0:01
This is part two of the training session in relation to leading quality in a regulated
0:09
setting. In terms of part two. So in terms of part two, the aims and objectives would be to reflect on the learning from session one and how practice has been
0:18
shaped. That's not always an expectation that things have fundamentally changed, but that there's some thinking happening with some reflection and there's some
0:27
insights into practice that maybe you hadn't had before that you've got now. That's what you think individually or as an organisation.
0:36
We're going to focus more on the strengths-based approach in practice in part two and introduce the
0:44
principles of compassionate leadership to build on the strengths-based approach and to lead us into
0:50
how we can shape quality standards and how these inform our quality of care reviews as providers.
0:58
When it comes to quality, one of the key things to do is to be clear about what is our definition
1:10
of quality as an organisation? What does it look like? What does it mean? How would it
1:15
feel for people? How is that promoted across the organisation so that everybody understands it?
1:22
How is it measured in terms of how do we know we're doing it? And then how is it monitored n in terms of what's the impact we're having on the lives of the individuals that we're supporting?
1:33
That's the thread that's running through the part two session. So picking up in
1:39
terms of our approaches to working with people in a strengths-based way, working in a strengths way where it's something that gets talked about a lot.
1:47
As we discussed in part one, it isn't simply a case of we need to pull out the strengths,
1:52
we need to identify what works and we need to think about what the person is able to do. We need to see it as an approach, an approach that then
2:00
goes to support independence, resilience, choice for people and improves well-being.
2:06
We've got to think about a strengths-based approach in a number of contexts. It could be that we are wanting to improve an individual situation and we'll
2:18
use those strengths to be able to do that. It could be that maintaining the current situation for the individual is what we're aspiring to do and we can. We
2:27
need to think about how we adopt the strengths-based approach to do that. But it might also be a case of the person’s situation
2:35
is likely to be, and is deteriorating how we still maintain as much independence
2:40
and resilience and choice despite that decline in somebody's circumstances.
2:46
A strengths-based approach has to be collaborative. It can't simply be a case of the practitioner tells the individual what they're good at. If we're going to play to
2:55
people's strengths and use them, the individual has to have an element of self-belief and insight
3:01
into that being the strengths in terms of what they're capable and able to do for themselves.
3:06
We need to understand if they can trust other people and feel comfortable having other people to help them, or if it is that they feel able to go and access support in their communities.
3:17
The approach needs to be proportionate and flexible and appropriate to the individual’s circumstances. But like the example we used earlier about Betty being able to
3:25
drive – when you actually speak to her she says she hasn’t driven for two years as she has lost her confidence and is unlikely to drive again.
3:33
In terms of children, we'll hear references to the strengths for a particular child
3:38
is that they're attending school. But without the “so what” question there’s no
3:43
context about what this means for the child and why that's a strength for them. Is it
3:50
the fact that they're going to school and the strength associated with that is because the
3:55
time they're in school, they're not home exposed to domestic abuse between parents at home? Is it
4:00
that when they're in school and they're on the playground, it's the only chance they have to develop their social skills and spend time with peers? Is it because the school meal
4:10
they get is the only nutritious, hot cooked meal they get that day? Or that the cook or
4:15
the cleaner of the school is the trusted adult that the child knows they can go and speak to?
4:21
So again, it's not the high-level generic statements that we're looking for. It’s the detail of the context for the individual, what does it mean to them?
4:31
The strengths-based approach will be aligned to positive risk taking. If we're able to recognise the strengths of the individual, we can use those. We can play to those strengths
4:41
to help to mitigate against any risks that are being identified for the individual.
4:48
Ultimately a strengths-based approach has a focus on what matters to the individual, and it isn't just about identifying what they can do for themselves,
4:54
but who and what else is around them to help. For example, maybe some of our activities as a practitioner is connecting individuals up to members of their community.
5:04
For example, we know that there are two or three individuals living on the same housing estate who don't get out and about, who are feeling isolated and as
5:13
a result it's having an impact on their well-being, which means they could then need some form of care or support to be able to address the consequences of the impact of
5:22
the isolation. Can we think about how we can connect those individuals up together?
5:28
What's really interesting when we think about the strengths-based approach is about being something collaborative, but also recognising how the individual sees themselves.
5:39
For a lot of individuals that we work they we will at some point have heard conversations happening
5:45
around them that describes the things that they can't do and that they're not able to do,
5:51
things we can't allow them to do because there is a risk associated or it will have a detrimental impact on the individual. So we have to think about how we adopt the strengths-based approach
6:00
when the tone and the nature of any discussion or involvement with the individual has been about identifying the support they need as they can’t do things and there are risks associated.
6:10
Knowing how the individual sees themselves and their situation, sees their own world, is really important.
6:17
When we listen to family members, when we listen to other practitioners, when we listen to neighbours, carers, friends, who is it that
6:26
they're actually describing? I had an example shared recently of a lady who was a midwife for many years and the staff had
6:34
noticed that she would continuously go up to the members of staff holding their arms
6:39
checking that they were okay, genuinely attentive to how the staff were. And it was only when they
6:45
were trying to unpick why that behaviour was happening as the lady has dementia and wasn't able to verbalise or articulate why she was doing it, they started to unpick the story
6:56
of the lady and how she used to be a midwife. So what they did was on eBay, they bought one of the old blood pressure monitors that she would have used when she was practising
7:04
as a midwife and bought it for her. She now goes round taking the blood pressure of the members of
7:10
staff on a regular basis because that's her way of being able to show that she cares for people.
7:18
I've seen an example of an individual who used to be a head teacher and once a week the staff would come to him with their exercise books and their pens and they would sit down at
7:27
the table with the gentleman and he would teach a lesson as if he was back in school.
7:35
Another example was of a gentleman who every day knocks on the office door in the residential home where he lives to collect his wages (which is only paper money). This gentleman used to be
7:43
a coal miner and this how he would collect his money – what was important to him them was his role as the person that brought the money home to the family and the one who put the
7:50
food on the table and looked after his family. He hasn't lost that element of identity and purpose.
7:56
So really think about first off, who do you see? Who do you describe? Do we spend
8:04
enough time trying to understand the person they see in the mirror? Do we ask the individual who they see when they look in the mirror? Because that
8:11
opens up conversations about really finding out who the individual is.
8:17
If I'm working with children and young people I ask them who they see? Do they see themselves as a superhero, as somebody who's strong and confident,
8:26
or do they see themselves in a different light because they’ve maybe been described negatively by other people? Do I ask them if they could be a superhero or have a superpower?
8:35
What would it be? Are there elements of that they've already got in themselves?
8:42
There's really something about how we see, and everybody else, sees the individual and
8:47
how they actually see themselves. So when we're thinking about our strengths-based approach, an
8:54
exercise that you can have a go at either through individual reflection or in a group is to really
9:01
start to think about how as an organisation, do you work in a strengths-based way?
9:07
It isn't a case of we tell people they've done a good job we might follow it up with a personalised email, buy cakes one day, give people half an hour extra for lunch.
9:16
Really give thought to how do you work in a strengths-based way in your organisation,
9:28
either as an individual leader or manager, or in terms of what you see leaders and managers
9:33
doing? What are their behaviours, their traits, their activities in terms of the way they lead.
9:42
If you're a leader and a manager and you've seen your staff work and interact and engage with individuals. Think about what you see them doing and/or what you hear them saying. Does this
9:51
tell or show you, and give you the confidence, that staff are working in a strengths-based way?
9:57
If you're a member of staff, what do you do to promote a strengths-based approach to working with the individuals that you're working with and supporting?
10:13
Really think about what difference you make - it's the “so what” question again - So
10:18
what impact does this approach have on the way individual needs are met and outcomes achieved? So it isn't just we describe how we work and or lead but about the
10:31
impact it has and the difference it makes So to recap. Taking a strengths-based approach means we're exploring in a collaborative way
10:42
the individual strengths, abilities, their circumstances, the people, the things around them.
10:48
It is a shift away from making the deficit the problem, the risk, the challenge, the focus of the intervention.
10:53
It is important to remember the strengths-based approach is not just about arranging services. We have to think about if we took those services away,
11:02
how resilient, how independent would the individual be?
11:09
The next few slides are suggestions in terms of resources or tools that you could look to adopt or could try within your organisations. This is a set of questions that could be used. It's not the suggestion that this becomes another
11:14
page in a form, another document that's filled in and that we work our way through a scripted set of
11:21
questions. They are more suggestions in terms of conversation starters with individuals and we can
11:27
use them in lots of different contexts. It could be just a general chat with somebody. It could be part of the assessment that formulates the personal plan. It could be that when I'm reviewing
11:37
the personal plan every few months, that these are some of the questions that are considered.
11:44
It could be a set of questions that leaders and managers could you use in conversations with staff
11:50
with a bit of tweaking to the wording of some of these questions. For example, what are the things
11:57
you used to do in your job that you used to enjoy doing but you're not able to do anymore? what level of autonomy did you have but you don't feel like you have anymore? What impact is that having?
12:07
What level of autonomy would you like to be able to have when you're supporting individuals? What
12:13
have you been able to do in your role that you didn't think you would be able to do? You can phrase these questions in terms of interactions, conversations, relationships
12:23
with individuals who are receiving support, but also think about those you manage and maybe use the questions in terms of supporting staff and adopting a strengths-based approach with them.
12:35
Another helpful exercise here is to really focus on the individuals because we can talk generically about what we mean by a strengths-based approach but it really comes
12:45
to life when we start to identify individuals we're supporting. So in groups or by yourself
12:55
locate an individual in your mind. think of an individual you're working with who's being supported within your organisation. Then work through the questions on the screen.
13:12
When you think of that individual what have they been able to do that either they or the people around them didn't think they could? What have they been
13:21
able to do themselves? Who has helped them? What support have they accessed
13:31
to be able to do this? How does impact on the support they need going forward?
13:43
As part of our reviews of supporting individuals we always have to be thinking about a strengths-based way of promoting independence, well-being, choice and control. The more we
13:53
can start to recognise and help individuals to recognise their strengths the better. Part of my
13:59
review process should be around do we need to keep supporting you in the way we have been supporting you. Because if the individual starts to share that they've got more confidence
14:07
now and can prove to themselves that they're able to do tasks, they don't need that extra support
14:14
any more. Or they might actually feel more confident to try other things by themselves or
14:24
their family and friends may be willing to help them and they don't feel they need the service. So reflect on an individual, by yourself or in groups, and work through the questions.
14:42
They're good questions to use in supervision, team meetings or peer reflection sessions.
14:48
So to summarise the key features of a strengths-based approach. We need to think about how it values capacity. That doesn't
14:57
necessarily mean mental capacity it is about the individual's capacity to be able to support themselves using their skills, knowledge and connections.
15:04
Focusing in on strengths does not mean we ignore the challenges or spin the struggles into strengths. It is about how we get the balance right in terms
15:13
of making sure we're proportionate in how we support individuals. We have to work in collaboration either with
15:19
the individual themselves or with other people around them.
15:25
We might find ourselves in a position where we're having to challenge other individuals.
15:30
For example, a lot of the reasons why referrals come into social care or come in to providers will
15:35
be because there is a perception an individual needs help with something as they're unable to do something. It is important to have a conversation with the referrer to say,
15:45
Why do you think the person can’t do this thing? When has it happened that they can’t? Give me some examples of why you think that's a risk or why you think they're not able to do something.
15:53
Because quite often when we're talking about risks and the absence of strength, it's not always about
15:59
the risk to the individual. It could be that this is professional anxiety, family guilt
16:04
or worry. That means our sense and perception of the situation isn't always quite accurate.
16:11
Ask the questions of the individual themselves. For example, I'm hearing a lot from other people about what they think you can't do, but what can you do? What have you
16:16
been able to do yourself or with help from others? What's the one thing you want to be able to do but
16:22
no one else thinks you're able to do it? Why do you think they don't think you're able to do it? Explore the conversation. And if we start to adopt this approach and embed it a lot more
16:32
individuals become co-producers of the support rather than passive consumers of that support
16:38
So for this final part of the session, we're going to move into pulling together what
16:44
we've done in part one, pulling together what we've done in the first section of part two to start thinking about how we start to shape what quality looks like.
16:53
Leadership is a key aspect of driving quality forward in an organisation and in terms of
16:58
shaping what quality looks like. Knowing and measuring whether we're delivering the quality we should be providing is often seen as a leadership task. It predominantly is,
17:09
but it's also thinking about everybody who works in an organisation having a responsibility to lead quality in one way or another.
17:17
But for those of you in leadership roles, it is important that you give consideration to
17:22
how well you lead in the organisation. The way in which you lead the organisation will,
17:28
by default, lead to delivering a good quality service, or not
17:34
In Wales we now have Health and Social Care principles of Compassionate
17:41
Leadership developed by Social Care Wales and Health Education Improvement Wales and
17:54
it's really interesting when you start to read the narrative around the principles,
18:03
because for most of what you can see on the screen, we've already talked about it throughout part one of the training and the first part of this part two.
18:13
When considering the principles what we don’t want to do is have lots of generic and technical words that people can't relate to. So one thing to think about as a leader and manager is how you translate
18:27
the principles into language and terminology that people can buy into and recognise. One
18:33
approach to using these principles is to think about is what they are telling us about what we need to do and why we need to do it. But what leaders need to also be able to do is describe
18:44
the how. For example, as a leader you don't want to just stand in front of a group of staff and say
18:52
“I will make sure I strengthen respect, voice, influence and choice”, because the majority of
18:57
the workforce are going to turn and say, What does that mean? What you need to be able to
19:02
say is “This is what I want to do. This is how I will strive to be. This is how I will do it,
19:10
and this is how I would want you to feel if I was leading in this way”. So we need to
19:16
be able to translate the principles into what the experience will be for the people we are leading.
19:25
What are the traits or behaviours of the leader if they're working in this way? How
19:31
does that translate into how staff will then feel if they're being led compassionately?
19:37
Ultimately, if staff feel that they're being led compassionately then that will
19:42
play out in the way staff will go on to support individuals. So if you're a leader, we want to be thinking about what your behaviours, traits and how
19:51
staff will feel. If you're a staff member, think about the same thing. What would you want
19:56
to see in leaders and managers in terms of their behaviours and traits and activities? How do you
20:02
want to feel or how will you feel if your manager is leading in the way described on the screen?
20:14
It can be useful to think about how to translate these into practice. Because the leadership within the organisation, leading compassionately,
20:23
it aligns with the duty of candour that we all have the responsibility
20:28
to work towards. The RI has a responsibility to make sure that the culture of the organisation
20:35
is in line with the duty of candour that we're required to follow. And the two go hand-in-hand.
20:44
So either by yourself in reflection as a leader, or if you're a member of staff think
20:51
about how you sit and look at leaders and managers around you. If you're in a group,
20:58
have a think about how compassionate leadership plays out, or would play out, or should play out.
21:05
So it's thinking about what the behaviours, traits and competencies should be. How should
21:11
managers and leaders be doing this? Is this demonstrated by the managers and leaders
21:19
you see? If you're a manager or leader, do some of that honest self-reflection about whether you think you do that. Quite often as managers and leaders we believe
21:28
for the right reasons that we're leading in the right way. But actually, do we ever test that out? Do we ever check with staff that that's the experience they're getting from us?
21:39
Also think about either for the staff you lead or manage or if you're that member of staff how do staff then feel if they're being led in this way?
21:48
For this final part of the session we're going to think about how we start to shape, describe and define the aspects of quality that are really important. Earlier on,
21:57
I talked about the key stages of setting and managing quality. The first one is to define what quality looks like and should feel like. Second is how it's
22:06
promoted within the organisation. Third is how is measured and fourth is how it's monitored in terms of the impact it's having on the individual's experiences.
22:17
Before we get into the legislative context and policy context of quality it is helpful
22:24
for us to just stop and think about where you are as an organisation at the moment. So either individually or in groups, take ten minutes to think about what
22:36
the key elements of quality are within your organisation and give some thought to how
22:41
it is defined and how it is promoted. But also how is the impact measured in
22:49
terms of making a difference to the individual's daily lived experience?
22:55
As you do this activity, the temptation will be to define processes and activities linked
23:03
to quality. Quarterly reviews, quarterly visits, quality of care review reports,
23:09
checking paperwork. These aren't definitions of quality, they're ways to measure quality.
23:16
What we want to think about is what is it that we're actually measuring? For example, we'll all do reviews of policies and procedures, managers will be reviewing what's in assessments, personal
23:28
plans, review documents. We know we've got to do the task. The question is, what is it that we're
23:33
looking for? So if we came back to the principles of practice from earlier on, if I was, for
23:40
example, reviewing personal plans and the reviews of those personal plans, would I be wanting to see
23:49
evidence of them being completed or would I also be looking for evidence of the individual's voice choice and control, that the plan has been co-produced,
24:02
is outcome-focused and strengths-based, has an element of positive risk-taking and is proportionate. So think about how you define quality before you think about measurement tools.
24:18
So either alone or in a group, we really have to think about what are the key elements or the key descriptions of quality, how are they promoted and how do we know
24:27
whether they're having an impact on the daily lived experience of the individual? A lot of the discussion around quality and the activities that take place will
24:37
be based on the quality of care that is being provided to the individual.
24:43
It's helpful to make sure that when we're talking about quality that we're talking about all aspects of quality. There's an element of person-centred care but we also need to
24:56
think about what else is covered in regulations and statutory guidance and safe and effective
25:02
practice. My health and safety arrangements and my incident management, my medication management,
25:07
my safeguarding arrangements. They're equally important in terms of what quality looks like.
25:13
The leadership, management and culture aspect which we just covered, where I talked about compassionate leadership and the need to define, promote, measure and monitor,
25:24
set the culture of the organisation. That all has an influence and impact on quality,
25:30
as does our recruitment processes. Making sure we're following induction processes,
25:35
registering our staff with Social Care Wales, covering the workforce elements in regulations and
25:43
guidance. And then there'll be the auditing and review processes that we're required to follow,
25:48
equality care reviews, visits, adequacy of resources reports, and so on.
25:55
This is just a reminder that quality comes from a number of different areas that impact on the experiences the individual is having.
26:04
So providers and RIs are required to undertake quality of care reviews.
26:13
CIW in their guidance are very clear that an effective quality of care review seeks
26:18
to determine the extent to which people have their needs met, their rights promoted and that they can achieve their personal outcomes through the service that's being provided.
26:27
We also have to make sure we're focusing on meeting the individual's care and support needs.
26:34
As part of the process of undertaking reviews and the activities that come with that,
26:40
the RI then prepares that assessment of the standard of care and support being provided and will make recommendations for the improvement of the service.
26:50
What we need to be thinking about again is what is being measured. So it's very clear
26:57
that quality is a core strand of the legislation. We've got responsible individuals with a key role
27:02
and purpose to promote quality. But how well are we defining quality? Because if you were to go back into the regulations and the statutory guidance, the features of quality are
27:12
scattered through all of the documents they are not succinct and in one place. Some of that was illustrated in the previous slide with the circles,
27:19
in terms of quality is about person-centred care, safe and effective practice, leadership and culture, and audit and review processes.
27:29
We really need to think about what it is we're actually measuring when we talk about quality.
27:37
A lot of quality of care reviews will list and describe a lot of activity, there will
27:44
be some element of individual experience, but it tends to be quite quantitative. So what we
27:50
need to be thinking about is what do we say as an organisation a our standards of quality? What
27:58
is it we're striving towards? How will we measure it and how will we know we are achieving it?
28:04
And those quality standards need to be clear jargon free, something everybody can relate to.
28:10
As you can see on the slides, the regulations and the guidance are clear about what a quality standard is. It needs to be measurable in terms of knowing what
28:20
we need to do to achieve the quality standard that we've stated. It needs to be measurable in terms of what the impact will be for the individual and their daily lived experience.
28:31
The quality standards should run through the statement of purpose. They may well
28:36
be referenced in your information guide. They need to be the focus of the RI’s
28:42
quarterly visits. They need to be evident in the way personal plans
28:47
are produced and reviewed. They need to be evident in the way staff are working on a day-to-day basis
28:52
supporting an individual, for example the way they are helping with personal care needs, supporting them with getting out and about in the community, going to school, whatever that might be.
28:59
So we really need to think about how are we defining quality. Drawing on the exercise that you've previously done thinking about what it is that we're
29:09
actually defining as quality becomes really important. This becomes even more important
29:14
now because in the annual return that is required by CIW to be completed in line with the regulations in the statutory guidance of RISCA providers need to
29:23
include a statement of compliance against the four areas that you can see on the screen.
29:29
It isn't simply a statement that says people feel their voices are heard or they have
29:35
choice about their care and support and they have opportunities made available to them. We need to be able to demonstrate how that happens. So what's the process? What's
29:46
the activity by which we enable people to have their voices heard? How do we know that that's
29:52
happening and what's the impact that's having having in terms of individuals experiences?
30:00
Same for the second, third and fourth statement. The process becomes a lot easier
30:06
if you've got a set of quality standards that are clearly understood, that are measured. So when considering quality everyone is thinking in terms of what they are seeing, reading, hearing.
30:20
The same thing goes when sending satisfaction questionnaires out, to staff, to individuals in receipt of support, to family members, stakeholders - you need
30:30
to be gathering evidence and intelligence about whether these four things are happening. One of the things you need to be very mindful of in terms of the processes around understanding and
30:40
measuring quality is the person-centred element as well. It's a tricky one because there a lot
30:47
of activities to fulfill. My encouragement to all providers is to just stop and think
30:52
about all the processes we've got in place such as the questionnaires, the surveys, the
30:58
residents meetings. Are they giving individuals the opportunities to really tell you what their
31:04
experience is? The residents meetings that you have - step back and think are they really for
31:09
the residents or are they for the organisation in terms of providing the service. The questions
31:15
that go into questionnaires and surveys as part of quality of care reviews, are you asking questions on the basis of what you think you need to know or on the basis of what people want to
31:23
tell you. Always be thinking about developing a co-produced approach to quality of care?
31:29
If it was me and I was the responsible individual that was having to think about how I conducted my quality of care review, I would probably be sitting down with staff,
31:38
with individuals receiving care and support, with their families, friends and sharing with them what my role is to review and monitor and measure quality. It's part of why I have to undertake
31:49
regular visits. I need to engage with all of you in terms of your experiences. What would you want
31:54
to be able to tell me at those regular intervals and how would you want to be able to tell me?
32:00
Because if you were being really honest, how many people would want to fill in a questionnaire versus can we have a sit down of a cup of tea and cake. A child in a children's residential home is
32:10
more likely to tell you about their experiences kicking a ball around in a football field or having an ice cream down at the beach. So you really need to be thinking about your arrangements
32:19
for gathering information about what you can see on the screen, making sure you're person-centred
32:28
and thinking about the quantitative and qualitative measures that you're putting in place. For example, if you have a question in the questionnaire that asks are you happy
32:39
receiving the service? are you happy living in this home? and people are given the option of yes or no when it comes to writing the quality of care review report it will probably say 98 per cent of
32:49
people in this residential home say they're happy or 89 per cent of the people in this residential home say they feel safe. It's still not clear what that means in terms
32:58
of quality so think about how you expand the question and ask What makes you happy?
33:07
When was the last time you felt happy? What's happening around you that makes you feel safe?
33:12
You know, we all want to make sure that people feel as independent as possible so we will ask the question do you feel independent? Is your independence promoted 92 per cent say
33:20
yes, But how do in know what independence looks and feels like for individuals and how do I know about how we are supporting this and the impact it is having on someone's quality of life. support and information that says an independent looks like this for people and this is how they're being supported achieve it. That's a much fuller picture of quality.
33:31
As an exercise, reflecting on the quality standards you've already written and remember the strengths-based approach
33:38
if you feel you've got quality standards that are hitting the mark, talk about them, promote them, be proud of them.
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If you're not sure how you define it, remember that we know what we're looking for,
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we know what we mean but it may be that you haven't articulated it that clearly.
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The other thing is that when you're looking at those quality standards, really think about through whose lens they're written. So do you have a quality standard that
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says "we want all staff in our organisation to feel valued"? A question on a questionnaire that
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says "do you feel valued? yes or no?" doesn't tell you if staff feel valued. But if I go out to staff and say "what makes you feel valued to work in this organisation?" and
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they can tell me what makes them feel valued, my measurement of quality is going out and finding
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that that is their experience. Do I write a quality standard that says "we actively promote the outcomes of individuals"? Or do I write a quality standard through the lens
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of the individual that says "I'm able to do the things that make happy", "I'm able to do the things I enjoy", "I'm able to sleep well at night knowing I'm safe in my own home",
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"I'm able to spend time with the people who are important to me". Because when I
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go to measure these, I'll include a question on those in my survey and look for that in
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the paperwork and I'll ask people to share their experiences with me when I visit them.
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So have a go at deciding what quality looks like, by yourself or in a group, and have a go at
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writing a couple of quality standards that would sit under each of these statements of compliance.
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As we come back from the previous exercise around developing quality standards,
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this could be a helpful model to come back to and reflect on as its thinking about what
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do we say are our quality standards? Are they clear? Are they understood and are they defined?
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It's thinking about what we measure and how we get the evidence that we're meeting the quality standards or not.
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And then it's about how do we use that information to determine quality impact? It's really important
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that we make a judgment of some sort and I don't mean that in a bureaucratic way, but we have to be able, at the end of the quality of care review processes,
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be in a position to say collectively this is what quality looks like in our organisation and this is how we know we're doing that and this is how we know the impact we are having.
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It's about remembering that a lot of the quality of care review reports, can become a bit of a description and a list of things under a series of headings. But actually what you want
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to be able to do is conduct the analysis, and conclude or summarise what quality looks like.
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Another helpful model to do that which aligns with this one in terms of bringing the information together is the "What? So What? Now what?" model of reflection
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and analysis. For example when writing and concluding a quality of care review report. How do I bring this together into something condensed, tangible that I understand?
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The model explores three key questions. WHAT information have I gathered? SO WHAT - so what are we proud of? So what is working well? So what
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difference are we making to people? So what do we know? So what do we need to work on? So what are the areas that are causing concern?
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So you take that information to feed the 'now what?', which essentially becomes the action plan.
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NOW WHAT do we need to do in response? In terms of the action plan that comes out of quality of care reviews, it's taking the
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strengths based approach. It should be okay to have a quality of care review action plan that
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says we recognise that this works really well in our organisation and we're proud of it and part of our plan is to keep that going, to keep the emphasis, to keep the energy invested
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into the things that are working really well, and that we're explicit about that in our plan.
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The second half of the plan will be the areas we know we need to work on and address and this is how we're going to do it.
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The other thing to think about is what happens with the information when the quality of care
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review report is finished. I see a real mix across providers where it's completed and
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shared only with the service provider, it goes to the commissioner and it's shared with CIW.
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Sometimes staff are just given a copy of the report. I see other examples
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where leaders and managers sit down and they talk through the report with individuals receiving the service or with staff.
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It is really important to think about the ethos of being person-centred, co-productive,
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strengths-based, promoting voice, choice and control (all those principles we've talked about throughout the training) and making sure those people who've been part of the
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quality of care review process are provided with information about what's come from the review.
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To give somebody a full copy of the report is probably too much, but a nice visual summary
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shared with staff, family members, individuals, commissioners that says this is what our quality
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of care review processes concluded for this period can be more accessible. And again, the What? So what? Now what? Model is a really nice framework in which you can say this is what
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we're proud of, this is what we do well, this is what we know we need to work on, these are the things we're going to keep investing our energies in,
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and this is how we're going to work on the areas we know we need to develop. The quality of care review process shouldn't just be an inclusive process
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when people are feeding into it, but actually hearing what's coming out of that review and sharing it openly and honestly with people in keeping with the
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principles of compassionate leadership, duty of candour, and so on, is important.
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So to summarise the key messages coming out of the session: There is a very strong close relationship between the Social Services and well-being Act and RISCA.
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The two complement each other really nicely. A lot of the concepts, the principles, the terminology
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and language of RISCA is heavily informed by the detail that sits within the Social Services and
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Well-being Act, which is why it's really key for us to understand how the two connect together.
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We've explored the importance of defining understanding and measuring quality through the lens of the individual primarily,
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but to strip out the jargon, the generic statements become meaningless if we don't ask the so what questions and get into the detail of what this means for individuals.
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Throughout the sessions, we've explored strengths-based approaches. Remember the strengths-based approach is not just writing down things that are working well. It's what
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underpins and embeds our approach to practice and aligns the principles for practice. It
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aligns very nicely with how we drive and deliver quality within our organisations.
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And finally, compassionate leadership is a really nice tool by which we can drive the
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strengths-based approach. It aligns nicely with the principles for practice. It sits
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as a key feature of how we deliver quality within our organisations.
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So if we bring all of these aspects together, that's when we are in that area of being able
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to drive quality within regulated settings through the lens of the individual.
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So before we conclude the session. It is really helpful when you've had so much information to reflect.
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Some of you will have picked up on key bits in part one that were more pertinent and others will have picked up more things in part two.
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You can go back and watch the video again, but it's so important that you take But it is really important that you take some time to condense all of that
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information you have received throughout the training and the reflections you have made into something that's meaningful for you as an individual as a team and/or as an organisation that you can take away from the session.
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One of the ways that you can think about doing that is to reflect on the materials, reflect on the learning and all the discussions that have happened and make a commitment in terms
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of one thing that you will stop doing as a result of the sessions, one thing you will start doing as
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a result of the learning and the reflections and one thing that you will continue doing.
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Keep these alive, come back to these and review them. Don't just review them in terms of I can say I did it but review it with the so what
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question. Say to yourself I've been able to do it. So what difference does it make?
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So that brings us to the end of the session. Thank you very much for engaging,
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for listening and for all of your individual reflections and group discussions.