Power of suggestion

A former residential care home re-invented three years ago as a groundbreaking rehabilitation unit staffed by health and social services seemed to be at the cutting edge of best practice in joint working. But it seemed to lose its way.

The unit was staffed by local authority residential care workers with physiotherapists and occupational therapists from the acute hospital, and community nurses from the district nurse service. However, rather than being a model of integration, the three groups of staff were working under three different management arrangements and separate sets of policies and procedures.

“They believed they were working as a multi-disciplinary team but there were several professional tensions and boundaries that were inhibiting care and increasing, unacceptably, the length of stay. This meant that there was a backlog of hospital patients awaiting placement,” says nurse consultant, Sue Bailey who, as an interim measure, replaced the departing manager to see how the staff could work better together to improve and quicken up the outcomes for patients (the unit’s preferred term). She also had the brief to develop the unit into an intermediate care service which could provide treatment as well as rehabilitation.

Staff told Bailey that patients liked it at the unit and never wanted to leave – and believed this was an indicator of good care practice, forgetting that their job was to rehabilitate people back into independent living. “With people being here for months, staff didn’t realise that they had institutionalised them,” says Bailey.

Coming from outside the organisations involved meant that she brought little baggage to the job. However, her appointment rustled up some scepticism, not least over her job title. “They were unsure what this was all about. However, once I stuck on my nurse’s uniform and pitched in helping with patients then I got some street cred. That’s important when working with professional groups – they need to understand that you know what the work is and what patients need. And also I didn’t come in with a ‘We need to do this and we need to do that’ sort of attitude. It was more about me asking staff what they would do if they were given a free hand,” she says.

Bailey, who had spent time working in management consultancy, discovered that the most effective way forward was to listen rather than talk: “When I started listening to the professional groups rather than talking to them they did acknowledge there were problems but these were to be expected and they were living with them.”

Her work was made easier by a projected £1m cash injection to upgrade the building. Says Bailey: “This was extremely lucky and proved to be an enormously effective tool because I was able to ask staff what sort of unit they wanted to work in: what do you need? What kind of floor do you want? What can’t you do in this building? And from that we advised the architects. The staff became so involved that the professional boundaries just fell away. I know it sounds a bit trite and it’s hard to quantify, but staff really did start valuing each other.”

For example, with just the one large lounge, all mobility and therapy work with patients took place in the day room or in corridors in front of everybody else. As staff wanted a specific area with some privacy they designed a therapy suite for one-to-one and small group work in the new building. “That their suggestions and ideas were translated into the architect’s plans created an enormous dynamism among the group,” adds Bailey.

With a refurbished building and re-motivated staff, lengths of stay at the unit have come down “enormously”. The introduction of targeted care has also helped. Previously staff thought that everything had to be right before someone could leave – “it was as if the residents almost had to be able to dance the Can-Can before they could go home,” smiles Bailey – whereas they now see themselves as having to carry out specific tasks on each patient.

“We haven’t licked it yet,” Bailey concludes, “but we have come a long way down the road. There’s a lot more openness and we’re beginning to do some cross-skilling and joint training. Staff were trained differently so we even moved and handled patients differently. We’re teaching care staff to take temperatures and blood pressure readings – things that would have seen as being quite ‘nursey’. But they have found that empowering and enjoyable.”

Curriculum Vitae

Name: Sue Bailey.

Job : Nurse consultant

Qualifications: RGN, district nurse, BSc Social Sciences, MSc nursing.

Last job: General manager, independent residential sector.

First job: Nursing auxiliary

Top tips

• Simply listen and find out from the groups how they perceived the problems in the unit.
• Listen to, and act on, feedback. It’s like the Asda advertisements – “You told us this and we did that”. Go back to people and say “You suggested this – well, we’ve done it”. 
• Facilitate meetings – do not chair or take them over.

Rubbish tips

• You’ve got a management vacancy – fill it with like-for-like.
• As an interim manager you can afford to upset people to get the job done – you’re not sticking around so don’t worry about people issues.
• Consult staff, let them feel involved, tick that box and then do what you originally intended.