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SeCtion one Four key approaches to change
of stakeholders. The findings of the ‘Discovery’ stage were shared and those present asked to consider how they could build upon what was seen as being good, and respond to what was seen to be less good. The workshop identified a better environment, more selection of food and a better range of activities but did not come up with more visionary ideas. The workshop participants seemed to be unable to move beyond making what they a bit better. They could also not see how they could make any major changes without more funding for staffing and they knew this was not an option. At the end of the session everyone, including Manager A, felt deflated.
Manager A discussed with her line manager what had happened and the lack of momentum. He suggested contacting another home in the neighbouring area which was seen as a national example of best practice. Manager A arranged for the change team to visit the home. They were impressed by the way in which residents were involved in undertaking day-to-day tasks. Two hours per week of support had been separated out for each person in an Individual Service Fund in order to facilitate them undertaking an activity of their choice. This could be used each week or saved up for a longer activity. Underpinning the support were individual person-centred plans for each resident. A second workshop was held and the change team fed back what had been observed during the visit. At the end of this workshop there was a very different vision that was based on a set of principles regarding what people can expect from the care in the home and a set of outcome statements regarding what this would look like in practice if successfully implemented.
The vision was shared with people living in the home, staff team and families and comments received about how it could be improved. Suggestions were made for minor amendments and additions but there was a general agreement about what was being proposed.
Implementing the change
Having established the vision, Manager A met with the change team to undertake the ‘Design’ of the new care at Acorns (the third stage of Appreciative Inquiry). They looked again at the feedback about what was good and what needed to improve, and did a mapping of the vision and the degree to which they were currently meeting the aspirations of the vision. To facilitate this process and ensure that they thought creatively about the potential resources that could be drawn upon, Manager A suggested that they use de bono’s six thinking hats exercise to help people to think differently. This also led to much laughter as Manager A went to the charity shops at the weekend and bought a range of unusual headgear.
They identified four main areas for improvement and potential strengths that can be built upon with Acorns (Table A1). Mini project groups were set up to take forward the different areas of improvement with representatives from the stakeholder groups, and one of the two deputy managers also present. A Project Plan was drawn up to ensure that the necessary activities were completed.
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