Helping care homes to cope with change

Organisational resilience is key to enabling care homes to adapt to the many changes they face, whilst still delivering good care to their residents. In this blog post, Dr Al Ross from the University of Glasgow explains what resilience ‘looks like’ in the context of care homes and what factors contribute to it.

For care homes, resilience means being able to cope with complexity and variability while still maintaining standards and delivering good care

Care homes are complex environments, with lots of things going on and many people with different needs. This makes it difficult to identify the specific factors that contribute to good care. With funding from the Dunhill Medical Trust, we worked within care homes to better understand these complex environments and identify the characteristics that make them resilient to change and better able to deliver good care for their residents.

What is resilience?
Changes in care for older people are very common. People’s needs change, staff come and go, and unexpected things happen that disrupt plans. Official guidelines and directives are often ‘one size fits all’ in their approach, so good care homes need to be able to adapt them for everyone and – importantly – their own set of circumstances and systems. This might mean adapting best practice guidance so that it can be effectively implemented in your specific care home with your residents.

In recent years, researchers are increasingly recognising the importance of organisational resilience – the ability of staff, teams and systems to cope with and adapt to the many demands that are thrown at them. For care homes, this means being able to cope with complexity and variability while still maintaining standards and delivering good care.

What makes a resilient care environment?
Through our project, we explored this concept of resilience in the context of older people’s care, identifying several factors that contribute to resilience and seem to be shared by good care homes. We’ve developed a handbook to help others to build resilience in their own care homes, hospital wards and other healthcare settings. 

There are five key activities that work together to provide good, resilient care: 

  • Anticipating: Good care homes were found to have systems in place that will anticipate future needs, both in the short and long term.
  • Responding: They also recognise and respond to challenges, identifying where a response is required and how best to approach it. 
  • Monitoring: Resilient care environments have robust systems for monitoring and tracking day-to-day activities and changes, and ways to record and share this information between staff.
  • Coordinating: Good communication and coordination between different activities and teams is vital, allowing the whole system to function more efficiently.
  • Learning: Staff and management learn from what happens when things don’t go quite right, and adjust their systems and processes accordingly.

For example, a care home that is resilient might have good systems in place for monitoring residents’ moods and sharing these with other carers, as this can reflect changing health or care needs. 

A resilient home will anticipate how a new care directive may affect the records that they need to keep or the amount of time tasks will now take. Management may also allow staff the autonomy to make the best decisions for residents, and provide the ability to record and share this information with others. 

Importantly, we found that the best care homes let their staff do what they were best at – caring for people – and then found ways to utilise, capture and share their skills and insights to create a positive environment that was resilient to change.

Our handbook gives more detail and background on resilience and all of these different factors, and takes you through a step-by-step process to implementing these in your own care setting.

You can download the CARe QI booklet on our website.