This practice example is part of the Guidance for better workplace wellbeing
It is based on interviews with the manager and three staff.
“An open and inclusive culture with clear and positive leadership” CQC report, 2016
“It’s so close knit here, as a home it is very much like a family home”
Abbottswood Lodge is a learning disability care home, situated in a rural setting and under the umbrella of a national care provider. Although the home only accommodates around 20 residents, it is a relatively large facility for a home in the disability care sector. The home has a person-centred approach to delivering care for residents, supporting individual choice and integration with the community as much as possible.
The 22 staff employed at the home work in a variety of full and part time positions on a shift basis providing 24 hour/7 day care service for the residents. Since the home is a small organisation, the management structure is relatively flat, with a manager, deputy manager and two senior members of staff. The home employs a diverse range of staff including long serving members of the care team who are very familiar with the residents and the setting and earlier career stage employees undertaking professional degree level training alongside their work.
Wellbeing risk factors
The physical nature of the work and shift system creates potential wellbeing risks staff working in care settings are exposed to musculoskeletal risk factors from the physical nature of the work. The home also requires staffing around the clock meaning that staff work night shifts, which can disrupt sleep patterns negatively impacting on wellbeing. Residents in the home tend to have changing levels of needs and shorter life expectancy meaning that staff, particularly those that have been there for a long time, have to cope psychologically with the loss of residents or major changes to their health. In the wider sector, care work is considered to be poorly paid and often not valued so this is a cultural challenge for Abbottswood to ensure that staff do feel valued in their work, where they may have come from a context where that wasn’t the case.
Overall approach to wellbeing
The primary organisational aim of Abbottswood is to ensure employees and residents feel valued and feel a sense of belonging. A holistic approach to staff and resident wellbeing focuses on how much each employee is capable of, encouraging employees to pursue their aims and bring their own experience and knowledge into their care practices at work.
Staff development is central to how wellbeing is supported and the wellbeing of staff and residents is seen as intrinsically linked, the home very much trying to create a relaxed and social atmosphere for employees and residents alike that gives the home a family feel. Employees at Abbottswood have previously experienced negative treatment from managers and colleagues in the care sector, such as being made to feel of little value. These experiences have driven an open and inclusive culture, and a wellbeing oriented approach to staff as well as residents at Abbottswood Lodge.
“If you are valued and you are told you are doing a good job on a day to day basis and things like that, it makes you better and it makes you want to work better if you know what I mean. Where other care homes that don’t bother, you are still just a number to them… being classed as a number makes you not really want to do your job because I suppose you see it as why should I? If they don’t appreciate what I am doing sort of thing and obviously you don’t want to go to work like that. You want to go to work and feel appreciated for what you have done and know you are doing a good job.”
Spotlight on the culture
Here we shine a light on how a supportive and inclusive culture that enables staff to contribute and progress has been created at Abbottswood Lodge. This culture creates a context in which employees can develop and enrich the quality of their work, their own jobs, the jobs of colleagues and the care they provide. Abbottswood’s approach to a positive wellbeing culture is created through strong leadership and role modelling of wellbeing behaviours along with support for personal development and staff engagement, without a structured or formalised wellbeing plan.
The cultural shift at Abbottswood Lodge was driven by the home’s manager, who through previous experience had witnessed how a lack of understanding and devaluing staff capabilities could have a toxic effect on workplace relations and lead to the formation of cliques amongst workers, which in turn negatively influenced the quality of care. Abbottswood’s approach was to clarify that acceptance and support is a keystone of their workplace culture, with a zero tolerance policy for disrespectful, negative behaviour. Recognizing that if senior managers do not feel supported that will filter down, managers and senior staff were identified as key role models and actors in underpinning a positive culture.
“…a lot of the time maybe it starts from managers not feeling supported in care homes as well I think, so they’re not able to give that support are they to their staff…”
Abbottswood recognised that the care sector offers limited opportunities for personal and career development, whether in the care sector or outside it. At Abbottswood Lodge progression is prioritised over staff retention, although this approach may result in staff moving on to new roles outside of the organisation, it was recognized that high turnover was already an issue in the sector. By promoting training and personal development, Abbottswood motivate early career staff who wanted to train and progress, and create a more positive working environment for those staff who are later in their career, whilst still supporting them to develop and take on-going learning opportunities. The value placed in training and progression by Abbottswood Lodge recognises the reality that there is only so much room to progress in a small organization and when staff do leave it is seen as a positive reflection on the organisational environment.
“So I have tried with the staff to tell them all how much they’re capable of and they can achieve more and it does sometimes result in obviously somebody leaving to do something better but I’ve always said I’ve not got an issue with that. I’ve never had somebody leave to do a like for like job in another care home and I probably would question what was going on if they did … if people are made to feel capable and sort of respected and valued then… It’s the same for all of us isn’t it? And a lot of care homes, that doesn’t happen with carers…”
The aim is to create a positive culture with more motivated, happier staff and therefore a high quality of care for residents through a more stimulating environment. Abbottswood Lodge have worked to achieve this through creating quality jobs and learning opportunities which have a positive feedback loop, enabling employees to further enhance job quality.
Open and supportive culture
Although employees remain professional, Abbottswood Lodge fosters a relaxed and social atmosphere for employees and residents alike. Senior staff are key role models and this means recognising when people are struggling at work and ensuring staff feel comfortable to talk about mental health issues including those prompted by experiences with residents. Openness about mental health and expression of emotion is encouraged at Abbottswood Lodge, especially in the wake of a resident’s death. Although professional support is available, employees tend to deal with issues through group discussion and the mutual support that flows from the close-knit culture.
“We wouldn’t do like a workshop but everybody is quite open actually about their mental health. I don’t know whether it’s the job we do but we tend to talk in a group…I’ve had staff had a cry about somebody dying, none of that is discouraged, do you know what I mean, it’s more encouraged…”
“I think everyone supports each other and it sounds kind of weird but everyone really supports each other with their mental health. So we are often talking about it very informally but because everyone works in this environment I think it works quite well. That others are quite supportive as well and I think due to a supportive manager it does rub off on us quite a lot.”
The supportive atmosphere is fostered at Abbottswood Lodge through a recruitment strategy that encourages relatives and friends to join. Several employees are related or friends outside of work, adding to the feeling of community and informal support. The strong personal and social connections also make flexibility in hours easier, since there is a degree of autonomy, but also fluidity to accommodate employee needs. The social environment of the home not only supports mental health, but also underpins greater enjoyment of work.
“To be fair it doesn’t feel like work, I know it is work it’s a job but it doesn’t feel like it, it feels like home from home…I think in other places its felt like such a chore to even go there. This doesn’t really feel like work. So it’s going to a job that you love it’s a lot better I think than going to a job for the sake of going to do a job…. we all get along outside of work so it’s very nice we come to work and work with each other it’s like working with your best friends.”
Enriching job quality by supporting staff development and engagement
In line with their person-oriented approach, Abbottswood Lodge fosters the positive and active encouragement of employees in personal and professional development to fulfil their aims, even outside the care sector. This approach brings benefits to residents with staff able to bring their interests and skills into activities, such as art and craft workshops, which involve both the employees and the residents. A supportive culture and attention to staff development means that employees are both empowered to shape their own work environment and have the skills and capabilities to make improvements for themselves instead of simply following pre-defined tasks and roles.
“That’s changed a lot over the years, before we were just a number we were just a staff member we weren’t allowed to have opinions or anything like that. We didn’t, we weren’t involved in the day to day running of the place… But now since the manager started, which is I think six years we have been encouraged to take day to day things and if we can think of a better way of doing something, we then discuss it and we put it into practice. And sometimes it works and sometimes it doesn’t but as they always say we won’t know until we try. So we are all involved in the day to day running of the place really.”
Abbottswood Lodge take the view that it is important for staff to feel comfortable in providing input to their work and to have opportunities to develop skills and learning, regardless of age, position, or career stage. Therefore, distance-learning opportunities are supported and work is structured to accommodate and support employees’ progression in learning programmes and personal development. Staff who are at a later career stage are still encouraged to learn and the diversity of age and career stage fosters opportunities for team learning that is supported by a non-hierarchical work environment. This open culture extends to the residents creating close bonds between staff and residents, giving meaning to work and improving job quality.
“…The manager will just say have we got any ideas how to make the place run better, how to make the residents more happy, we are all involved in that and if we come up with any ideas we just get on and do it. The residents are not institutionalised they get up when they want, they have a drink when they want, a lot of them come into the kitchen and make their own drinks and things like that. So it’s like we are going into their home to look after them, it’s their home not ours if you know what I mean. And we are here to support them. Which when they come up to us at the end of the day and say oh no you are not going home we will miss you, it makes everything worthwhile doesn’t it.”
Impact and looking forward
Sickness rates at Abbottswood Lodge are lower than those typical for the sector and the home has seen a number of employees leave to progress their career. The working environment at the home has also encouraged staff who did not see a career in care to stay and pursue one. This workplace culture and quality of the team-working environment was recognised in 2017, when the team won a regional carer team award.
The award recognized the positive changes at the home and the achievement of creating an enjoyable and rewarding space for working and living in a sector, which has particular wellbeing challenges and risks. Abbottswood Lodge sees that there are still areas to develop, and is constantly evaluating opportunities for further improvements. The next step is reconnecting with the umbrella company to share what has been learned and achieved. #
This evaluation will allow them to compare and consider a range of other care home contexts and their approaches to staff and resident wellbeing to identify the most successful options and share good practice. Abbottswood Lodge’s openness and support for individual development acknowledges the contribution that employee experience can make, enriching the quality of work and the service provided whilst continuing to develop and learn.
“Yes because everybody brings something and we do take our life experiences with us where ever we go don’t we? So obviously we apply it into the work place as well and if it works it works it’s a good thing and if it doesn’t well we try something else.”