In thinking about co-production there are easy questions and hard questions, easy decisions and hard decisions. The easy questions are where it is easy to involve people and answer the question, but often these are not the important questions that really make a difference in peoples lives. One of the harder questions, is ‘How can people getting support from home care services choose their own staff?”
Co-production – making decisions together about what matters – has to include the questions that really matter in someones life. The most important decision in homecare is who supports the person. How can we make sure that the person themselves in central to that decision, and it is co-produced?
Involving people in recruitment
I (Helen) have been part of different recruitment processes that have involved people with learning disabilities, in different ways.
Interview panel. I have been part of an interview panel where someone who uses services had received training on recruitment, and was involved in all interviews. There were four of us recruiting for a voluntary sector post. The Human Resources team developed the interview questions, and we had two questions each. We all made notes on how the candidate answered, and discussed the answers at the end to make our decision. The decision was made by consensus and the person with the learning disability had the same role and decision-making contribution as everyone else.
Interview session. I was also part of an assessment centre to recruit to a new post for Dimensions. The candidates each had an individual session with someone who uses the service (with their supporter). The person who uses services had five of six questions that they asked, and then they gave feedback to the main interview panel. This information was given the same weight in the decision making process as the psychologist who did psychometric testing, and had a significant impact on who was recruited.
The power of both of these processes is that we learned first hand how candidates responded to people who use services. People who use services in recruiting staff demonstrate the values of the organisation and their commitment to co-production.
What could this mean for home care?
Both of these approaches could also work in home care and some organisations are already using these. In an earlier blog I looked at how people or families could be involved in how people can demonstrate how they would support someone, for example, to put on a cardigan. This could be revealing, and much more powerful if this was with someone who receives support from homecare who could share their views with the panel about what that experience was like. Where they patronising? respectful,? awkward,? comfortable? chatty? anxious? What was the experience like?
Involving people in choosing their own staff.
Home care organisations recruit staff to support many people. This is not the same as choosing your own staff. If this was my mum, I would favour an organisation that involved people in recruitment, and what would be even more important to me would be whether she had any say in who turns up at her door every day? How could she be involved in choosing her staff?
I have been working with several home care organisations who want to explore this and we have been looking at two approaches. The first is how we involve people in ‘matching’ and the second is going further and the person choosing.
Home care organisers make the decision about who will support someone who uses their service. Mostly this is on the basis of who is available. If several people are available, how do they make their final decision? One possibility is to use a process for matching staff to someone.
The relationship between the person receiving support and the person who supports them is the critical factor in the person’s experience of the service. The quality of this match is one the most powerful determinant of quality of life for people dependent on services and could be a significant contributor in staff retention.
Matching starts with the practicalities of who is available, but assuming there is more than one person, what could the homecare manager look at next? Lets imagine there are four possible staff members for someone.
Once you have a match for availability, the next match is for personality. Who is most likely to get on with the person? Using one-page profiles is an important way to do this. Where all the staff have one-page profiles, you have a description of the person’s characteristics. In the appreciation section you can learn whether they are lively, chatty full of fun, or a great listener, and calm. This really matters. If I needed support to get up in the morning, and was supported by someone who is chatty and lively, that would set me up for a seriously bad day! This means we also need to ask the person what kind of staff they ideally would like. As soon as I say that to homecare managers they say versions of:
“That is setting us up to fail, we could not guarantee that.”
“It is unrealistic to expect that we can deliver that.”
I think it is a matter of clearly communicating that we go as far as we can to get the best match, and knowing what kind of person they get on with best, helps with that decision-making. That is a promise to try, to be thoughtful, to know what matters and to be working towards that.
If we imagine then that matching for personality takes one person off the potential staff list, the next match is for shared interests.
Personality trumps interests, and if we can find someone who the person is likely to get on with, it would be even better if they have something in common.
Again, this is where using one-page profiles for both the person who wants the service and staff is vital. Several home care organisations are gathering information about what matters to the person in the initial meeting/assessment and using this to develop a draft one-page profile. This will give you three or four hobbies or interests. Hilda was 94 and lived by herself near Blackpool. She was a great film buff and her all time favourite with Cary Grant. She loved old movies and movie stars, and her favourite music was by Vera Lynn, Susan Boyle, and Aled Jones. Getting a good match for Hilda meant seeing if the home care organiser could find someone who loved movies.
Ofcourse if you only have three potential staff to choose from, to find someone who loves old movies may not be possible, but you could find someone who loves films. That is a close as we could get to a ‘good match’ – starting with availability and then looking at personality characteristics, and shared interests.
Great homecare managers tell me that this is what they do intuitively. That is wonderful. Even better to have a process that you can explain and record to demonstrate how you do this. Then you can evidence it and know that you colleagues are consistently working the same way. Don’t leave something so important to chance, have a process and check how people are using it.
Matching helps to identify the staff who could be a good fit with the person. Can we go further an enable the person themselves to make the final decision and choose their own staff? Two homecare organisations have been exploring this with me. Using the example earlier, could the manager share the one-page profiles of the three remaining possible staff members for the person to make the final choice? Could the manager take an iPad with her and show a one-minute video clip introduction of each staff member, again, so the person can see them and decide? If you know an organisation who is doing this now, please let me know.
There are ways that people who use home care services can be involved in recruiting staff to the organisation. This is important. How close we get to finding the best match or even better, the person choosing their final staff team, could be the most significant way to both give the person the best experience and support. Can we see co-production happening here too?