants were then asked to work in groups to come to a consensus of how to define improvement, followed by a group discussion to see if a single definition of improvement could be agreed. Everyone agreed that improvement was not just about making things better, but that improvement needed to be defined by all stakeholders working together for a common purpose that results in positive outcomes and interactions that meet everyone’s expectations. Everyone agreed that improvement needed to be documented in a balanced and honest fashion for future reference.
Our final agreed definition is that:
Making improvements is about working together to achieve a shared vision that results in positive interactions and outcomes for people.
After these activities I gave a short talk on a survey I analysed of 67 people who worked in various roles in the Care Inspectorate. The findings were consistent with the findings of the last meeting. Survey respondents universally agreed that clear feedback with specific directions was the best way to encourage improvement, as well as maintaining positive, constructive and honest relationships between care homes, inspectors and external and internal stakeholders.
Delegates then divided into four groups and were asked to complete an improvement plan along the following four themes:
- Trust between inspectors and services
- Involving staff in inspection and improvement
- Signposting to good practice
- Understanding limitations (financial, bureaucracy, partners, etc)
This activity was guided by a worksheet that gave the following questions based on the Plan, Do Study, Act (PDSA) method of improvement science:
- What is the outcome you are seeking?
- What needs to happen?
- How should it be done?
- Who needs to be involved (roles)?
- How will you know it has worked?
Groups engaged very effectively on this activity, with a variety of themes emerging, including the need for all staff to be involved, and the need for time-limited milestones to be achieved. The findings from this activity will be further explored and used to create a guide for improvement for the Care Inspectorate.
Conclusion and Evaluation
At the end of the event, we invited participants to write their evaluation on post-its. Delegates enjoyed the opportunity to collaborate with people from outside their own services and the group discussions. In terms of what could have been better, delegates said that they would have liked more time to discuss themes and recap what they had learned. Several wanted future workshops, with many expressing an interest in a continued relationship with Iriss. Overall, this series of events was a positive way for care professionals and care inspectors to interact and share experiences and practice.