By the late 1990s, caregivers started to question the benefits of clinical paths. Organizations reported problems integrating the pathway document into patient records, thus dampening caregiver enthusiasm for using the pathway. Physicians, nurse, and other clinicians found the pathways difficult to apply to all patient populations. A variety of factors may be causing clinical paths to look like yesterday’s failed solution, when in fact the lessons learned during years of pathway development are being put to good use in many organizations.
Today caregivers are adopting outcomes-based practice methods to achieve desired patient care goals. Outcomes-based practice (sometimes called outcomes management) involves a combination of teamwork, continuous quality improvement, and process and outcome measurement. These collaborative multidisciplinary efforts build on the pathway development work of the 1990s. It’s quite likely that outcomes-based practice would not have been possible if caregivers hadn’t learned how to work together while designing clinical paths.
All of those multidisciplinary meetings to develop paths were not a waste of time! Paths and Outcomes-Based Practice Caregivers have discovered that an “as needed” pathway philosophy seems to work best. Clinical paths were never intended to solve every documentation challenge, eliminate every unnecessary cost, or be used for every patient. Instead of trying to develop an unlimited number of clinical paths, organizations are now adopting outcomes-based practice as the goal. Paths are viewed as one of the many different tools caregivers can use to achieve that goal.
The Research paper on Evidenced based practice
This paper discuses a research proposal on the above topic. Study on the effectiveness on the bone marrow transplant is essential to determine the best practice possible to revive patients back to health. The study will review on the literature available for the topic and discuss the current practice. The study will consider authoritative literature based on the topic and what is related to it. ...
An outcomes management initiative starts with the decision to improve clinical care for a particular group of patients. All involved caregivers must agree that it is important to study and improve the process. Improving a clinical process is hard work and unless the physicians, nurses, and other team members are rooting for project success, their interest in the initiative will be short-lived. Administrative and medical staff leaders should jointly define the goals for the project.
Once the patient population for the project is chosen a multidisciplinary team of people involved in caring for these patients is formed. After studying current patient care practices, the outcomes management team selects the actions necessary for achieving the project goals. What people have learned from their clinical pathway experiences is that the process improvement actions should be chosen after everyone knows what needs fixing. Otherwise organizations end up with “solutions in search of a problem” rather than measurable improvements.
Any number of actions can be taken to achieve the goals of an outcomes management project. For example, if data show that physician practices vary widely for no particular reason and reducing variation is a goal, then physician-friendly tools are developed. It’s unlikely that physicians will use a clinical path located in the nursing section of the patient’s hospital record. That’s why hospitals are designing physician-friendly point-of-care reminder tools such as pre-printed order forms.
As order entry becomes computerized, written order sets can easily be converted to an electronic format. Computerized decision support systems are another effective tool for changing physician practices. These automated systems offer physicians point-of-care treatment advice for a variety of conditions and diseases. Protocols are also an effective strategy for reducing undesirable variation in patient care practices. Unlike clinical paths that cover all aspects of care for a particular group of patients, protocols are designed for specific clinical situations, e. . administration of heparin, management of postoperative nausea, treatment of pressure sores, etc. Protocols can be used by themselves or in combination with clinical paths. In the latter situation, the protocol serves as an expanded definition of the ideal plan of care found on the pathway. For example, a clinical path for oncology patients undergoing chemotherapy might state, “Initiate anti-emetic protocol. ” The path helps to remind physicians and nurses that the anti-emetic protocol should be implemented at a particular time.
The Essay on Terminal Ill Care Patient Family
Assumptions And Principles Underlying Standards For Care of The Terminally Ill Introduction There is agreement that patients with life-threatening illnesses, including progressive malignancies, need appropriate therapy and treatment throughout the course of illness. At one stage, therapy is directed toward assessment and intervention in order to control and / or to cure such illness and alleviate ...
The protocol contains all the treatment details that would be impossible to completely spell out in a less detailed clinical path. Good Data is Essential The outcomes management project team focuses on fundamental changes in systems and practices that are most likely to produce positive long-term gains. The team does this by determining the barriers to goal attainment and then incrementally investing in strategies to achieve these goals. The project team must learn how to analyse practice pattern data to determine the best interventions and then monitor the success of various strategies.
Each initiative requires timely feedback of process and outcome measures to the clinicians. Clinical paths are not close to extinction. These patient management tools will continue to be key components of the outcomes management initiatives in many organizations. However, unlike the situation in the 1990s, a clinical path will not be the primary tool used to control costs and improve patient outcomes. Clinical paths have been joined by a variety of different tools and techniques which are all intended to improve patient outcomes and reduce unwarranted practice variation.
Regardless of how health care organizations implement outcomes-based practice, there’s one certainty – caregivers will always need valid, reliable and timely information about important clinical processes and patient outcomes. Copyright 2003 by Brown-Spath & Associates Critically review approaches to outcome based practice Outcome based care is about putting the person at the centre of the care service, and not prescribing a standard service to everyone. It is about delivering meaningful outcomes to every individual and helping people to lead more fulfilling lives.
Outcome based care requires careful planning, which involves working with the people who use our services to help them identify and achieve the things they want to do. Delivered well, outcome based care increases interest and motivation and creates the enthusiasm needed to support people to lead a more fulfilling life. Analyse the effect of legislation and policy on outcome based practice Analyse the data. Depending on the types of data you collect and the nature of your evaluation, analysis may involve qualitative, quantitative or a combination of both methods.
The Essay on Pay for Performance Best Practices
Best practice can be defined as an idea that suggests that there is some sort of technique, method, process, incentive or reward which is considered to be more useful at producing the desired outcome or result for the company than any other technique, method or a reward etc. The performance best practice is mostly done through checklists or rating scales etc. so that the desired outcome can be ...
When describing program activities or experiences, qualitative analysis is appropriate. Quantitative analysis is used when trying to assess policy outcomes and impacts. Explain how outcome based practice can result in positive change in individuals lives An outcomes-based approach encourages us all to focus on the difference that we make and not just the inputs or processes over which we have control. Success for the Government and its Public Bodies is about impact and it is right that we should be judged by tangible improvements in the things that matter to the people of Scotland.
Government is therefore committed to an outcomes based approach and will work with Public Bodies to: Align activity to connect explicitly to the Government’s over-arching purpose of sustainable economic growth through the National Performance Framework Scotland Performs. Better integrate activities with local government, with other Public Bodies, and in partnership with the third sector and private sector, to deliver the Government’s Purpose Targets and National Outcomes.
The current development of Single Outcome Agreements (SOAs) with community planning partnerships, under the leadership of local authorities, offers a significant opportunity for Public Bodies which are delivering local services to help achieve this locally. Focus activity and spend on achieving real and lasting benefits for people and as such minimise the time and expense on associated tasks which do not support this purpose. Create the conditions to release innovation and creativity to deliver better outcomes. 2.
Able to lead practice that promotes social, emotional, cultural, spiritual and intellectual well being Explain the psychological basis for well being Key points: The psychological well-being of young people (a) Psychological models of mental health, quintessentially, emphasise the key role of a Healthy, loving, supportive, connected childhood in producing well-adjusted adults. (b) It must clearly be a key policy aim to protect children from abuse, to identify children at risk from abuse, and to help address any problems resulting from abuse at the earliest possible stage. c) We therefore fully and unequivocally support the emphasis in ‘New Horizons’ and elsewhere on the importance of a healthy start in life. As elsewhere, investment in positive policies to support parents, families and communities will pay dividends in terms of a healthy adult population. (d) When specialised care in needed, a well-being focused approach should be used within services to address a child’s or young person’s physical and psychological needs. Promote a culture among the workforce of considering all aspects of individuals’ well-being in day to day practice.
The Essay on Tesco organisation culture
The purpose of the essay is to critically analyse a key organisational behavioral and/or human resource issue facing an organisation of our choice. The author will be looking at the important issues surrounding the fall and challenges of Tesco in China. This essay is to show an understanding of the general cultural differences between UK and China by applying the cultural dimensions of Hofstede. ...
The implementation of The Wellbeing and Performance Strategy requires an Agenda for Action. The purpose of this agenda is to embed into the organisation a culture, attitudes and daily behaviours that result in high levels of wellbeing amongst all staff (managers and employees) and will produce the high level performance dividend that can be measured as lower sickness absence, staff turnover, presenteeism and HR/Manager time on conflicts, disputes, tribunals and other features of presenteeism.
The agenda items also improve involvement, innovation, energy, motivation, engagement, commitment, trust, all of which lead to greater profit/flexible budget, market share, innovation and improved reputation and resilience. The Agenda items are: * 1. Engage top management in the Wellbeing and Performance Agenda * 2. Undertake an analysis of the current levels of wellbeing and performance * 3. Establish a steering group * 4. Develop a strategic framework for action * 5. Build a culture for wellbeing and performance * 6. Develop the ethics and behaviours that produce wellbeing and performance * 7.
Take the actions that produce wellbeing and effective performance * 8. Strengthen personal resilience * 9. Implement change management utilising the Managers Code of Conduct 1. Engage top management in the Wellbeing and Performance Agenda Senior management influences the behaviours of those below them, and senior management set the tone for the organisation. The culture of the organisation is heavily determined by the personalities and characteristics of senior managers, and their own determination in promulgating a wellbeing and performance culture.
The Essay on Organisation Culture A Gung-Ho Culture Rules
Brazilian-managed beverage giant InBev NV isn’t a household name in the U.S. now, but if it proceeds with its unsolicited bid for Anheuser-Busch Cos., its high-octane corporate culture could easily overwhelm the iconic U.S. brewer. |[pic] | |Bloomberg News/Landov | |A production line at InBev’s brewery in Leuven, Belgium | That culture is on display each workday at the 7:20 a.m. sales ...
This will normally necessitate the champions of wellbeing and performance to raise awareness of the arguments, and issues relating to wellbeing. 2. Undertake an analysis of the current levels of wellbeing and performance A survey of staff provides the benchmark against which the effect of various wellbeing initiatives can be measured. A year on year assessment of progress can be made, and those initiatives which show least impact can be dropped in favour of those with greatest impact. Various surveys exist with different purposes.
At the least, all organisations that employ 5 or more people are obliged to demonstrate they comply with the Health and Safety Management Standards. More comprehensive surveys examine the health and wellbeing of staff, the quality of working lives of staff, the intention to leave or stay amongst staff, and the assessment of the organisation in relation to commitment, trust and engagement. The results of a survey provide the information to focus attention of specific actions that are needed to build and sustain a culture of Wellbeing and Performance. 3. Establish a steering group
Many organisations are made up of different divisions and departments, with different purposes. They will have different managers and perform differently. In order to promote a wellbeing and performance culture, it may be necessary to establish a steering group to oversee and take responsibility for this project. A steering group needs to have decision makers on it, as there will be decisions about resource allocation that will be necessary. 4. Develop a strategic framework for action A strategic framework provides the focus for action, and a map against which progress can be routinely measured.
A suggested framework embraces * a) promoting wellbeing and performance and the prevention of risks of psychological distress and other forms of ill health and accidents; * b) preventing deterioration amongst those who suffer distress; * c) restoring those with psychological distress back to their normal level of performance and beyond; * d) supporting those with chronic conditions and * e) sustaining wellbeing and performance. In addition, a strategy will need to consider the services and training required to implement a wellbeing and performance programme.
The Business plan on Customer Service Essay
Excellence in customer service is the objective of all organisations wishing to be successful. However, there is often a gap between customer expectations and management perceptions of customer expectations. Organisations often fail to get close to their customers and correctly read their expectations. Customers expect certain things when they walk into a business, and those with the highest level ...
Suggested topics are Behaviour, Wellbeing programmes and services, Structure, Culture, Resilience and tolerance. 5. Build a culture for wellbeing and performance The culture of the organisation embraces the features that influence how people behave. In building a culture of wellbeing and performance the features need to be those that promote commitment, trust, engagement and a strong psychological contract – the idiosyncratic unwritten contract that individuals have between themselves and their organisation based on personal notions of fairness.
Most psychological contracts are based on the behaviour that managers and employees exhibit towards each other that denote trust, value, and reliance, where each party engages fully with each other and builds trust between them. For this to happen, the context in which behaviour takes place needs to promote values that accord with the values of the employee. The steps to be taken in building a culture of wellbeing and performance are: Clarity of purpose – The clarification of the purpose of the organisation and its sub divisions in ways that are simply expressed, and that staff and the public can understand and relate to.
The structures – The design of structures that enable staff to be engaged in decisions about themselves and their work. The ‘rules’ – The rules are the policies and procedures that are expressed (often in writing) that describe how the organisation is meant to work. Among the topics that are known to influence trust and commitment are: * Recruitment – The recruitment of managers and staff based on the convergence of clear and unambiguous expectations of the skills, knowledge and experience needed for the job and those of the applicant. Training and development – The training and development (the acquisition of skills, knowledge and experience) of all staff based on meeting the needs of the organisation and those of the trainee; the training is based on sound learning principles, and applied in practice. * Challenge –
The provision of challenges and stimulation in the work employees and managers are expected to perform. * Teams – The building of teams with people who are sufficiently trusting of each other that they can critique each other’s work without fear of humiliation or retribution, and in the knowledge that lessons can be learnt and applied. Communication – The provision of excellent communication – the process of engaging people in communication, interpreting messages, conveying them intelligibly, seeking responses, and reacting to them positively. * Involvement – The involvement of staff, organisations and customers/clients in the processes and decisions that affect them. * Performance appraisal – The provision of regular and routine performance appraisal of staff as part of the bloodstream of management, together with providing appropriate supporting resources to raise performance where needed. Career development – The provision of career development opportunities through nurturing and developing staff to use wider skills, knowledge and experience in practice. * Security – The protection of tasks, projects and assignments from termination in advance of their completion. * Encouragement – The encouragement of staff in their work, and in taking calculated risks intended to contribute to the performance of the organisation. * Worklife balance – The motivation to respond positively to domestic crisis. * Openness – The maintenance of transparency in all aspects of management.
These ‘rules’ need to be formulated in consultation with managers and staff, and implemented into the bloodstream of management through a range of devices that reinforce the ‘messages’ of trust, commitment and engagement. 6. Develop the ethics and behaviours that produce wellbeing and performance The behaviours that managers need to demonstrate are those that build and sustain trust, commitment and staff engagement. These behaviours are the building blocks for a Wellbeing and Performance culture. The headlines are in the diagram. Attentiveness * Politeness * Courtesy * Personal communication * The Use of Body language Addressing needs * Empathy Intellectual flexibility * Emotional intelligence * Negotiation * Sharing Reliability * Honesty * Clarity * Fairness * Humility Resolving conflicts Encouraging contribution These behaviours can be developed in every manager and staff member using Corporate Cognitive Behaviour Therapy (CCBT) approaches, in a coaching or group workshop setting. This involves replacing ambivalent attitudes about people at work with positive thoughts that promote the benefits of positive interaction, and the benefits that accrue from gaining commitment, trust and engagement between staff and managers.
. Take the actions that produce wellbeing and effective performance The actions required from managers who wish to implement the Wellbeing and Performance Agenda are divided into the classical purposes of management. They are: Decision making * Justification for decisions based on appropriateness, evidence, experience, timeliness and feasibility. Direction * Providing direction based on analysis and with committed ambition. Co-ordination * Integration of the mosaic of available resources to achieve a declared aim. Control Reaching an agreed goal within agreed boundaries of time and resources. * Keeping resources at his/her disposal within agreed boundaries. These classical purposes of management normally form the basic training for managers. There are technical and psychological aspects in their application to practice. The psychological aspect embraces the ability to follow the ‘Just a Minute Model’ of performance, that seeks to ensure that actions are taken without hesitation, deviation or repetition, and that the decisions are appropriate, efficacious, effective and efficient.
This requires intense concentration by managers, and is the principal benefit arising from a Wellbeing and Performance strategy, and a Positive Work Culture. 8. Strengthen personal resilience Resilience is the capacity to tolerate excessive demands and stresses without experiencing personal stress. Resilience is about the maintenance of person control in adverse situations, combined with the capacity to control the responses of others to oneself in these situations. Resilience is based on individual attitudes towards an adverse event.
Attitudes are developed from conditioning throughout life, combined with personal experiences that have either built or reduced self esteem (depending on one’s capacity to cope with the situation), combined with a decision to be motivated to overcome and tolerate an adverse event or not. Most people have built a degree of resilience, simply through the process of experiencing challenges and rising to them successfully. However, there are some established adverse events that pose a risk to individuals. Many of these arise in the workplace.
A substantial number of people are not prepared for these challenges and find them difficult to tolerate, causing a lowering in performance, reduction in motivation, and the possibility of significant distress. Training in building the capacity for resilience is an important aspect of the Wellbeing and Performance Agenda. 9. Implement change management – the Manager’s Code This is a method of change that uses a Manager’s Code that all managers are expected to follow. The Code is based on the principles of a Positive Work Culture and the link between wellbeing and performance. The Manager’s Code focuses on: Managing my Organisation * Managing my Enterprise * Managing my Workforce * Managing Myself. All organisations have the capacity to develop a Positive Work Culture with managers promoting wellbeing and performance. Introducing this approach is made easier with a Code that has been drawn up based on sound principles and supportive of manager behaviours that promote commitment and trust. Implementing the Code needs to follow the enabling as opposed to policing principle. Managers should be encouraged to follow the Code rather than feeling threatened if they don’t follow the Code.
Manager’s need to be convinced a Code is helpful in forming their attitudes towards their staff which encourages high level performance from the workforce by ensuring high levels of wellbeing. Review the extent to which systems and processes promote individual well being In this day and age of individualised, person-centred service provision, effectively promoting and maintaining well-being and choice for people who use services, presents many-headed challenges for service providers, especially frontline staff.
From their waking moments to bedtime as well as throughout the night, providers of adult social care, especially frontline staff, have a social and legal responsibility to ensure that the needs of individuals who use services are being continually met. It is important to note that a key challenge for staff to effectively promote and enhance the well-being of service-users, is in understanding and accepting that it is both a process and outcome involving service-users and frontline staff.
Thus it requires presence of mind, careful consideration and monitoring and evaluation by service providers in order to maximise the quality of life of the vulnerable people who they care for and support. The importance of well-being and the availability of choices is unsurprisingly a common thread which runs throughout the Essential Standards of Quality and Safety outlined by the Care Quality Commission, and involves meeting the needs and aspirations of service-users. Let us consider well-being and choice touching on a few examples during a hypothetical day in the life of a service-user.
The timing, approach and manner in which a service-user is supported to get out of bed impacts on their well-being. Knocking, waiting to be invited in and offering the person choices such as whether or not they are ready to get out of bed and if they are, how they would like to proceed, may make the person feel respected. This may even be the case when the service-user has an established routine. A key challenge for service providers is to ensure continuity of care, so that staff who are familiar with the needs of the service-user are also those who care for and support them.
Effective communication is also important in promoting well-being and choice, as it fosters mutual understanding, which is at the core of the process to facilitate desired outcomes. Achieving this is however fraught with pitfalls, including limited or non-existent knowledge of the best way or means to communicate with individuals. Inappropriate or poor communication also manifests itself in various ways such as making critical comments about service-users who are within ear shot or chatting with colleagues and excluding the service-user from conversations.
This becomes more obvious when temporary staff such as different agency workers who are not properly inducted are called upon on a regular basis to care for and support people they have not met before. Respecting the privacy of service-users is also key in maintaining the well-being of the individual. Thus, invading personal spaces such as barging into bathrooms, bedrooms or quiet areas especially when there is a perceived ‘emergency’ does little to foster well-being. Staff may also unconsciously speak loudly in the presence of others when talking to individuals about things the service-user may wish to keep private.
Issues of confidentiality in all its forms must also be maintained in order to facilitate the well-being of individual service-users. Personal care such as bathing, toileting and managing continence presents its own challenges for frontline staff in their bid to promote, the well-being of service-users who require this level of support. Privacy and dignity is always linked to the well-being of individuals. Another aspect of the service-user’s day which is often taken for granted by staff is nutritional care.
It is generally accepted and a well documented fact that mealtime is among the highlights of a service-user’s day. It is therefore an activity, when managed properly, which improves the quality of the day for the individual. The challenge is for staff to ensure that meals are provided to individuals when and where they want it, and not only at set times when it is convenient for the service-provider. Furthermore, offering a wide range of food choices becomes a logistical nightmare for providers, especially when catering for more than a handful of individuals.
Offering the appropriate cutlery and crockery for the individual service-user is also very important to promoting well-being. Service-users may wish to feed themselves, rather than be fed by staff in what may sometimes be undignified ways. The only inhibiting factors may be the lack of non-slip table mats, especially modified cutlery and the use of ‘pseudo-bowls’ instead of flat plates to reduce spillage, promote independent eating and make mealtimes an enjoyable experience. Regular input from a dietician may also help to ensure that meals are of nutritional value.
Another area worthy of note is that of healthcare and a particular ‘typical’ scenario which springs to mind. A service-user has an appointment with the GP and is supported by staff to attend. The doctor completely ignores the patient and talks to the staff about the patient’s symptoms as though the service-user is not present. No physical examination of the person is made even though required. This attitude of some healthcare professionals seems to be just like this when dealing with patients with learning disabilities.
In such cases GPs need to be reminded that they too are subject to the requirements of the Health and Social Care Act 2008, and are expected to follow the Essential Standards of Quality and Safety when dealing with service-users. It appears that due to the limited or scanty knowledge that some General Practitioner’s (especially locums) may have about certain conditions that fall within the broad spectrum of learning disabilities, there is consequently a perceived reluctance to engage with such patients even when no communication difficulties exist.
It is the writer’s view that this attitude is another subtle dimension of health inequality which needs to be addressed whenever it arises. Such attitudes can diminish the feeling of well-being, which a service-user may have developed over a period of time. The challenge faced by care and support staff is to be confident enough to politely challenge GP’s and other health professionals who display a distinct lack of decorum based on such assumptions. It is also important for staff to encourage self advocacy in service-users.
Good health also has a direct impact on our well-being and more so for someone who is vulnerable or who has a disability. Thus it becomes even more disorienting when people who use services do not understand why they may be feeling a particular way. This is frequently the case when it comes to prescribed medication, its known side-effects and the management thereof. Often staff who have been trained to administer medication to those in their care are not always fully aware of the possible side effects of some prescribed medication.
To promote the well-being of service-users, staff need to learn about the medication their clients take in order to facilitate this. What is also relevant is the need to be acutely aware of pain management strategies and how communication difficulties may affect the ability of some individuals, such as those with dementia or learning disabilities, to express themselves. It is good practice for staff to routinely enquire about well-being and to know the service-users well enough in order to spot signs of pain and discomfort and to then take steps to alleviate this.
Assisting service-users to participate in the wider community, such as attending social/ cultural and religious activities, is another method of maintaining the well-being of individuals (facilitating personal shopping trips also falls within this description).
The challenge for staff is to understand the need for this, and to positively encourage the service-user, thereby making it a worthwhile activity for the individual to undertake. Just as vital is the facilitation of contact with family and friends. Celebrating birthdays in the way the individual chooses is also a great boost to self confidence.
This helps in no small measure to foster well-being and choice. Effective person-centred-planning is therefore key to achieving this endeavour. Promoting the well-being and choice of the service-user may also be achieved in the development of everyday living skills. This may involve staff offering practical assistance to carry out household tasks. It is key however, to use simple tools such as an Everyday Living Skills Inventory (ELSI) form to accurately chart progress. (This may be found in the QCS Management System).
Choice is always inextricably linked to the making of decisions and suggests that at least two options/a range of options/limited alternatives exist, and that the choice is made independently. However in practice this is hardly ever the case. Thus the use of independent advocates is of crucial significance in the quest to promote and maintain well-being and choice for service-users in different care settings. Source: David E Kingsley-Nyinah Be able to lead practice that promotes individuals’ health Demonstrate the effective use of resources to promote good health and healthy choices in all aspects of the provision
It is estimated that illness at work costs UK employers ? 12. 2 billion a year, as a result of sick days taken. Whatever the cause of ill health, it is in the interests of the organisation to support an employee’s return to work wherever possible. Health issues can not only affect the individuals concerned but can also have a detrimental effect on the wider workforce and the organisation’s performance. Organisations should be aware of possible problems and be confident that they have the background knowledge and policies in place to deal with them.
According to research recently conducted by the Institute: “The Quality of Working Life 2007”, 42 per cent of managers reported that sickness rates in their organisation had increased over the last year. 67 per cent of managers who suffered ill health reported that it had affected their productivity levels. There appears to be an emerging trend that absence and sickness rates are on the increase and there is a high degree of ill health that does not necessarily translate into days off but appears to be affecting motivation levels.
This guide seeks to raise awareness of health and well-being issues, the effects on organisations, strategies for dealing with ill health and suggests how a policy may be implemented. Ill health in the workplace It is recognised that many factors from genetics to the external environment can cause or trigger ill health. There are, however, numerous health conditions that can be caused or exacerbated by the workplace: * Stress The adverse reaction that people have to excessive pressure or demands being placed upon them. Stress accounts for one in three new incidences of ill health at work.
This leads to reduced performance of the individual and will also affect others around them. * Musculo-skeletal disorders These include repetitive strain injuries (RSI) and back and joint pain. Problems are increasing principally through the intensive use of computers and other technology, or simply poor manual handling practices such as picking up objects without bending the knees. Posture related health problems are also growing due to the sedentary nature of many jobs. * Minor illness This includes coughs, colds and headaches.
In the majority of cases these do not result in sick leave being taken, but they may affect motivation and performance. * Accidents Injuries and deaths arising from accidents are due to many things including lack of forethought in preventative planning, faulty work practices and unprotected machinery. Whether caused by work or not, employee illness or injury can be affected by workplace support structures. Having practical policies, information and support available can reduce the sick leave taken by an employee, and in some cases prevent an employee leaving. The Business Case
Health issues should be driven by the understanding that improved health and well-being can generate significant employee productivity benefits resulting in higher levels of motivation. Maintaining the health and well-being of employees can have the potential to benefit an organisation in the following ways: * Reduced absenteeism An effective absence management policy and improved health in the workforce can reduce the number of days taken off work and the amount spent on sick pay. * Improved productivity When staff are absent through illness or injury the financial cost is not just sick pay, but also lost productivity and output. Losing fewer experienced staff through retirement on ill health grounds Few organisations can afford to lose expensively trained and valuable employees through ill health. * Attracting and retaining the best staff Effective health and well-being policies and practices can enhance an organisation’s reputation as an employer of choice, helping to attract and retain well qualified, skilled and experienced staff. This has cost benefits as it is estimated that the cost of replacing an employee is about five times their monthly salary.
It also reduces the loss of knowledge through having to replace skilled and experienced employees. * Improving staff morale Institute research demonstrates how healthy staff are likely to be more motivated, productive and committed to the strategic goals of the organisation. * Improving employee relations This enhances corporate image, and helps to reduce conflict in the workplace, which can be a key contributor to workplace stress and absence from work. * Reducing premiums for health insurance A healthier workforce will mean employees have less need to use health insurance; consequently premiums are likely to be lower.
Working ‘Wounded’ One in three managers thought there was a culture of not taking time off for sickness in their organisation. Not all health issues cause employees to take sick leave; some employees while suffering from illness may feel pressurised or are acting through misplaced loyalty when they attend work. This has the potential to affect an organisation in two ways: * employees may prolong their illness resulting in a negative effect on their quality of work. * employees may pass on their illness to others, causing further absence within the organisation.
Both aspects are indicative of hidden costs as there are no costs in terms of sick leave taken, but the reduction in productivity could be more costly in the long term. Managing absence Employees suffering from ill health may need time off work to recover effectively. Providing sickness absence is accurately monitored it can be effectively managed, by such means as: * Keeping in touch If an employee is on long-term sickness leave, just keeping in regular touch at times organised between the manager and the employee will show that the organisation cares.
Regular contact can help prevent feelings of isolation and encourage recovery and return to work. * Return to work interviews These can identify short-term absence problems at an early stage and provide an opportunity to start a dialogue about underlying issues which may be causing the absence. * Disciplinary procedures for unacceptable absence levels These can be applied to make it clear that unjustified absence will not be tolerated and that absence policies will be enforced. There should be robust systems in place to monitor and manage both short and long term absences from work due to ill health. Recuperative programmes These can enable employees with more serious illness or injury to return to work earlier than otherwise possible, by facilitating short term adjustments such as reduced working hours, change of duties or location. The aim is to provide organisational support and flexibility to reintegrate the employee and work towards a resumption of full duties in an agreed period of time. Occupational health professionals can assess an individual’s workplace needs and make appropriate recommendations for recuperative duties.
This can be put in place and monitored following agreement by the employee and their line manager. “Well-being Management” There is some evidence to show that where particular health benefits are offered, absence levels are lowered. These benefits included nutritional advice, health/fitness coaching, private healthcare insurance, health screenings and healthy eating facilities. The concept of well-being should be acknowledged if the full benefits of the business case are to be realised.
This moves beyond the requirements of legislation and is more proactive – encouraging wellbeing and continued attendance at work. There are numerous strategies for well-being, which can be split into two categories; illustrated by the following equation: Well people + well managed = well organisation Well People Promoting healthier lifestyles: ensuring that individuals can perform to the best of their abilities by offering such organisational facilities as: * Advice lines * Coaching services * Counselling services * Ergonomics advice Family friendly policies and procedures that take account of caring responsibilities, domestic crises and bereavement * Flexible work options * Gym membership or provision of in-house gym facilities * Healthy eating facilities * Private medical insurance * Personal evaluation of health risks Well Managed Where innovative and accessible styles of management prevail, managers report a significantly lower number of days’ sickness absence: 1. 94 days in innovative organisations and 2. 50 days in accessible organisations in contrast to the average of 3. 46 days per year.
This is a holistic approach, a way of management that implies a comprehensive review of existing people management practices and takes into account job design, management styles and working environment to improve the productivity of an organisation. Job Design: Good job design increases the employee’s perception of ‘control’ over their working environment. Research suggests that employees who feel externally controlled have a less positive attitude to their work than those who have a higher degree of role autonomy and thus in greater control of their working environment.
Management Styles: A high level of reciprocal trust between manager and employee and innovative and accessible management styles are beneficial in helping to reduce absence rates. Institute research shows that an authoritarian style of management significantly depresses all aspects of job enjoyment and has a negative impact on motivation health and productivity levels. Environment: A well managed work environment also contributes to well-being in terms of good ventilation, appropriate temperature, noise and light control, and good hygiene of air and water.
Developing a health policy Where absence management and stress management policies are in place, there is some evidence that absence is lower, but the differences are not marked, which suggests that some of these policies are not as effective as they could be. Despite high media visibility and a growing awareness of health issues, many health policies are still not always effective. To be able to work towards a healthier workplace, it is important that an effective policy is implemented. Steps that should be considered include: * gain commitment from senior management find out and assess what could cause harm to health within the workplace * identify who might be harmed – public, visitors, employees * consult with employees on solutions to highlighted problems * decide what action should occur to prevent or lessen the chance of harm * determine the responsibilities of managers and contact officers * communicate the policies to employees through effective channels * make available training for managers, health and safety representatives and staff * implement, monitor, and review policy
The culture of an organisation, the type of business and the personality and management style of those in positions of authority are all factors that must be taken into consideration when developing a policy. Summary A healthier workforce means employees are more motivated and productive, have higher attendance levels and return to work more quickly after episodes of ill health. Any well-being policies need to be realistic and considered in their approach, integrated into management systems, giving both employees and managers the willingness to buy into the idea and make it work. Further Information
Further information may be obtained from: Chartered Institute of Personnel and Development http://www. cipd. co. uk/ Provides a series of booklets on mental health, stress at work, and occupational health and an absence management toolkit for managers Desktop Lawyer http://www. desktoplawyer. co. uk An overview the laws applying to different workplaces European Network of Workplace Health Promotion http://www. enwhp. org Provides good practice information for workplace health promotion across all European Workplaces. Federation of European Employers http://www. fedee. com/wellness. shtml Provides a breakdown of a model wellness policy
Health Promotion Agency for Northern Ireland http://www. healthpromotionagency. org. uk Provides public and professional information on best practice for health promotion, along with research and policy advice. Health and Safety Executive http://www. hse. gov. uk Responsible for health and safety regulation in the UK. Also provides a stress management toolkit Institution of Occupational Safety and Health http://www. iosh. co. uk Europe’s leading body for health and safety professionals. Provides a toolkit for the managing of health and safety risks in small firms RSI Awareness http://www. rsi. org. uk
Information, forums, factsheets and directory of support services for repetitive strain conditions Scottish Centre for Healthy Working Lives http://www. healthyworkinglives. com Provides free, confidential advice, resources and support on all aspects of workplace health, available on-line, by phone, or through its network of local Healthy Working Lives Advisors. Welsh Assembly Government http://wales. gov. uk/topics/health/improvement/work/ Use appropriate methods to meet the health needs of individuals The uses of epidemiology and other methods in defining health service needs and in policy development * Participatory needs assessment Formulation and interpretation of measures of utilisation and performance * Measures of supply and demand * Study design for assessing effectiveness, efficiency and acceptability of services including measures of structure, process, service quality, and outcome of health care * Measures of health status, quality of life and health care * Population health outcome indicators * Deprivation measures * Principles of evaluation, including quality assessment and quality assurance * Equity in health care * Clinical audit * Confidential enquiry processes The use of Delphi methods * Economic evaluation * Appropriateness and adequacy of services and their acceptability to consumers and providers * Epidemiological basis for preventive strategies * Health and environmental impact assessment * Health Care Evaluation Frameworks Authors: Rosalind Blackwood and Dr Renu Bindra Implement practice and protocols for involving appropriate professional health care expertise for individuals All clients are entitled to good standards of practice and care from their practitioners in counselling and psychotherapy.
Good standards of practice and care require professional competence; good relationships with clients and colleagues; and commitment to and observance of professional ethics. Good quality of care * Good quality of care requires competently delivered services that meet the client’s needs by practitioners who are appropriately supported and accountable. * Practitioners should give careful consideration to the limitations of their training and experience and work within these limits, taking advantage of available professional support. If work with clients equires the provision of additional services operating in parallel with counselling or psychotherapy, the availability of such services ought to be taken into account, as their absence may constitute a significant limitation. * Good practice involves clarifying and agreeing the rights and responsibilities of both the practitioner and client at appropriate points in their working relationship. * Dual relationships arise when the practitioner has two or more kinds of relationship concurrently with a client, for example client and trainee, acquaintance and client, colleague and supervisee.
The existence of a dual relationship with a client is seldom neutral and can have a powerful beneficial or detrimental impact that may not always be easily foreseeable. For these reasons practitioners are required to consider the implications of entering into dual relationships with clients, to avoid entering into relationships that are likely to be detrimental to clients, and to be readily accountable to clients and colleagues for any dual relationships that occur. * Practitioners are encouraged to keep appropriate records of their work with clients unless there are adequate reasons for not keeping any records.
All records should be accurate, respectful of clients and colleagues and protected from unauthorised disclosure. Practitioners should take into account their responsibilities and their clients’ rights under data protection legislation and any other legal requirements. * Clients are entitled to competently delivered services that are periodically reviewed by the practitioner. These reviews may be conducted, when appropriate, in consultation with clients, supervisors, managers or other practitioners with relevant expertise. Maintaining competent practice All counsellors, psychotherapists, trainers and supervisors are required to have regular and on-going formal supervision/consultative support for their work in accordance with professional requirements. Managers, researchers and providers of counselling skills are strongly encouraged to review their need for professional and personal support and to obtain appropriate services for themselves. * Regularly monitoring and reviewing one’s work is essential to maintaining good practice. It is important to be open to, and conscientious in considering, feedback from colleagues, appraisals and assessments.
Responding constructively to feedback helps to advance practice. * A commitment to good practice requires practitioners to keep up to date with the latest knowledge and respond to changing circumstances. They should consider carefully their own need for continuing professional development and engage in appropriate educational activities. * Practitioners should be aware of and understand any legal requirements concerning their work, consider these conscientiously and be legally accountable for their practice. Keeping trust * The practice of counselling and psychotherapy depends on gaining and honouring the trust of clients.
Keeping trust requires: * attentiveness to the quality of listening and respect offered to clients * culturally appropriate ways of communicating that are courteous and clear * respect for privacy and dignity * careful attention to client consent and confidentiality * Clients should be adequately informed about the nature of the services being offered. Practitioners should obtain adequately informed consent from their clients and respect a client’s right to choose whether to continue or withdraw. * Practitioners should ensure that services are normally delivered on the basis of the client’s explicit consent.
Reliance on implicit consent is more vulnerable to misunderstandings and is best avoided unless there are sound reasons for doing so. Overriding a client’s known wishes or consent is a serious matter that requires commensurate justification. Practitioners should be prepared to be readily accountable to clients, colleagues and professional body if they override a client’s known wishes. * Situations in which clients pose a risk of causing serious harm to themselves or others are particularly challenging for the practitioner.
These are situations in which the practitioner should be alert to the possibility of conflicting responsibilities between those concerning their client, other people who may be significantly affected, and society generally. Resolving conflicting responsibilities may require due consideration of the context in which the service is being provided. Consultation with a supervisor or experienced practitioner is strongly recommended, whenever this would not cause undue delay. In all cases, the aim should be to ensure for the client a good quality of care that is as espectful of the client’s capacity for self-determination and their trust as circumstances permit. * Working with young people requires specific ethical awareness and competence. The practitioner is required to consider and assess the balance between young people’s dependence on adults and carers and their progressive development towards acting independently. Working with children and young people requires careful consideration of issues concerning their capacity to give consent to receiving any service independently of someone with parental responsibilities and the management of confidences disclosed by clients. Respecting client confidentiality is a fundamental requirement for keeping trust. The professional management of confidentiality concerns the protection of personally identifiable and sensitive information from unauthorised disclosure. Disclosure may be authorised by client consent or the law. Any disclosures should be undertaken in ways that best protect the client’s trust. Practitioners should be willing to be accountable to their clients and to their profession for their management of confidentiality in general and particularly for any disclosures made without their client’s consent. Practitioners should normally be willing to respond to their client’s requests for information about the way that they are working and any assessment that they may have made. This professional requirement does not apply if it is considered that imparting this information would be detrimental to the client or inconsistent with the counselling or psychotherapeutic approach previously agreed with the client. Clients may have legal rights to this information and these need to be taken into account. Practitioners must not abuse their client’s trust in order to gain sexual, emotional, financial or any other kind of personal advantage. Sexual relations with clients are prohibited. ‘Sexual relations’ include intercourse, any other type of sexual activity or sexualised behaviour. Practitioners should think carefully about, and exercise considerable caution before, entering into personal or business relationships with former clients and should expect to be professionally accountable if the relationship becomes detrimental to the client or the standing of the profession. Practitioners should not allow their professional relationships with clients to be prejudiced by any personal views they may hold about lifestyle, age, gender, disability, gender reassignment, race, sexual orientation, pregnancy and maternity, religion or belief, marriage and civil partnership. * Practitioners should be clear about any commitment to be available to clients and colleagues and honour these commitments. Teaching and training * All practitioners are encouraged to share their professional knowledge and practice in order to benefit their clients and the public. Practitioners who provide education and training should acquire the skills, attitudes and knowledge required to be competent teachers and facilitators of learning. * Practitioners are required to be fair, accurate and honest in their assessments of their students. * Prior consent is required from clients if they are to be observed, recorded or if their personally identifiable disclosures are to be used for training purposes. Supervising and managing * Practitioners are responsible for clarifying who holds responsibility for the work with the client. There is a general obligation for all counsellors, psychotherapists, supervisors and trainers to receive supervision/consultative support independently of any managerial relationships. * Supervisors and managers have a responsibility to maintain and enhance good practice by practitioners, to protect clients from poor practice and to acquire the attitudes, skills and knowledge required by their role. Researching * The Association is committed to fostering research that will inform and develop practice. All practitioners are encouraged to support research undertaken on behalf of the profession and to participate actively in research work. All research should be undertaken with rigorous attentiveness to the quality and integrity both of the research itself and of the dissemination of the results of the research. * The rights of all research participants should be carefully considered and protected. The minimum rights include the right to freely given and informed consent, and the right to withdraw at any point. * The research methods used should comply with the standards of good practice in counselling and psychotherapy and must not adversely affect clients. Fitness to practise
Practitioners have a responsibility to monitor and maintain their fitness to practise at a level that enables them to provide an effective service. If their effectiveness becomes impaired for any reason, including health or personal circumstances, they should seek the advice of their supervisor, experienced colleagues or line manager and, if necessary, withdraw from practice until their fitness to practise returns. Suitable arrangements should be made for clients who are adversely affected. If things go wrong with own clients * Practitioners should respond promptly and appropriately to any complaint received from their clients.
An appropriate response in agency-based services would take account of any agency policy and procedures. * Practitioners should endeavour to remedy any harm they may have caused to their clients and to prevent any further harm. An apology may be the appropriate response. * Practitioners should discuss, with their supervisor, manager or other experienced practitioner(s), the circumstances in which they may have harmed a client in order to ensure that the appropriate steps have been taken to mitigate any harm and to prevent any repetition. Practitioners are strongly encouraged to ensure that their work is adequately covered by insurance for professional indemnity and liability. * If practitioners consider that they have acted in accordance with good practice but their client is not satisfied that this is the case, they may wish to use independent dispute resolution, for example: seeking a second professional opinion, mediation, or conciliation where this is both appropriate and practical. * Clients should be informed about the existence of the Professional Conduct Procedure of this Association and any other applicable complaints or disciplinary procedures.
If requested to do so, practitioners should inform their clients about how they may obtain further information concerning these procedures. Responsibilities to all clients * Practitioners have a responsibility to protect clients when they have good reason for believing that other practitioners are placing them at risk of harm. * They should raise their concerns with the practitioner concerned in the first instance, unless it is inappropriate to do so. If the atter cannot be resolved, they should review the grounds for their concern and the evidence available to them and, when appropriate, raise their concerns with the practitioner’s manager, agency or professional body. * If they are uncertain what to do, their concerns should be discussed with an experienced colleague, a supervisor or raised with this Association. * All members of this Association share a responsibility to take part in its professional conduct procedures whether as the person complained against or as the provider of relevant information. Working with colleagues
The increasing availability of counselling and psychotherapy means that most practitioners have other practitioners working in their locality, or may be working closely with colleagues within specialised or multidisciplinary teams. The quality of the interactions between practitioners can enhance or undermine the claim that counselling and psychotherapy enable clients to increase their insight and expertise in personal relationships. This is particularly true for practitioners who work in agencies or teams. Working in teams * Professional relationships should be conducted in a spirit of mutual respect.
Practitioners should endeavour to attain good working relationships and systems of communication that enhance services to clients at all times. * Practitioners should treat all colleagues fairly and foster equality opportunity. * They should not allow their professional relationships with colleagues to be prejudiced by their own personal views about a colleague’s lifestyle, age, gender, disability, gender reassignment, race, sexual orientation, pregnancy and maternity, religion or belief, marriage and civil partnership. It is unacceptable and unethical to discriminate against colleagues on any of these grounds. Practitioners must not undermine a colleague’s relationships with clients by making unjustified or unsustainable comments. * All communications between colleagues about clients should be on a professional basis and thus purposeful, respectful and consistent with the management of confidences as declared to clients. Awareness of context The practitioner is responsible for learning about and taking account of the different protocols, conventions and customs that can pertain to different working contexts and cultures. Making and receiving referrals
All routine referrals to colleagues and other services should be discussed with the client in advance and the client’s consent obtained both to making the referral and also to disclosing information to accompany the referral. Reasonable care should be taken to ensure that: * the recipient of the referral is able to provide the required service; * any confidential information disclosed during the referral process will be adequately protected; * The referral will be likely to benefit the client. Prior to accepting a referral the practitioner should give careful consideration to: * the appropriateness of the referral; the likelihood that the referral will be beneficial to the client; * The adequacy of the client’s consent for the referral. If the referrer is professionally required to retain overall responsibility for the work with the client, it is considered to be professionally appropriate to provide the referrer with brief progress reports. Such reports should be made in consultation with clients and not normally against their explicit wishes. Probity in professional practice Ensuring the probity of practice is important both to those who are directly affected but also to the standing of the profession as a whole.
Providing clients with adequate information British Association for Counselling & Psychotherapy BACP House Develop a plan to ensure the workforce has the necessary training to recognise individual health care needs Labour Demographics Recruitment Pools Health indices Talent Leadership Supply chains Apprenticeships / Cadets Labour Demographics Recruitment Pools Health indices Talent Leadership Supply chains Apprenticeships / Cadets Current Reality Understand Current Workforce Demographics Ambitions Expectations Ability to change Current Reality Understand Current Workforce Demographics Ambitions Expectations
Ability to change Education and Learning Plan Grow and Develop own via CPD, Succession Planning, Competencies and Skills Education and Learning Plan Grow and Develop own via CPD, Succession Planning, Competencies and Skills Operations Understand Financial Envelopes Quality indicators Patient Safety Performance Strategic Vision Operations Understand Financial Envelopes Quality indicators Patient Safety Performance Strategic Vision Current Workforce Current Workforce Future Workforce Future Workforce Stakeholders and Capture Networks Plan Strategy Hot issues Actions Commissions Report Outputs Stakeholders and Capture Networks
Plan Strategy Hot issues Actions Commissions Report Outputs Contingencies Cause, effect and impact on Medical and Dental Filling shortage roles and posts Integrated approaches Contingencies Cause, effect and impact on Medical and Dental Filling shortage roles and posts Integrated approaches Pathways Competencies Skills Curricula RCN Input Education Outcomes Framework Pathways Competencies Skills Curricula RCN Input Education Outcomes Framework Future Modelling Attrition Wastage Churn Participation CPD Development The 5 R’s Alignment to activity and finance Future Modelling Attrition Wastage Churn Participation CPD Development
The 5 R’s Alignment to activity and finance Be able to lead inclusive provision that gives individuals choice and control over the outcomes they want to achieve Explain the necessary steps in order for individuals to have choice and control over decisions Informed choice An informed choice means that a person has the information and support to think the choice through and to understand what the reasonably expected consequences may be of making that choice. It is important to remember that too much information can be oppressive and individuals have differing needs in relation to how information is presented to them.
Professionals and organisations must be able to demonstrate that they have taken these individual needs into account. Enabling people to make informed choices does not mean the local authority or provider organisation should abdicate its responsibility to ensure people have a good quality of life. For example if a person „chooses? to stay in bed all day, every day, the local authority or provider organisation has a responsibility to explore what is happening and respond to this appropriately, working to ensure that the individual fully understands the consequences of their decision.
It is not acceptable to simply accept such a decision at face value if this would put the individual at significant risk, as acts of omission can be considered to be abusive. Duty of care Duty of care requires everyone to „take reasonable care to avoid acts or omissions which you can reasonably foresee would be likely to injure your neighbour?. Donoghue (or M? Alister) v Stevenson ([1932] “You must take reasonable care to avoid acts or omissions which you can reasonably foresee would be likely to injure your neighbour.
Who, then, in law, is my neighbour? The answer seems to be —persons who are so closely and directly affected by my act that I ought reasonably to have them in contemplation as being so affected when I am directing my mind to the acts or omissions that are called in question. ” (26 May 1932, Lord Atkin) Within this duty there is a responsibility to enable people to make informed choices and decisions as well as to take steps to minimise foreseeable risks, in liaison with the person and others who know and care about them. erson you are supporting can make a decision with or without support, the process of risk assessing is advisory in nature rather than something which the individual is required to adhere to. In the event that there appears to be a clear risk that an individual will be harmed, or at risk of harm, or where there is a risk that they may harm another, then local adult protection / safeguarding procedures should be referred to. There may in some circumstances be a requirement to break confidentiality and act to report and intervene in such instances.
The duty of care requires you to consider the consequences of your acts and omissions and to ensure that those acts and/or omissions do not give rise to a foreseeable risk of injury to any other person. Clearly, one is not expected to guarantee the safety of others; one is expected to act reasonably. Statutory Duty In addition to a common law duty of care, the local authority has a statutory duty under the NHS and Community Care Act 1990 to assess people’s needs and to decide what services are called for. It decides whether services are called for by applying an eligibility system called “fair access to care”.
People are eligible for help if the local authority believes there is a sufficiently high risk to their independence. If there is, it must arrange for services to meet their needs. Most commonly this involves provision of services in people’s own homes under the Chronically Sick and Disabled Persons Act 1970 , or of residential accommodation under the National Assistance Act 1948 Communication It is important to involve people in decisions even when they do not use speech as their main means of communication.
Person centred planning techniques point us towards many ways of listening to people in different ways other than relying on what they actually say, using tools such as learning logs, communication charts and supported decision making agreements, and these should all be utilised if we are to demonstrate that we have truly attempted to communicate effectively with an individual. It is also imperative that professionals and organisations ensure that the views of others who know and care about the person are invited and taken into account in any decision making process, without these taking precedence over the individual’s views and wishes.
Where we are supporting people who have complex communication needs, person centred approaches are essential to ensure people’s involvement in decisions which affect their lives. Abuse “Abuse is a violation of an individual’s human and civil rights by any other person or persons. ” („No Secrets? , Department of Health 2000).
Abuse may be a single act or a series of repeated acts over a period of time. It may be physical, psychological, sexual, financial, neglect or discriminatory abuse.
It may occur in a relationship and may result in significant harm to, or the serious exploitation of, the person concerned. It is important to remember that many cases of “abuse” are in fact, criminal acts, and should be treated accordingly. There is a danger that the language of “abuse” can lead to a dilution of this fact, and it is imperative that the involvement of the police is requested at the earliest possible point where there are any suspicions of a criminal act having taken place.
Financial abuse may be theft; sexual abuse may be sexual assault or rape; emotional abuse may be coercion or fraud. Informed decision making In relation to risk, as with any other decision making, if the person has capacity and has been supported to consider the potential consequences, both positive and negative, arising from the proposed course of action and has decided to take the risk, then that is their informed decision. It is arguable that an organisation withdrawing services on the basis of disagreeing with that decision could potentially be seen as acting abusively.
An organisation taking such action could be subject to severe scrutiny if they withdrew or withheld services on the basis that they disagreed with the person’s informed choice. An example of this would be if a local authority or provider organisation unnecessarily and unreasonably denied a person’s wish to be assisted manually, and insisted instead on hoisting which was detrimental to a person’s independence and mobility. However, a local authority can reasonably state that it cannot fund a service which puts the physical welfare of carers and/other person themselves at undue and unacceptable risk.
In this instance, it should instead offer a reasonable alternative. The key in all of these cases is to work in partnership with the individual to explore all possible mechanisms for managing the situation and to strive to arrive at a solution which is acceptable to both parties. Where an individual’s informed choice may put them at risk of abuse or neglect by another person or persons, this potential should be discussed with them, and these discussions must be clearly recorded.
If there is a failure to reach an agreed course of action which both parties are happy with, then it may be necessary to refer to the Risk Enablement Panel template and/or, if appropriate, action may need to be taken under the safeguarding adults procedures. If the person lacks capacity, and a decision has put her / him at risk of abuse or neglect from a particular person or persons then a referral should be made for action to be taken under the safeguarding adults procedures.
An example of this might be a person who has a learning disability who has previously been sexually abused by a relative and is currently living in supported housing who expresses a desire to live independently. If this were considered to put her at risk from her previous abuser, a multi-disciplinary approach through „safeguarding adult procedures? would allow for a full discussion of and subsequent actions, to facilitate a move to independence. Such actions may include direct intervention with the previous abuser and or the provision of personal safety equipment, alarms and household security provision.
Capacity issues Where capacity is in question, refer IN ALL CASES to the Mental Capacity Act 2005, Code of Practice, which states: 1. Every adult has the right to make their own decisions if they have the capacity to do so. You must assume that a person has capacity unless it can be established otherwise. 2. Individuals should receive support to help them make their own decisions and all possible steps should be taken to try to help him / her to reach a decision themselves. 3. Individuals have the right to make decisions that others might think are unwise.
Making an “unwise” decision does not mean that a person lacks capacity. 4. A person’s capacity must not be judged simply on the basis of their age, appearance, condition or an aspect of their behaviour. 5. It is important to take all possible steps to try to help people make a decision for themselves 6. Any act or decision should be the least restrictive in relation to its purpose. If there are concerns that an individual may lack the mental capacity to make a decision, a competent person may complete an assessment of capacity: see the MCA Code of Practice (http://www. ca. gov. uk/legal-policy/mental-capacity/mca-cp. pdf) Primarily it is for the person who requires a decision to make the assessment. The MCA Code of Practice gives clear guidance on these issues. “The person who assesses an individual’s capacity to make a decision will usually be the person who is directly concerned with the individual at the time the decision needs to be made . (http://www. opsi. gov. uk/acts/acts2005/ukpga_20050009_en_1) This means that different people will be involved in assessing someone’s capacity to make different decisions at different times.
For most day-to-day decisions, this will be the person caring for them at the time a decision must be made. For example, a care worker might need to assess if the person can agree to being bathed. Then a district nurse might assess if the person can consent to have a dressing changed. http://www. dca. gov. uk/legal-policy/mental-capacity/mca-cp. pdf When things go wrong Inevitably if we are supporting individuals to have more choice and control in their lives through positive approaches to managing risk, things are likely to go wrong from time to time.
If this happens and the risk taken results in a negative outcome for the individual, there is no doubt that the risk taking process will come under scrutiny and the way in which this process worked to minimise the foreseeable risks will be considered. Those scrutinising what happened will be looking at whether those involved in the risk assessing process: 1. Acted reasonably. 2. Acted in an informed way, reflecting their expertise. 3. Acted responsibly in relation to their duty of care and were not negligent. 4. Assessed and took steps to manage and minimise the foreseeable risks. 5.
Involved the person in the process and supported them to make informed decisions. Involved and liaised with other people whom it would be reasonable to involve in the process. 7. Followed organisational policy, procedures and guidance. This does not mean that there should be a formal risk assessment document in place if this was deemed unnecessary, rather that the process of assessing the risk has been clearly documented and was reasonable and proportionate. There is no guarantee that those involved in the risk assessing process would be free from consequences if something went wrong.
However there is unlikely to be an adverse outcome to the scrutiny of any decision if it is clear that professionals and organisations have acted reasonably and responsibly in partnership with the person, those who know and care about them and others involved in their support. Health and safety issues It is sometimes the case that a service culture can be seen to put safety at all costs above all other considerations, including people’s rights to make informed decisions and live their lives in ways which work for them.
It is a failure if professionals and organisations do not take account of the risks to people’s health and well being of not taking a risk, as well as those associated with taking the risk. This policy does not replace or ignore existing health and safety policies and if you are in any doubt about supporting the positive risk in relation to health and safety issues, it is responsible to stop, think and discuss with others before proceeding. This process must not, however, be used as an excuse to unreasonably delay a course of action which an individual is choosing, nor be used to subtly dissuade people from wanting to try new things.
The process of assessing risk needs to be timely, inclusive and well documented. Where it is helpful in delivering support to an individual and positively managing situations which contain risk, then there may be a need for this to be written into a specific “risk assessment” document. Summary A service-led approach to risk management can compromise individual’s rights to make choices and take risks. Often concerns about minimising and attempting to eliminate risks are in the interests of the organisation, but not necessarily in the interests of the person they are attempting to support.
This policy framework is designed to change the focus of risk management to one where the person is at the centre of all discussions, is enabled more fully to self direct their support where able, and is supported in ways which are clearly in their best interests where they are unable to do so for themselves. Procedure to follow 1. Where an individual indicates a choice that you or others may consider to be a risk you should utilise your assessment skills to determine if there may be issues of capacity or safeguarding. If unsure, consult with your line manager.
Record the decision / outcome and the discussion on the file. If there may be a safeguarding issue, refer to local Safeguarding Vulnerable Adults Procedures. 2. If there are thought to be Mental Capacity issues you, or a competent person, should complete an assessment of capacity. 3. If, having applied safeguarding procedures or capacity procedures, it is deemed that the person could not be supported in making their decision or choice, appropriate actions may need to be taken to protect the individual within Safeguarding Procedures or Mental Health legislation.
However, a local authority has the power to refuse to fund a service which it believes, after a process of due discussion and exploration, would put the person at increased risk of harm. For example, a person with capacity may state that they wish to have a stair lift installed, and yet it is clear that they would find it impossible, even with support, to safely utilise this piece of equipment: in this case, for the local authority to provide the budget for the stair lift would not be consonant with duties to meet need under s. 7 of the NHS and Community Act 1990. 4. If, having applied safeguarding procedures or capacity procedures, it is deemed that the person could be supported in making the decision or choice then they should be supported to do so. 5. Professionals and organisations supporting people who use social care and support services will ensure that each individual they work with is given the support to understand the issues of risk connected with their decision or choice, in a way that is appropriate and accessible to them. 6.
Professionals and organisations must be able to show that they have done this in a reasonable and proportional manner, having regard to the communication and understanding needs of the individual concerned. 7. Where a professional or organisation makes a decision not to support an individual to pursue a particular decision or course of action, they must be able to explain this and demonstrate that they have thought through and discussed in a balanced and proportional way the potential consequences of refusing to support the risk. . Health and Safety and risk assessment policies must not be used to prevent or inhibit an individual to think through the risks they want to take. Nor should these prevent or inhibit the person from having access to the support they need to take any reasonable risks they choose to take, following a supported decision making process. 9. A Risk Assessment conducted with individual or significant parties to the decision or choice may be one method of demonstrating levels of risk once the decision or choice is made. 0. Where the individual is able to make an informed choice and still wishes to pursue a high risk decision or choice, having a signed risk assessment is one way of showing that they are aware of the risks and are willing to take them. This provides organisations and professionals with a significant degree of protection for their support of the decision should things go wrong. However, if the risk agreed on is unreasonable in all the circumstances, then the local authority or organisation may well be less protected.
In principle, if a local authority or organisation actively supports an obviously hazardous course of action, then it could be legally liable should things go wrong, if what it agreed is considered to be too risky and therefore constituted negligence. 11. A recording of risk does not necessarily indicate levels of understanding. Therefore, the work you have undertaken to ensure that the risk is understood must be recorded and shared with the service user. Any such records should be signed by the service user where possible. 2. Additionally, you may ask the individual to complete a relevant record for your files. However an individual’s recording or documentation should be additional to your own. 13. Opting for a course of action simply because it carries least risk must not come before what is in the best interests of the individual concerned. 14. Where there are issues of capacity this policy could be applied to supporting legal deputies to make decisions or choices or take positive actions which have the potential for risk. 15.
Where supporting a legal deputy, it is imperative that all parties are concerned with the potential gains and risks to the service user and that the decision is being made from the perspective of the service user. All such discussions must be recorded. Thanks Our thanks to those who helped produce this document, including representatives from the following local authorities: Lancashire, Cumbria, York, Northumberland, Northamptonshire, Oldham, Cambridgeshire, Hackney and Newcastle. Our thanks also to Michael Mandelstam, who provided useful advice on the legal aspects of the contents.
Manage resources so that individuals can achieve positive outcomes Performance Management Overview Setting performance standards, observing and providing feedback, and conducting appraisals enables you to achieve the best results through managing employee performance. To begin the process, you and the employee will collaborate on the development of performance standards. You will develop a performance plan that directs the employee’s efforts toward achieving specific results, to support organizational growth as well as the employee’s professional growth.
Discuss goals and objectives throughout the year, providing a framework to ensure employees achieve results through coaching and mutual feedback. At the end of the rating period, you will appraise the employee’s performance against existing standards, and establish new goals together for the next rating period. As the immediate supervisor, you play an important role; your closest interaction with the employee occurs at this level. Performance Standards Performance expectations are the basis for appraising employee performance.
Written performance standards let you compare the employee’s performance with mutually understood expectations and minimize ambiguity in providing feedback. Having performance standards is not a new concept; standards exist whether or not they are discussed or put in writing. When you observe an employee’s performance, you usually make a judgment about whether that performance is acceptable. How do you decide what’s acceptable and what’s unacceptable performance? The answer to this question is the first step in establishing written standards. Standards identify a baseline for measuring performance.
From performance standards, supervisors can provide specific feedback describing the gap between expected and actual performance. Guiding Principles Effective performance standards: * Serve as an objective basis for communicating about performance * Enable the employee to differentiate between acceptable and unacceptable results * Increase job satisfaction because employees know when tasks are performed well * Inform new employees of your expectations about job performance * Encourage an open and trusting relationship with employees Key Areas of Responsibility
Write performance standards for each key area of responsibility on the employee’s job description. The employee should participate actively in their development. Standards are usually established when an assignment is made, and they should be reviewed if the employee’s job description is updated. The discussion of standards should include the criteria for achieving satisfactory performance and the proof of performance (methods you will use to gather information about work performance).
Characteristics of Performance Standards
Standards describe the conditions that must exist before the performance can be rated satisfactory. A performance standard should: * Be realistic, in other words, attainable by any qualified, competent, and fully trained person who has the authority and resources to achieve the desired result * Describe the conditions that exist when performance meets expectations * Be expressed in terms of quantity, quality, time, cost, effect, manner of performance, or method of doing * Be measurable, with specified method(s) of gathering performance data and measuring performance against standards Expressing Standards
The terms for expressing performance standards are outlined below: * Quantity: specifies how much work must be completed within a certain period of time, e. g. , enters 30 enrollments per day. * Quality: describes how well the work must be accomplished. Specifies accuracy, precision, appearance, or effectiveness, e. g. , 95% of documents submitted are accepted without revision. * Timeliness: answers the questions, By when? , How soon? , or Within what period? , e. g. , all work orders completed within five working days of receipt. Effective Use of Resources: used when performance can be assessed in terms of utilization of resources: money saved, waste reduced, etc. , e. g. , the computer handbook project will be completed with only internal resources. * Effects of Effort: addresses the ultimate effect to beobtained; expands statements of effectiveness by using phrases such as: so that, in order to, or as shown by, e. g. , establish inventory levels for storeroom so that supplies are maintained 100% of the time. * Manner of Performance: describes conditions in which an individual’s personal behavior has an effect on performance, e. . , assists other employees in the work unit in accomplishing assignments. * Method of Performing Assignments: describes requirements; used when only the officially-prescribed policy, procedure, or rule for accomplishing the work is acceptable, e. g. , 100A Forms are completed in accordance with established office procedures. Performance Measurements Since one of the characteristics of a performance standard is that it can be measured, you should identify how and where evidence about the employee’s performance will be gathered.
Specifying the performance measurements when the responsibility is assigned will help the employee keep track of his progress, as well as helping you in the future performance discussions. There are many effective ways to monitor and verify performance, the most common of which are: * Direct observation * Specific work results (tangible evidence that can be reviewed without the employee being present) * Reports and records, such as attendance, safety, inventory, financial records, etc. * Commendations or constructive or critical comments received about the employee’s work Observation and Feedback (Coaching)
Once performance objectives and standards are established, you should observe employees’ performance and provide feedback. You have a responsibility to recognize and reinforce strong performance by an employee, and identify and encourage improvement where it is needed. You provide informal feedback almost every day. By observing and providing detailed feedback, you play a critical role in the employee’s continued success and motivation to meet performance expectations. Coaching is a method of strengthening communication between you and the employee.
It helps to shape performance and increase the likelihood that the employee’s results will meet your expectations. Coaching sessions provide you and the employee the opportunity to discuss her progress toward meeting mutually-established standards and goals. A coaching session focuses on one or two aspects of performance, rather than the total review that takes place in a performance evaluation. Guiding Principles Effective coaching can: * Strengthen communication between you and the employee * Help the employee attain performance objectives * Increase employee motivation and commitment Maintain and increase the employee’s self-esteem * Provide support Key Elements of Coaching To make your coaching session effective, you must understand the key elements of coaching: * Coach when you want to focus attention on any specific aspect of the employee’s performance. * Observe the employee’s work and solicit feedback from others. * When performance is successful, take the time to understand why. * Advise the employee ahead of time on issues to be discussed. * Discuss alternative solutions. * Agree on action to be taken. * Schedule follow-up meeting(s) to measure results. Recognize successes and improvements. * Document key elements of coaching session. Questions to Consider When Coaching To provide effective feedback you must understand the elements of performance and analyze marginal performance. Keep these questions in mind: * How is the employee expected to perform? * Does the employee understand these expectations? If not, why not? * Does the employee know what successful results look like? How do you know? * Does the employee know the performance is marginal? How do you know? * Are there obstacles beyond the employee’s control?
Can you remove them? * Has the employee ever performed this task satisfactorily? * Is the employee willing and able to learn? * Does satisfactory performance result in excessive work being assigned? * Does unsatisfactory performance result in positive consequences such as an undesirable task being reassigned? Coaching Behaviors To make the most of coaching the employee, remember to practice these coaching behaviors: * Focus on behavior, not personality. * Ask the employee for help in problem identification and resolution. Use active listening to show you understand. Set specific goals and maintain communication. * Use reinforcement techniques to shape behavior. During the Coaching Session If you conduct a coaching session to provide positive feedback to the employee, keep the following ideas in mind: * Describe the positive performance result or work habit using specific details. * Solicit your employee’s opinion of the same product or behavior. * Ask the employee to identify elements that contributed to success (adequate time or resources, support from management or other employees, the employee’s talent and interest in the project).
Discuss ways in which you and the employee can support continued positive results. * Reinforce for the employee the value of the work and how it fits in with the goals of the work unit or department. * Show your appreciation of the positive results and your confidence that the employee will continue to perform satisfactorily. * If appropriate, document your discussion for the employee’s file. When you conduct a coaching session to improve performance, you may want to use the following format: * Describe the issue or problem, referring to specific behaviors. Involve the employee in the problem-solving process. * Discuss causes of the problem. * Identify and write down possible solutions. * Decide on specific actions to be taken by each of you. * Agree on a follow-up date. * Document key elements of the session. If your coaching session is conducted to address poor work habits such as continued tardiness, keep these steps in mind: * Describe in detail the poor work habit observed. * Say why it concerns you. * Ask why it occurred and listen non-judgmentally to the explanation. Describe the need for change and ask for ideas. Discuss each idea and offer your help. * Agree on specific actions to be taken and set a specific follow-up date. * Document results from the session. Follow-Up Discussion To conduct a follow-up discussion, consider the following steps: * Review the previous discussion(s).
* Discuss insufficient improvement and ask for reasons why. * Indicate consequence of continued lack of improvement. (No threats! This isn’t an oral warning. ) * Agree on action to be taken and set a follow-up date, if appropriate. * Convey your confidence in the employee. * Document your discussion. Performance Appraisal
The campus carries out its mission through the individual and collective contributions of its employees. To do their best, staff members need to know that those contributions will be recognized and acknowledged. Overseeing performance and providing feedback is not an isolated event, but rather an ongoing process that takes place throughout the year. The performance appraisal is part of that process, and provides an excellent opportunity for you to communicate with the employee about past performance, evaluate the employee’s job satisfaction, and make plans for the employee’s future performance.
Remember that the performance appraisal summarizes the employee’s contributions over the entire appraisal period (usually one year).
It is not a step in the disciplinary process. It may occur as often as you believe is necessary to acknowledge the employee for accomplishments and to plan together for improved performance. Guiding Principles The goal of the performance appraisal process is to help the employee feel: * Positive about the job * Motivated to do well and to develop * Benefited by specific, constructive feedback * Appreciated for specific contributions Informed about current and future performance objectives * Involved as a participant in the process Preparing for the Appraisal Both you and the employee play an important role in creating a productive performance appraisal process. Here are some suggestions to get the employee involved: * Schedule a mutually convenient time and place for the performance appraisal discussion. Allow enough time and ensure privacy. * Explain that you would like the discussion to be a dialog, with input from both of you included in the final written document. Give the employee some options about how to prepare for the discussion. For example, ask the employee to prepare a self-evaluation using the same form you will use for your draft. The employee can address accomplishments and things that could be done better. Explain that you will be doing the same and that you may exchange these documents a few hours before your meeting * Give the employee a list of questions to consider to evaluate his own performance. Sample questions might be: What have been your major accomplishments?
What could you have done better? What could I do as your supervisor to help you do your job better? Would you like to see your responsibilities change? If so, how? * Prepare a draft appraisal, making sure you have as much information as possible, including: job description, performance standards, previous appraisals, letters of commendation and/or criticism, samples of work, and records of disciplinary action. * Consider the question, What can I do to help the employee do the job better and achieve developmental goals? Conducting the Appraisal Discussion
Continue the momentum you have established throughout the year with your ongoing dialog about performance. You want to set the tone for an open and productive discussion. Here are some steps you can take to make it as successful as possible: * Create a supportive environment by stating clearly the purpose of the discussion. Be as non-threatening and open as possible since the employee may be tense or uncomfortable. * Discuss key areas of responsibility and give examples of specific results. Have the employee go first, based on the self-appraisal or the questions you provided in advance.
Ask lots of questions and get clarification to make sure you understand the employee’s point of view. * Discuss what could have been done better. Identify your concerns and listen to the employee’s explanations. * Ask your employee for help in resolving problems. Focus on future performance and be sure the employee takes responsibility for improvement. * Make sure you and the employee have the same understanding of future expectations regarding performance. * Give positive recognition for performance that reinforces the goals of the work unit. Discuss the employee’s interests and potential new responsibilities. Discuss both of your roles in achieving new objectives while maintaining ongoing responsibilities. * Conclude on a positive note, emphasizing the benefits of your dialog. The Final Appraisal Document Record the results of your discussion on the performance appraisal form. Ask the employee to sign the form, and explain that this signature acknowledges discussion of the contents, not necessarily agreement with them. Route to your manager for final signatures and placement in the employee’s departmental personnel file.
Give a copy of the signed appraisal to the employee. * Staff Development Classes * Relevant personnel policies and collective bargaining agreements. * Other Resources Source: UC Berkeley, Guide to Managing Human Resources Be able to to lead inclusive provision that gives individuals’ choice and control over the outcomes they want to achieve Explain the necessary steps in order to have choice and control over decisions Choice and control are at the heart of developments for people with learning difficulties.
The recent White Paper, Valuing people: A new strategy for learning disability for the 21st century, acknowledges this in its key principles. People with high support needs (who may be labelled as having severe or profound learning difficulties and may also have physical and sensory impairments) may find themselves excluded from these developments. Research by Values Into Action investigated how decision-making can be supported and demonstrated.
The researchers found: * Some people with learning difficulties and high support needs received good support to make choices and be in control of their lives. Among the factors enabling this were: – ways of working that actively facilitated the ‘supported decision-making’ model, particularly around good communication and relationships; – a focus on the process of decision-making, rather than on assessments of capacity to decide; – a rigorous approach to building evidence of the process, including careful and creative recording and monitoring. Some people were not supported to have effective choice and control over their lives. Reasons included: – negative assumptions that people could not make choices; – organisational systems and structures that reduced choices to a fixed menu; – poor staffing levels and low awareness of supported decision-making; – service cultures and staff fears that set aside people’s wishes and feelings where there were contentious issues or perceived risks; – lack of independent advocacy; concerns about the law around decision-making and capacity, and lack of knowledge about legal rights and systems. * The researchers concluded that: – advocates, managers, staff and family members need better information about the supported decision-making model and people’s legal rights; – legal change around decision-making is required that revisits the concept of capacity and provides a clear legal framework for the use of ‘supported decision-making’; this needs to go beyond ‘substitute decision-making’.
Background and policy context Choice and control are at the heart of modern developments in opportunities and services for all people with learning difficulties. Examples from policy initiatives include the recent White Paper from the Department of Health, Valuing people: A new strategy for learning disability for the 21st century (2001), and the Scottish Executive’s Review of Services for People with a Learning Disability, The same as you? 2000).
“We believe that everyone should be able to make choices. This includes people with severe and profound learning disabilities who, with the right help and support, can make important choices and express preferences about their day to day lives. ” (Valuing people, Department of Health 2001, p. 24) However, people with high support needs (who may be labelled as having severe or