Practice Team Leader

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Practice Team Leader
Induction Training
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Objectives of session

• Overview of strategic plan 10 key themes
• Improving practice and service quality
• Sustaining and developing local services
• Increasing reach and local presence
• Explore what are our practice strengths,
  challenges and opportunities
• How can you build on these and continue to
  improve?

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Strategic Plan- Ten Themes

• Raising awareness
• Influencing change and promoting rights
• Sustaining and developing local services
• Increasing reach and local presence
• Improving practice and service quality
• Investing in our people
• Research and collaboration
• Efficiency and effectiveness
• Raising funds and increasing support
• Developing innovations and creating new
  opportunities

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Improving practice and service quality

• Introduce, train and support new service role of
  Practice Team Leader (PTL)
• Every member of service staff will be trained to
  the appropriate level on Promoting Excellence
  Framework
• Introduce a leadership training programme for all
  managers
• Ensure maximum use of professional development
  fund
• Support all staff to attain relevant level of
  Scottish Vocational Qualification (SVQ) and
  registration
• Ensure that the quality, delivery and content of
  training programme is of the highest standard and
  relevant to the issues faced by local staff and
  services
• Support services to develop and improve
  transition planning post diagnostic support
  service audit and quality approaches and person
  centred support
• Engage with relevant lesbian, gay, bisexual and
  transgender (LGBT) organisations and develop an
  organisational strategy to ensure equality of
  access and treatment
• Engage with relevant black and minority ethnic
  (BME) organisations and develop an organisational
  strategy to ensure equality of access and
  treatment

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Sustaining and developing local services

• Develop new Enhanced Sensory Community Care
  (ESCC) therapeutic model for people with advanced
  dementia using our services and use this to
  inform 2015 policy report
• Open three new Dementia Resource Centres (DRCs)
  each year
• Develop a strategy for each region to promote
  personalised support services and self-directed
  support
• Consolidate and build on the role of Link Worker
  ensuring all Link Workers deliver on the 5 pillar
  model and meet the new Post Diagnostic Support
  HEAT target
• Ensure that each service area provides a balance
  of peer support activity and therapeutic group
  activity
• Ensure that the Dementia Advisor Network
  continues to offer a high quality local service,
  reaching as many people and carers as possible
• Ensure that our services are financially
  competitive and sustainable and local fundraised
  contributions are used to add value
• Make sure our services are the best possible
  quality

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Increasing reach and local presence

• Recruit, induct and train six new Deputy Regional
  Manager (DRM) posts
• Each Regional Manager will develop a regional
  strategy that will include supporting new and
  existing membership engagement liaison and links
  with branches regional fundraising focus and
  strategy ensuring representation and policy
  engagement in new integrated bodies
• Develop a national campaign to increase members
  and develop an on-going engagement strategy to
  link members into both national and local
  activity
• Use social media to engage regionally locally
  and extend reach
• Develop Alzheimer Scotland online community
  groups, blogs, live chat and QA
• Put in place a clear database strategy
  profiling, data capture, re-segmentation and
  re-targeting
• Review and develop Alzheimer Scotlands brand and
  introduce across each region and nationally

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What are our practice strengths

• What do we mean by dementia specific?
• How do we evidence this in our day services and
  individual support?
• What type of activities best support this and how
  does this relate to each person's support plan?
• Do we explain this to partners and families?

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What are our practice challenges?

• How do we deal with more complex care within same
  staffing and budgets?
• How do we continue to demonstrate we offer better
  value for money in this funding climate?
• How do we ensure all staff are driven by our
  practice values and provide best possible
  standard of care at all times?

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Role of Practice Team Leader

• So whats different?
• What do you want to change or improve?
• What is your role as a leader and change agent?
• What will you need to help you in this?
• What will your personal action plan be?

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Policy into Practice
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Human rights based approach

• Participation
• Accountability
• Non Discrimination
• Empowerment
• Legality

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Personalised supports

• Mandatory training aligned to Promoting
  Excellence Framework
• Peer Support
• Person Power Module

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Support for carers

• Lloyds Live Well Officer - 3 year post
• Creative Breaks Fund - into year 3 (helping to
  inform Self-Directed Support activities
  self-design)

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What else?

• Getting to know me
• KIS (NHS Key Information Summary)
• Sensory Programme (ESCC)
• LGBT champions
• Black Minority Ethnic (BME) work
• Telecare e.g. GPS systems
• Induction revision (training for trainers)

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Innovation in PracticeFrom dogs to clocks
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Valuable Digital Applications for people affected
by Dementia
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the game jam
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Pocket Pal allows people to record personalized
support prompts for their daily tasks, such as
making coffee and washing clothes.
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Transitions
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People may need to consider

• What information they need to make their decision
• What are their options
• What are the potential costs and benefits of each
  option (this may be financial, emotional,
  practical)
• Do they have any experience of making similar
  decisions or would they like to speak to someone
  who has had a similar experience or is there a
  resource you can signpost them to.

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Making transitions easier

• Always tell people from the outset about
  transitions and how they will be informed and
  supported during these times
• What are the persons preferences what is
  practical and possible to achieve within their
  chosen preference?
• Who is in their circle of support and how will
  they be involved in assisting the person to make
  their decision?
• How can the person be supported to maintain links
  to their community, spirituality and their social
  networks?
• What type of activities interest the person and
  how can they be supported to engage in them?

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• Identifying and communicating potential
  transition points i.e when your service would no
  longer be suitable for the person.

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• Talk to the person, their family and people who
  know them well to gather information about how
  they have managed other transitions in their life
  and what their personal preferences are

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• Discuss transitions with the person and record
  who else they may wish to consider involving at
  these times

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• Advise when they likely major transitions points
  will be and how you will communicate when those
  points are approaching.

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• If there is a clear pathway in place for people
  to transition, let people know what the pathway
  is.

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• Keeping the person and their family/ supporters
  and other professionals informed when possible
  transitions are approaching and discuss their
  feelings about it.

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• Discuss the possible options available at the
  transition point, ensure the person has the right
  information, advice and support to enable them to
  make an informed choice and agree a plan for the
  transition.

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• Discuss possible transitions at outcomes focused
  review session.

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• Consider the impact of the transition on the
  persons sense of identity, independence and
  self-esteem and agree a plan to minimise any
  negative effects. Ensure family/carers/supporters
  feelings are addressed within the transition
  support plan.

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• Ensure support is in place for the person to
  adapt to their new circumstances

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Risk Enablement
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• Risks should be taken to achieve specific goals
  in the light of possible harms occurring
• (David Carson 1988)

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• Pursue a course of action in order to realise
  one or more beneficial outcomes, in the knowledge
  that there are consequences or outcomes that
  would be perceived as negative or harmful in
  nature should they occur
• (Saunders 1998)

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The Law

• The Health Safety at Work Act 1974
• The Management of Health and Safety at Work
  Regulations 1999 (Risk Assessment)
• The Human Rights Act 1998
• The law requires reasonable professional conduct
  according to appropriate standards

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The Law

• No law prohibits safe risk-taking
• Legal areas which affect practice
• Recklessness (criminal)
• Negligence (civil)

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Risk a matter of balance?

• Potential beneficial results
• Harms that might result

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Justifying Risk Taking

• Make the possible positive outcomes explicit!
• Why are we taking these risks?

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Ethics and Benefits of Risk Taking

• Benefits judged more important than possible
  harms
• Risk taking is value laden but should consider
  moral values
• Outcomes can be beneficial, harmful or both

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Rights and Risks

• The right to exercise informed choice
• There may be tension between physical safety and
  right to self-determination
• There may be differing agendas
• Recognise strengths and abilities as well as
  difficulties

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Decision Making

• A process
• Must be shared
• Must be monitored and reviewed
• Needs to be modified by people/circumstances
• Needs relevant expertise

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Risk Management

• Risk will not
• usually be eliminated!

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Formal Approaches

• When
• Very serious outcomes are possible
• The situation is very complex
• Opinions differ and a consensus is not easily
  reached
• An existing plan is not working or is not adhered
  to
• On basis of experience probability of high risk

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The Planning Meeting

• Must be recorded
• Assessments and opinions shared
• Identify key stakeholders
• What do people have to gain or lose?
• Information available considered
• Recommendations made plan of action roles and
  responsibilities arrangements to monitor and
  review

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Be a Risk Taker

• Support pwd in the taking of risks
• Feel good about the decisions you have made
• Understand and be able to explain to others why
  you have made these decisions include
  values/principles that underlie your decisions

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Case Study

• Mrs D has been attending your day service for 2
  years. She has Alzheimers disease and you have
  noted a marked change in recent months in Mrs Ds
  abilities
• One of the few activities Mrs D still enjoys is
  being in the kitchen and helping with cooking and
  clearing up. She now shows a greatly reduced
  awareness of factors relating to her own safety
  and that of others. She moves very quickly,
  lifting and laying hot items and becomes very
  irritated with anyone who tries to help her or
  guide her away from hazardous activities. At
  home, Mrs Ds husband has fitted a lock to their
  kitchen door and doesnt let her in there at all.
  He reports that although this keeps her safe, she
  becomes extremely agitated and angry with him.
  You have decided to carry out a risk assessment
  because Mrs D says she loves being at the centre
  so that she can be in the kitchen
• Complete a risk assessment enablement plan for
  Mrs D

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Being Person Centred and Planning Outcomes
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A good life for Alastair

• Case study
• How could Alastair
• be best supported?

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What do we mean by being person-centred?

• Person-centred thinking and planning is a set of
  values and skills that involves asking questions
  that keep the focus on the person and the
  persons priorities for their own life.
• The person is kept at the centre, and the
  expertise of the person and those closest to them
  are valued as key sources of person-centred
  information about how the person wishes to live,
  their hopes and dreams, their gifts and skills,
  what is important to them, and what makes good
  support for them.
• Person-centred approaches provide an agenda that
  is focused on the values of inclusion and on
  enabling the person to live a valued life as a
  contributing citizen and friend in the community
  on their own terms.

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Person Power(person centred thinking ( acting))

• Whats important to/for you?
• The power of relationships friendship
• Circle of Support

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Personalising support

• The power of contribution!
• Gifts

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Loneliness and isolation
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Outcomes

• The impact or end result of services/supports on
  a persons life
• The person or carer is involved in identifying
  desired outcomes setting goals in partnership
  with services

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A good life?

• What makes life worth living for you?
• Any themes emerging?

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Talking Points Outcomes
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Having an outcomes focused conversation.

• What do you say?

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Therapeutic Interventions? (8 Pillars model)

• What kinds of things are we doing?
• Cognitive Stimulation Therapy (CST) ?
• Inheritance tracks
• http//www.playlistforlife.org.uk/

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The Nun Study

• Aging with Grace
• The Nun Study and the Science of Old Age How we
  can all live longer, healthier and more vital
  lives
• By David Snowdon
• http//www.youtube.com/watch?vnw2lafKIEio

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Capturing the Outcomes
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Participation empowerment
Agreement that everyone is very enthusiastic
about the group with the men saying that of
themselves and of the staff and volunteers
Always like outings so more of them would be
welcome
Whole layout is fantastic. Bigger than was led
to believe. Great place. Should be replicated.
gardens are kept nice- lovely If choice
between something like building being painted and
other staff, would choose staff how building
looks is not a priority.
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• How do we do this at the moment?
• Could we be more creative?

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Managing Staff
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Topics

• Personalising approaches to recruitment
• Increasing staff retention satisfaction
• Balancing contracted/sessional staff
• Managing banked hours

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Personalising Approaches to Recruitment

• Standardised recruitment procedures
• Care Inspectorate requirements
• Areas to be standardised
• Advertising
• Application Form
• Shortlisting and interviewing
• Pre-employment checks

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• Areas that can be personalised
• Where to advertise
• Recruitment tests

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• Staff Retention
• Average length of service is 14 years.
• Key areas of turnover occur
• Within the first 6 months
• Between 3 4 years service
• Initiatives to reduce help improve retention
• Remember not all turnover is negative.

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Increasing staff retention satisfaction
continued

• Staff Satisfaction
• 2013 Staff Survey - 86.4 level of satisfaction
• Line managers impact on staff satisfaction
• Communication team meetings
• Support Guidance supervision appraisals
• Autonomy control experienced staff
• Team working

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Balancing contracted/sessional staff

• Service Dependent
• Flexibility
• Risks
• High contracted hours/low availability
• Sessional staff can refuse shifts
• Employment law status

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Managing banked hours

• Key points when managing flexible contracts
• Regular monitoring
• Availability
• Review contract hours
• Communications
• Ownership

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• Questions?

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Quality Control
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Service Audit

• Tool is currently being reviewed
• Can be used as a checklist to ensure standards
  and procedures are being followed
• Includes
• Self-assessment section (pre service audit)
• Main audit sections general quality check
• Personnel file audit template
• Enhanced Performance Checklist (spot checks)
• Carried out by Regional Manager or another
  Service Manager

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Care Inspectorate (CI)

• 2 sets of guidance on intranet (care at home /
  not care at home)
• Guidance follows CI quality themes / statements
• Includes suggestions of possible evidence sources
  from
• Alzheimer Scotland policies and procedures
• Local service approaches
• Legislation and external guidance
• Be aware of different terminology used by CI
  (personal plan)
• Can be useful to gather documented evidence on
  ongoing basis to present at inspection

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Customer Satisfaction Questionnaires

• Strategic Plan(2013-2016)...90 of people with
  dementia and carers using our services rate them
  very good or excellent
• Results fed into Survey Monkey
• Services produce local summary report (template
  on intranet)
• Organisation-wide summary report produced by PDT

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Participation empowerment
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Support Worker Feedback

• Vital aspect of evidencing quality of service
• Guidance on intranet for this
• Use of case studies/examples in how to feedback
  effectively
• Can be used at support supervision to
  facilitate discussion and capture outcomes
• Feed into review process and updating of support
  plans as required

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Reviews

• Initial review at 6 weeks after service starting
• Ongoing reviews must be no less than 6 monthly
• Need to capture both outputs and outcomes of
  support
• Dont need to be face to face meetings be
  guided by individual preference (recorded in
  Support Agreement)
• Can do telephone reviews
• Any changes to Support Plan/Risk Enablement Plans
  must be signed and dated

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Feedback and questions