If you walked away from your care home for a few weeks, would it cope without you?

Would your staff continue to deliver quality care as before? Would care plans be kept up to date? Would relatives be happy that they still had someone (other than you) to discuss their concerns with? Would major incidents and accidents be resolved? Would inspections run as well as if you were present?

Or would cracks start to appear and would plates that you kept spinning, start to crash to the ground?

Unfortunately, crashing plates without their leader on hand is all too common for any business including care homes.

If your care home can’t function without you then it isn’t as strong as it needs to be and doesn’t run as efficiently and effectively as it should.

On top of that the pressure on you to keep those plates spinning will wear you down and is, in the long run, unsustainable.

Fortunately it doesn’t have to be this way and a key part of your leadership and the success of your care home, is in preparing it for the day you can step away and it not break.

Here is a case study of how I helped one care home to be able to step away from her business so she could control it better and make plans to expand.

As well as the owner, Carol (not her name) was also the Registered Manager. She wanted to grow her business and open other homes, but she didn’t see how she could, when she was such a key figure in her current home.

Her desk was piled high with work that she needed to get through in order to keep her beds full and the business working. Every day she was brought issues that apparently only she could resolve.

If Carol took a holiday her people would panic and it wasn’t unusual for her to receive telephone calls whilst away. Carol always returned to a desk full of issues and sighs of relief from her staff.

When I met Carol, we talked through how she wasn’t in a position to open a new care home without negatively impacting her current one. In order to expand, Carol need to be able to step away and her current care home be able to run successfully without her day-to-day presence.

She had to be able to let it go and know that it wouldn’t break.

The problem was that so much of how the business needed to run was in Carol’s head. And simply hiring an experienced person to replace her, as Registered Manager, was an option that she couldn’t afford at this stage.

The care home needed to run well without Carol’s day-to-day involvement.

She still needed to make sure that the right care was being delivered, that standards were maintained, that beds were full, that external relationships were strong, that improvements were made and that targets were met.

But to do that from a stepped back, bigger picture position.

Like any successful business, Carol needed as much certainty and control as possible.

A business needs 3 key components to establish certainty and control. It needs a balanced strategy to guide and keep the business on course, a strong leader to create the strategy, make it work and keep the business on course, and systems to make the business run as efficiently and effectively as possible.

The strategy that we put together would focus on how Carol would achieve her long-term expansion plans. But for it to work we first needed to focus on making the home run well without her daily involvement – it needed to be systemised.

I worked with Carol and a core team from across the home to assess how the home was run and what worked and what didn’t.

We mapped out how Carol’s home should run and, with the help of the assessment, identified areas that didn’t run well.

(The image below shows part of that mapping. Of course, it is too small to read but it gives you an idea of the mapping I describe.)

What was key was not to just identify and solve individual problems but to bring as many of them to a root cause.

For example, care delivery was good but too many mistakes were being made. Too many issues from the floor were arriving on Carol’s desk.

Looking for the root cause(s), instead of simply addressing the problems as they arose, we identified an issue with the organization staff structure.

Carol had some good, loyal staff, but there were problems with others being disruptive, having bad attitudes, being unreliable, doing the bare minimum, making mistakes and so on.

Basically there were good people who went beyond in order to compensate for the bad people. This was impacting morale and motivation, especially because the organization structure was flat and these people all sat at the same level.

We made a number of changes, which included changing the organisation structure.

We created extra levels of responsibility and pay and rewarded the good staff by moving them into team supervisory roles.

It became clearer as to who was responsible for what and the new hierarchical structure also gave good people much better career opportunities.

Roles and responsibilities became clearer, good people were more motivated, less experienced people were better supervised and people saw real long-term career opportunities.

It wasn’t long before many of the day-to-day client and staff issues just disappeared.

To help reduce mistakes and improve the way tasks were learned and carried out, we created process flows. These were easier to teach, to learn, to understand, to remember and to test against.

For example, below is a task for bathing a client using a hoist. At first glance it may look over complicated but what’s key here is that the process flow includes how and when the carer should speak to the client to make them aware of what is going to happen and to check that they are ok and comfortable.

Over time, each department created their own process flows and training new people became more straightforward as each new person received a manual of process flows, which showed them, step-by-step, all the things they needed to know.

To help bring out the best in, and motivate, the good staff we introduced a daily scorecard system where managers and shift supervisors scored each member of their team. This helped monitor performance and spot areas of concern early on.

And, because of this system, supervisions became more accurate, because they were evidence-based and sessions more productive and useful to both.

Rather than these scorecards being a resented, those who wanted to give their best and whom had the right values (which is particularly important when working with vulnerable adults) welcomed them.

With better training, clearer roles, responsibilities, real career opportunities, ‘how to’ process flows and objective performance scoring and reviews, that were linked to a quarterly reward program, many of the problems that had previously landed on Carol’s desk became rare occurrences or disappeared entirely.

With these and other changes in place the home ran more efficiently and effectively and Carol was finally able to step away and focus on her long-term strategy to open new homes.

Within 6 months of starting this project together, Carol was able to step away, knowing that her home would run well, the business would continue to be profitable and the quality of care remain at a high level.

A year after starting the project, Carol opened her second care home and with her first home systemised, she had a blueprint to copy.

The result of all this is that Carol…

  • Is rarely presented with problems that her teams can’t handle;
  • Has 2 homes that provide first-class care to those with extreme dementia and mental health;
  • Had a CQC inspection where one of the inspectors left saying she had never felt so reassured that the residents were receiving the best care possible;
  • Has a healthy business and strong financial support from her bank;
  • With her bank’s support and both homes working well has started project home 3;
  • Can relax when on holiday.

Once the right systems were in place Carol could let go of her business and instead of breaking, it carried on just fine. Carol could then focus on making her business stronger and on creating a long-term growth strategy, which is still working well for her.

If you let go of your business would it break? If you think it might then it’s too reliant on you. If you need help to make your care home work better and independently of you then contact us to see how we can help. 

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