Why it is so difficult to get this change of approach right is worth exploring, particularly in the context of working with organisations trying to achieve practice improvement and better care and support outcomes. The constraints on achieving genuine change can be multiple, and inter-related, but are likely to include some or all of the following:<\/p>\n\n\n\n Organisational culture is a vague term, but it describes a range of beliefs, behaviours and shared values and principles which combine to set the framework for the overall style and character of local authorities and health partners. The culture can therefore be positive or negative; it can support innovation and encourage responsive and personalised support, or it can be reactionary and conservative. The culture will often be covert rather than explicitly stated, but it will be reflected by employees in the language and behaviours they demonstrate, and in the image of the organisation that they promote.<\/p>\n\n\n\n The resources available to public services will always be finite and usually under considerable pressure. This requires organisations to effectively ration services and support, but to do so on a fair, consistent and transparent basis. It is unacceptable \u2013 and illegal \u2013 to deny assessments of need to carers, or those they support, or to advise them that \u2018there is no point\u2019 to an assessment if they won\u2019t get any support as a result of the process. Resources need to be seen more widely as those of the wider community, and of the social capital which exists within and between families and the community, in addition to the resources available through public services. The availability of \u2018universal services\u2019 which are open access and free or low cost for local citizens can significantly add to the resources available to help people manage their wellbeing.<\/p>\n\n\n\n The style of leadership is probably the most important influence on shaping overall organisational culture, and the features of the \u2018brand\u2019 of service that is on offer. Is it aspirational (wanting to do the best possible for citizens), or is it apparently more concerned with discouraging likely demands on resources? Are staff encouraged to act autonomously and flexibly, or are they required to adhere to rigid protocols and to have their decision making checked and their judgements queried?<\/p>\n\n\n\n The skills and abilities of staff will be directly and indirectly shaped by the organisational culture and messages from managers. For example, attempts to introduce better strengths-based assessments for carers, and to have an offer of support that is not just about eligibility, that can respond to carers\u2019 needs other than by providing replacement care may be more likely to succeed under the following conditions:<\/p>\n\n\n\n The importance of establishing a cultural shift and empowering staff to understand patients\u2019 goals and priorities has also been a theme of the \u2018What Matters to you?\u2019 initiative in Scotland. This is intended to encourage more meaningful communication between people providing health and social care, and the people for whom they provide care and support. The focus on the importance of the relational aspects of care is consistent with the wider objectives of providing person-centred care. A multiple case study <\/a>evaluation of approaches identified both barriers to implementation and enablers, and comments made by participants highlighted some of the experience. Undertaking a \u2018What Matters\u2019 conversation can be challenging, despite the professional experience of health and care staff, as this comment demonstrates:<\/p>\n\n\n\n \u201cAsking \u2018What matters to you?\u2019 to patients means stepping out of your routine to do something odd and different. Not different in a huge way, but different enough to feel uncertain about it.\u201d <\/em>(P.19)<\/p>\n\n\n\n Feeling supported in using a \u2018What matters\u2019 approach was identified as a key enabler, as this comment also identifies:<\/p>\n\n\n\n \u201cI have worked at other places so I\u2019m very well aware of the strong teamwork ethics in this unit. I know that all of us are asking \u2018what matters?\u2019 every day, and that helps me feel more confident about doing it myself. You are just better on the floor when you feel supported.\u201d<\/em> (P.16)<\/p>\n\n\n\n Findings from the case studies overall identified positive outcomes, and in particular:<\/p>\n\n\n\n The biggest challenge identified was how to embed the approach into day-to-day practice. Or, how to move from a successful small-scale initiative, to achieving organisational cultural change.<\/p>\n\n\n\n IPC are currently working with a number of leadership teams supporting them to develop and embed their own bespoke principles for strengths-based working throughout their organisations. Part of our work includes a reminder of the DHSC guidance<\/a> on strengths-based social work which set out a number of key characteristics of an organisation enabling a strengths-based approach:<\/p>\n\n\n\n This first bullet is the challenge that is key to leadership development work more broadly, and the necessity to ensure that the four components of culture, leadership, resources and skills are brought into alignment and form a mutually reinforcing virtuous circle.<\/p>\n\n\n\n![\"\"\/](\"https:\/\/ipc.brookes.ac.uk\/images\/ipc-516.png\")
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