Supporting Workforce Challenges is a continuation of Iriss' project The View from Here which aimed to understand the experiences of Scotland's social services workforce. This project was developed as a response to the wealth of qualitative data about the daily challenges facing those who provide care and support. This project was focused on improving the experience of the workforce by giving them space and support to develop ideas to help them improve their experience in their role.
The key aims of this project were to:
- Raise awareness and public understanding of the experiences and commitment of the social services workforce across Scotland.
- Improve well-being and resilience of the frontline workforce
- Develop and deliver improvement ideas
- Share these ideas across the sector to improve recruitment and retention
This small-scale project was a test of what kind of small-scale improvements the sector would find useful, as well as a test of how The View from Here materials could be used to prompt reflection and change.
Iriss chose to work with the Telford Centre in Highland as it was a service that reflected many of the challenges facing rural services across Scotland.
This project prioritised the emotional experiences of social care practitioners. Evaluation of The View from Here project showed that emotional reflection formed an important part of reflective practice which was valued by the workforce.
We facilitated three half-day workshops which focused on group discussion and reflection.
In the first workshop, we used The View from Here materials (illustrations, diary entries, poems and songs) to reflect on the individual experience of delivering care and support and then discussed this as a group to find key themes and challenges. A result was that the group identified that they wanted to focus on the days where everything went wrong. The group spoke about these days as if they were out of their control, citing 'the moon' and 'something in the water' and described that some days, nothing went right and it was often a very hopeless feeling.
The second workshop explored more about this phenomenon and invited practitioners to think about how they felt and experienced these stressful days. To direct their focus, the group identified a single stressor (a resident experiencing stress and distress) and explored their own thoughts, feelings and behaviours. They noticed that their actions often led them into a cycle of negativity, not allowing them breathing space to focus on themselves.
Our thoughts, behaviours and emotions when a resident is showing signs of distress
Thoughts - what we think
- Negative reports at the start of shift make you think 'oh no'
- Work is a drag
- Get this sorted quickly
- What next? go home, what can I do?
- How have the residents been? Any problems? Take control
- How to regain control
Emotions - what we feel
- Ricochet of emotions
- Not again
- Downbeat and unhappy
- Creates a negative environment/atmosphere for everyone
- There's an instinct to laugh (it doesn't feel real)
- Frustration, challenging
- Feel frustrated, how are we going to cope
- Frustrated and scared
Behaviour - what we do
- Try not to react, go out for 5 minutes, support the staff
- Support staff, get advice, discuss
- Step back
- Step up, try to keep calm
- Work is a drag
The group identified and planned two interventions which aimed to help them take space to focus on themselves and cultivate stronger relationships: the afternoon tea and the tea-brief. In the three month period between workshop two and three, the group had the opportunity to test out their intervention.
The third workshop acted as an evaluation of the interventions, as well as a space to reflect on the process and how to address ongoing challenges in the sector.
Test of change
The improvement idea was intended to act as a test of change roughly following a Plan-Do-Study-Act cycle over a three month period. The group developed key evaluation questions as part of their work together as a means of studying their change. This approach was chosen because it allows for the iteration and flexibility necessary in a practice environment.
What did the interventions seek to achieve?
The group wanted to address the feelings of frustration and helplessness that emerge when they had to face incidents outwith their control. While the group acknowledged that stress is part of the job, they wanted to look at how to manage their reactions better and support each other rather than rush to 'fix' the problem or move onto the next task.
The tea-brief wasn't tested between workshop two and workshop three because of staffing challenges.
The idea for the tea-brief was not shared with the full staff team, and although the smaller group felt it was an intervention that would be helpful, they recognised that it would need to be embraced by all staff (particularly shift leaders) to be implemented effectively.
The initial issue that had prompted the need for the tea-brief (stress and distress of one particular resident) had also improved greatly because of input from specialists, which may have meant there was a less immediate need for the intervention. The care home also introduced a step up/step down bed to the home to support reablement, changing the profile of needs of residents during this time.
The group reiterated that the communication in the care home is good, but always about residents. This was compounded by a change in staffing which meant that staff were having to introduce residents to new staff on shifts, not leaving time to think about their own experience. There is continued pressure on the team, and making sure that quality of care is not compromised was a priority for staff above improving their own experience.
The group suggested that once the staffing levels were more stable, they could have a whole team meeting and add the 'Tea-brief' to the agenda. The group also wanted to share this idea with other services who may be in a better position to implement this.
Afternoon tea evaluation
The group tested out an afternoon tea with staff, residents and older people who access daycare. It was an opportunity for staff to take time to slow down and spend time together, which came as a surprise to some:
Staff seemed surprised to be asked to come along and leave everything behind just for the opportunity of having a cup of tea and a blether.
There was music in the background, reminiscence and staff who work in the kitchen helped out by baking cakes, and were invited to take part.
The group identified some key outcomes from the small test of change including a more cohesive resident and staff relationship and an opportunity for the full staff team (including kitchen staff) to come together. Some staff were called away to a resident incident, so perhaps didn't get the full benefit, but this is an inevitable part of the job.
However, the afternoon tea was time away from work, and the group reflected that in the future, the shift leader responsible on the day would really need to buy into the benefits of the afternoon tea in order to free up staff time.
The group wanted to repeat the experience regularly and expand into tea dances. The intervention had no real cost impact, but if it became more regular the group agreed that they may need to use their amenity fund.
However, my own reflection on this intervention was that it evolved to be very resident focused rather than on the breathing space and reflection space for staff. This is a reflection of the inclusivity of the staff team, and a helpful reiteration of how challenging it is for social care teams to focus on themselves.
Overall learning and challenges
The group struggled initially with speaking about their own experiences, particularly because it sometimes came off as negative. The environment the staff team were in was supportive, and they felt like their relationships were an asset.
The tea-brief was not tested in practice because of changes in staffing. The intervention was identified as being culturally challenging in itself and the group worried that staff might find it a bit "airy fairy" or might see it as just an excuse to have a break rather than protected reflection time. The group identified a challenge in implementation as the staff team changed radically during the time period between the second and third workshop.
A key challenge throughout this journey was capacity to respond to challenges. There was a radical shift in staffing changes due in part to a change in agency staffing and a flu outbreak that meant 10 staff (of a team of 20) were not in work over an extended period of time. The group identified that to make the changes they wanted to see, they would need:
Time in the workplace to discuss how we can move forward.
The group also identified that it was sometimes difficult to focus on themselves rather than on residents. This was an ongoing challenge throughout the process and the group needed to be regularly reminded that this project was about the experience rather than practice. However, despite the challenges associated, some members of the group found it worthwhile.
I was surprised that the workshops were mainly aimed at understanding staff's feelings and emotions (and my own) from that opened up discussions which were interesting and informative.
Outcomes for the group
The process was new for the group, and after an initial session with a much larger group, a smaller cohort of five core staff attended the last two workshops. This smaller group was more conducive to idea generation and reflection and formed a strong relationship with one another.
I feel closer to staff members that attended with me
The group also enjoyed talking through common problems together and developing ideas. There was a particular energy that came with the feeling they had a shared experience and the environment welcomed discussion around solutions.
It was good to hear how other staff felt about work problems and ideas of how to overcome them
Challenges of a rural care home
NHS Highland has pursued a lead agency model of integration which means the recruitment of support staff now follows NHS procedures. The group felt this had a knock-on effect on their ability to recruit and retain staff. The new system offers less flexibility in terms of shifts (for example, a person cannot have a set shift pattern such as nights), and the method of recruitment has become corporate rather than local.
The group also discussed the pressure of staff having to work towards SVQ2, a qualification that some staff find daunting. The team felt that the mandatory qualification might exclude individuals who are excellent carers but may not have the language skills or confidence to undertake the qualification. Ultimately, the group felt that support staff had the opportunity to learn and grow, but currently, the recruitment of care roles made training feel like a prerequisite rather than a supported process. The team felt that their recruitment challenges could be improved if they were able to manage recruitment locally, portraying the opportunities of working for the Telford centre and the career opportunities in a local context.