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Engaging staff whilst maintaining quality

Tom Owen and Jess Watson continue their series looking at how to maintain quality and engage staff in a climate of austerity.

In our last article, we shared our learning about leadership and positive culture from nearly ten years immersed in the care home sector. At My Home Life (MHL), we’re always interested in hearing what works well in delivering a good quality of life for those living, dying, visiting and working in care homes. This month, we look at care homes’ approaches to keeping staff supported, valued and engaged in continuing to deliver quality care in the difficult financial circumstances we are all working in.

Staff at the heart of quality service

At the heart of delivering quality care are the staff and their relationships with the people they care for. Potential customers, when looking around a care home, look at how staff ‘are’ with the residents and it forms a large part of what attracts them to a particular home.

The importance of relationships means that at MHL we make relationship-centred care our focus. In relationship-centred care, everyone in the care home community needs to have six senses fulfilled. These are described in the Senses Framework, from Mike Nolan and colleagues, and are a sense of:

  • Security (feeling safe).
  • Belonging (feeling part of things).
  • Continuity (experiencing links and connections).
  • Purpose (having goals to aspire to).
  • Achievement (making progress towards these goals).
  • Significance (feeling you matter as a person).

These are the building blocks for great relationships.

When we talk to older people living in care homes and staff working there, their words tell the story of these beautiful moments of connection in their relationships.

  • ‘They reassure me if I am scared, listen and show me I am a valued human being.’ Resident.
  • ‘They love us and I love them. It’s the little things that matter.’ Resident.
  • ‘We are all like family; we laugh with them and we cry when they are down, but we are always here for our residents.’ Staff member.

While such sentiments are not uncommon in care homes, the complex, emotional role can make it difficult for staff to focus on their relationships with residents and relatives. Additionally, working in a society that doesn’t value care work takes its toll, so it’s understandable that sometimes staff can switch off their emotions and, as one manager described it, ‘drag residents through the tasks of the day’.

Organisations need to understand the underlying motivations that staff have for their work, what’s important to them and create an organisational culture that supports this. With this in place, staff will be better able to nurture those beautiful relationship moments. These moments then become part and parcel of everyday practice, enhance people’s quality of life and attract customers to your business.

What do we know about staff motivation?

As you might expect, despite a range of motivating factors for care staff, most agree that their relationships with residents and the rewarding nature of this part of their job is a big motivator. When it comes to their relationship with their employer, staff are often motivated by a commitment of the organisation to allow them to do their job – to care.

Our learning suggests that staff feel more motivated when:

  • There is less interference or change at an organisational level. For example, if rules and policies are changing all the time, or if paperwork is pulling them away from care-giving, this can demotivate staff.
  • They feel the organisation truly values the interests of the people being cared for. For example, when the power of decision-making is given to residents, staff feel they are delivering a service that residents truly want.
  • The organisation shows it values high-quality relationships as an employer. For example, through modelling relationship-centred approaches with staff, helping create a sense of commitment of the organisation to its people and vice versa.

As a result, there’s value in investing time and energy to help staff connect more strongly with the primary aim of the care home: positive relationships with residents.

Is pay the bottom line?

How can the organisation create the conditions that support staff to focus on their relationships with residents and relatives? It may be a relief to hear that MHL research into pay and quality of care showed that the evidence was inconclusive about a direct connection between the level of pay offered to staff and the quality of the service being delivered. However, other indicators suggest that pay levels do have an indirect impact on quality.

Within an organisation with a general culture of support, improving pay is one of the ways staff feel that commitment to them. This recognition can improve general levels of motivation and wellbeing, which in turn appear to have a positive impact upon the quality of care being delivered.

Additionally, increased staff pay may lead to:

  • Greater ability to retain care staff, particularly if the organisation is losing good staff to the NHS, local supermarkets or other competitors paying more.
  • Some staff feeling less worried about their finances, and so are more able to ‘give more of themselves’ to the complex emotional role they play.
  • The organisation being able to recruit from a wider pool of candidates with the right skills and attitudes. This, in turn, may help the organisation feel more confident in taking action to ask more from those staff already in post that may not be performing well.

At the moment, and with the significant increase in the minimum wage to meet the National Living Wage coming into force in April, pay increases are off the cards for the majority of the sector. However, investment in staff isn’t only about finances. There are other ways homes can promote a culture that allows staff to build the relationships, leading to both quality as well as meeting their own motivations for working in care.

Creating a culture that values and supports staff

Care homes have identified a range of ways to help staff feel valued through the organisation’s culture. Their overall approach is well summed up by one provider that we interviewed who admitted that he was not paying staff particularly well, yet continued to recruit good people who stayed with the organisation. He felt that the culture was about communicating that, ‘while you stay with us, we will support you, and try to make your work interesting and meaningful’.

With this in mind, organisations need to consider how they can create an environment where staff feel they are given the time and autonomy to develop and ‘own’ the relationship with the resident.

Care home colleagues have shared ways they’ve sought to value and motivate their teams, which they felt helped to retain good staff and improve or sustain quality. Some also felt that this had reduced the costs associated with staff sickness and staff recruitment. These include:

  • Providing supervision, induction and opportunities for safe and open reflection.
  • Helping to create connections between the personal interests and lives of individual staff and the lives of the people they are supporting.
  • Tailoring the work to be flexible to the needs and motivations of staff (eg having key workers, altering rotas or flexible working hours).
  • Helping staff feel connected to the ‘heart’ of the organisation, sharing and shaping its values and vision, making the plans and goals meaningful to staff.

There are also other options which require some financial input. These include:

  • Investing in training and personal or professional development options as requested or valued by staff.
  • Offering staff benefits (eg access to staff discounts, access to the local gym, parties, games room, staff awards, hardship fund, childcare vouchers or debt counselling services).

Overall, there was a real sense that the relationship that the organisation has with the individual staff member impacts greatly on the way staff feel about themselves and their work. This, in turn, impacts upon their quality of work. Much can be achieved through little things, like how managers communicate and connect with staff.

One example shared with us from a care home was that each member of staff receives a personal letter each year from the director in which they are individually recognised for their contribution. A simple gesture that can go a long way.

The vital importance of a great manager

As always, the manager role is pivotal to quality. Where managers are enabled by their organisation to spend proper time supporting staff to reflect and develop their practice, this provides significant value and motivation to staff. It also helps staff to better understand the behaviours expected of them and their role in strengthening relationships with residents and relatives. As we discussed in our last article, don’t underestimate the value of professional support to managers to take on this complex role.

Investment is more than just financial

There is no doubt that recruiting, retaining and developing care staff remains a significant challenge and we work in a context where opportunities for financial investment are drastically limited. Although pay can be a motivating factor, investment in staff is about more than pay cheques. Listening and responding to your staff’s motivations and development needs is one of many ways to keep them engaged whilst demonstrating that you see their value to your organisation.

Central to this is the relationship-centred approach to care, where positive relationships across the whole organisation need to aim to provide everyone, including staff, with a sense of security, belonging, continuity, purpose, achievement and significance. Such a culture can grow a well-motivated community that is committed to its members and through this, delivers the quality of care that will attract business.

Tom Owen is Director and Jess Watson is Social Action Lead at My Home Life England, based at City University London. Email: mhl@city.ac.uk Twitter: @MyHomeLifeUK

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