Workshop 2, 1st March

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.

Defining Improvement

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.

By: Jon Rawlinson

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.

 

Survey Analysis

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.

Group Activity

Delegates then divided into four groups and were asked to complete an improvement plan along the following four themes:

  1. Trust between inspectors and services
  2. Involving staff in inspection and improvement
  3. Signposting to good practice
  4. 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)?
  • Timings/duration
  • 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.

Workshop 1, 1st February 2017

Introduction

My name is Rebecca Dodd and I work with Iriss as an associate researcher. I have worked on a number of public and third sector projects involving education, libraries, health and wellbeing, youth issues and the arts.   My role in the Care Inspectorate Project involves analysing a survey of Care Inspectorate employees and observing workshops held between Iriss and the Care Inspectorate and sharing my observations and conclusions.

The Workshop

On 1st February 2017 I observed a workshop held at the Scottish Youth Theatre, between IRISS and a group of care professionals, 4 of whom worked for the Care Inspectorate (1 Project lead, 3 Inspectors) and 11 Managers and Team Leaders who worked across 6 different Scottish Care Homes, the majority of which focused on residential elderly care. The purpose of this workshop was to encourage dialogue between managerial staff and inspectors with the aim of establishing effective relationships between care homes and inspectors and continually improving services.

The first part of the workshop involved asking the participants to establish ground rules. Participants agreed that all discussions were to remain confidential. Everyone agreed that it was best to frame feedback from a positive perspective while remaining honest, and acknowledged the need to agree to disagree. Speaking one at a time and reflection was also an essential ground rule. All participants agreed that all members of the group needed to acknowledge each other’s mutual investment in care. I was pleased to see inspectors and frontline care professionals so eager to establish effective modes of communication.

Participants were split into four groups and asked to respond to the following questions:

Question 1: What worked when it came to improvement? (include actions from both inspectors and services)

Common themes included trust between inspectors and management teams, and involving all staff in care homes in the self-evaluation and inspection processes. Signposting good practice was universally regarded as a positive step toward improvement, as well as having clear direction; it was agreed that communicating specific requirements for improvement often resulted in quick wins, a sense of achievement and improved morale. All participants agreed that improvement plans needed to be realistic in terms of time and finances.

Question 2: What didn’t work? Why?

Challenges included poor attitude and power balance between managers and inspectors, as well as a lack of consistency with inspectors. Failing to recognise degrees of improvement, together with excessive focus on grades also were considered ineffective ways of creating improvement. Service providers agreed that inspectors need to improve their appreciation for changes to everyday services such as new, challenging residents or high staff turnover. I was pleased to see that inspectors seemed receptive to this suggestion. Further discussion led to both sides agreeing that external pressures from the Care Commission, Care Home Owners and Local Authorities were not helpful in sustaining improvement.

Question 3: Rank what worked in order of effectiveness

Positive engagement and cooperation both within care facilities at all levels and with inspectors was consistently ranked as the most effective means of ensuring improvement. Clarity of expectations and clear directions for improvement were also top priorities. Recognition of resources and limitations, together with realistic planning for improvement rated the third highest. Focus on success was also a focal point.

Conclusion

Participants were invited to give feedback on the workshop, and one participant suggested the use of My Home Life cards. These cards contain a picture, and participants selected which card best represented their impression of the workshop. For example, one person selected a picture of a tree and said that they considered the workshop to represent growth; another selected a compass and said that it represented her service going in the right direction. I had never heard of Home Life Cards prior to the workshop, and would recommend their use in any group as a fun and effective icebreaker to get everyone talking. Overall, this workshop was highly successful and sure to open more positive dialogue at our next workshop in March.

– Rebecca Dodd

What are the characteristics of an inspection process that leads to improvement?

Iriss is currently collaborating in partnership with the Care Inspectorate to undertake a short inquiry project focusing on improvement. Our inquiry will focus on understanding the key characteristics of inspection processes that lead to improvement. This project has been designed to be short term and agile to help us respond to the experience and ideas of inspectors and providers.

Over the next three months, we will gather data and generate ideas in three ways:

  1. Analysing existing inspection and improvement intelligence.
  2. Internal scoping exercises including a staff survey.
  3. Qualitative in-depth workshops with inspectors and providers.

In February and March, we will host two workshops with providers and inspectors to begin to understand and unpick the complexity of improvement. We will share the learning from these workshops in this blog and in a final written output.

By blending our own expertise in improvement with this engagement, we will learn about the mechanics and the magic of improvement and how to implement it across the sector.

A note from The Care Inspectorate:

“As part of the Care Inspectorates review of methodology, we have sought to develop approaches to scrutiny which support improvement.

We have a specific duty under section 44 of the Public Service Reform (Scotland) Act 2010 to further improvement in the quality of social care services, and we do this in a variety of ways through our inspections.

We need to be able to identify what aspects of care need to improve, and show how this can help evidence improved outcomes for people who use care services and their carers.

Partnership working is an imperative priority for the Care Inspectorate, and we are committed to collaboration and joint working. We embrace the opportunity to work in the most efficient and effective way possible, utilising knowledge, skill and expertise within and outwith the Care Inspectorate to bring about delivery of high quality services.

We are delighted to have the opportunity to undertake this piece of work jointly with Iriss and care service staff.

Our vision is that the people across Scotland receive high quality care that meets their need, rights and choices.”

– Linda Kemp, Project Lead: Methodologies

Iriss and the Care Inspectorate: Partners in Innovation

In January 2015, Iriss launched a joint project with the Care Inspectorate to explore strategic innovation, resilience and risk in the context of the Care Inspectorate’s mandate of scrutiny and improvement.

Our work so far

To date, this project has comprised of an internal staff survey with 108 responses, two workshops with 18 staff members, and has sought to engage the wider Care Inspectorate workforce through the findings. Following a staff survey which intended to identify attitudes towards risk and innovation, Iriss delivered two workshops using the scenario planning tool ‘Imagining the Future’. Delegates were immersed in four scenarios set in 2025 to prompt the group to explore, challenge and shape the future trajectory of risk and innovation at the Care Inspectorate. Collectively, the group identified key action areas for development as

  • Leadership
  • Culture
  • Communication (both within and outwith the organisation)
  • Infrastructure/systems

These sessions encouraged workshop participants to embrace action within their own role and to use their influence to support others do the same. The evaluation of the workshops highlighted that staff felt the sessions offered an opportunity to think differently about the strategic direction of the Care Inspectorate as well as explore their individual roles.

“These sessions have renewed my enthusiasm for my role. I hope that senior management share in this. It could be possible for the organisation to change its culture of working to embrace innovation and risk. We need a shift in focus to support a whole new way of working inspired by this project.”

There was also a sense that the project should not stop there. The project group recognised their role in developing a culture of innovation. They also openly sought wider, systemic leadership on the issues they identified. Iriss wrote an internal report and shared recommendations from the group with the Executive Team, who welcomed the enthusiasm and suggestions that emerged from these workshops and recommended that we continue this work.

Iriss took the opportunity to present the work to 600 Care Inspectorate staff members at their staff conference in September 2015. Iriss asked delegates to identify their own priorities in innovation. Although suggestions were varied, they could be categorised into the following themes:

  • supporting and participating in innovation with providers
  • further engaging with providers and the sector
  • using more research and policy in work.

Staff also identified the importance of:

  • protected time for personal development and learning
  • sharing good practice with colleagues
  • the need for permission and support from senior management.

Next Steps

Following a successful and exciting first phase of work together, the group devised a piece of work which led to a wider corporate consultation on the resources allocated to producing inspection reports against the added value they provide in terms of safeguarding, improvement or public assurance. The Care Inspectorate has now successfully incorporated this workstream into their review of methodology.

Iriss and the Care Inspectorate are now working together to design, facilitate and deliver a phase 2 collaborative project for 2016-17, which we hope will support strategic re-imagining of risk management to support innovation within the sector.

We are now working with a smaller cohort, which includes some members from the original workshops to explore and discover opportunities to apply our learning in practice. This has culminated in various ideas being explored.

The work of the group going forward will focus again on the strategic appetite for risk and innovation and concentrate on progressing this across different service types to support the organisations’ direction of travel.

We hope to continue to provide a space for ideas and innovation, and to come together to work with the Care Inspectorate, providers and people accessing support, to embrace innovation and risk.

To find out more or to get involved with this work please contact
rhiann.mclean@iriss.org.uk or rikke.iversholt@iriss.org.uk

Feedback from workshops 2015

Following our first workshop, we asked a couple of participants to blog about their experience and their hopes for the future.

For me the IRISS day was a way to start thinking about a future world which will be greatly different due to social/economic/demographic changes which are a reality of our time. Although no one knows exactly how the future will be shaped it will undoubtedly be different. So IRISS was setting the scene to consider how regulation will adapt to this changing world and what tensions will be thrown up. I feel that the second IRISS day will get into more detail about what the changes may actually mean for us, for now I think it has just been food for thought:: in the words of Karen Carpenter; “We’ve only just begun.”

My expectation of this workshop was to consider how future thinking about risk, innovation and improvement could feature in how our methodology develops. While I enjoyed the discussions on the day and look forward to the second workshop, the way I undertake my day to day role has not significantly changed. I consider myself to be an innovative manager with a strong focus on improvement. I’m hoping the project has a longer term structural impact on how my organisation develops.

 

What is Imagining the Future?

Imagining the Future is an ‘enhanced scenario planning’ resource that explores ideas of care, support and social services, in Scotland, in 2025.

The future can be anticipated, explored and changed and the scenarios presented by Imagining the Future can help us prepare. They provoke and challenge our assumptions and help us reappraise our current strategic plans around, for example, health and social care integration, the role of professionals and leadership practices.

We are using this tool to help guide our future thinking in order to explore, challenge and shape risk and innovation in the Care Inspectorate.

About this work

IRISS is working with the Care Inspectorate to explore risk, innovation and improvement across Scotland. We are interested in understanding how the inspection and improvement process can facilitate innovation. We also want to understand the role of the Care Inspectorate in risk enablement across services.

Background

It is continually recognised that the current economic climate requires new ideas and creativity to maintain and achieve quality support for people using social services. Innovation and creativity require experimentation if we are not allowed the room to make mistakes, creativity and originality become scarcer (IRISS, 2010). The role of the Care Inspectorate is scrutiny and improvement for care services across Scotland and is in the position to support this valuable creativity throughout the sector. The approach of regulators such as the Care Inspectorate will set the scene for social services in Scotland, as audit and regulatory regimes that serve to create a ‘blame culture’ may undermine desire and willingness to test and implement innovations (Brown, 2010; Munro, 2004).

Through this short project, we want to understand more about the role of the Care Inspectorate (CI) in stimulating innovation within the sector and want to support inspectors themselves to develop ways where, in their role, they can create the space for experimentation and creativity. We hope that this work will build upon existing developments aimed to move away from tick-boxed risk assessment towards a system that is based on outcomes and positive risk taking.

Activities

In early 2015, we launched a survey for all staff within the Care Inspectorate to understand their views on risk, innovation and improvement. We followed up this survey with two interactive workshops with staff from across the organisation using “Imagining the Future” to frame our thinking about the future of Scottish Social Services. These future scenarios are a useful and provocative guide for conversations around the associated opportunities and barriers we face together, as well as our respective roles in supporting change to happen positively.

Outcomes

  • The group is able to explore issues or risk and innovation
  • The group can determine opportunities and challenges in supporting innovation and improvement within the sector
  • Relationships are improved between people working in all areas of inspection
  • There is a better understanding of the relationship between risk/innovation/improvement and inspection

If you have any questions, comments or suggestions about this projectplease contact Rhiann McLean from IRISS (rhiann.mclean@iriss.org.uk)