CAROLINE BARTLE discusses a knowledge management strategy that helps leaders in dementia care become enablers, rather than directors.

Over the last year a group of people and organisations have set about developing the vision for dementia care services. This is the work of the Dementia Cooperative tasked with setting the agenda for change and scoping tasks needed to achieve this. There are six main actions groups which include Network action group, Whanau Carers, Research, Dementia Care Pathways, Advocacy and Workforce Development. I have been privy to being involved in this group, and can attest to the excellent work that has been achieved to date, the legacy of which will shape services. However, as we look to the future we need to explore how this vision will be transitioned into action through leadership. In this article I explore what skills are required to lead and champion change in dementia care services.

Alongside the work of the Dementia Cooperative, Careerforce have begun a qualification review. It is hoped that within this some consideration is given to developing our leaders to be courageous, skilled and visionary. However, education is only a small part of what makes a good leader in dementia care as whilst knowledge of best practice is critical, knowledge of how to develop and inspire others and knowledge of how to evolve services within a changing market are all essential criteria.

Leadership in dementia care requires passion and vision. Vision to understand how services are now and what is needed to get to where we want to be. A leader needs to have a good understanding of the policy context as well as the evidence base. Leaders need to understand the barriers to improvement and be willing to work creatively around these. Education often is the catalyst as the way we think affects how we feel which affects the way we act.

A leader needs to understand the concept of ‘excess disability’; this is about understanding how behaviours and other symptoms are created by living in a poor environment. All too often these symptoms are wrongly attributed to the dementia and therefore are not viewed as being something that can be worked with, minimised or eliminated. Lack of this foresight ultimately leaves people unnecessarily disabled. A poor environment relates to both the social and the physical environment.

On a simple level this is a about sensory skills and cognition, and how these are used to interpret the environment. It is also about how a positive social environment can strengthen self esteem, and ultimately positively impact on coping skills and capabilities. Good leaders should be able to support their staff to understand the impact of these and to create an environment which is conducive to enablement. So many people with dementia have told me over the years, “empower us, don’t limit us”. Where we operate within the social model of care all of these skills are available to us, and they are powerful where applied appropriately. However, working within a model of psycho-social approaches requires an understanding of the cause and effect of our working practices.

A leader needs to see his or herself as a leader and not a ‘manager’; there is a subtle but essential difference in this approach. A leader should see themselves as enabler rather than director. A leader needs to take a truly person-centred approach to their staff team; understanding strengths within the team, delegating responsibilities and encouraging personal reflection in others.

All of these skills require a strong knowledge management strategy, and over many years working with different organisations to develop their capacity to become better services, I have created a knowledge management strategy in dementia care PHASE ONE. This framework provides leaders with the tools required to champion change in their services.

Policy – This is about understanding national policy and how this impacts on the shape of services. For example, Counties Manukau District Health Board has developed their dementia pathway and the national

New Zealand dementia care pathway, which is currently in draft format, is due any day. Understanding this is critical to how you operate within a fluid environment and in ensuring skilled support is accessible to your client group.

Human Resources – This is about adopting a culture of innovation within your services, where mistakes are explored rather than reprimanded. It is about recreating job descriptions so that they capture more of a person centred approach rather than a task based approach, for example detailing how to meet important psychological needs alongside basic care. Having good supervision systems in place is the cornerstone of risk management, safeguarding from abuse and serves well as a vehicle for dealing with the challenges faced with working with this client group. Skilled leaders need to be able to guide reflection appropriately to get support staff to examine their attitudes and actions.

Assets – This is about defining the knowledge in your organisation as an asset of value. In many other sectors there is a greater understanding that we live in a knowledge economy, not an industrial one. Knowledge of processes and practices creates profit. Work needs to be done within organisations to catalogue these intangible assests, and be able to determine the return on investment for educational projects.

Services – This is about knowledge in services. In this context it is about understanding psycho-social approaches, working in a therapeutic, almost rehabilitative way. Owning this and promoting this as part of your service. Understanding what defines your service from others in terms of its outcomes for people who have dementia. It’s about valuable ‘differentiation’ within a competitive environment.

Experience – This is about understanding the experience of dementia, or rather customer knowledge. Being able to put in systems to capture this and use this information in the development of services. There are many forms of social media now available to use where we can learn about the experience of dementia, such as the inspirational Kate Swaffer.

Organisational memory – This helps to ensure that knowledge is not lost as people move on. Knowledge for example of how to deal with ‘emotional distress’ or specific approaches that work well with individuals. For most organisations this needs to be captured in the service plan or team meetings, however there are now available many more innovative mechanisms to achieve this.

Networks – This is about knowledge in networks or relationships, having mechanisms to create knowledge across boundaries. A report carried out by the dementia cooperative makes very interesting reading as it talks about organisations’ capacity to access an evidence base, analyse this and synthesise new knowledge. Making links and using information external to the organisation is critical.

Embedding operational excellence – This is about the procedures that operate to capture data and how local policies can hinder or support outcomes. For example some organisations have limiting policies on risk management or how and when to share data, all of this impacts on operational efficiency. In addition, the role that audits play in this process needs to be explored.

A leader needs to be committed to change, as nothing stays still.

For more information on leadership in dementia care courses delivered by Caroline Bartle, contact Leigh Kelly on +64 9 834 4825, or email info@careadvisoryservices.co.nz. These courses will be running in Dunedin and Auckland in June and July 2013.

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