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Culture and Practice
I'm probably not alone in feeling a sense of inevitability every time I read a newspaper article or hear a radio report about allegations of abuse in care homes. Since Winterbourne View, this has become so much a part of our experience that our first response is usually to sigh and prepare for the general criticism that follows. A friend who is not in the same line of work once commented that anyone would think care workers had a mean streak built in. I was swift to contest her point of view, but it does seem that caring for the vulnerable can attract sinister and flawed personalities.
Of course none of us set out to recruit people with a tendency to cruelty, nor are many of those who are involved in poor practice consciously abusive. The combination of peer pressure, weak management and insufficient training can make Devils of anyone. The latter two causal factors are within our power as leaders to address. We can ensure that the people we recruit have the right stuff and are supported to perform safely and with integrity; we can provide high quality information and training from the outset and through good supervision practice can continuously monitor and encourage staff.
"How we do it here"
Peer pressure can be a force for amazing good, when the overall management of staff teams engenders a positive and progressive attitude in which all staff members are working together to deliver high quality care. However, as we have seen all too often, the consequences of negative behaviours within teams can lead to less assertive members being sucked into dangerous collusion.
Positive workplace culture is the holy grail of care services. You see it in some establishments that consistently achieve high regulatory praise, but it is universally absent in those that make the headlines. In cases of institutional abuse, the managers and owners are brought to justice but the key perpetrators are seen to be the direct care workers. I would argue that managers have a greater responsibility, to lead from the front, to identify the seeds of negative practice and to support a just and open reporting culture that would drive such abuses out of the workplace.
Lead from the front
As a senior manager, it is vital not to lose sight of what is going on at the front line. It's not easy; staff do not immediately welcome your scrutiny and you may find that your presence in the workplace is met with suspicion - look busy, here comes the boss. However if you make a habit of breezing in from time to time and become more of a fixture, then staff will relax and open up. You can demonstrate your own positive behaviour and encourage staff to question and challenge you.
Management walk-rounds are cited as a benefit to the culture of any organisation, from engineering to healthcare. It sounds simple and actually, it is simple. Make time to get to the coal face and not only will you experience firsthand what you are paying people to do, but you will learn how teams tick and spot excellence as well as concern. The Japanese have a saying; "The fish rots from the head". While it is true that grim goings on happen in closed and unmonitored staff teams, you have a responsibility to build environments that remove the risk of such behaviour. Culture is built from good leadership.
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