How important are managers in reducing PI usage?

[andy]

In my view training is seen too much as the solution to reducing PI ovr usage. We need to examine cultures that allow such practices to happen. The social psychologist Stanly Milgram in his book 'Obedience to Authority' did demonstrate in a series of classic studies that many people will carry out dangerous activities if the context makes it appear normal.

In care environments it can become 'normal' to restrain people. In my view managers can influence such processes. Who discusses with staff teams why they had to restrain a person? Who sets the boundaries. I have worked in services where restraint has been massively reduced by strong managers who make the boundaries clear. They also encourage staff to think about alternatives.

So should we train staff or should we train managers?


What do you think?

[forumAdmin]

I had a long post but the answer to the subject is

Vital - both should be trained together

Managers should also get instruction in how important their attitude is in destroying or creating
staff progress towards a reduction in Physical Interventions.

[anon_e-mouse]

Agree with above, often staffs first thought about whether PI is right or wrong is not the legality of the PI but whether or not its use would be supported by the manager.

They set the tone for the culture.

[John O'Dwyer]

I agree that you have to train both but if you had to decide, due to limited resources or time, for the sake of argument....who do you train?

You may have even given yourself the answer Andy. You mention that strong managers can bring about this change, but what happens where there are weak managers. How do we introduce culture shift? By focusing on where the power is held in the organisation?

The people who would need to be trained would be the ones who hold the power, or the culture of the organisation. Train them and ensure they have empowerment and motivation to change and the organisation should follow.

[anon_e-mouse]

MHO is that If managers attend the course with staff it has a beneficial effect. There are lots of manager-staff tensions that arise in the workplace and sometimes its just a good idea to drop the barriers and get outside people in to work toward a common goal.

I would find it strange to think that any manager would let a training company in without attending the course first! especially since policy, procedure and guidance are key issues to its successful implementation, (regardless of the course content.)

Can you prove that there are beneficial effects from certain groups being present on course? i think the published papers show better overall results once a critical mass of people have been trained or at least more trained than untrained. - can you confirm/clarify Andy?

Skill improvement and culture change are good aims for a course. I would also include trustees, accountants, parents and anyone else with an interest to help encourage organizational change.

A bit of borrowed wisdom and advice to managers
"There is nothing more difficult to take in hand, more perilous to conduct, or more uncertain in its success, than to take the lead in the introduction of a new order of things."— Niccolo Machiavelli
The Prince (1532)

[forumAdmin]

MHO is that If managers attend the course with staff it has a beneficial effect. There are lots of manager-staff tensions that arise in the workplace and sometimes its just a good idea to drop the barriers and get outside people in to work toward a common goal.

I could go on about this for a while as I said before - Vital

if the training attitude is at level 100
the staff may take on and change to reach a level 30
if the manager is in the room and agrees openly the staff will actually reach 70-80.

I know this may not make sence but when you teach those learning do not reach the same knowledge you present at..

and

I agree that you have to train both but if you had to decide, due to limited resources or time, for the sake of argument....who do you train?

why would this happen ? 1 extra person (manager) on a course when you are bound to have a sick participant not turn up...

[anon_e-mouse]

I do have a pet hate about an aspect of this discussion that maybe others will share, its at least a 3.5 on my tolerance scale...

When you have a manager who puts themselves on the course on a part time basis.

What i mean by this is when a manager considers that partially attending the course will be enough, so attends the bits they want and wanders off to "work" when they feel like it.

It is even more annoying when they also decide to "interject" on points that were clarified in their absense....

should the attendence be on an "all or nothing" basis?

[forumAdmin]

When you have a manager who puts themselves on the course on a part time basis.

agreed

you must be a trainer then no one else seems to understand this point of view but us

[steveg]

I agree with all that is said!

The key is culture change on management levels and above. I have seen so many staff attending workshops and "invigorated" with new ideas and approaches only to be knocked back when higher echelons fail to react positively and staff just fall back into usual cycle of events.

But to be fair to ground level Managers, where do they get their training from? Whatever peoples views on LDAF and NVQ, as a support worker you get this training and support, then when you get to managerment level, what have you got? There appears to be a distinct lack of quality training in care management. (as a side, is there a good training package for managers that someone has completed?)

Also i have had discussions before about this, but a lack of 1:1 supervisions, appraisels and team meetings (at all levels) has a major imapct on any effective running of services, homes, units and alike.

There also appears to be a management culture that "behaviour management" training is just a "tick off" issue to satisfy CSCI.

[anon_e-mouse]

IMHO direction and examples can be set at certain managerial levels but the people who receive services will experience a culture and community created by the staff who directly deliver services to them.

The staff have a huge role in creating a culture for the service users because of the relationships they form, often regardless of how the service is managed. Listening to the behavior of the service users and acting on it is a good basis for evaluating the direction of change for a service.

Dissatisfaction with the way things are done or service provision is often expressed as challenging behavior. Each person in an organization has a role to play, some people will support the service directly rather than play a direct role with service users. Managers are often "in-between-ers" playing a dual role of supporting the legal entity, (the company), that exists to provide a service and the staff that directly provide the service. It is the staffs responsibility to badger the "in-between-ers" on behalf of the service users frequently, over a long time and with as much intensity as they can muster.
If a manager "fails to react positively" to an idea that invigorated a staff member the staff member should not give up so easily and "fall back into usual cycle of events". This is a poor excuse for what I would prefer to call "committing an act of abuse".

Surely once staff have been taught more reasonable methods of managing a situation and then fail to use them the "reasonableness" of what they have just done starts to be more fragile than before a course. Any "act" done before the course "In Good Faith" might well now be deemed "unreasonable" in light of less intrusive and dangerous alternatives being shown on a course and learned by staff.

If the 3 day course is so good then "falling back into usual cycle of events" sounds criminal to me ;)

[timp]

while I believe managers are important in the process I also believe that they do not get enough support and cannot be blamed wholly for the problems with their attendance - we all have a boss to please.

[southbourne@hillcrestcare]

while I believe managers are important in the process I also believe that they do not get enough support and cannot be blamed wholly for the problems with their attendance - we all have a boss to please.

Managers are integral in the reduction of PI, as an instructor and manager myself, I see my responsibility as failing if my staff feel there is no option but to physically intervene. However, I also feel that much of the PI used is the consequence of actions within the control of the staff in place. It therefore demonstrates the need for fully considered training packages to encompass some aspects of work that most take for granted, ie. use of language and physical expression, empathy and consideration and basic understanding of the needs of oneself before attempting to support others with their. It is vital that staff can first understand why they behave the way the do before being able to understand the behaviour of others. In doing so, a greater empathy is held for those exhibiting Ch.Behav allowing for a more sensitive means of management, hence redcution in use of PI

[andy]

Yes, the 3 day course is very good (but, I would say that). I think you are correct in your statement that if staff have been clearly taught safer methods but, ignore these then there is always a case to answer in these circumstances. Speaking from experience we can make a huge difference on the ground, its one of the factors that is so motivating to trainers who do the work. But, service managers who do not actively support training are in my humble opinion displaying negligent behaviour.Consider this example if a person was taught how to lift a person in a safe manner on a training course. What view would we take of a staff member who reported 'well my way is better'? The answer is a dim view. But, people are trained in restraint methods and often not questioned when they 'customise' techniques etc.

[anon_e-mouse]

But, service managers who do not actively support training are in my humble opinion displaying negligent behavior.Consider this example if a person was taught how to lift a person in a safe manner on a training course. What view would we take of a staff member who reported 'well my way is better'? The answer is a dim view. But, people are trained in restraint methods and often not questioned when they 'customize' techniques etc.

I refer the honorable gentlemen to the answer i gave a few moments ago


..."reasonableness" of what they have just done .....Fragile. Any "act" done before the course "In Good Faith" might well now be deemed "unreasonable" in light of less intrusive and less dangerous alternatives being shown on a course and learned by staff...."falling back into usual cycle of events" sounds criminal to me ;) .


Although andy you put it across better as a question.

[bethr]

To go back to what Steve g said, and as an ex manager myself (albeit acting), i feel that training is vital. I had very little training myself, and stood in for a manager on and off for about 8 months. During which time i had NO TRAINING at all; other than what i had had during my own 'support worker' induction. This meant that i was woefully ill equipped for the task ahead. Although i had experienced supervision, i was never given training around providing this, appraisals were non existent etc - this definitely had a knock on effect as to how i managed the home. Althought i have slightly (!!!) drifted off the original point, i think that it is essential that managers are given the training and support required to take on the responsibility of what is essentially managing other peoples lives.

Also, i agree with anon e mouse - managers certainly should have to attend the whole of the training course - what message are they giving t the staff if they feel that certain aspects are 'less important' in effect, than others?

[forumAdmin]

perfectly summed up bethr.

[janeth]

but as well as direct mangers there is a culture of just not knowing everywhere. I was involved in the aftermath of a recent incident in a cildrens home. A young person was restained by a member of staff using an alternative restraint procedure (not ours) they have an express ban on floor restraint but the staff member decided to lowere the person to the floor where upon the young person hurt their back and had to be taken to hospital in ambulance. Proceedures were followed and all releventy people informed including child protection police, and csci. Both declined to investigate the incident even though it contravened the companys policy. The message given to the staf was therefore it doesn't matter if there is a serious incident whilst using restraint nothing will happen! The manager of the unit has been complaining about the quality of their PI for some time but the company is deaf to that. This incident could have leant weight to the argument, as it now stands the company can continue ticking the box saying all is well!!!!!
Long winded answer yes its vital but education needs doing at all levels to support all. :-?