\1.1 Outcome based care is about putting the customer at the center of the care service and not prescribing a one size fits all policy. Care should always be bespoke to the customer taking into account their needs and choices. Care should allow the customer to live a fulfilled life, help them identify and achieve the things they would like to do. Outcome based care requires careful planning with full involvement from the customer their relatives should they wish and other health care professionals if required. Teamwork and communication is essential to ensure continuous quality improvement, and process and outcome measurement.
There are key benefits of outcome based care
1.2 there are positives and negatives to outcomes based practice. The positives could be that failing or poor areas of practice will be targeted on and outcomes will be measured and new improved ways implemented. For people using a service this would be beneficial to them as they will be provided with a holistic service, support and care. So this can be demonstrated that any individual using as service is being supported in all areas rather than only in certain areas. Negatives may be that there is too much focus on outcomes, goals and results which potentially could mean that the wishes and opinions of people using the service may not be taken into account as the focus may be on outcomes rather than the person. Making a system less person centred and more business focussed.
1.3 There’s a lot of legislation that refers to outcome based practice which have led to changes in health and social care. The Health and Social Care Act, Regulation of services by CQC, (also the new regulations in April 2015 Fundamental Standards. The Green Paper 2009 and the White Paper 2010 re a national assessment of health and social care incorporating joined up working with all professionals and information, advice being more readily available which would illustrate what the outcomes were from an assessment, and what the advice was to ensure that the outcomes could be achieved and also what the plans were for the future. The Equality Act 2010 re making it illegal for anyone to discriminate which makes it easier for everyone to gain employment and access services.
1.4 Positive changes in individuals lives can come from proper assessments that highlight care needs and then services can be put in place so the individual can live a comfortable life a lot longer in their own home or they can be put in touch with outside services in the community that they can call upon for support to live an independent life such as day services or charity based service to assist with things like shopping etc the salvation army the red cross or age concern and they may also use the respite service in the future giving them a break or their carers a break.
Outcome 2. Be able to lead practice that promotes social, emotional, cultural, spiritual and intellectual well-being.
2.1 Abraham Maslow (Maslow’s Hierarchy) maintained that basic physical needs are fundamental as without food, water, warmth, shelter and clothing people would not survive so before anything else in life people need these things to continue in life then achieve the other things as in safety, social, esteem and self-actualization.
2.2 When booking in the staff go through a check list and a Person centred plans are filled in on individuals so that all aspects of their needs are looked at and all the individual’s well-being is viewed from Physiological needs their diet requirements and preference heating control in rooms for suitable warmth situ of bed and bedding to aid restful sleep as much as possible, the security of the individual do they need pressure mat to reduce risk of falls are they likely to wonder or leave building and be at risk ,the social aspect communal areas where they can mix with others any activities taking place to stimulate them mentally and physically give them the sense of being part of a group belonging, to make the individual feel they are still useful and give them some self-esteem, worth and boost their ego.
2.3 The person centred plans that are completed on each individual look at all aspects of care needs and try to use following.
encourage risk taking where assessment has been made
clearly promote choice, dignity and respect
recognise and promote individual cultural preferences
promote equality and human rights.
Policies reflect these things, staff are actively encouraged to promote self-care. Our safeguarding policies promote the 6 principles of safeguarding – empowerment, protection-prevention-proportionate response – partnership and accountability.
Outcomes 3 Be able to lead practice that promotes individuals health.
3.1 On admission care staff fill in an admission check list and diet requirements asked and then a person centred plan filled in and this is covering diet, personal care needs, religious beliefs, past medical history, toileting needs and interests and hobbies making sure that all aspects of well-being are covered and health and healthy choices, staff also monitor and review a person’s needs as they deal with them on a one-to-one basis.
3.2 obtain information relevant to health and wellbeing in an assessment, using a questionnaire; physical measurements e.g. height, weight, consulting with people close to the individual family, carers other health professional.
3.3 contact doctor’s surgery, district nurses, dietitians and family or carer if any health concerns.
3.4 nutrition, first aid and safe guarding training is given to staff including domestics then they can be aware of the signs if an individual appears to be failing or a change in their wellbeing.
Outcome 4. Be able to lead inclusive provisions that give individuals choice
and control over the outcomes they want to achieve.
4.1 Take time to understand and know the person, their previous lives and past achievements, and support people to develop ‘life story books’ Treat people as equals, ensuring they remain in control of what happens to them. Empower people by making sure they have access to jargon-free information about services when they want or need it. Ensure that people are fully involved in any decision that affects their care, including personal decisions (such as what to eat, what to wear and what time to go to bed), and wider decisions about the service or establishment (such as menu planning or recruiting new staff). Don’t assume that people are not able to make decisions.
Value the time spent supporting people with decision-making as much as the time spent doing other tasks. Provide opportunities for people to participate as fully as they can at all levels of the service, including the day-to-day running of the service. Ensure that staff have the necessary skills to include people with cognitive or communication difficulties in decision-making. For example, ‘full documentation of a person’s previous history, preferences and habits’ can be used by staff to support ‘choices consistent with the person’s character’. (Randers and Mattiasson, 2004).Identify areas where people’s independence is being undermined in the service and look for ways to redress the balance. Work to develop local advocacy services and raise awareness of them. Support people who wish to use direct payments or personal budgets. Encourage and support people to participate in the wider community. Involve people who use services in staff training.
4.2 To make sure that the individuals have a healthy diet option and that there they are warm comfortable and there are as much social interaction and stimulation as the individual wants.
4.3 daily reports are written on service users and questionnaires are completed throughout their stay also a review is carried out on the person centered plans.
4.4 All staff have mandatory training which is monitored and reviewed to makes sure the appropriate training is given to all staff.4.5 There is already systems and processes in place on the person centered plans and this would not be in my job description to implement them.
Outcomes 5 Be able to manage effective working partnerships with carers, families and significant others to achieve positive outcomes
5.1 If we work with careers and family members we can make sure that the individual has an as normal as possible support plan as at home with the added extra of company 24/7 and different activities and a varied diet.
5.2 On admission process the care staff who books in the individual completes most of the person centred plan and the write in the individuals personal file and verbally hand over to the next shift.
5.3 Management needs to always remain calm when dealing with conflict and dilemmas, plus never get personally involved. Mediating conflict and dilemmas is one of the starting points for management to help solve issues. There are times where caring can have a negative impact on the carers health and wellbeing, due to the anxiety and depression of the duties itself, that can cause carers to become tense and anxious, therefore causing issues with other workers. It is important to acknowledge and respond to the different circumstances and get the carer to address the issue and may even require extra time off to relax and become self-contained again.
Also recognise the diversity of care relationships, with different cultures and other barriers that may add to different situations. As for addressing conflicts and dilemmas that arise between individuals, staff, families and significant others, it is important that one is understanding and sympathetic to the different situations and understand the history of the relationship and changes in the relationship due to the care role, including cultural considerations and the role of family member in decision making.
It is important to help to negotiate outcomes to meet the needs of both parties Address all the important positive questions to help everyone understand the outcomes, such as ‘describe your family routine’, ‘how do you manage looking after the recipient/’, ‘what do you find most difficult or tiring? Or are you sleep OK?’ Creating understanding and acknowledging ones needs and depravations over the need of the recipient can help solve issues.
5.4 The emphasis is upon empowerment, person centred planning, public protection and a well-trained and regulated workforce to deliver quality services. There are trends in legislation, policy and guidelines all reflect the same aim. To name a few, CODE OF PRACTICE, HUMAN RIGHTS ACT, DISABILITY DISCRIMINATION ACT 1995, DATA PROTECTION ACT, CARE STANDARDS ACT 2000, MENTAL HEALTH ACT, Covering;
• The need to achieve positive outcomes for people
• the need to safeguard and protect people for all forms of danger, harm and abuse
• employment practices for the provision and service
• data protection, recording and reporting
• making and dealing with comments and complaints to improve services
• Whistle blowing
• Health and Safety
• Equality and Diversity
5.5 The main piece of legislation is the Data Protection Act 1998. This covers the medical, social, credit information and the local authority. There are eight principles. The data must be: -fairly and lawfully processed -processed for intended purposes -adequate, relevant and not excessive -accurate -not kept for longer than necessary -processed in accordance with the data subject rights -kept secure -not transferred to countries without adequate protection.