Over the years, I have been struck by how differently managers and their teams respond to receiving feedback. It’s not easy to hear what they might perceive as criticism, and it’s even more difficult to face the truth that what you are offering the people you support just isn’t good enough.  When team members themselves practice doing observations as part of our Butterfly training, they are sometimes visibly upset and even shocked by what they see.  “I never normally sit down long enough to just see, feel and hear the reality of what life is like here for people.”  “I had no idea how chaotic our mealtimes were.”  “I didn’t realise how many individuals can so easily get forgotten.”  These light bulb moments are essential to the process of driving and motivating change to happen. Before teams can acknowledge these realities, they are likely to settle for the status quo, often believing it is ‘good enough.’  

Some time ago, I worked with two teams where the response to feedback given in their annual Audit was very different. In one home, which had achieved the highest level of Butterfly Accreditation, the manager was incredibly proud and excited to share this success with her team. However, what stood out for me, was what she said; “It was a particularly fantastic day when you were with us. But what I want to ensure is that every day looks and feels like that. We will look at your recommendations to see how we can improve even more.” Even at the height of success, she was humble and open to learning more.

In another home which also achieved the accreditation but didn’t shine in quite the same way, the response of the manager and his team was much more defensive and critical.  They tried to critique the Audit methodology (which has been well established over 30+ years) and gave excuses and defences for some of the things which were highlighted in the report as needing improvement. Their home has an excellent reputation, and it felt that in their eyes, there really wasn’t anything they needed to change or do better. I understand that some of the feedback they had received had hurt their pride in what they considered was a brilliant service. This pride was a very positive feature of this team as they all felt a strong sense of loyalty and belonging to the home. However, it seemed a shame to me that there was no room in this pride to acknowledge that there will ALWAYS be things which can be done even better. This was what the first manager had demonstrated so clearly to me, and which gave me much hope that their success would be sustained.

However, on reflection this experience also gave me pause to reflect on whether I could do anything differently in the ways I give and receive feedback. I needed to think about how it might feel to have someone who is an outsider or stranger coming into my home and telling me that some of the ways I run my home or look after my family weren’t as good as they could be. Even if that person also told me all the great things I was doing, it is likely that what will stay with me is the not so positive bits. This is human nature and I know I would find this hurtful. We ask Butterfly Home teams to invest emotionally in the work, so we shouldn’t really be surprised if at times team members take things very personally.  What can I do to ensure that we remember feelings do matter most and ensure that people are left feeling motivated rather than demoralised after our visits?

So, what then does this tale of two care homes tell me about the most important quality to achieve and maintain culture change? This quality is of course – HUMILITY which includes the ability to really listen to feedback, to face the truth and be prepared to own the things which could be better.  This applies to leaders in particular, but applies to us all in our work and in life generally. We can still be proud and celebrate our talents and strengths, but arrogance and complacency are the enemies of meaningful change.

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Those words have always remained with me, stressing how vital it is to create and maintain community connections. There are many ways of doing this and this article will focus on volunteering – something I am passionate about as a trainer who delivers Managing Volunteers training as part of my work.

This is a large and complex arena, so I will particularly focus here on the ethics and benefits of involving volunteers in care homes.

Ethics of Volunteering/Volunteers

There are several key ethical issues regarding involving volunteers:

• Volunteer roles should be of benefit to the individual (e.g., an opportunity to use current/develop new knowledge/skills, be meaningful, an opportunity to make friends etc.)
• Volunteering is an opportunity to promote equality, diversity and inclusion
• Volunteering should only be within charity/not-for-profit care organisations – it is perceived by many in the volunteering world as unethical and exploitative for volunteers to be used for profit
• Volunteering should never be confused with ‘paid work’ or contractual roles in law. Therefore, there should be Volunteer Role Descriptions, not Volunteer Job Descriptions etc.
• Volunteers need and deserve appropriate, regular support/supervision structures
• Volunteers should be reimbursed for proven, reasonable out-of-pocket expenses (e.g., travel, meals) upon receipts. Note that giving volunteers an honorarium or a set amount (e.g. £10/$10 for lunch is illegal)
• Volunteers should never be a substitute for paid roles (e.g., undertaking direct care tasks that should be the domain or paid care-workers

Reasons to volunteer

Organisations often fall into the trap of thinking about what volunteers can do for them, rather than the reasons individuals choose to give their time unpaid. Frequently during training, I use the acronym WIIFT – What’s In It For Them. It is vital to understand the main motivators for volunteering:

• Affiliation with the organisation
• Asked personally to help
• Connected to work
• Enjoy type of ‘work’
• Making life changes
• Personal commitment or connection to mission – the ‘cause’
• Want to learn new skills
• Want to meet people
• Want to offer specific, specialist skills/expertise

David McClelland’s motivation management theory simplifies these as:

• This is crucial for volunteer-involving organisations to understand. For example:
  • Sujata wants to volunteer in a care home because her father had dementia
  • Abayomi wants to volunteer as (due to mental health issues) they have been out of paid employment for some time and keen to develop new skills
  • MoneyBank plc, has a Corporate Social Responsibility policy that encourages staff to volunteer for local projects.  MoneyBank plc staff are offering a week of their time to create a dementia-friendly, multi-sensory garden for a local care home
  • Katy is a musician and wants to run music workshops for care home residents.

Therefore, wherever possible, volunteer roles and volunteering projects should be flexible and tailored to the skills and interests of the prospective volunteer(s). This might involve creating a specific role for a volunteer such as Katy above, rather than trying to fit the person in with what you want. It might also involve creativity in designing short-term projects for which individuals/organisations can support and engage with.

It is only after looking at WIIFT, that we can explore WIIFM: What’s In It For Me – the benefits for care homes in involving volunteers. These include:

• Connecting with the local community
• Enabling new and greater opportunities for people living in your care-setting to engage with others, chat and make meaningful connections
• Facilitating a greater range of activities and things to do
  • Maia is a local artist who can work one-to-one with residents who are interested in arts activities
  • Four volunteers from the local youth group visit monthly to find out about the life histories of people living in the care home and help them to access the internet to look up local history online
• Opportunity to find befrienders for specific people living in your care-setting
  • Joe used to love riding motorbikes and you target your volunteer recruitment to a local motorcycling club – Angus now visits Joe regularly with photos of his motorbike and recently took Joe to a vintage motorbike show)
• Volunteers can free up staff time, so the team can get on with other things
  • Elaine comes in to help with mealtimes and chat with Marion, which enables staff to spend more time with Mrs Abdul, who needs greater assistance with eating

These are just a few examples of how involving volunteers can enhance your service, help maintain community connections and improve the quality of life of people with dementia and others you support.

Properly involving and managing volunteers requires skill, time and effort – it also needs resourcing (e.g. staff time to co-ordinate, expenses, volunteer training etc.). It can’t be done ‘on the cheap.’

Nevertheless it can bring infinite benefits and possibilities if we take a creative approach. There is so much more that could be said, if space allowed.

However, if you would like to find out more or I can support you in any way, why not email me at mike@meaningfulcarematters.co.uk

I often think of volunteers as superheroines and superheroes. As Mother Teresa once said: “Not all of us can do great things. But we can do small things with great love.”

Involving volunteers can unleash potential for care homes and the people who live in them, to ensure they are no longer ‘islands of the old’ and become thriving communities bringing together people of all ages and backgrounds and making life more meaningful.

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Traditionally, care settings have tended to be shut off from their surrounding community. In most care facilities, services are provided ‘in-house’, and this has the effect of reducing the need to reach out to the wider community. We know that more recently the focus has shifted to create better links with organisations and services in the local area to provide benefits for people requiring care and support, as well as enriching the local community as well.   

I believe that community links should focus not just on this, but also focus on establishing and nurturing connections between health and care providers too.  Having spent much of my working life as a community based occupational therapist, I have come to realise it is so important to establish and nurture these links. 

People who require care and support at home, or who live in care homes don’t only require support through one service provider.  As the need arises, people transition through a range of care and services.  Many support services can come into people’s homes to provide the support people may require, for example, a hairdresser, podiatrist or physiotherapist.  However, some care and services, cannot be provided in the home. 

As service providers, we are often not very good at supporting a smooth transition between care environments.  A good example of this is when someone is admitted or discharged from hospital.  Whether this is a smooth process or not, is rather hit and miss.  This is a real concern, as the consequences (good or bad) have a very real impact on the person receiving care and support, as well as their families and carers. 

I can recall some great examples where the effort put in by care and service providers working together to establish good connections has resulted in fantastic outcomes for the people receiving care.  For example, when I worked for disability services, there was a person who was very frightened of going to the dentist, and a visit to the dentist usually required a general anaesthetic.  Through a process of several pre-arranged visits, they were able to become familiar with the dental facility and clinic room, the dentist and various equipment.  In turn, they were able to have their teeth cleaned without a general anaesthetic. 

I can also think of other examples working in community health, where we were able to foster good relationships between the various community and hospital-based teams to facilitate smooth admission and discharge [SK1] from hospital, and in some cases avoid hospital admission and attend to the person in their own home. 

These successes didn’t just happen by chance.  It was achieved by:

• A system wide approach:  rather than focussing on any one service, we looked broadly across the region, and mapped a typical ‘patient’ journey across various services, with an effort to focus on improving communication and coordination.   This focus on the person receiving care, became the common thread.
• Communication/Relationships: effective communication at every level (top to bottom and across) both within services, externally and via inter-agency / service forums is essential.  In particular, the division of general practice (primary health care network) was very effective for this.  Networking through shared education and training initiatives was also well received and fostered relationship building between key direct care team members.  Meetings that provided morning or afternoon tea also encouraged attendance, particularly if there was a shared focus such as an International Older Person’s Day or International Nurse’s Day, etc.
• Sharing tools / governance arrangements:  a key feature of this approach was developing and agreeing to shared communication tools.  This included understanding what information was required by all services and could reasonably be communicated via a shared tool. This also avoids lots of duplicated questions which can be very frustrating for the person receiving care and their families.
• Safety culture:  integral to this approach was understanding the importance of safety for all; for the people we support and ourselves.  Identifying areas of highest risk and addressing those first helps all involved feel confident and secure.  It is important to avoid a ‘blame’ culture where different services point the finger at other services when things go wrong.

If you don’t already have a strong focus on improving connections between care and services for the people you support, can I encourage you to make a first step.  If you do already have established connections, make sure you continue to nurture them, so they grow and thrive.

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Resentment too. Another Manager described how there was a divide in the staff team between those who carried on coming to work and those who had self-isolated. The resentment went both ways. Those who had stayed, felt let down. Whilst those who self-isolated resented being judged for their actions.

So, you may have not just a weary team, but a dysfunctional one too.

We have to carry on, but I feel the sector will continue to get limited help. If we think governmental and societal attitudes to health and social care have changed because of the pandemic, then we are not taking into account of the desire to move on. The sacrifice will not be compensated.

Whilst this may seem gloomy, we have to remember that Health and Social Care has always been resourceful and the best changes and ideas have come from the ‘workforce’. This comes from an inner belief and passion for the work that we do.

The answer to the question of how do we build resilience is not going to come from the outside, it will come from within.

Pre-pandemic most organisation in all sectors streamlined functions in order to increase efficiency. This though creates a weakness in being able to respond to disruption. The lesson is that teams have to be more flexible in responding to changes and of course flexibility doesn’t just happen.

The first steps come from the leadership in being open and honest about what is going on.

In the case of the team where resentment was simmering, the manager named it and got staff to talk candidly about how they felt. The manager got a positive outcome because she is known for being honest and open and she enabled the team to recognise that everyone has been affected by a situation that was nobody in the team’s fault.

I have often been moved about how much teams care about each other. Without it, how can they care compassionately for those that they support? Creating opportunities to acknowledge this is very important. Care teams though can often develop into cliques and it is a role of leadership to get the whole team to recognise each other’s qualities.

Having a strategy to support the emotional needs of staff is key in being able to build the resilience to create the flexibility as described above. The ultimate aim is to move away from designing roles that focus on tasks, but rather on the wider outcomes of ensuring the well-being of people we support. This is desirable as the well being of people becomes the responsibility of all.

“Resilience is very different than being numb. Resilience means you experience, you feel, you fail, you hurt. You fall. But, you keep going.” 

Yasmin Mogahed

To build resilience in teams, we have to show that we care for each other.

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The same maintenance man was a great character and throughout the day created amazing magic moments with people.  At one point, he came into the living room and announced with suitable drama that he was “looking for a new wife”, and lots of laughter and chat resulted about who might be a suitable bride!  At another point, he came in with a bag of tools and a broken chair and asked one of the men to give him a hand with re-screwing the leg back on the chair.  The man did this with great enjoyment and focus and they then had a beer together to celebrate their achievement.

In another care home, one of the housekeepers, who is Portuguese, takes time every morning to sit and chat to one of the women living in the home who also speaks Portuguese and is losing her spoken English with the development of her dementia.  The woman’s face lights up when she hears a greeting in her native language. She also takes time to create lovely designs from folding and arranging towels, such as swans and flowers and places them on people’s beds.

One of the kitchen team members in another care home takes pride in putting something fun on the tables at lunch time to spark a conversation.   Everyone looked forward to seeing what she has done to make the table interesting. Examples included a basket of leaves in the Autumn/Fall, a large pineapple, a photograph of Queen Elizabeth or a little bird house, with a pretend bird inside.

A young housekeeper from Lithuania came into the room during an art activity in a care home one afternoon. He was a quiet young man with very little English, but I invited him to join us.  He started to sketch one of the women sitting at the table, and it was clear he was a very talented artist!   We decided to purchase a proper artist easel and for him to do fortnightly portrait sessions in the home.  The person whose portrait was being done enjoyed getting ready for the occasion, deciding what to wear and how to pose.   Lots of people really enjoyed watching him at work, especially one of the women living in the home who was also an artist. The worker felt a very valued member of the team and proud he could share his talent with the care home.

All of these examples demonstrate how important it is to recognise, appreciate and use the different skills, interests and abilities which your team offers.  No one is ‘just a cleaner’ or ‘just a maintenance person’ and in many care environments, these so called ‘ancillary’ or ‘support’ staff can provide a vital role in bringing fun, variety and companionship into the day.

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