Manage health and social care practice to ensure positive outcomes for individuals
Outcome based care is about putting the customer at the centre of the care service and not prescribing a one size fits all policy. Care should always be bespoke to the customer taking into account their needs and choices. Care should allow the customer to live a fulfilled life, help them identify and achieve the things they would like to do. Outcome based care requires careful planning with full involvement from the customer their relatives should they wish and other health care professionals if required.
Teamwork and communication is essential to ensure continuous quality improvement, and process and outcome measurement. There are key benefits of outcome based care •The customer’s desires, aspirations, abilities and talents are explored and utilised to help ensure they lead a more fulfilling life. •It empowers care workers to work more closely with service users to understand how best to enable their independence •The service can respond more easily to changing needs and preferences •It contributes to maintaining a customer’s independence.
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•It enables customers to exercise more choice and have more flexibility in the day to day delivery of their service •It encourages partnership working between all stakeholders involved in the delivery and management of an individual’s care. •It uses resources, such as funding and time, to greater effect •It provide a basis for evaluating the effectiveness of services The main focus of outcome based care is looking for opportunities to support people in activity throughout the day. This means thinking about the activities that need to be completed – Key tasks such as personal care, travel, social inclusion or meal preparation.
The practice of outcome based care ensures that customers are involved in their daily living activities and choices, regardless of their physical or mental ability. Not everyone using our support services can undertake all activities independently people need different levels of assistance and support. The role of the care worker is to provide just enough support without removing the customers’ ability to successfully participate. A key principle outcome is helping customers to engage little and often so that they are able to build up their experiences of success and increase their motivation. 1.
Critically review approaches to outcome based practice Outcome based practice was introduced as a new way of working replacing a needs based approach to care and support offered. Rather than a ‘needs’ based approach to care and the support offered it became Outcome/results based accountability. A needs based delivery of care was difficult to measure in terms of success or failure where as an ‘outcome’ based delivery was more focused on an individual’s achievement. Outcomes within a social care context are concerned with quality of life rather than simply levels of ability, health, health or housing status.
At a community level this can be about people feeling protected and safe, people being much healthier and communities overall being stronger and more connected. For an individual person their outcomes can be framed in terms of the steps they need to take in order to improve the daily living activities relating to their own individual safety and security. 1. 3Analyse the effect of legislation and policy on outcome based practice The NHS and Community Care Act 1990 – Section 47(1) Assessment of needs for community care services.
This meant that local authorities were duty bound to carry out a full assessment of need for the community care services where a person appeared to be someone for whom community care services could be provided, and a person’s circumstances may have need the provision of some community care services. Community Care and Direct Payment Act 1996 Direct payments were set up with the community care act which came in to force in April 1997. This empowered individuals enabling them to the right to choose and control their care services.
Although initially this was only available to people under 65 years with physical and sensory impairments, learning difficulties and mental health problems. It was later amended to include older people, 16 -17 year olds and parents of disabled children. The Act gave local authorities in Britain and Northern Ireland the powers to make cash payments to disabled people In the Health and Social care act placed a mandatory duty on all local authorities to offer direct payments to all eligible people requesting one this came in to effect in 2003.
Valuing People (Department of Health 2001) it was introduced by the labour government who were keen to promote independent living. This white paper on learning disabilities was for the first in England in 30 years. It made direct payments available to more people with a learning disability and was the first paper where we officially come across the term ‘Person Centred Planning’. It stresses the importance of Personal Centred Planning in helping people with learning difficulties take charge of their own lives.
This paper has been ‘refreshed’ in 2009 titling it Value People Now and is a new three year strategy for people with learning disabilities, and will lead to better lives for people. Person Centred Planning allows more control for the customer allowing their individual choices and needs to be catered for and in turn services such as what I as a manager provides will be run in a Partnership with the customer to support their needs in the way they want. 1. 4Explain how outcome-based practice can result in positive changes in individual’s lives. Health and social care is increasingly moving towards outcome-based services.
An outcome describes the measurable impact of the service on a person’s life. Every customer has different needs and goals and an outcomes- based service places these at the centre of its delivery, rather than using a one size fits all approach. This represents a major shift in the way services are designed, commissioned and delivered. Along with the way they are evaluated has differed. Outcomes based approach is used as a means of improving performance, accountability and consistency in a service provision, which can only promote and result in positive changes in people’s lives.
A bespoke tailor made care service for every individual that is evaluated by the benefits and positive outcomes in a customer’s life from a general health improvement, or reaching or achieving individual’s targets or goals set. Such as increasing social inclusion and access to the community or reducing pain and discomfort with medication support for instance. 2. 1 Explain the psychological basis for well being Psychological health is important with respect to how we function and adapt, and with respect to whether our lives are pleasing and productive.
As the manager of a care service I am aware that this needs to apply to both my staff and customers. General wellbeing does not just mean that we are free from stress, anxiety and depression. People who suffer with long term physical health conditions with often have psychological and emotional needs resulting from the burden of symptoms relating to their illness. This could be the disability associated with the physical illness such as mobility problems or the impact of more than one physical condition at any one time. There are clear links between physical and mental health.
Wellbeing is a multi-directional concept that includes subjective, social and psychological dimensions as well as health-related behaviours. The Ryff Scales of Psychological Well-Being is a theoretically grounded instrument that specifically focuses on measuring multiple facets of psychological well-being. These facets include the following: •self-acceptance •the establishment of quality ties to other •a sense of autonomy in thought and action •the ability to manage complex environments to suit personal needs and values •the pursuit of meaningful goals and a sense of purpose in life •continued growth and development as a person
Maslow Abraham Maslow developed the ‘hierarchy of needs model. This pictures human behaviours as subject to a set of fundamental drives. It explains human behaviours as driven by a set of needs which influence our behaviours in hierarchical fashion – please see image below. Reference sourced from Google images 2013. 2. 2 Promote a culture among the workforce of considering all aspects of an individual’s wellbeing in day to day practice. As the Manager I need to be able to provide a supportive environment for all individuals to achieve positive outcomes.
To manage outcome based care requires careful organising and planning to help identify and achieve the things people want to do. It is important that I ensure staff allow customer to make choices, feel valued, treat them with dignity and respect at all times and support them in a way which takes in to account their individuality as no two persons needs are identical. An individual’s spiritual well-being is also very important with regard to their mental, emotional and physical health. It may be connected to a specific religion but does not have to be.
It is about an individual’s own personal journey to discover things of importance in their life. It is important that my staff know that their role is to support customers to feel both physical and emotional well-being and in order to do this individuals need to feel, safe and secure. Customers need to be able to request and have additional support when they are feeling lonely or sad. Customers have the right to respect and to be listened too. Staff should ensure that customers feel independently and in control of their lives.
It is important that staff have good interpersonal skills, which are fundamental in promoting and individuals well-being. Good robust staff training is essential. Care workers need to have many skills gained from both the classroom and every day experiences and reflective practice. Care workers perform better when coming from a supporting work environmental which encouraged team discussion and mutual support. Staff development opportunities are crucial with resources available to help promote and enhance care worker skill sets.
Regular supervisions, training, staff meetings and communication with staff ensures promotion of this. I as a manager have ensured that each individual care worker has his or her own tailored career development plan and training plan to ensure that staff receive as much training and guidance as possible to fulfil their roles as care support workers. 2. 3Review the extent to which systems and processes promote individual wellbeing. Effectively promoting and maintaining well-being and choice for people who use services, presents a variety of challenges for service providers particularly front line care staff.
As the manager I am aware that I have a social and legal responsibility to ensure that customers who use my service have their needs met. The importance of well-being is clearly the core of the Essential Standards of Quality and Safety outlined by the Care Quality Commission and it involves meeting the needs and aspirations of service users (customers) a customer must always remain the centre of the care provided and be fully involved in deciding their positive outcomes. By planning the care provided around those outcomes, always offering alternative choices and ensuring that there are systems in place to meet the customer’s needs. This will in turn ensure that as the Manager I am able to fully promote a customer’s well-being effectively. Care planning and review ensuring that the customer is fully involved and consents to the care plan in place and alter and change where necessary to accommodate any changes in preferences etc. 3. 1Demonstrate the effective use of resources to promote good health and healthy choices in all aspects of the provision. Good health is a state of both mental and physical well-being.
Achieving good health for all means not just reacting to ill-health but to promote good health, preventing diseases and helping people to make informed health choices. Achieving good health for all is a shared responsibility that requires co-operation, partnership working and positive action between service providers, customers and other professionals involved in providing health care. Customers need and expect reliable, easy read/user friendly information, about how to stay in good health and the effects of lifestyle on health.
When a customer falls ill, they need professional and authoritative information about their condition and treatment options available to them. This enables the customer to make informed decisions and help to make the right choices for themselves. Individual health is about having a holistic approach when providing care to ensure all areas of a customer’s well-being is catered for. As a Manager it is important for me to find the most cost effective ways of delivering the best outcomes for people who need care and support using the resources available.
Funding restrictions from local authorities, social care services and the primary care trusts can limit the resources available and as the Manager I need to be able to source valuable support with the budget available. For example rather that an expensive care call for medication support a simple low cost dispensing device may in fact support a customer who perhaps has short term memory to remain independent with their medication and eliminating the need of a care worker and the hourly expenses that this may entail.
As the manager I often work with voluntary organisations for additional support. With family members of customers (with their consent) and other statutory services to achieve the right result for the customer. 3. 2 Use appropriate methods to meet the health needs of individuals. The CQC provide prompts for all providers to consider and for Outcome 4 these include: •Ensure effective, safe and appropriate,
personalised care, treatment and support through t coordinated assessment, planning and delivery •People who use services have safe and appropriate care, treatment and support because their individual needs are established from when they are referred or begin to use the service. •Maintain their welfare and promotes their wellbeing by taking into account of all their needs, including – ? Physical ?Mental ?Social ?Personal relationships ?Emotional ?Daytime activity •Encourage the prevention and early detection of ill health, including relapse, wherever there are real factors that present a risk to their health and welfare.
•Enables them to make healthy living choices concerning exercise, diet and lifestyle. It is important to recognise that all people are individuals with individual needs and wishes which impact on their lives. As a Care Manager I must ensure that I have the full details of all or any services that are available so that I can then offer the appropriate information to the individual thereby allowing them an informed choice about care available so they are able to choose the option that they believe best suits them and their needs.
I encourage and fully support complete participation in care planning and reviewing ensure that the customer’s needs and wishes are respected at all teams ensuring that they are provided with full support in the areas that they feel is necessary and less support in other areas where the customer feels that they are fully independent. 3. 3Implement practice and protocols for involving appropriate professional health care expertise for individuals. oAs the Care Manager it is my responsibility to ensure that the care needed is provided with capable and competent staff.
I have a duty to ensure that the staff have received the correct and appropriate training to recognise a customer’s health care needs and now when to report any issues that may require further attention or support. This can often lead to additional service providers and health care professionals being invited to support the individual such as continence trained nurse to provide support for customer who is suffering from bladder control problems or a district nurse to monitor and access skin breakdowns. The CQC regulation state that care workers should receive the following mandatory training – oHealth and Safety awareness training oMoving and Handling/ Moving and Positioning oFire Safety oEmergency Aid Awareness oAccredited Training for First Aiders oInfection Control oFood Safety in Catering or Food Hygiene oNutrition and Hydration oMedication Safe Handling and Awareness oSafeguarding Adults Briefing oSafeguarding Adults local policies and procedures . 3. 4Develop a plan to ensure the workforce has the necessary training to recognise individual health care needs. I have produced a staff training matrix which has all training requirements needed and when they are due to be commenced.
The training matrix includes the skills for care requirements and mandatory training needed. Along with this additional more specialised areas of care training are also included which staff are offered the choice to attend supported or independently to further their career development. Staff are aware of the importance of being the best care worker they can and that training is an important part of this. I am aware that training must meet the regulations laid down by the health and social care act, CQC and many other governing bodies.
As the Manager and under the Essential Standards for Quality and Safety I am aware that I am legally responsible for making sure it meets with new essential standards and safety. The CQC will continuously monitor compliance with essential standards. 4. 1 Explain the necessary steps in order for individuals to have choice and control over decisions As the Manager I must ensure that customers have all the information they need to make an informed choice. It is important to remember that too much information can be oppressive and customers 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 individuals needs into account. My organisation initially meets with potential customers to discuss their needs in full ensuring that their preferences are taken in to consideration throughout the process. We ask that the customers to sign consent to the care plan but staff are aware that they must seek consent at each visit as circumstances and situations change, on-going this will promote the customers right to choose.
4. 2Manage resources so that individuals can achieve positive outcomes As the manager I have written a contingency plan to ensure that we as a service are able to cover customer calls etc in the event of an emergency. This protects the customers and their right to receive care as and when they choose on their care plan and to ensure that the continuity of care is not disrupted wherever possible. 4. 3 Monitor and evaluate progress towards the achievement of outcomes As a manager I regularly gather feedback form all those involved in the care of a customer.
This is sourced in a variety of ways. From the customer themselves in a review of service meeting, Quality Assurance, other health care professionals (views of others reports), family and friends of the customer and care workers directly involved in providing care. I am responsible for monitoring the customer’s progress ensuring that their care plan reflects and supports their needs and wishes helping them to reach their goals and their own planned goals. Outcomes need to be measured at Review, so they will need to be SMART SSpecific
MMeasurable AAttainable RRelevant TTimely 4. 4Develop a plan to ensure the workforce has the necessary training to support individuals to achieve outcomes All staff are placed on the Skills for Care – Common Induction Standards programme when commencing as a care worker. Staff always complete a comprehensive induction training course – office based. Along with this they are shadowed and supported closely for the first 12 weeks. This is monitored weekly by way of spot checks, supervisions and further short course training.
As a Manager I use Staff Plan roster programme which also allows training information to be added and alerts me when training requires updating. CPD (continued Professional Development) is promoted strongly within my organisation and staff are regularly requested to attend training including both Mandatory and specific specialist training such as Level 3 Medication or QCF levels 2 and 3. As a Manager I must ensure that workers are training and competent to support people to : a.
Identify positive outcomes that are appropriate and achievable b. Monitor and celebrate the achievement of the outcomes and any steps towards them. c. Cope with and overcome problems, obstacles and barriers. Standard 2 of the Common Induction Standards recognises the value of learning and development and reflective practice to improve skills and improve the quality of the service provided. The Manager Induction Standard develops that understanding to working with and supporting others in their professional development.
It included knowledge of effective supervision practice and how this can be embraced within the organisations performance management processes where they exist. I recognise as a Manager I need to understand this standard from two different perspectives: that of being a supervisor and mentor and that of being the supervisee or learner. It is important that I take steps to develop my own continuing professional development according to my own personal development needs as well as supporting others for whom I am responsible.
The health and social cat act regulation 23a states that the registered person must have suitable arrangements in place in order to ensure that persons employed for the purpose of carrying out a regulated activity are appropriately supported in relation to their responsibilities, to enable them to deliver care and treatment to service users safely and to an appropriate standard including by – A. Receiving appropriate training, professional development, supervision, appraisal And B. Being able from time to time to obtain further qualifications appropriate to the work they
perform I have a complete supervision programme which is support within my organisations policies and procedures. This ensures that regular communication with staff is encouraged with an open door and transparent approach. Staff are met with regularly a minimum of once a month for supervision, observations and spot checks, training, Appraisals and staff meetings. As a Manager I have also introduced a regular staff newsletter. 4. 5implement systems and processes for recording the identification, progress and achievement of outcomes. Recording is an essential task.
It helps to focus the work of staff and supports effective partnership and planning with people who use the services. All communication received within the office via email, telephone of face to face meetings etc are all documented within our secure Roster System each customer and staff member have journals which every piece of communication can be recorded securely. Along with this all supervisions/Appraisals/Spot Checks/Observations and recording in writing and keep in staff files. All customers are reviewed regularly again this is in written format and the customer is asked to confirm that the review is accurate by signing the document.
Care Plans are reviewed every 6 months if not before if changes in needs or circumstances arise. Recording has been identified as one of three key elements essential to maximising the benefits of an outcome’s approach. •Outcomes focused engagement (to develop, implement and monitor and individual plan) •The recording of the outcomes following assessment and planning and review •The use of that collated information for a range of purposes including planning, commissioning, accountability and performance improvement. 5.1Analyse the importance of effective working relationships with carers, families and significant others for the achievement of positive outcomes. Carers, families and significant others, play an important role in many customers lives. They are often the people who know the service user best and can be an invaluable source of information and support. Carers might be best positioned to provide the help needed to achieve the best possible outcomes for the service user. They often provide emotional, social and financial support for the service user.
They also assist with domestic tasks, monitor their well-being and often become and advocate for the individual. By making time to get to know the customer and their families, meeting agreements and taking actions within set timescales, maintaining on-going communication helps to building trust and mutual respect. Informal carers have skills and knowledge which I may not have. They get used to reading the signs of relapse, assisting with medication compliance or suggesting different ways to support the customer.
Their involvement can be helpful for the clinical team and this will be more effective if the informal caring role is noticeably valued and respected by myself and my colleagues. An effective working relationship with all those involved in the individuals life and working as a team, you can deliver improved outcomes for the service user. 5. 2Implement systems, procedures and practices that engage carers, families and significant others. As a Manager when evaluating, identifying the progress and achievement of outcomes you will involve the customers carers, families and significant others as there feedback is vital.
I am duty bound to regularly ask for feedback from customers and their family with regards to the service I am providing them with. Telephone review of service, face to face review of service and quality assurance questionnaires one of which being anonymous to ensure that customers are able to freely discuss any issues or concerns they may have. As the manager it is my responsibility to collate the information and act on the results and implement changes or resolve issues as they arise.
For example a customer may be receiving calls to late in the mornings resulting in some of the care being given is not appropriate for that time of day. As the manager I would look in to the cause of the late visits and adjust accordingly. 5. 3Use appropriate approaches to address conflicts and dilemmas that may arise between individuals, staff and carers, families and significant others. It is important to evaluate, manage and intervene by mediating when conflicts may and do impact upon the lives and outcomes of people within the provision.
There are various appropriate approaches which can be used to address conflicts and issues. Depending on the circumstances this could take the form of – oOne to one discussion oGroup discussion oUsing contracts oProviding information to inform choices oMentoring for conflict resolution As a Manager I must first evaluate my own systems, beliefs and attitudes in relation to the specific conflicts and issues between people, care workers and carers and significant others to identify those: (a)you can deal with objectively and fairly(b)where expert advice and guidance is required Once this has been established it as a conflict you are able to deal with objectively and fairly you need to support and ensure that workers and relevant others are aware of the provisions systems, procedures and practices for addressing ethical dilemmas and conflicts and also negotiating agreed boundaries on behaviour. Part of my role as a manager is to develop effective systems and approaches to handle conflicts and issues. 5.4Explain how legislation and regulation influence working relationships with carers, families and significant others. In my work setting there are a number of legislations and regulations which influence my working relationship with carers, families and significant others. My organisation has clear and concise policies and procedures which all employees are expected to adhere to. These dictate our individual roles and responsibilities and accountability for me when leading others and also when managing working with the individuals family.
There are also local, national, UK, European and international legislation, standards, guidance and organisational requirements for the leadership and management of work with individuals, families, carers and significant others, which include: •the need to achieve positive outcomes for people •the need to safeguard and protect people for all forms of danger, harm and abuse •employment practices for the provision and service •data protection, recording and reporting •making and dealing with comments and complaints to improve services •Whistle blowing •Health and Safety •Equality and Diversity
These all affect the way I work with individuals and their families. The Care Quality Commission regulates, inspects and reviews all adult social care services in the public, private and voluntary sectors in England. The Essential Standards for Quality and Safety – From 1 October 2010, every health and adult social care service in England is legally responsible for making sure it meets new essential standards of quality and safety. Providers must show that they are meeting essential standards as part of the new registration system which focusses on people rather than policies, on outcomes rather than systems.
The essential standards relate to important aspects of care such as involvement and information for people, personalised care and treatment (bespoke to the individual), safety and safeguarding. The CQC continuously monitor compliance with essential standards as part of a more dynamic, responsive, robust system of regulation accompanied by new enforcement powers. My customers can expect from my service as a care provider the following – The essential standards 1. You can expect to be involved and told what is happening at every stage of your care 2. You can expect care, treatment and support that meets your needs 3. You can expect to be safe.
You can expect to be cared for by qualified staff 5. You can expect your care provider will constantly check the quality of its services 5. 5 Implement safe and confidential recording systems and process to provide effective information sharing and recording. Records and reports provide evidence for Health and Safety procedures and any issues. They will need to be clear, concise, factual and not based on opinion or assumptions. If an opinion is expressed it should be clearly stated that is an opinion and not based on fact. As a Manager it is my responsibility to ensure that all records are accurate, ordered, up to date and safe and secure.
I have as the Manager to ensure that all records are secure kept within locked filing cabinets and I am the principal key holder. Any documents sent via email to others are always password protected which requires the recipient to contact me for the password prior to being able to gain access to the information and allows me the opportunity to confirm that the correct person has the information required. As a manager I must adhere to the Date Protection Act 1998 which sets out 8 principles governing the use of personal information. •Personal date shall be processed fairly and lawfully
•Personal data shall be obtained only for one or more specified and lawful purposes •Personal Data shall be adequate, relevant and not excessive •Personal Data shall be accurate and where necessary, kept up to date •Personal Date processed for any purpose or purposes shall not be kept for longer than is necessary •Personal Data shall be processed in accordance with the rights of data subjects under this Act •Appropriate technical and organisational measures shall be taken against unauthorised or unlawful processing of personal data and against accidental loss or destruction of, or damage to, personal data.
•Personal Data shall not be transferred to a country or territory outside the European Economic Area, unless that country or territory ensures an adequate level of protection of rights and freedoms of data subjects in relation to the processing of personal data. When sharing information with others the Caldicott Principles are put in to place. The Caldicott Report set out a number of general principles that health and social care organisations should use when reviewing its use of client information •Justif