Joanne Howcroft, Dementia Lead, Bupa UK Care Services
On the 2nd April 2019 I was provided with a fantastic opportunity to attend a lecture at the University of Leeds ‘Staffing Matters: Interim findings from the first national study of the relationship between care home staffing and quality’, the first of its kind. The 3 mains speakers were:
• Professor Karen Spilsbury, School of Healthcare, University of Leeds
• Research Fellow Kirsty Haunch, University of Leeds
• Professor Any Charlwood, Head of Work and Employment Relations Division, University of Leeds
It was interesting to hear that the research of Kirsty’s involved staff being permitted to talk to each other and ask questions, learning along the way. This helps develop an understanding of others knowledge and experience and the impact this can have on shared learning. This can be applied in the care home setting by developing peer groups, allowing a culture of supporting and learning from each other. Currently in Bupa UK Care Services we are developing an Ambassador and Gatekeeper network, to encourage this learning and development culture within the Dementia Strategy.
A statement made by Professor Spillsbury, ‘Not ‘what works’ but what
works for whom, in what circumstances and why?’ was quite a broad statement but made me think about the demographic and cultural diversity of both residents, families and staff in the homes that we work in, particularly with the size of the geographic spread of the homes.
Whilst Kirsty’s and Karen’s research appeared to provide qualitative outcomes, Professor Charlwood appeared to use a quantative approach to understand the relationship between workforce and quality of care. Professor Charlwood's questions that he raised, ‘Can we organise, analyse and interpret routinely collected data to make better decisions?’ and ‘Can we draw causal conclusions from observational data?’ were interesting. Particularly as he identified that there is a need for the ‘Recognition of estimation of Cofounders’ resulting in the quality indicators.
This would suggest that there is a need to collect both quantative and qualative data to analyse and be proactive rather than reactive in improving quality. In Care Services we collect data at the initial assessment of potential residents. We already know how many staff members we have or should have within a skill mix and how many hours each provide. The data we collect relating to residents, particularly their comorbidities, isn’t always accurate or in enough detail to evidence the increased risk of the resident. For example, a resident’s weight is not always captured prior to admission, and records after admission are not always completed accurately, therefore this could impact upon the cause of the quality outcomes. Weight, nutrition and hydration are known contributors to the risk of falls and skin integrity problems such as pressure ulcers . This is a potential area for development within Bupa UK Care Services.
In conclusion I would suggest that both pieces of research outcomes are important to explore further because they lead to further questions that need to be answered. There is not enough evidence to concur that numbers of staff will improve quality; however, experience of staff certainly can improve quality, but their needs to be more evidence of why this is. I would suggest that there is evidence to prove that reciprocity is an important factor in developing engaged and committed workforces to enable an improvement in quality, by driving change in cultures.
If you would like to read Joanne’s entire article with further insight into the lecture and research then please click here.
Nadia Jenja, Compliance and Governance Inspector, Bupa UK Care Services
It was interesting to attend the second of these lectures and to learn how useful qualitative data collection can be linked to outcomes and predicting potential outcomes.
The research had looked at staff numbers and other data sets such as pressure ulcers, falls and medication errors. Overall the outcome seemed to be that it is the staff themselves and their 'behaviours' that promotes quality care linked to their knowledge, skills and abilities which in turn is linked to provision of 'good' training and support systems.
The summary that came to my mind during the lecture was that good quality care is intrinsically linked to:
- Good positive Person centred care
- Good teamwork and communication
- Good training and skills, abilities of staff
- Good and consistent leadership
The theories behind “reciprocity” were very interesting linked to team support and problem solving. Another positive that I took from the lecture was knowing that future studies were planned looking at quality and good experience indicators for people using the services.
**Disclaimer - Please note that the views and opinions of Joanne Howcroft and Nadia Jenja may not necessarily reflect the views of the NIHR and/ or DHSC**