Embedding culture change to enable care and support planning
The change in culture needed to make care and support planning work is a long-term commitment and requires a holistic understanding of patient care and partnership working.
One of the main findings from the programme was confirmation that implementing the House of Care framework takes time.1 Some interviewees commented that the programme was very process-driven and recognised that these changes in approach can only be effective when accompanied by culture change.
In this context, we define culture change as a long-term commitment to a holistic understanding of patient care and partnership working. Partnership working refers to understanding patients as equals in their own care, as well as whole teams and systems working more closely together to embed this shared understanding. In practice this requires engagement at all levels and parts of the system – from senior leaders to front-line staff in health, social care, community and voluntary sectors.
We’ve been so distracted by the tools, paperwork, the things you fill in. I think we’ve lost sight of the wider things a bit.
Although there is some evidence of culture change at practice level, the shifts needed to embed the care and support planning approach at healthcare community and system level are only just beginning.
In many cases, this was because so much time was required in setting up the roof of the House – the essential IT infrastructure and other processes. For new sites, it can take new teams at least six months to put systems in place before care and support planning can start and it might be two to three years before it is fully established.
A further challenge was high staff turnover, which meant more time and resource spent engaging and training new staff in the care and support planning approach. Train the Trainer and top-up training delivered by local, well-respected healthcare professionals helped maintain momentum, with at least two sites saying this was central to driving culture change.2
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1 ICF Consulting Ltd, 2018. House of Care Evaluation: Final Report, page 86
2 ICF Consulting Ltd, 2018. House of Care Evaluation: Final Report, page 35