Our shared purpose: dignity in care for older people

With support from the Health Foundation’s Shared Purpose programme, Northumbria Healthcare NHS Foundation Trust has designed an ambitious project which builds on the role that corporate services play in improving the dignity of care provided to frail older people.

Here we look in detail at a key strand of the Dignity in Practice project, which focuses on changing the way the HR team supports the organisation, realising that their work can have a significant role in ensuring older people receive compassionate care.

Transforming human resources support

‘This project is really important for us as we’re focusing on the hidden processes that sit behind good care for older people’, says Project Lead and Director of Patient Experience, Annie Laverty.

‘Nationally, people aged over 65 use 70% of all hospital bed days and represent 80% of emergency readmissions, and a third of those admitted to hospital will suffer from depression, delirium or dementia. The average age of patients occupying medical beds is 82, so we really do have a shared purpose to get this right.’

Annie and her team, including Project Manager Cath Ashbrook-Raby, are supporting HR with a range of changes which will transform the way the Trust recruits, inducts, trains and develops staff in order to improve the dignity of care provided to frail older people.

Identifying learning needs

‘We did some work to identify what optimum care for older people looks like, and then analysed what we’re actually providing. There was a gap between the two which translated into some clear learning needs’, explains Cath. ‘For example, only 10% of our newly qualified doctors felt confident about meeting the needs of frail older people.’

Findings from a two-year study into the Trust’s care for older confused people also uncovered that some staff didn’t feel equipped to deal with older patients with dementia and delirium. This lack of confidence could result in negative attitudes towards this patient group, who were seen by some as hard to manage. It was also obvious that staff didn’t always think about how frightening being in hospital can be for frail older people.

An educational programme

These findings fed into a new education programme for staff, specifically designed to build confidence, knowledge, compassion and understanding about the needs of older patients.

Over 500 new employees have now attended the Trust’s revised induction day, which includes films and stories about dignity and respect, as well as a strong cultural message that staff are expected to speak up if they witness poor care. This induction is provided to all new staff, no matter what grade or job title.

The Trust's two-day ‘Dementia and Delirium’ training course is delivered to all members of staff working on a ward, from doctors and nurses to allied health professionals and domestics. Five ward teams have completed this so far, with plans to train a further 15 teams.

Cath says the training is already helping to engage and empower staff. ‘It encourages them to come up with ideas for small practical changes that contribute greatly to older people’s levels of independence and dignity. This includes things like providing appropriate crockery, signage and orientation devices such as large clocks and calendars.’

People with dementia and their carers are involved in the training, helping staff to better understand the daily challenges and emotions older patients with dementia face.

‘You can see staff now thinking about things from an older person’s perspective. Asking, “how would I go to the toilet in this ward?” or “as a person with dementia, what does it feel like to drink my tea out of a plastic cup rather than a mug like I’m used to?”’ says Cath.

Recruiting for values

Another big change has been the development of a new approach to recruiting all Trust staff which focuses on values as well as skills. A new interview assessment framework is being tested which highlights compassion as a core value and helps recruiters select candidates with the right attitudes and behaviours. This approach is being rolled out gradually and will eventually be used in the recruitment of staff in every discipline.

Values and behaviours will be incorporated into staff appraisals for the first time this year, and a new skills matrix for ward staff will help them understand the particular strengths of team members with regards to skills like listening, empathy and compassionate care.

A shared purpose for change

The team are ten months into the two-year project, and it’s clear a huge amount has already been achieved.

A detailed evaluation, led by Professor Winifred Tadd of Cardiff University, will help to assess the true impact of this work, involving some 200 hours of observation of the care provided to older people.

‘We hope the changes are having a strong impact already’ says Annie. ‘But the shift is quite intangible so it will be great to have such a detailed evaluation to work with. For example, we’ll be able to see whether people recruited since January 2013 retain and act on the messages from the induction, and whether they see the Trust’s values in action where they work.’