ENRICHEnabling Research in Care Homes
A care home managers take on research
We care home managers are really keen to work with and develop research. So why don’t we?
My name is Robin Willmott and I am the manager of an 80 bed care home in Gloucestershire.
To start with can I say that we care home managers are really keen to work with and develop research. The idea of being at that cutting edge and being able to contribute to the pool of learning and understanding and develop better pathways of care for our residents is fantastic and motivating. So why don’t we?
You the researcher have developed your hypothesis: you’ve applied for funding and worked through the maze that is the research ethics committee and GLORY BE! You’ve come out the other side. All you need now are some care homes which will be willing to assist you with your research… and there the trail goes cold. This is why, and what you can do about it.
You may want just a meeting with the care home manager to outline your research programme. Okay, but for me to get to meet with you there are a few things to consider, for example, the 80 statutory meetings that I have to hold and record each year, which are just the meetings that have to be completed to meet statutory requirements. You may say that this is only approximately seven meetings per month, but to those must also be added to daily one to one meetings with staff, residents, families, social workers, nurses, GPs the police (occasionally), my managers, other organisational development meetings etc.
So, an hour of a manager’s time is a lot.
You may want me just to complete this small audit. Sounds okay, but as a care home manager who has to evidence the excellent care that we deliver, we undertake approximately 78-80 audits per year. This again does not include the monthly returns and data collated that has to be returned to form our organisation key performance indicators, as well as the associated action planning and home development.
You may just want to try a new system or approach. This will undoubtedly involve training or upskilling staff to use the new system. So within your budget for the research have you factored in what it would cost me, the manager, to replace the staff on the floor? And who will I replace them with? Some regions are presently facing huge recruitment problems, as the nurses are just not available. The turnover of staff within the home should also be considered and the fact that you may have to return to the home in the future to train new members of staff six months later.
But managers must be interested? We are offering incentives… With the day to day demands of ensuring high standards of care, balanced against managing some 150 members of staff, any incentives you can offer must be really spectacular! And you should also bear in mind that many organisations will not allow managers to accept them anyway, at least, not for themselves. Try offering incentives that are of benefit to the residents.
As I said at the start, we managers would LOVE to be involved in research, but sadly, with the needs and logistics of running a care home time does not often make this possible. However, if you really do want to engage with care providers, here are a few ideas which may help.
If the care home is part of a large group, instead of approaching the individual managers, contact the head office; this will enable two things. Firstly, the head office may have a research team and the information that you require may already be held by them. For instance, you may require data on number and grades of pressure sores. This kind of data could well be held by the head office and there may not be the need to go to the individual managers. Secondly the head office may be able to make suggestions about your research that would dovetail it into existing procedures and policies. In short, avoid repetition.
When you are costing your research, do factor in the cost of training staff (if needed) or even replacing the staff on the floor. If you have done this, then please demonstrate this to the manager. Be aware that the use of agency staff by care homes can be heavily monitored and controlled and may not be an option for the manager to employ. It may be worth talking first to an agency provider, agreeing a contract with them THEN going into the home with the manager’s staffing issue resolved.
Electronic audits. To be honest these are the ones I tend to complete when requested, as often they do not seem to take much time to complete. Paper audits (even when sent electronically) seem to take longer and are hence ignored. If you are going to use electronic media what would really help is an idea of how many questions are going to asked and, more critically, roughly how long it will take to complete.
If you are intending to run some research through a care home it may be worth spending some time on the CQC website to see the legislation to which home managers are expected to respond. Have a look at legislation such as the new Care Act to broaden your knowledge base about the government’s expectations of care; essentially have an understanding about what extra work you are potentially asking the manager to undertake.
In short, think ‘TURC’.
Time- how much time will the manager need to engage with your research? Then balance this against the demands already placed on them.
Understanding- what are the systems and procedures used in the home already (legislation will give good guidance on this)? How can you dovetail your research to fit with the present systems?
Repetition- Is the information you require held anywhere else, such as at the head office?
Cost- Have an understanding of what the real term costs are to the home manager and the organisation.
Recently, I took part in a research programme conducted by the local health trust. I was approached by an individual who opened the conversation by saying “I know you are pressured for time but we would like your home to take part in a local research initiative that we hope will improve prescribing practice and reduce medication errors in the home…” I stopped what I was doing and listened, it got even better… “This won’t involve your staff; we will bring in our own person, who is a qualified pharmacist. He only needs a desk once a week to audit the present prescribing practice.” I engaged and took part.
If any of you are wondering how I had the time to write this, it is 10pm and I am sat at home with my laptop and a drink!