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5 ways to stop stress making health and social care sick

The role of compliance management in a strategic approach to reducing occupational stress in health and social care settings

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Introduction

We all experience acute stress from time to time. After all, life would not be life unless it threw up situations which cause transient increases in stress levels. Unfortunately for some, stress is a chronic condition related to their profession.

Stress in the workplace has the ability to impact performance and it is measurable. Research among UK health workers shows that on the internationally recognised Impact of Event Scale (IES), nursing staff typically have a stress score of 43.35. A score above 44 is categorised as severe and potentially alters the ability of an individual to function.

The score for nurses exceeds the average of those experiencing military trauma in a warzone by a factor of 1.5; it is also twice as high as that of emergency services personnel with recent experience of handling human remains.

What effect does excessive occupational stress have on those that work in the health and social care sector?

For those that accept healthcare as a vocation to which they are called, compassion is a deeply embedded attribute, an article of faith indivisible from the individual. However, this may not be quite the unshakable bedrock that it seems. In January 2013, while giving evidence to the Commons health select committee on the state of nursing, NHS Commissioning Board CNO Jane Cummings responded to a question about whether there was a conflict between two of the 6Cs - competence and compassion.

Ms Cummings said “You can be a highly competent, experienced, professional nurse and still be compassionate.”  She also highlighted that when nurses were very busy “day-in day-out” dealing with very complex tasks “it can be quite difficult to remain compassionate all the time”.

These comments build on concerns raised repeatedly in the media that the increasingly professional nature of registered nursing is detracting from its compassionate side.

In the words of the Francis inquiry’s 1,782 page report into failures at Mid Staffordshire NHS Foundation Trust between 2005 and 2009: “Conditions of appalling care were able to flourish” and patients were let down by a “lack of care, compassion, humanity and leadership.” The report catalogued failures at every level, from nursing staff up through layers of management.

Whether fulfilling a role in NHS hospitals as nurses, or as carers carrying some of the responsibility of nurses in care homes and domiciliary care , many find health and social care an emotionally draining environment. And it is not just at the sharp end of care or clinical decision making; whether as those with responsibility in NHS hospitals or those in the wider health and social care sector, managers face complexity and increasing professional pressures.

There is a set of overriding imperatives which must be met: balancing reduced budgets; doing more with less; providing user centric care that meets compliance requirements. This often places registered managers in care homes and domiciliary care into a box in which they have very little room to manoeuvre and consequently means they are also subject to significant levels of stress.

Here we discuss 5 ways how compliance management is an invaluable tool and fits into a strategic approach to reducing stress in health and social care settings.

1. Permanently curing the recurring headache: What is my next compliance issue?

Care settings may be dynamic, fluid environments; situations may crop up suddenly demanding immediate answers. Many registered managers may be in a position where they wonder what is coming across the desk next. Matters of equal importance may need to be prioritised one over the other. This may impact service quality. Bringing together lengthy guidance and legislative sources to create compliant policies is a time consuming business for registered managers. The need to respond to situations quickly means that creating custom policies may be a source of considerable stress.

The QCS compliance management system is a comprehensive set of pre-written policies and procedures produced by experts. This lets registered managers have rapid access to documentation that adheres to guidelines and legislation, providing finger tip access to compliant policies and procedures first time, every time. Safe in the knowledge that policies are available for any contingency, care managers are relieved of a significant source of stress.

  • The review process is a good example of how compliance management relieves stress in a care environment.
    • The system provides a continuous and iterative review process. This comprises a comprehensive set of risk assessments ranging from personal, through environmental to existential such as disaster planning (DR). Assessments result in action planning and because there is a need for consistent action planning throughout, there is a system policy; this both affirms the need for an action planning culture and enables it.
    • The QCS approach promotes and systematises a formal management review process. The format of this enables the gathering all the action data generated throughout the organisation.  The ability to assess where you are in meeting the regulations - ‘compliance with compliance’, if you will - is enabled and encouraged by systematic audits, which again feed into the management review to complete the picture. All of this is a rolling process which applies the principle of the plan, do, check, act cycle.

2. Overcoming stress induced by care planning

In care planning, care workers take on responsibility which may lie beyond the extent of their formal training. Care workers may feel uncomfortable especially given the consequences of a mistake. At one end of the spectrum, disciplinary action may result; at the other end it may result in the sack and a wrecked career. For service providers it may result in fines or damage to reputation. Such high stakes precipitate a crisis of confidence and stress is an inevitable consequence.

QCS care planning policies and procedures ensure that practices do not compromise safety or other compliance areas. This enables a systematic approach to care planning which prevents factors that are vital to good care planning from being omitted. Such an approach builds the confidence of care planners and managers, significantly reducing stress associated with care planning.

  • Falls is a good example of how compliance management reduces the stress associated with care planning.
    • The QCS system provides a set of documentation for the management of falls risks. Falls are a significant risk to life in a care home and at home.  Falls in older people often lead to immobilisation and this may provide sufficient time for complications to manifest. Operations, such as for a broken femur, are also problematic for older people due to the deleterious effects of general anaesthetics.
    • The system provides a six-part system for falls risk management; an at risk identifier assessment, a detailed risk assessment, an action planner; a plan of care format, a recording of incidents format, and a regular review format. Care planning instructions throughout the system emphasise the need for an immediate review following every fall – such is the level of risk.

 3. Reducing the risk of person dependence

When knowledge or expertise is held in the head of a single individual it underscores the value of that person; however, it also makes an organisation person dependant. This is a strategic weakness in any organisation; in a care setting faced with meeting the demands of a robust compliance regime on a daily basis it poses an unacceptable risk. For service providers this is a problem and for business owners it may be a source of considerable stress.

QCS enables health and social care organisations to person independent in compliance management. The system is a centralised source of compliance information that enables organisations to avoid the risk from the single point of failure which results when the knowledge and responsibility for compliance management resides with one individual.

As a central point of reference, the QCS management system enables compliance matters to be handed over much more easily. Consistency is assured; although compliance responsibility may pass through the hands of different individuals, each is informed by a common set of reference materials. With person dependence removed from the compliance management function, service providers and business owners eliminate a significant source of stress.

  • The area of performance provides an insight into how compliance management addresses the question of stress in health and social care.
    • Performance management is an area where compliant and consistent behaviour is essential. Standardised procedures are available to everyone, setting out the limits to all employees. Hands-on supervisors have access to the knowledge to promote and enforce compliant behaviour before poor performance becomes entrenched and a real problem. Ultimately, this reduces the incidence of performance related problems and reduces the management workload.
    • The system is customised and therefore standardised for each organisation; customisation eliminates the need for modification by the user organisation; the system eliminates the risk of multiple versions of the same policy existing. The resulting standardisation makes training and delegation of responsibility a realistic and achievable goal.

4. Ensuring HR and disciplinary processes are not flawed

It is a fact that one of the most tricky compliance areas in health and social care organisations is managing the HR function. Recruitment, contracts of employment and disciplinary actions are all areas that have legal implications and must be managed in a compliant manner. Free movement of workers across the EU is just one factor which means UK employment law is an area subject to change.

There’s no shortage of legal practitioners touting for unfair dismissal business. Never mind the rights or wrongs of an individual case; if the HR process is flawed significant compensation may need to be paid. If reducing stress associated with the HR function is to be achieved, it is a necessity for disciplinary procedures to follow precise workflows.

QCS compliance management provides a robust set of policies and procedures that enable HR matters to be dealt with in an efficient and effective manner. These are updated with changes in the law and enable health and social care providers to remain in step with the regulatory requirement. Such an approach minimises the stress associated with difficult HR and disciplinary processes.

  • Disciplinary procedure is the natural progression once the limits of performance management process have been reached.
    • QCS compliance management means that when faced with a significant disciplinary problem, management does not have to waste time or effort worrying about following a legally compliant process. The ACAS compliant process is there for them, what it is, and what they have to do to follow it step by step.
    • If management follows the correct procedure the chances of a challenge based on flawed procedure is significantly reduced. If a sustained challenge is mounted following the procedure ensures that documented defence is in place.

5. Minimising absenteeism, turnover and burnout

Occupational stress is strongly identified as a factor which contributes significantly to high rates of staff absenteeism and turnover. Driven by such factors as pay rates and changes to conditions, care workers may already feel a sense of dissatisfaction with their work. Adding stress into the mix only serves to deepen this, increasing the likelihood of absenteeism and reducing retention rates. At the management level burnout may be the consequence if high levels of stress are not addressed.

QCS compliance management contributes to reducing stress in health and social care settings. As a consequence, this positively influences absenteeism, staff turnover and on the job burnout. Reducing the overall level of occupational stress creates a calmer, happier working environment for service users as well as care workers.

In this area, compliance management exerts a positive influence on the bottom line by minimising the cost of HR activities such as recruiting, training and mentoring replacement care workers. As well as directly reducing stress at care worker and management levels, compliance management also promotes reduced levels of stress induced by financial worries on business owners and service providers.

  • Return to work interviews is an area where compliance management is seen to reduce stress in health and social care settings. This works on a number of levels.
    • The incidence of odd day absences is reduced. Employees know that attendance behaviour is under scrutiny; absences result in mandatory face to face meetings with line managers to discuss the reasons; trends or patterns are identified by tracking absences over time. This makes employees think twice before taking odd days off. Any action taken can be measured and appropriate.
    • On a more positive level, this process readily helps with the identification of absences which result from elevated levels of stress. Help may be offered and remedial action taken to reduce stress.
    • Finally, a safe and effective service user oriented care culture is highly dependent on a pervading sense of fairness. This is the natural approach of carers; however the organisation’s approach to staff and service users must also be genuinely fair. With compliance management, the organisation promotes fairness which shapes the attitudes and the behaviour of all employees toward delivering service user oriented care. Use of a QCS compliance management system to govern operations provides the framework for a consistently fair care environment. This promotes the appropriate culture and removes inconsistency and unfairness, significant drivers of stress and burnout.

Summary

Compliance management is not a silver bullet that eliminates stress from health and social care environments. It is a tool which many health and social care organisations find indispensable for managing CQC compliance and driving quality assurance processes. Stress reduction is a beneficial side effect.

Compliance management should not be seen as an alternative to interventions and techniques designed to help those suffering from the effects of stress, such as acquiring coping and relaxation skills. Studies on the subject of occupational stress in health and social care remain ongoing and the conclusions in the literature reviewed in preparing this guide emphasise the need for more research work.

Whatever the shape of future optimised approaches to dealing with stress, it is highly likely that compliance management will remain an essential element in a strategic approach to reducing the occupational stress levels of those in health and social care.

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