Morale at this service was particularly low. The inspectors were putting pressure on management. Management were putting pressure on the nurse manager. The nurse manager was putting pressure on the care support staff, and the care support staff were on the floor with the service users, during covid lockdowns and with everyone looking at them!
Historically, training in the service had been carried out with a singular focus on the physical techniques of restraint and breakaway. Unfortunately those techniques were mis-matched to the needs of most of the staff and service users in the service and this had caused a degree of ‘cognitive dissonance’ in the workplace.
Staff had no confidence that the breakaway tactics they had been taught would protect them from harm. Conversely, staff also believed that the restraint and holding techniques were overly-robust and indeed likely to cause injury to the people they were supposed to be looking after.
There was very little input to the staff team about de-escalating high-stress enounters (or any encounters, in fact) and no opportunities to practice these or to get feedback from experienced colleagues or trainers about them.
Due to all of these factors, there was an inevitable problem with being asked to attend training!
Under the old regime, Training used to mean:
- being told what you shouldn’t do
- being told what you couldn’t do
- being told about the bad things that could go wrong
- being told what would happen to you if things went wrong
Tactically, the training was very specific and required an attention to detail which would in all likelihood be very taxing in the midst of a high-stress incident.
The result of all of these complications was that people didn’t want to do ‘the training’ and didn’t think it was going to help!
There was quite a lot of initial resistance and reluctance to even the new models of training that the newly-qualified instructor team introduced, which in many ways was aimed at fixing the issues with the previous programme.
Happily though, with the new energy brought to the classroom by the newly-qualified training team and the new values-based training programme, the experience of the trainers was that their staff colleagues were experiencing a change of heart in the classroom.
“I’ve really enjoyed this.
You said you would change my mind about training, and you did!”
Besides the restraint-reduction results, this team have reported a sea-change in the staff culture and attitudes, including a change of feelings about the value of the training in creating a different, safer environment for everyone in the service.
The instructors now report that, months after the programme was initiated:
- staff engage with a common values-set
- staff persist in de-escalation longer
- more incidents are resolved, more quickly
- far fewer incidents conclude in a physical intervention
- improved staff morale both ‘on the floor’ and in training
- more frequent post-incident debriefs
- better overall behaviour planning and insights
- consistent use of common language to describe behaviour
- inspections resulting in positive outcomes
Our friend and hugely experienced colleague Gary Klugiewicz from Vistelar tells a story about how he once knew of a service in which everyone remarked on how dirty the physical environment was. Everyone complained. Staff blamed the service users – “they don’t clean up after themselves and dirty the whole place.
Service users blamed the staff – “they should arrange cleaning rotas, equipment and organise things for us”.
The management blamed the system – “we need resources and policies to get this place cleaned up!”
Gary’s lesson about this story is that “We ALL come together in this service – some of us to work, some to manage the work, some of us are the work – but if we don’t ALL agree that the condition of the environment is all of our problem, then we won’t get anywhere”. He finishes the story by underlining that if senior leaders in an organisation send the message that they are watching a specific area or outcome, it will soon be addressed, all the way down through the chain of leadership to the shop-floor. This is a powerful lesson about the need for top-down leadership in changing the nature of care in our services.
In the next and final of this blog series, we will look at the Restraint Reduction outcomes in this service since implementing this training programme.