Practice Leadership explained

Dr Andrew Hider, Iris Care Group’s Clinical Director, explains Practice Leadership

Lots of you might have heard of the term ‘practice leadership.’ It’s a term that many people use in health and social care, but people don’t always say what it means! So, I thought I’d write a blog on it – here goes!

What does the word ‘practice’ mean?

Practice means ‘what we do to directly provide support to people.” It is anything that is done by any of us to provide direct support to a person in our care. The people we support have lots of different needs. Practice, in everyday terms, means what is written in their behaviour support plan, activity plans and physical health care plans. Practice is what we do, what we say, and how we do it and how we say it. Practice is about direct care, no matter who carries it out, and where it is done. So, this blog applies to all our sites – supported living, residential care, education, and hospitals.

Everyone is responsible for practice. Focusing on good quality practice is the most important thing in health and social care. It is what makes the biggest difference to the lives of the people we support. It helps us help them achieve their goals. It sounds obvious, doesn’t it? But often, particularly in busy environments, the detail of what we should be doing, and how, can sometimes get forgotten.

What is ‘practice leadership.’

‘Practice leadership’ is a term used to help people tell the difference between focusing on ‘administrative’ work such as filling in forms, following rotas, doing audits and other paperwork, and work involving direct contact with the people we support. Everything we know about good quality health and social care tells us that if we lose the balance between administrative work and practice, we can lose our focus on the really important stuff – making sure that everyone knows the ‘what,’ ‘how’ and ‘why’ of following people’s support plans.

The important thing to remember is that all of us are practice leaders. Sometimes it may be a formal role we have – such as clinicians who have to prescribe treatment and support plans. But everyone plays their part in supporting and leading good practice.

Good practice leadership makes the difference between a good day and a bad day for the people we support. Even if we do all the tasks we are supposed to do, if we don’t focus on how and why we are doing those things, according to the needs and wishes of the people we support, we probably won’t be giving them the best experience of care and the best chance of moving forward with their lives.

So, practice leadership is about making sure that all of us keep our focus on the needs of the person –knowing and following their support plan closely and supporting our colleagues to do this as well.

A big part of practice leadership is about feedback and support – making sure that we all take responsibility for checking that the whole team are working to someone’s prescribed plan – and making sure that nobody goes outside of that plan. It’s easy for people, particularly if they don’t know a person well, to think they are doing the right thing, but in doing so make matters worse. A good example is if we give someone food they aren’t supposed to have because of the risk of choking, or if we respond in a certain way, perhaps using a ‘trigger word’ in someone’s PBS plan, because we haven’t followed the plan. It’s a bit like someone going for a walk and not following the signs on the path. They can get lost and could come to harm. It’s the same when we’re supporting people in or care – practice leaders keep the team on the track, knowing where they’re going, and why.

But despite what we know about how important it is, making sure that plans are always followed is really, really difficult, so all of us are responsible for supporting each other to stick to the plans we have. At Iris Care Group we want to encourage everyone to help lead the service they work in by creating a culture where we all feel safe to give each other feedback. And the best thing about this is that most of the feedback should be positive – good practice leaders make sure that they notice and give feedback on everyday good work. Not out of the ordinary work – just everyday good work that helps keep people safe and well. All of us need this feedback – otherwise we might feel that nobody notices that we are doing a good job. And it’s also important that we speak up about anything that might not be safe. This isn’t about blame – we all make mistakes – but feeling safe about telling each other if a plan isn’t being followed properly is one of the most important things that a practice leader can do.

Here are some examples:

• A Home Manager has discussed active support in supervision with a support worker. She suggests that the next time they are both on duty, the support worker observes her helping a person we support with a household task, like chopping vegetables for dinner. The manager supports the individual and then asks the staff member what they observed, encouraging them to notice and recognise important aspects of active support like “graded assistance” and “little and often.”
• A deputy manager is on shift when a person we support who has autism becomes agitated as a result of the way in which a support worker has communicated with them. The deputy manager steps in to de-escalate the situation following the PBS plan. Once the situation has calmed down, the deputy has a debrief with the support worker to discuss lessons learnt, including observations of practice.
• A support worker working with someone with a complex mental health difficulty notices a colleague having a conversation with the person and notices that the support that the person needs isn’t being offered. Later in the shift, they remind their colleague of the support plan, tell them where the support materials can be found, and talk about how the client has asked for them to be used.

To help us with practice leadership we’ll soon be introducing a new safety principle for Iris Care Group – we call it ‘See it, Say it, Send it”. It’s a quick way to remember what we can do to give each other feedback as practice leaders, and to make sure that any really serious safety issues get identified and addressed quickly. It goes alongside all the things we do as an organisation to make sure that the people we support can give us feedback on the quality of the care we provide. Let us know what you think about it when you see it in your service.

So, this is the end of the blog about practice leadership. Hopefully, it’s been helpful. Please get in touch if you’ve got any questions or if you’d like to know more about the ideas in this blog, or just have a conversation. You can find me at andrew.hider@iriscaregroup.co.uk