Title of the Change Project Student ID. MSc in Healthcare Management, Institute of Leadership, Royal College of Surgeons in Ireland Header line 1 Header line 2 Header line 3 “Introducing Reflective Practice Groups for Frontline Staff in Services for Adults with Disabilities” Corinne Pearson Abstract This project focussed on the experiences of the Author through the process of introducing facilitated reflective practice sessions for front line staff working within a challenging behaviour unit. Staff supporting individuals who display challenging behaviour may be at risk of increased work related stress (Jennings, 2004) and can inadvertently interact in ways that can contribute to the presentation of challenging behaviour (Mitchell & Hastings, 2001; Noone, 2013; Phillips & Rose, 2010). Yet frontline staff working with individuals living in residential services are the key to promoting and facilitating participation with a focus on rights and equality as highlighted throughout the Disability Standards (Health Information and Quality Authority, 2013) following the recent introduction of regulation within this sector (Health Act, 2013). To support the Author in their role of leading the change initiative, the HSE model for change (HSE, 2008) was used as a framework to guide the process and the outcome of the project was evaluated through the identified SMART objectives, achieving each objective within the range of 60 – 75%. Alongside the identified objectives the Author identifies other potential benefits from introducing the reflective groups. The groups were shown to provide a positive impact for staff attending as they were able to have a safe space to discuss the challenges they faced and a forum to share ideas. Through a reflective process, the author provides a critical review of the project and also highlights recommendations for future progression of the project and ideas for actions that may have improved the outcome for the original project.

Introduction & Background Organisational Impact “Introducing Reflective Practice Groups for Frontline Staff in Services for Adults with Disabilities” Corinne Pearson Introduction & Background Figure 1: Job Demands-Resources Model 4 Evaluation Working with Challenging Behaviour can lead to 1, 2 : High Emotional Burden for Staff High Staff Turnover/Sickness Difficulties with Recruitment Reduced satisfaction with services Increased service costs through loss of corporate knowledge & increased training costs Supervision, training and other support mechanisms vital to promote continuity of staff as well as provide appropriate governance of frontline staff 3 Frontline staff are vital to promote rights and participation for residents living in Disability Services 3 Support will help motivation & lead to improved outcomes for organisation 4 (see figure 1) The HSE model (see figure 2) has been developed to support change within the Irish Health care System and was applied within this project. To support the project a stakeholder and force field analysis was completed. Key drivers for/against change: National Standards/Regulation Expert Service Review Staff survey Lack of tangible results History of service provision Service Culture/Ethos Managed through: Communication with focus on key stakeholders Explicit identification & brainstorming management of barriers 75% of planned reflective groups took place 3 units had 75% of staff on shift attend the allocated groups 1 unit had 75% of staff attend the allocated group for 75% of the groups A monthly meeting with the PIC & Clinical Director took place 60% of the time Methodology Organisational Impact Figure 2: HSE Change Model 5 Additional formal structure for support/supervision/ communication Frontline Staff report benefit of groups and being “listened to” Opportunity to build/challenge reasoning for behaviour/interventions Frontline staff increased involvement in creating opportunities for residents Developments needed: Upskilling of Nurse Managers to facilitate groups Senior staff reflective group required Aims & Objectives Aim: To promote reflective practice skills within all frontline staff working within an intensive challenging behaviour unit by having reflective groups for all units. Objectives: Each unit within an intensive challenging behaviour unit will have access to a scheduled reflective group session at least once a month by 30th April 2015 Each group will be attended by 75% of the staff on shift by 30th April 2015. A feedback system will be created to provide feedback to the senior management team of any relevant, identified and agreed issues that are important for frontline staff by 30th April 2015. Conclusion Leading change means managing complex systems & a leader must Monitor & review Adapt plan to changing environments Communicate relentlessly References 1. Hastings, R. P. (2002). Do Challenging Behaviors Affect Staff Psychological Well-Being? Issues of Causality and Mechanism. American Journal on Mental Retardation, 107(6), 455–467. 2. Howard, R., Rose, J., & Levenson, V. (2009). The psychological impact of violence on staff working with adults with intellectual disabilities. Journal of Applied Research in Intellectual Disabilities, 22, 538–548. 3. Health Information and Quality Authority. (2013). National Standards for Residential Services for Children and Adults with Disabilities 4. Demerouti, E., Bakker, A. B., Nachreiner, F., & Schaufeli, W. B. (2001). The Job Demands-Resources Model of Burnout. Journal of Applied Psychology, 86(3), 499–512. 5. HSE (2008) Improving Our Services: A User’s Guide to Managing Change in the Health Service Executive.