Managing Stress and Mental Health Risks in Social Care: A Case Study
On this page, you'll find resources related to a presentation to the Society of Occupational Medicine on 20th June, 2023. The case study concerns the challenges of transforming the culture and behaviours in a social care charity and care home, William Simpsons, and more particularly what we did to improve mental health health and wellbeing and prevent stress. In the webinar, we covered:
Below you'll find some transcript elements, but also a video conversation I recorded with William Simpsons' Chief Executive, Zoe Nolan. You'll also find some documents related to the case study and what we did, and our latest Care Inspectorate Report is included too.
Webinar Transcript
Thanks Lara and thanks Nick and SOM for organizing.
Today I’m talking about aspect of my work which isn’t really my day job. My day job is helping orgs prevent and reduce stress, particularly the management of associated risks and much of that work is through partnering with Occupational Health Consultancies. But I wear another hat as Deputy Chair of a social care charity and care home called William Simpsons. As an organisation, we have had some major challenges related to managing stress and wellbeing and I thought it would be good to share how we dealt with those as a kind of case study.
I was going to be joined by our Chief Exec, Zoe Nolan, today, but sadly Zoe cannot attend today, so I’ve recorded a video conversation we had yesterday as part of this webinar (you can find the video recording below).
William Simpsons is a charity and residential care facility near Stirling for people with long-term mental health problems, often related to addictive behaviours like alcohol misuse. We have 8 flats in the main home, each with 8 residents in ensuite rooms, and a separate respite unit we call ‘flat 9’. We have a mix of long-term, short-term and respite residents, who come via local authority social work referrals from all over Scotland. We’re usually very close to 100% full and finding that demand for respite is increasing. We have about 100 staff and a turnover of about £3M. We’ve got 7 acres of beautiful grounds, including a walled garden, which residents and staff use, including to de-stress.
Our history goes back to 1836, when it was called William Simpsons Asylum and provided care for old soldiers and sailors. Our archive is kept by Stirling Uni. I joined the board in May 19, first as a trustee / director, then later became Deputy Chair. I also chair the Care Committee. The committee’s aim is: To provide oversight of strategic leadership of care at William Simpsons. I lead on oversight of the management of risks related to stress, mental health, wellbeing. We discuss these issues every month in Care Committee and make recommendations to the board where investment decisions are required.
I’m going to play a video now of a conversation I had with our Chief Exec, Zoe, where we discuss: where we were a few years ago, which was not in a great place in terms of stress and wellbeing; what we did to address that, and; where we are now and what's changed.
.
After that, I’ll discuss some of the lessons we learned about managing these issues and then look forward to any comments or questions you have.
- A profile of William Simpsons - what the organisation does and why
- Where we were four to five years ago and the wellbeing challenges we faced around structure, culture, stress problems and associated costs.
- What we did, and do now, to manage stress and mental health risks.
- Where we are now and the differeces we have seen, including business benefits and quality of care.
- What we learned - key lessons for managing wellbeing in care-oriented organisations.
Below you'll find some transcript elements, but also a video conversation I recorded with William Simpsons' Chief Executive, Zoe Nolan. You'll also find some documents related to the case study and what we did, and our latest Care Inspectorate Report is included too.
Webinar Transcript
Thanks Lara and thanks Nick and SOM for organizing.
Today I’m talking about aspect of my work which isn’t really my day job. My day job is helping orgs prevent and reduce stress, particularly the management of associated risks and much of that work is through partnering with Occupational Health Consultancies. But I wear another hat as Deputy Chair of a social care charity and care home called William Simpsons. As an organisation, we have had some major challenges related to managing stress and wellbeing and I thought it would be good to share how we dealt with those as a kind of case study.
I was going to be joined by our Chief Exec, Zoe Nolan, today, but sadly Zoe cannot attend today, so I’ve recorded a video conversation we had yesterday as part of this webinar (you can find the video recording below).
William Simpsons is a charity and residential care facility near Stirling for people with long-term mental health problems, often related to addictive behaviours like alcohol misuse. We have 8 flats in the main home, each with 8 residents in ensuite rooms, and a separate respite unit we call ‘flat 9’. We have a mix of long-term, short-term and respite residents, who come via local authority social work referrals from all over Scotland. We’re usually very close to 100% full and finding that demand for respite is increasing. We have about 100 staff and a turnover of about £3M. We’ve got 7 acres of beautiful grounds, including a walled garden, which residents and staff use, including to de-stress.
Our history goes back to 1836, when it was called William Simpsons Asylum and provided care for old soldiers and sailors. Our archive is kept by Stirling Uni. I joined the board in May 19, first as a trustee / director, then later became Deputy Chair. I also chair the Care Committee. The committee’s aim is: To provide oversight of strategic leadership of care at William Simpsons. I lead on oversight of the management of risks related to stress, mental health, wellbeing. We discuss these issues every month in Care Committee and make recommendations to the board where investment decisions are required.
I’m going to play a video now of a conversation I had with our Chief Exec, Zoe, where we discuss: where we were a few years ago, which was not in a great place in terms of stress and wellbeing; what we did to address that, and; where we are now and what's changed.
.
After that, I’ll discuss some of the lessons we learned about managing these issues and then look forward to any comments or questions you have.
During the video Zoe mentions stress risk assessment. We used a set of tools and methodology for this which I developed called SSPPT (Stressful Situations Profiling and Planning Tools). You can find out more about that approach on the Tools page. But essentially this is about building a simple picture or profile of stress risks, in this case from looking at a variety of sources of data relating to our workforce at William Simpsons. Once you have a profile like this you can develop plans to tackle issues. We look at stress issues affecting staff wellbeing on a monthly basis, so see the management of stress risks as an ongoing task. We discuss this in our Care Committee, then take any recommendations to the full Board. Examples include a change of strategy, something like a new support structure which requires investment, or some new tech that makes it easier for staff to manage demands. We also include the management of wellbeing in our annual report and understandably, Care Inspectors are very interested in all aspects of wellbeing, including both residents' and staff wellbeing. I've included our latest inspection results further down this page.
| staff_stressful_situations_profile_march_22.docx |
Back to the transcript...
I'd like to discuss some of the lessons we learned and I'm going to start with general lessons and then look at lessons for Boards
General lessons:
Lessons for Boards:
One thing Zoe didn’t highlight in the conversation was the transformation in our care inspection results, so here they are (you'll find the inpection report below). We weren’t inspected during Covid, but they came unannounced, as they always do, in May of last year. Here is the report. Being inspected a bit scary, well a LOT scary. Inspectors can go anywhere, speak to anyone, including: residents, staff and not just care staff, relatives and friends of residents, and they can look at any documentation and records. Thankfully, our inspection scores were transformed from 2019. What we did about stress, mental health and wellbeing wasn’t the whole story in that change, but it was certainly a very big part of that transformation.
I can tell you from a personal point of view that I’m very proud of William Simpsons and our work there. I’m proud of every member of staff, and we have a great management team and an outstanding leader in Zoe. And it’s great to be part of a board that had the courage and leadership to make difficult decisions to support structural and cultural change. I do feel we made a difference.
Thanks for listening.
I'd like to discuss some of the lessons we learned and I'm going to start with general lessons and then look at lessons for Boards
General lessons:
- Organisational structure matters and influences stress risks - someone needs to lead and be accountable.
- Wellbeing (residents' and staff) influences organisational performance and the quality of care - they are inextricably linked.
- A blame culture and punitive approach is counterproductive.
- All staff are involved in care (it's One Team) and every single employee is important.
- Trust is key, adopt a ‘trust first’ policy, even if uncomfortable at first.
- Also key are involvement in decisions and peer support, which is fostered by management support.
- Give people responsibility – make them champions.
- Complaints, though uncomfortable, need to be welcome - it's better to know.
- Keep doors OPEN.
- Adversity in care (like Covid) can have unforeseen, positive consequences for wellbeing.
- Management performance and behaviours can improve and this positively impacts on wellbeing.
- Everyone has different wellbeing needs (residents and staff) and that needs to be taken into account.
- Non-work stress (such as financial stress) is still work-relevant (that is, affects wellbeing at work) and the organisation needs to support where it can
- Stress risk assessment and risk management are ongoing activities, not one-off.
- Inspectors will rightly ask about wellbeing - always be prepared!
- Culture can and does change, but rarely by accident.
- Community engagement is good for wellbeing - in the home and in the community.
- Money matters, although it’s not all about pay – it’s also about flexibility and access and support.
Lessons for Boards:
- The board needs to be both accountable and transparent about wellbeing.
- Someone on the board should lead on this and ensure it’s always on the agenda.
- Where decisions about investment in wellbeing are concerned, the business case should be made, but the default position should be 'Yes' (Our experience was that such decisions saved £100s of thousands and improved the quality of care.)
- When a culture is toxic and manager behaviours are causing fear, the board needs to act decisively, even if it is costly – the investment is worth it and it may require independent oversight.
One thing Zoe didn’t highlight in the conversation was the transformation in our care inspection results, so here they are (you'll find the inpection report below). We weren’t inspected during Covid, but they came unannounced, as they always do, in May of last year. Here is the report. Being inspected a bit scary, well a LOT scary. Inspectors can go anywhere, speak to anyone, including: residents, staff and not just care staff, relatives and friends of residents, and they can look at any documentation and records. Thankfully, our inspection scores were transformed from 2019. What we did about stress, mental health and wellbeing wasn’t the whole story in that change, but it was certainly a very big part of that transformation.
I can tell you from a personal point of view that I’m very proud of William Simpsons and our work there. I’m proud of every member of staff, and we have a great management team and an outstanding leader in Zoe. And it’s great to be part of a board that had the courage and leadership to make difficult decisions to support structural and cultural change. I do feel we made a difference.
Thanks for listening.
Below is our Care Inspection report from last year. Much of this report concerns how we support wellbeing in the home. (Please note the Care Inspectorate in Scotland is the equivalent of the CQC in England.)
| inspectionreport-311506.pdf |
Below is a useful resource about promoting positive mental wellbeing for older people from Nice. Its main focus is on residents' wellbeing rather than staff wellbeing. Nonetheless useful and interesting. Nice have also recently updated guidance on promoting mental wellbeing at work.
| mental-wellbeing-in-care-homes.pdf |