Recording Contract

Recording is an integral part of social care work but is a task
that is not met with undiluted enthusiasm. If anything it can be
resented (“I’m not a typist”), as seemingly increasing paperwork
takes more time away from “real” work with service users. Neither
are staff trained to record effectively – often they are just
expected to know how to do it.

Nonetheless, workers do understand its importance. Recording has
several purposes: it provides evidence of an organisation’s
involvement with a service user and the standard of service; helps
with continuity when workers are unavailable or change; provides
evidence for planning, and allocating resources; and supports
supervision and professional development.

However, workers can be sceptical about new systems or audits that
are imposed from outside or above. So, the refreshingly simple
solution adopted by community care services in Reading, Berkshire,
was to have workers do it themselves.

Team manager Melanie Birtchnell says: “Our multi-disciplinary
practice reference group (PRG) was set up as part of our quality
improvement agenda. It includes occupational therapists, social
workers and case co-ordinators and it has been involved in projects
such as developing assessment and care planning tools.”

With support from two external consultants – Andy Foster and
Jacquie Henley – the PRG turned to case file recording. Birtchnell
says: “We knew our files needed work but we didn’t have the tools
to see where we were or to set benchmarks. Practitioners do spend
a
lot of energy doing paperwork so it’s better to spend that energy
doing it right.”

Foster says: “We managed the audit but it was carried out by
members of the PRG because we felt there would be greater ownership
of the process. The comprehensive audit tool, which has 120 areas
of enquiry, was agreed on the fourth draft, which shows it was a
collaborative process.”

After the audit of 50 case files, the PRG, team managers and
assistant team managers agreed an action plan from the audit
report’s recommendations. Case co-ordinator Anita Hawthorne says:
“Staff weren’t so anxious about changes because they knew that
their colleagues had been involved.”

Checking colleagues’ files was a worry for some. Occupational
therapist David Coast says: “I was thinking, ‘Oh no, I’m going to
be poking around my mate’s file’. This seemed like bad news. But we
were reassured and we were able to reassure our colleagues that
there would be no repercussions. If there was a rubbish file you
wouldn’t get hauled up in front of the management”.

Hawthorne adds: “It was also successful because our colleagues
really supported us in allowing us to do the audit.”

Anxieties apart, the audit itself proved an eye-opener. Senior
practitioner, occupational health, Melanie Adcock says: “It was
amazing how much duplication there was, and the amount of
paper-chasing needed to get authorisation signatures from
management – which reduced the time people spent with
clients.”

Coast adds: “I knew we needed to improve but I didn’t know how much
until we had to answer all the questions from the audit
tool.”
The audit found that a lack of time often prevented good work being
recorded which, says Birtchnell, “didn’t do the
worker justice”.

However, Foster adds: “In reality if it’s not evidenced on file it
can only be assumed that it hasn’t taken place.” There were also
difficulties in pulling out information from many files. “It was
usually there and often in the contact sheets – but there could be
about 50 of them,” says Coast.

The process, says Hawthorne, also helped staff feel more empowered.
She says: “I feel valued because the department listened when I
said things, and I feel proud to have been involved. Even if I move
jobs I will still have had a big input into designing this tool and
so will have left a piece of me here.”

LESSONS LEARNED

• There will be greater staff ownership if staff are involved. 
  Hawthorne says: “People pay more attention to thins like that. 
  It’s like if one of their own, as it can’t be all that bad.”
• Build trust with staff.  Coast says: “I was apprehensive about
  the PRG at first and it took a few good meetings before we could
  trust management.  But once we could it was good for them to hear
  what we were saying.”
• It can lead to other things. Adcock says: “We’ve been thinking
  about making care plans more specific, alive and relevant to
  service users.”