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SeCtion one Four key approaches to change
Building the model required them to keep returning to the various diagrams to ensure that they had captured all of the viewpoints. One striking element of the model was that being in a care home did not seem to be required as such – rather it was about the location, the facilities and the support that was available within the accommodation.
Having designed the model Manager D then facilitated workshops for the three different homes which included all the people living in a house, those of their families who wanted to attend, and the staff members (including the night shift). The meetings were held in a church hall so that there was plenty of room. On the walls of the room were the different PQR diagrams which Manager D introduced, and the draft model. She explained this in depth, and used it to generate discussions regarding what was important about the new arrangements and who could contribute. She also introduced the need to monitor what impacts the service was having, and used the following outcomes-
• Is the service providing what people want and need day to day (efficacy)?
• Has the funding (local authority, benefits and individuals’ own) been used efficiently?
• Are the longer term outcomes (such as being happy and health) being met effectively?
At the end of each meeting manager D would redraw the model to incorporate the discussions that had taken part into the model, and then present the new model to the next meeting. At the end of this sequence of meetings she did not have consensus regards all aspects, but did have a number of areas of agreement. There were also a few issues that were of less concern to most people but for a number of key stakeholders were of crucial importance. Most importantly there had been a good discussion amongst those who had taken part about what was important in any future arrangements and there was a better sense of shared purpose and respect for other people’s viewpoints.
Implementing the change
The care management team had completed the person centred plans for each of the people living in the home and also calculated their personal budgets. Out of the 10 people currently living in the home, two people were going to move into nursing home care and another one person was going to leave the area to move closer to his brother. This left 7 people who were interested in moving into the new tenancies. Using the model developed in the ‘deciding’ phase and the person centred plans for the individual people Manager D started to work with the staff team to consider what their responsibilities would be in the new service and what skills and team processes they would need to respond to these. One of the ‘world views’ from the staff was that they were stifled in developing new practices due to the Board wanting to agree to any new ideas. Manager D therefore proposed that they try a self-managed team approach, in which the staff would have greater autonomy and responsibility on creating how the new support would operate. Having talked to the Chief Executive a paper was presented to the
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