In my experience, it’s a very luck care home or domiciliary care manager indeed who is not spending most of their time engaged in ‘fire-fighting’ or, to use the slightly more ‘professional’ term, crisis management. To a certain extent this goes with the territory: care work is by its very nature unpredictable because human beings themselves are unpredictable. This is especially true with regards to human beings who are frail, sick, vulnerable or who have multiple and complex health needs. And when you are working with a large number of such individuals, be it in a residential or home care environment, such unpredictability is multiplied by a hundred-fold. Furthermore, if you then add staff into the mix, each of whom has their own needs and idiosyncrasies, then things become pretty much totally unpredictable.
So however much planning a manager does, they know that it only takes one member of staff to go off sick at short notice, or one resident to be suddenly taken seriously ill, and the best laid plans of mice and (wo)men suddenly count for nothing. And, of course, for most managers this is a daily, if not hourly, occurrence. In other words, in the care environment crisis management has become the new norm.
But does it have to be like this? I think the most honest answer is yes – but only up to a point. In other words, by its very nature there will always be a large element of crisis management, of ‘fire-fighting’, in any managerial role. However, such crisis management can itself be managed and kept within limits. The real problem starts when such such ‘fires’ can no longer be contained and spiral out of control into a vicious circle in which the whole service eventually becomes consumed by one crisis after another.
And I think the analogy with fires and fire-fighting is a useful one. To start with, as any actual fire-fighter knows, identifying and containing a fire as early on as possible is the key to stopping it spreading and consuming the whole building. What’s more, before tackling any fire, the fire crew will want to know as much as possible about the wider situation that confronts them; not only in terms of where the fire is, how fast it is spreading, who’s in the building, etc, but also the layout of the building itself, its structure, its escape routes, the risk posed to adjoining buildings, and so on. And, finally, of course, one of the key roles of the fire and rescue services is to try and help prevent fires and other disasters in the first place, through a careful assessment of potential fire hazards, advising the owners and occupants how to minimise fire risk, etc.
The common factor in all this is information; or, perhaps it would be better to say, knowledge. Information by itself is not much use unless you know how to interpret it, to understand what it means. When fire-fighters arrive at the scene of a blaze, or other disaster, they already have a great deal of accumulated knowledge that they can put into practice. At the same time, they will need to gather new information, which then becomes new knowledge, in order to ensure they tackle this specific situation in the most effective manner. And in order to be able to successfully help prevent future disasters they will need to be able to share their knowledge with others.
Applying this to the social care setting, the more a manager knows about their service, the more they will be able to manage and contain any particular crisis that may arise. Furthermore, the greater their understanding of the service, the more ‘intelligence’ they have about it, the more likely it is that they will be able to spot the potential signs of trouble early on and prevent a crisis developing in the first place.
But where does all this intelligence, this knowledge, come from? From many different sources, including reports, audits, care plans, staff records, staff and service user feedback, supervision and appraisals, training courses, and so on. Whether they realise it or not, all organisations are continually gathering new information; in fact, organisational learning is a key part of the functioning and development of any service. How successful such learning is in practice is another question; and part of this depends on the extent to which such information becomes ‘translated’ into useful knowledge for the service. In other words, simply gathering reams of information is not, in itself, much help unless some sense is made of it, and it can be put to good use within the service.
One way to help ensure that there is meaningful learning within a service is to have effective systems and processes in place that facilitate the gathering of meaningful information, along with the ability to turn such information into useful, practical knowledge that can be of benefit to the service. And needless to say, this is where robust quality assurance and good governance takes centre stage. From a CQC perspective, robust quality assurance and good governance are the cornerstones of the ‘Well-led’ domain of every service, but even without the CQC, it seems obvious that it is only through a process of continuous monitoring and gathering of information that managers and providers will have the knowledge they need to be able to operate their services on a day-to-day basis, and to strategically plan for the future.
So, just to recapitulate: crisis management may be inevitable in any service, but the key thing is to ensure it doesn’t spiral out of control. One of the key ways to ensure it doesn’t is to have good intelligence, effective knowledge, about the service, so that any crisis can be managed more effectively, and, in many cases, can be prevented from occurring in the first place. And having robust quality assurance and good governance systems and processes in place is the cornerstone to establishing such good intelligence.