As part of Meaningful Care Matters regular work, we carry out day-long observations in care services using the QUIS observational tool (Dean, Proudfoot, & Lindesay 1993) to focus on the quality of life of people living in that home or hospital.   This can provide a baseline understanding of where the service is at, but we also use this assessment as part of regular reviews and the final accreditation audit, to ascertain whether Butterfly or Dragonfly accreditation has been achieved.

Over the years, I have been struck by how differently managers and their teams respond to receiving feedback. It’s not easy to hear what they might perceive as criticism, and it’s even more difficult to face the truth that what you are offering the people you support just isn’t good enough.  When team members themselves practice doing observations as part of our Butterfly training, they are sometimes visibly upset and even shocked by what they see.  “I never normally sit down long enough to just see, feel and hear the reality of what life is like here for people.”  “I had no idea how chaotic our mealtimes were.”  “I didn’t realise how many individuals can so easily get forgotten.”  These light bulb moments are essential to the process of driving and motivating change to happen. Before teams can acknowledge these realities, they are likely to settle for the status quo, often believing it is ‘good enough.’  

Some time ago, I worked with two teams where the response to feedback given in their annual Audit was very different. In one home, which had achieved the highest level of Butterfly Accreditation, the manager was incredibly proud and excited to share this success with her team. However, what stood out for me, was what she said; “It was a particularly fantastic day when you were with us. But what I want to ensure is that every day looks and feels like that. We will look at your recommendations to see how we can improve even more.” Even at the height of success, she was humble and open to learning more.

In another home which also achieved the accreditation but didn’t shine in quite the same way, the response of the manager and his team was much more defensive and critical.  They tried to critique the Audit methodology (which has been well established over 30+ years) and gave excuses and defences for some of the things which were highlighted in the report as needing improvement. Their home has an excellent reputation, and it felt that in their eyes, there really wasn’t anything they needed to change or do better. I understand that some of the feedback they had received had hurt their pride in what they considered was a brilliant service. This pride was a very positive feature of this team as they all felt a strong sense of loyalty and belonging to the home. However, it seemed a shame to me that there was no room in this pride to acknowledge that there will ALWAYS be things which can be done even better. This was what the first manager had demonstrated so clearly to me, and which gave me much hope that their success would be sustained.

However, on reflection this experience also gave me pause to reflect on whether I could do anything differently in the ways I give and receive feedback. I needed to think about how it might feel to have someone who is an outsider or stranger coming into my home and telling me that some of the ways I run my home or look after my family weren’t as good as they could be. Even if that person also told me all the great things I was doing, it is likely that what will stay with me is the not so positive bits. This is human nature and I know I would find this hurtful. We ask Butterfly Home teams to invest emotionally in the work, so we shouldn’t really be surprised if at times team members take things very personally.  What can I do to ensure that we remember feelings do matter most and ensure that people are left feeling motivated rather than demoralised after our visits?

So, what then does this tale of two care homes tell me about the most important quality to achieve and maintain culture change? This quality is of course – HUMILITY which includes the ability to really listen to feedback, to face the truth and be prepared to own the things which could be better.  This applies to leaders in particular, but applies to us all in our work and in life generally. We can still be proud and celebrate our talents and strengths, but arrogance and complacency are the enemies of meaningful change.

Consultant Trainer
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