At a glance 4: Changing social care: an inclusive approach

Published: May 2009

Key messages

Successful change and improvement in social care depends on the participation of a wide range of people.
Effective leadership is the single most important factor in achieving lasting improvement. Leadership can come from a range of people, including people who use services.
Involving the workforce at all stages, including learning from any resistance, contributes to successful change and improvement.
All successful change genuinely involves a range of stakeholders, learns from their experience and expertise, and uses this to guide the change.
The knowledge and experience of people who use services is invaluable in developing your service and achieving lasting change.
Change and improvement that is led by people who use services is the ultimate goal for adult social care.

Introduction

Adult social care is changing, to put the people who use services at the heart of their own care and support. This requires a different approach from the social care workforce. This At a glance summary presents some ideas about how to successfully change social care services, based on the learning from two previous SCIE publications – Knowledge review 16: Improving social and health care services and Knowledge review 17: Service user driven culture change.

Practice and research tells us that there are four main aspects to achieving successful and lasting change in social care:

strong, effective leaders who understand the purpose of the change, communicate this message clearly, and support the involvement of others to achieve it
the full involvement and participation of the workforce in planning and achieving the change
genuine participation of a wide range of interested parties
people who use services contributing their knowledge and experience, and positively influencing the change.

Improving and altering a service can be a rewarding and exhilarating experience for all involved. However, it also has the potential to be frightening and challenging…

Why is adult social care changing?

The changes are about the people who use services having greater choice and control, and being at the heart of their own care and support. The vision for social care outlined in Putting People First (2007) is based on three fundamental beliefs:

that everyone has a contribution to make
that everyone has the right to control their own lives, and
that people using public services should be able to influence and change services to ensure their needs are met.

The extent to which this is a new approach will vary from service to service, but some change will be needed for all. And it helps to know how to do change well.

Leadership is key

Being a strong and effective leader includes a range of activities:

being clear about what needs to happen, why that is the right thing to do, and how it links to the organisation’s purpose
engaging with and being responsive to others, whilst staying focused on the overall aim
communicating effectively, using a range of different methods and checking that the messages have been heard and understood
reviewing progress and using it to inform what happens next.

A checklist for leaders

Do you have a clear sense of where your organisation is trying to get to? How easily can you explain this to someone else?
Are you clear about the purpose underpinning any planned change or improvements? Why is this purpose right for your organisation?
What steps have you taken to identify the actions needed to successfully achieve the change? Who have you involved in developing this plan?
What have you done to communicate clearly to everyone the rationale and purpose for change? What checks have you made to ensure everyone has understood your message?
How are you dealing with concerns about and resistance to the planned changes? Is progress towards the underlying purpose being affected?
How consistent are your actions with the rationale for and purpose of this change? What can you do to maintain greater consistency?
What steps have you taken to make sure all stakeholders understand and have engaged with the purpose of this improvement?

SCIE Guide 29: Changing social care includes checklists for each of the 4 aspects of successful change

Leadership is key. You need to work with people but do not appear weak. Do not be afraid to say 'this is my vision'.

Involving the workforce

People working within the service can be encouraged to play a full part in the change in many ways:

helping to develop the direction of change and identifying the specific actions needed to achieve it
through opportunities to raise concerns and discuss resistance
working out together what the changes mean to individual workers.
identifying what skills and support they may need to work differently.

Sometimes changes have been brought about because people who are often seen as “difficult” have astute ways of looking at things… They know what the barriers are likely to be, so you can use that to learn and see how you can get round them…

Stakeholder participation

Take the time and effort to work together with key partners by:

communicating clearly the planned changes and inviting their involvement to achieve them
learning from the expertise, interest and opinion of others outside the organisation
exploring what works well within the service and what would benefit from improvement
exploring how individuals might want to participate, and developing an approach that is right for your area.

People who use services driving culture change

The ultimate aim for adult social care, this can be achieved through:

genuine partnership working, where user participation runs throughout the service
careful consideration of practical steps to support involvement – access, timing, financial support, training
key roles within the organisation being taken on by people who use the service
people who use the service being regarded as experts, within an equal relationship.

A successful change

Willowbank is now an organisation that is controlled by people with disabilities and works with and for people with disabilities. Willowbank sees a person with a disability as someone with a ‘solution’, providing they are encouraged, enabled and empowered to articulate what they want and need to help overcome barriers (SCIE Knowledge review 16).

Five years ago I was happy to walk around the garden and plant a lot of bulbs. Now, I’m an equality commissioner for Northern Ireland…

Further information

This summary is taken from SCIE Guide 29: Changing social care.This guide seeks to give readers some ideas about how to successfully change services in order to place people at the centre of their own care and support. It begins with a brief overview of the policy context and then moves on to a series of ‘how to’ sections. It looks in turn at the importance of good leadership, and the full involvement of both the workforce and all stakeholders in achieving change. It also explores in more detail how to involve the people who use services in order to positively drive and influence change. The guide is illustrated throughout with quotes and examples from a range of case studies conducted with organisations who have undergone planned change and improvements.

The ‘how to.’ sections will all follow the same format:

what needs to be done – suggestions and examples from practice
how we know this – messages from the literature
how are you doing? To check progress in your organisation
Checklists – from practice and literature
case studies.