This series of blog posts first appeared a few years ago on a now defunct blog called ‘Care Training’. It was inspired by the training maxim of ‘making the unconscious conscious’. It is intended to take what really ought to be the most basic principles of health and social care and put them down on paper. The series isn’t only an exercise in stating the obvious though whatever the title might suggest. It’s actually intended as a philosophical foundation manual for workers and informal carers to help them get their care ‘on track’ and then to keep it that way.

The whole team approach

I have mentioned several times throughout this series of posts the importance of consistency throughout the whole team. There are several reasons for this:

• Clear boundaries;
• No ‘pedestals’ & staff safety;
• Effective, consistent care;
• If you can’t stop the person behaving poorly you can at least stop them doing it to you;
• Corporate identity – “you’re all the same”.

As we consider these reasons we will also be outlining the argument that staff who are too ‘permissive’ when faced with genuinely unacceptable behaviour are actually counter-productive. They do their clients no favours.

It is my belief, however hard or unpopular it may be, that such workers should have no place in health and social care. The outcome of such poor boundaries can be tragic and yet it is all too common for workers to forego their responsibilities in practice.

Health and social care workers need to develop the strength of character necessary to maintain consistent boundaries. They need both peer and management support to do so. We ask a great deal from staff who are faced with challenging behaviour and we owe it to them to offer sufficient support as well.

It has become trendy to talk about social care settings as though they are democracies but this is a misrepresentation. It’s true that we should always have an eye on the rights of service-users but this doesn’t mean that organisations should abandon control of their systems. We need to maintain firm boundaries.

Firm Boundaries

Ask any parent what happens when adults who share responsibility for a child have different boundaries and rules. Ask any worker how they react when they have to work with two or more managers (perhaps on a rotating shift pattern) who have different approaches. Think about your own reaction to varying and conflicting sets of rules.

Now think about the different ways that your colleagues approach ‘problem behaviours’ at work. In every case you’ll find that different colleagues face different types of behaviours’ based upon their particular responses to them. It’s cause and effect.

If you do the same things, you get the same results.

If our job is to help people move beyond their behaviours’ and the need for our services then we must ensure that the experiences we give them are both appropriate and consistent. This means a whole team approach.

No ‘Pedestals’ and Staff Safety

A common problem with inconsistent care is the divided perception of workers it creates. Staff who don’t ‘toe the party line’ as it were typically appear to the service-users as more compassionate. They also tend to appear weak because they are easily manipulated but that’s not the issue for the moment. They appear compassionate.

By contrast other staff who do their jobs properly are seen to be less compassionate when compared with the weaker staff member. This can breed resentment toward the more professionally minded workers and even put them at risk of assault or malicious allegations. In the end neither staff member comes out well and the service user’s care becomes inconsistent too. Everybody loses when staff try to put themselves on a pedestal of compassion.

The other big problem is that if you climb on to a pedestal you also gave to keep it clean. If you acquire a reputation for being a ‘soft touch’ the negative or potentially explosive reaction you get when you do eventually stand firm will be far worse as a result.

Effective, Consistent Care

The point about effective and consistent care has already been made and does not need much restatement here. However it is, of course a major reason for ensuring a whole team approach.

If You Can’t Stop The Person Behaving Poorly, You Can At Least Stop Them Doing It To You

Health and social care workers are not supposed to be able to save the world. Some service users behave poorly for reasons that are way beyond our influence or control. For example we will not necessarily stop a grown man being violent if he learned to be so in the schoolyard 30 years earlier and has lived that way ever since.

However, clear and consistent boundaries will go a long way to ensuring that they behave differently toward you and your colleagues.

Contrary to popular belief people aren’t ‘just violent’ or ‘just rude’ or ‘just’ anything. Human behaviours’ are the result of complex equations involving costs and benefits, social norms, consequences and degrees of acceptability.

Think about the people you know who are offensive but hide their insults through humour. Did you ever ask yourself why they do that?

Usually this sort of behaviour (one of several forms of passive-aggression) is only there because outright aggression and hostility isn’t worth the price. Either the group norms forbid open hostility or the victim of their venom is just too scary. So they hide behind humour instead.

There’s a valuable lesson there. People tend not to behave in ways that are too dangerous to them. Clear boundaries will make it too dangerous for potential abusers to aim their abuses at you. That won’t stop them from behaving badly toward others but that’s not within your control. We have a legal system (or if appropriate a mental health act) for that.

‘Corporate’ Identity – “You’re All The Same.”

Every worker has experienced blame for the actions of a colleague. We’ve all found ourselves faced with an angry service user or relative because of some other worker’s actions. That’s because in the eyes of many of the people we work with we really are all the same. The wrongs they perceive from one of us might as well have been perpetrated by any of us.

So a good, firm team agrees standards of behaviour and everyone sticks to them. That way we all know what to do, what to expect and how to deal with the inevitable conflicts that our work involves.

Or you could make your work harder and less effective if you prefer.

Remember…….

If you do the same things, you get the same results