A few weeks ago, I headed out to Fife to round off our project with Abbotsford Care. The train journey across the Forth and through the East Coast countryside is a perfect setting for reflection. And so I did just that: a reflection on all the things I’d learned throughout this project; from what we aimed to create, what we had to adapt, and what came to light that we didn’t expect.
Last year Abbotsford Care submitted their expression of interest, to work together to re-design one of their key pieces of paperwork. They had identified that it was a busy piece of paperwork that was difficult to read; and as a result sometimes only partially completed. As well as this, there was an aspirational part of the project, to think about how the quality and the meaning of the care that staff provide could be captured. How could the paperwork not only detail the important tasks that can be ticked off; but tell a story, or give greater detail, about an individual and the care they received? Alyson, the operations manager, wanted to recognise that staff do much more than tick box tasks and was keen to find a way to record this. We were aiming for the moon - not simply a paperwork re-design.
So with that, we began to explore together what dignity in care, and in care home settings looked like. I wrote about this, because it really struck me that when we talked about dignity, we didn’t just talk about what we typically think of, when we think of ‘good care’. Instead, we talked about the rights of individuals to live as they choose, and how that can be balanced in a communal environment. Care home managers shared the challenges in balancing the involvement of loved ones in a persons’ care plan, but upholding residents’ rights to privacy. And when talking with care home staff, it was clear that ensuring dignity was a foundational part of providing care - they didn’t see it as separate.
As we moved through, into the development of the paperwork, it emerged that there were some complexities. We wanted the paperwork to be a place where staff could easily and quickly record key information. And so, we worked with staff to understand what information had to be collected and how it should be formatted. It had to be set out clearly, easy to read, and we stripped out sections that asked for information that staff collected in other places. But, the aims for the document to be accessible with only key information, seemed to be inconsistent with the aims of the document as a place where the dignity of the person being cared for is recorded, and where care of this kind is prompted. There isn't a quick or simple way to do that; but there was a feeling that this document needed to be quick and simple!
So, at the close of our initial design sessions, I felt we were on the way to achieving a more user friendly document. But, I wasn’t sure if we were really answering the other part; how do we record the meaning of the care that’s given, and capture something of the story of the person receiving the care. As we moved through and had more conversations, it seemed that staff wanted - and needed - the paperwork to capture distinct, task based information. It didn’t feel like the best fit for a more in-depth narrative of the resident. Part of this, I think, comes from the time that staff have to actually do paperwork; and we see this across the sector. Increasing workloads, stretched resources and staff shortages, are placing demands on the time of social work and social care staff across Scotland. And, we also know that feeling confident in our own writing isn’t a given. We each have different connections and relationships to sharing our thoughts through writing, and if it’s something we’re not sure of, when you add that to an already full workload, it’s easy to see why it can become overwhelming.
We discussed other occasions or places where this kind of recording might happen, for example, when staff meet to discuss the care of an individual, this might be an opportunity to really consider that person, and what dignity means to them. The final paperwork included a space for staff to detail ‘The Resident’s Day’ where staff can write in a more detailed way, about what else went on for the resident that day. This updates a question on the previous layout, and we’ve allowed more room for staff to write, in hope that the space itself will encourage staff to share the ways they cared that day.
We discussed relationships with paperwork at other times during the project, and this is where I also love the creativity that Alyson and the team have in their thinking. We have so many ways to communicate in the modern world, might that ever apply to formal recording? Could there be a future where voice notes are viable formal recording options? Might we create time for staff to write diary-like entries for how residents have spent their day? Or, could we use software and digital tools to build interactive recording systems that allow us to build pictures of a whole person, over their time in the care home? The ideas are always bright, bold and engaging. We didn’t get to building the recording platform of the future, but we did learn a lot. The key takeaways as I see them are:
- Re-designing paperwork is not just about adding new questions; but thinking about the relationships we have with writing more broadly
- Considering workload and time is key to understanding what paperwork needs to look like, and how it needs to function
- When paperwork has a clear function, it can be difficult to expand and make it work beyond that function
There is always so much learning to be gained from an Iriss project, sometimes just by watching it unfold. There’s observations and lessons learned that you didn’t expect, alongside the knowledge and understanding you set out to achieve. It was such a pleasure to share these headline thoughts with the Abbotsford team; as Alyson and her colleagues have developed a robust learning culture in their team meetings. The enthusiasm and openness of the staff taking part, is so noticeable in the room.
So, as well as a newly formatted item of paperwork to trial, to improve, and test again, we’ve also left the team with the other, valuable pieces of information we learned along the way. I am taking it as a reminder that projects are so often iterative; and while it’s important to aim for the moon, a stop off along the way can be important too.
The team at Abbotsford have been great to work with - insightful, dedicated and creative. I look forward to hearing about their journey.
