Leading change

Nurse leads at Belong, a non-profit charitable organisation, implemented a best practice framework for residents living with dementia. This nurse-led programme aimed to improve staff knowledge, confidence and competence in caring for residents. The project has improved resident outcomes and experience, empowering staff across the organisation to implement change.

Where to look

Belong provide five established villages and two new villages within the UK and model their services on the needs of residents, ensuring they are at the heart of everything that is done. Each village offers several services, including independent living apartments, households for people that require more care, such as ‘Dementia expertise’, which is a village designed to offer the most supportive environment possible for people experiencing dementia. Belong also provide experience days for new residents or those considering using their services.

Nurse leads at Belong, whose ethos is ‘to support older people to live their own lives through the creation of vibrant village communities’ identified that although staff undertook dementia training, translating these key principles into practice was varied across services. This unwarranted variation in practice was also reflected in resident/family feedback and complaints, with an increasing trend for some individuals with particularly complex needs having to move into more specialised services.

What to change

A review of current practice and feedback from staff identified to nurse leads that unwarranted variation in staff confidence in relation to caring for individuals with dementia diagnoses and skills in implementing techniques and tools to support positive proactive care planning practices. Staff reported unwarranted variation in the amount and quality of time they felt they could spend sitting with residents, due to cultural and workload factors. Nurse leaders wanted to ensure that consistently high standards of care were being provided, and that training and evaluation of staff performance was based upon positive patient experiences and outcomes as well as tasks being completed.

Staff further reported gaps in their knowledge of each other’s skill sets so were not always working in a joined-up effective way which presented the nurse leads with an opportunity to remodel what ‘good’ looks like and support staff to develop their abilities to work in these ways. This benchmarking of knowledge, confidence and skills and any development needs would also support the leads in developing a framework for continued development of staff and the services they work within.

How to change

Nurse leaders developed a programme of work that encourages and supports staff to increase their knowledge, understanding and confidence to act appropriately, using a dementia best practice framework. An individualised approach to staff education and training was established, which includes 1:1 individual feedback and support to develop and agree a personalised development plan based on their current skills.

Situational judgement questions based on real life scenarios are discussed with staff to explore knowledge, competence and confidence in areas of their roles; the results of which highlight any strengths and areas for improvement whilst illustrating how they are likely to think, act and behave in different situations. This process encouraged reflective practice and ensures continuous improvement.

Following implementation of the programme, the organisation can now more accurately measure the competency levels and behaviour of carers working with those with dementia. They can evidence the quality of care as well as ensuring the right levels of support are available at the right times.

Adding value

Better outcomes – The programme has become a routine part of education and training for staff which is supporting them to further improve care for those with dementia and continuing to develop their skills to meet the needs of those they care for and work with. Staff report they are increasingly focused on providing high value care and feel that they are providing better outcomes for the residents.

Better experience – Staff reported that they feel more confident in providing specialised person-centre care and feel time spent with residents is of better quality. There is now an improved care experience for residents living with dementia due to staff having a greater understanding and they feel able to challenge practice if needed. Resident satisfaction is routinely measured and where residents are unable to provide feedback, this is obtained through relatives and the care village staff. Feedback includes:

“I can see a difference…the way they are, even with the residents. They’ve changed their attitude and their approach and I think they look at things a different way”

“A member of staff previously had less dementia knowledge and has now worked on that…it’s nice to see her understanding capacity, making decisions and how that can work in her household and has the confidence to say that to families as well”.

Better use of resources – Staff feel more empowered to make leadership decisions, implement changes and there is greater understanding of each other’s skillsets. There is improved career progression due to the learning, development and training opportunities which is positive.

Challenges and lessons learnt for implementation

The impact has been more prominent where leadership happens at a very local level, where staff have embraced their learning and really wanted to carry it forward to make some changes. You don’t need to have a leadership role in your job title to be a leader.

For more information contact

Phil Orton
Head of People Management and Development
Belong
Phil.orton@clsgroup.org.uk