There is a growing interest in promoting a positive culture in domiciliary care / home care services.
Increasingly, positive culture is becoming more recognised as important in contributing to the effectiveness of any service, yet it is an area that until recently that has tended to be overlooked. CQC have recognised the importance of a positive culture. In the Key Lines of Enquiry Well Led Prompts; the question is asked “How does the service promote a positive culture that is person-centred, open, inclusive and empowering?”
There is often a lack of understanding of what culture really means. A useful social care definition can be seen as ‘staff having a way of thinking, behaving and working that complies to the ethos and values of the service’. Culture affects practically all aspects of organisational life from the way in which people interact with each other to how they go about their work and the way decisions are made. It serves as a powerful force drawing people together and creating a sense of cohesion or division, defining what values and behaviour are acceptable and unconsciously telling people “how things are done around here”.
Why is culture so important? Research shows that the culture of a service directly affects the quality of life of Service Users. (My Home Life). It has become increasingly recognised that staff and Service Users are interdependent and this needs to be considered when fostering positive cultures in care services.
Creating a positive culture
Approaches to creating a positive culture will need to take account of the following:
• How management challenges the unquestioned routines that exist day to day.
• The importance of leadership.
• A recognition that managerial practices in the service are probably the most potent ways in which its culture is transmitted and reinforced.
A manager who sets out to create a positive culture in a domiciliary care / home care will need to recognise that their personal actions and behaviour are likely to evoke strong emotional reactions from staff. Setting an example by deliberate role modelling, teaching and coaching can have a profound effect on the willingness of staff to support or resist change and whether they participate or buy into it.
Regardless of the approach taken, management should look for congruency between what the service claims to be and what is practised. This combined with good communication, will play a powerful role in establishing and maintaining a healthy work culture. Honest discussion with staff about shared problems, responsibilities and potential solutions is a good starting point for improving culture at work.
Ethos and Values
Ethos can be defined as the beliefs or ideas by which a person or group lives. An example of ethos is the goals of a service set out in a mission statement.
The central characteristics of an ethos for domiciliary care/ home care services
The following are suggested characteristics of an ethos for domiciliary care / home care services:
• To be a service that seeks to learn and evolve, aiming to implement what is considered to be best practice in all aspects of service provision.
• Recognising that Service Users and their families have a right to a high standard of service.
• To support and empower families in achieving a fulfilling life for their family member.
• To support staff members to work to our ethos and values to achieve fulfilment in their working life.
• To work in partnership with statutory bodies and other stakeholders in the community to achieve high quality services and quality of life for Service Users.
Positive culture values for domiciliary care / home care services
The following are suggested core values that underpin and form part of the interdependent relationship between staff and Service Users:
• Service Users and their families will be actively involved in decisions effecting their care, treatment and support.
• The domiciliary care / home care services provide a service where management and staff see safety and security of paramount importance.
• All Service Users are treated equally and provided with equality of opportunity.
• Staff will always show compassion when providing care treatment and support.
• Service Users are always treated with dignity and respect.
• Staff will encourage Service Users to retain their independence as far as safely possible.
Promoting a positive culture
The establishment of a positive culture will depend upon:
• Staff who share, the values of the service.
• Promoting and encouraging a united feeling of identity where staff feel valued and are treated with trust, integrity and respect.
• Encouraging a feeling of belonging.
• Obtaining a commitment from all staff to work together for the benefit of Service Users and their families.
• Promoting a culture of honesty openness and transparency when mistakes occur.
• Investing time and energy into maintaining a positive workplace culture.
Value-based recruitment is an emerging theme in social care today. It emphasises the importance of assessing values and attitudes alongside skills and experience, which until recently held centre stage. This can be supported by having a clear Service ethos and values for staff and service Users.
Skills for Care Social Care Commitment
The Social Care Commitment is a promise made by people who work in social care to give the best care and support they can. This is an agreement from employers and employees to improve workforce quality, by focusing on the values and behaviours needed to work in a care service.
The manager and staff by signing up, acknowledge their responsibility for ensuring workforce quality, and opening up to a more transparent way of working. It focuses on key issues such as upholding dignity, staff development, and whistleblowing.
It’s a way of employers and employees mutually agreeing to take responsibility for driving up standards.
The manager in the role of leader in the domiciliary care/ home care service
There is no evidence to support the view that managers can control or manipulate culture, but as good leaders they can certainly initiate, influence and shape the direction of change to a more positive culture. Therefore, the role of leadership at all levels in achieving cultural change is almost indisputable and is a vital aspect of management development. To succeed managers must:
• Hold on to their ethos and values.
• Learn about what motivates their staff and encourage them to take part in cultural change.
• React positively to negative feedback: listen, learn and act.
An understanding of culture in home / domiciliary care services is important to the operation of the service and quality of life of Service Users. This is because culture affects practically all aspects of organisational life from the way in which people interact with each other to how they go about their work and the way decisions are made. In the end the achievement of a positive culture will largely depend on the acceptance and sharing of the ethos and values of the service and how these are followed in day to day practice.
Albert Cook Albert Cook BA, MA & Fellow Charted Quality Institute
Bettal Quality Consultancy