Systems and Culture Ideas - 6 Core Strategies by Iris Care Group

2024-11-27 16:11:11 UTC

Educating on what quality data looks like

2024-11-27 16:12:44 UTC

Engagement of the PWS

2024-11-27 16:12:45 UTC

Build specific lived experience roles into workforce planning

How is the person who was restrained or restricted debriefed? How do we collect their thoughts and feelings

2024-11-27 16:13:16 UTC

Measuring the impact on staff morale

2024-11-27 16:13:31 UTC

How do we collect data

2024-11-27 16:13:59 UTC

2024-11-27 16:14:08 UTC

Staff trained in effective de-briefing techniques and this being consistent across a company or care

Continuing to distinguish the need for leadership beyond administration into practice leadership and beyond, developing values led teams

2024-11-27 16:14:26 UTC

Leadership not just management

2024-11-27 16:14:35 UTC

We have developed and are piloting a few resources in empathy mapping, which was helpful with sharing experiences between staff and people we support,but is also proven helpful between staff roles and management. It opens up dialogue and understanding and seems to build some trust between those in different roles.

2024-11-27 16:14:43 UTC

Involving people with liver experience Should start from school aged children upwards, they are often traumatised from their experience at school, huge wait times that then filters into adulthood.

2024-11-27 16:14:43 UTC

Enable individuals to produce videos that can be used in training

2024-11-27 16:14:45 UTC

2024-11-27 16:14:59 UTC

Resisting 'us & them' mindsets - shrinking the perceived gap between Staff and PWS

Need additional and specific training for the management team. Culture change has to stem from the top down. It's not as effective from external professionals.

2024-11-27 16:14:59 UTC

What will you do with the data? If someone has increased restraints what then? Is there a process for multi- agency/disciplinary review

2024-11-27 16:14:59 UTC

Better training and pay for HCAs/support workers

2024-11-27 16:15:05 UTC

2024-11-27 16:15:11 UTC

Using total communication to carry out debrief with people we support

Investment, buy in, motivated

2024-11-27 16:15:13 UTC

As discussed, purposeful analysis of data. Analysing with intent not just for reporting

2024-11-27 16:15:45 UTC

Providing pathways for professional development for those whom embody the culture change. E.g., practice leadership, PBS Practitioners, Quality roles and companies pay for accredited qualifications.

2024-11-27 16:16:02 UTC

Involving and recognising the importance of people’s wider support networks- family and friends

2024-11-27 16:16:17 UTC

2024-11-27 16:16:23 UTC

Focusing on Primary interventions - quality of life/getting to know the people we support

2024-11-27 16:16:31 UTC

Use of strategies and tools and effectiveness - removing strategies that don't work rather than them remaining in care plans etc

Confidence in Dynamic risk assessment- feeling able to allow people to move freely in their shared spaces whilst also ensuring safeguarding when there are user to user risks (goes hand in hand with no blame culture)

2024-11-27 16:16:37 UTC

2024-11-27 16:16:47 UTC

Follow up with supportive measures for all parties involved.

Understanding these strategies, how to implement them and the desired outcomes

2024-11-27 16:16:49 UTC

2024-11-27 16:17:02 UTC

Simplify these. Staff get overwhelmed by prevention strategies. I have found that breaking it down as the person led approach and people like to buy into it

There are lots of tools out there, starting use of a Trauma tool soon

2024-11-27 16:17:13 UTC

Know our people!

2024-11-27 16:17:28 UTC

Spend time getting to know people we support. Good communication strategies.

Emphasis on relational practise

2024-11-27 16:17:29 UTC

Allowing staff time to get to know people- valuing the importance of this

Using people with lived experience to shape our training and awareness

2024-11-27 16:17:35 UTC

2024-11-27 16:17:48 UTC

Practice leadership from all levels not just qualified or management.

2024-11-27 16:18:00 UTC

Many providers and services need to understand the difference between a learning debrief (learning from the events to hopefully reduce likelihood of another) and a supportive debrief for welfare of the supported person and staff member.

Removing barriers to involving people with lived experience

2024-11-27 16:18:54 UTC

Greater understanding in education, health and social care etc to support greater understanding of people with LD’s, neurodiversity etc.

Reasonable adjustments should always be supported!

Overhauling the punitive systems we have in place, education, mental health units, prisons!

Understading people's lived experience and having compassion and empathy for them by having really effective "pen profile" type docs

2024-11-27 16:19:01 UTC

Gathering data about all restrictive practices?

2024-11-27 16:19:49 UTC

Has anyone had success gathering data around psychological and cultural restraint?

Parent/Carers being involved as lived experience practitioners

2024-11-27 16:20:01 UTC

Positive monitoring

2024-11-27 16:20:58 UTC

Prioritising observing staff practice and giving positive constructive feedback based on people’s support plans etc

2024-11-27 16:21:32 UTC

Debriefs when there hasn't been a need for physical intervention is an amazing idea, but currently our employer does not follow their own mandate for debriefs that did involve intervention. Staffing shortages, disinterest amongst staff, etc.

We are a charity and engage the people we support in our volunteering, inductions, employment and advocacy. We get everyone involved where we can, across our workforce teams in local service events and organisational projects

2024-11-27 16:21:38 UTC

Financial investment to develop and deliver training to all staff members throughout the organisation to ensure everyone knows their role and responsibilities with implementing the initiative.

2024-11-27 16:22:12 UTC

Practice leadership at all levels? Role model, open discussion? Visibility

2024-11-28 11:59:32 UTC

Knowing what data is? What the data sets are, and how to share this in a way that has “meaning” to all.

2024-11-28 12:00:15 UTC

2024-11-28 12:00:45 UTC

Important to capture the patients narrative of the incident to enable us to be truly trauma informed. We discuss openly that patients experience perceptual disturbances and delusions etc, why should that be any different around post incident support. We can’t fully support a patient unless we know their beliefs and understanding of a situation

Clear honest communication

2024-11-28 12:01:22 UTC

We waffle because of fear of the reaction this creates openness to interpretation which clouds message about what needs to be done

Development in all forms, discussion, training, qualifications, etc. Developing a workforce who understands what the “work” involves?

2024-11-28 12:01:24 UTC

2024-11-28 12:01:31 UTC

Leadership is about taking the same journey with people rather than simply instructing.

2024-11-28 12:01:50 UTC

Examples of What does good data look like

PEDW

2024-11-28 12:02:04 UTC

How do you pronounce “PEDW” - I think “Peddoo”

Asking the “Why” questions, why do we, why don’t we, why did we, why didn’t we? If we don’t ask Why questions then how can we get Why answers?

2024-11-28 12:02:18 UTC

Don’t shy away from peers on the ward supporting each other during and post incident. Sometimes there is too much emphasis on confidentiality/privacy but there is so much power in peer support within inpatient services (within reason)

2024-11-28 12:02:29 UTC

This is not utilized enough as a positive step, too many people still see this as punitive.

2024-11-28 12:02:35 UTC

Narratives

2024-11-28 12:02:39 UTC

I work in a trust where we often use the argument by if we collect better than others as a way of distancing from what we need to do about it

Finance business argument

2024-11-28 12:02:42 UTC

Work out the costs of getting it right Vs the costs of getting in wrong. Include staff support, environment changes claims for inquiries, time spent dealing with complaints loss of business etc

International Staff Teams

2024-11-28 12:03:21 UTC

Understand that HSC recruits worldwide from diverse cultures where values might be very different.

Avoid assumptions that values will be shared

Data

2024-11-28 12:03:36 UTC

Just wondering how detailed the disagregated data is- to look for any trends of use of restraint on certain groups of people - or in certain locations within centres?

Asking “Why, Who, Where, When, What………!” Seeing “Me”!

2024-11-28 12:03:36 UTC

Do you collect data on changes to staff retention and sickness?

2024-11-28 12:03:44 UTC

2024-11-28 12:03:54 UTC

Consistent approach from top to bottom so that everyone has a shared understanding of what is expected

Vital. When doing this I simply ask what the person needs from me to facilitate what they are going to do.

2024-11-28 12:03:57 UTC

Timing/ content and style

2024-11-28 12:04:03 UTC

We don’t train people when they need it, and we don’t train in an approachable way for people who often have lower literacy generally

Persons per month please

2024-11-28 12:04:03 UTC

Have you considered using “persons restrained per month” as a metric? It is hard to fudge, patients can remember more than counts, and it correlates on log log scales with detained persons and size of provider

See PROD-ALERT paper

Effective, open and honest leadership creates an effective, open and honest culture- lead by example

2024-11-28 12:04:20 UTC

2024-11-28 12:04:21 UTC

Genuine support for people moving from support work to leadership roles not just assuming that a good support worker makes a good leader.

I like the “5” sense approach, what did the event bring to our senses? Does it help us open up an event to support learning.

2024-11-28 12:04:31 UTC

2024-11-28 12:04:48 UTC

Change the narrative that this is a “tick box” exercise, rather than a supportive measure that benefits all involved based on evidence.

Speech and language therapy

2024-11-28 12:05:00 UTC

More access to communication support to enable meaningful engagement and equalise power

Is the distribution of events actually approximately normal?

2024-11-28 12:05:04 UTC

Process control charts often assume a normal distribution. I reckon it’s a Poisson curve. What do you think? Have you visualised it?

A great part on the presentation was we need to train to compliance. Too many people participate but dont then put into action.

2024-11-28 12:05:07 UTC

Reflective debrief - as a team for a collective learning !?

2024-11-28 12:05:09 UTC

2024-11-28 12:05:25 UTC

Engagement and reflective practice. Ongoing review of development and the leadership approaches that take place.

Learn how to adapt the learning styles as per the team you are managing. One size doesn’t fit all. But message needs to be consistent.

Valuing BI teams in culture change

2024-11-28 12:05:40 UTC

How can we value BI teams creativity in qualitative collections on patient experience? Transparency is a core commitment in the Culture Standards, how can we make the data more accessible? How can we measure positive culture and bring BI teams into the positive outcomes as a result?

2024-11-28 12:06:03 UTC

A clear understanding on the leadership structure. So everyone has an awareness of who is involved. Offer opportunity for healthy decisions to take place which will influence future learning.

2024-11-28 12:06:24 UTC

Recognition that this is sometimes hard and requires careful support for everyone working together

Systems of support

2024-11-28 12:06:43 UTC

Individuals risk retraumatisation, when reliving experiences as part of their roles. Support needs to be in place to ensure involvement is mutually beneficial

2024-11-28 12:06:44 UTC

Use Artificial Intelligence (A1) to collect contextual data to be more accurate and detailed

Data collected needs to be useful. Too much of what is collected is not useful for purposes of restraint reduction and/or improving quality of life.

2024-11-28 12:06:48 UTC

2024-11-28 12:07:04 UTC

Consider what ways people can be involved, supporting various communication methods and tools

Straw project

2024-11-28 12:07:54 UTC

Tizzard centre have developed this. It might be good training

2024-11-28 12:07:58 UTC

Continuous learning from the data. Qualitative data is just as important so we can get a deeper understanding of what is happening on the “shop floor”

There is more that happens in an incident rather than just the restraint.

Timing

2024-11-28 12:07:59 UTC

do we debrief when people need or are ready to

Is relational working a “tool or strategy?”

2024-11-28 12:08:06 UTC

Really like the structure of patient debrief (at a time that is suited and appropriate for them), staff debrief and a learning debrief. Having the learning debrief at a later date takes the emotion out of it so would provide a more reflective and supportive learning outcome

2024-11-28 12:08:32 UTC

Can patients see their own data on a simple graph?

2024-11-28 12:08:42 UTC

We do this it’s useful.

Families

2024-11-28 12:10:53 UTC

You mentioned you would be advocating fire you family member. . But families are often terrified of retribution or being excluded from their person's life. What can be done to help with that?

2024-11-28 12:10:55 UTC

Managers having training on how to support this on a day to day basis within their services and having their buy in is vital, they need to be practice leaders

2024-11-28 12:11:48 UTC

How do we capture context within data sets to ensure data shared is fully understood by the system.

Eg a reduction in restrictive interventions may not be a positive as may indicate reduction in close proximity working with someone who is extremely anxious around others ie someone in LTS or isolated in community

Or how do we capture context when a person requests or seeks sensory input from a hold or when a hold is used in a proactive way rather than a response to distressed behaviour.

2024-11-28 12:12:39 UTC

Ensure staff have this as part of their introduction so they understand from the off that this is a fundamental part of their role. As opposed to a tick box due to incidents as and when they arise.

Understanding

2024-11-28 12:13:27 UTC

What are the reasons that RI happen? Who does it most happen to? Do you collect data on psychological and environmental restraints?

How do we measure impact of training particularly around values based / relational learning

2024-11-28 12:13:48 UTC

2024-11-28 12:14:29 UTC

Training on how to record good quality data and having clear support to record for staff - so often we get inconsistent levels reporting because staff say they have no time to complete recordings but the importance of data can be missed by them

Social care

2024-11-28 12:20:26 UTC

Do we think that if social care read more available (for care act outcomes like maintaining a home & relationships, work and social activities) not just for people who can't wash and dress themselves that fewer people would be annoyed to hospital?

Removing sources of conflict

2024-11-28 12:21:19 UTC

Have you done anything to enable access to outdoor space, removing blanket rules etc?