Relationship Activated Care: The 360 Standard Framework Defining and Transforming Care Cultures

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Relationship Activated Care The 360 Standard
Framework Defining and Transforming Care
Cultures Patricia Duff OBE, MSc, BA, RN, RM,
PGCEA Rosemary Hurtley MSc, Dip COT, FRSA
Using measurable outcome standards to exemplify
and protect Human Rights in care settings
Rosemary Hurtley MSc, Dip COT, FRSA Royal
College of Medicine, Summer School 2013
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360 Forward provides Diagnostic
assessment Consultancy, education, coaching
training services Working with managers and staff
at all levels Health and social care Our aim is
to establish dynamic, sustainable person centred
cultures in their organisations in line with the
philosophy and principles of The 360 Standard
Framework.

Patricia Duff OBE, MSc, BA, RN, RM, PGCEA
Rosemary Hurtley MSc, Dip COT, FRSA
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What is the 360 Standard Framework?
A diagnostic assessment framework that shows care
organisations how to establish and maintain
person-centred cultures from the perspective of
the cared for person, their families and
carers An outcomes based practice development
framework for achieving continuous improvement
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Defining and Transforming the Care Experience
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Assessment Framework Residents' Measures

• Receiving person-centred care
• Opportunities for social/occupational activity
• Influencing meals and drink
• Meeting spiritual needs
• Resolving concerns and complaints

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Staff and Relatives Measures

Relative measures
Staff measures
1. Finding the work fulfilling
1. Welcoming ambience of the home
2. Having time to deliver good care
2. Communicating with staff and managers
3. Equipped to do the job
3. Being fully informed
4. Feeling valued as a staff member
4. Seeking to resolve concerns and complaints
5. Contributing to the care of the family member
and the community of the home
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Managers making it happen

• Enabling /facilitative management style - clear
  channels of communication, positive relationship
  building, collaboration with other professionals
  and agencies
• Pivotal leadership role in change management
• Operational management
• Practice development
• Quality improvement
• Business planning

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Example Resident Standard 31The resident has
a choice of culturally acceptable food and drink
that meet his/her dietary requirements
Structure
Process
Outcome
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Characteristics of the 360 Standard Framework

• Delivers continuous quality improvement and
  demonstrates measurable change

• Involves the cared-for person, relatives and staff

• A Standard of excellence in relationship
  activated care for person-centred outcomes

• Underpins all other service and practice standards

• Incorporates evidence from research and empirical
  studies

• Diagnostic with measurable outcomes

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1 - Client Decision
Routes The 10 Step Cycle
2 - Preparing and Planning
 
 
3 - Data Collection
4 - Data Analysis
 
 
 
5 - Feedback
 
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Why is the 360 Standard Framework
important to the NHS?

• Good patient outcomes - Create a patient-centred
  NHS
• Quality Improvement - Focus on improving their
  experience and their health outcomes
• Value added benefits effectiveness and
  efficiency
• Leadership and management enabling tools -
  Empower professionals end top-down control

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Work-based Learning Key topic areas For
delivering quality compassionate care

1. Understanding ageism in society
2. Understanding chronic conditions and their
   effects on the person identity, significance,
   continuity, purposefulness, belonging and being
   understood
3. Building positive relationships the triangle
4. Specialist communication skills
5. Understanding transition, loss and adapting
6. Understanding and preventing institutionalisation
7. Inter professional co-operation and collaboration
   - INTEGRATION

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The Elizabeth project

• Justine Cawley
• Independent Consultant
• Associate at Bucks New University

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Background

• Developing a career pathway for people working
  with older people
• From apprenticeship to post-registration nursing
• Mid Staffordshire and other incidents of
  unacceptable care
• Over the years older people have been moved out
  of hospital into residential care and as a result
  the health input has diminished

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• The Structure of the pathway
• Post apprenticeship course
• Elizabeth practitioner Foundation degree
• Elizabeth Nurse Post qualifying degree

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Why is this needed?

• Increase in complexity of care dementia, long
  term conditions
• Need to have higher standards in health and
  social care
• No dedicated career pathway for older people
• Need to give the sector and their staff more
  status and recognition

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Issues in the sector

• Societal
• Organisational
• Operational
• Practice- knowledge, skills, behaviours
• Lack of funding for socio-health nurse
  development
• No career pathway to higher education
  qualification in care of older
• people

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• Why training is essential
• 65 of people in hospital are over 65. 80 of
  people in care homes have dementia or cognitive
  impairment (Alzheimers Society, 2013)
• Residents of care homes have complex healthcare
  needs, reflecting multiple long-term conditions,
  significant disability and frailty.(BGS, 2011)
• All health and social care providers need
  training in the complex management of people with
  multiple long-term conditions (BGS, 2013)
• People living in a care home and suffering from
  dementia are more likely to go to hospital with
  avoidable conditions such as urinary
  infections.(CQC, 2012- Care Update)
• The social care model is central but insufficient
  to meet residents health needs.(BGS, 2011)

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Impact

• More young people coming into the Sector
• A more educated and adaptable workforce
• A career pathway that young people want to enter
• Work based learning and an alternative to
  University
• Less turnover of staff
• More profitable sector
• Happier staff
• More career opportunities
• More customer satisfaction

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Enabling the Willis and Francis Report
Recommendations

• The culture of healthcare provider organisations
  is routinely assessed
• More family and user involvement in education
• Streamline communication skills to provide
  dignity for people with dementia, mental health
  and chronic disease
• Flexible education programmes for nurses and
  carers, people and their families
• Work-based learning
• New status of nurse for older people (Francis
  Report)

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Integration

• Integration is essential if we are going to give
  older people the care they deserve.
• Partnership is essential Partnership which are
  equal
• Social Care sector is very fragmented.
• NHS have the money and Commissioners have the
  power
• Social care have less qualified staff

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Social Care Sector

• Predominantly SMEs who are fighting to survive
• High turnover of staff
• Lack of awareness of partnership lose staff to
  NHS
• High drop-out rate with young people

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Partnership and integration

• Partnerships are sustainable
• They are equal
• They have good foundations and have identified
  core common goals
• They have common training routes

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Building Bridges

• Construction began in 1831 but the project was
  beset by political and financial difficulties.
• By 1843, with only the towers completed, the
  project was abandoned.
• The bridge was finally completed and opened in
  1864.

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Bridges and innovation

• Underpin foundations of the weaker side or use
  strengthening members across it
• Victorians great engineers and innovators
• We have to be a different sort of innovator by
  being builders of social structures that work and
  provide excellent care.

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Thank you

Rosemary Hurtley Rosemary_at_360fwd.com 01483
275555 Justine Cawley jca_at_consultant.com 07767
442136