I am Kirsty Bateson the Project ECHO development lead and Knowledge Exchange Manager for Highland Hospice. I am an ex health and social care manager and a digital marketing practitioner (technology rather than slogans!), mother, community volunteer, wild swimmer and sometimes artist, when I'm in the mood.
I must have been in a really good mood in the run up to Christmas in 2022. The reason I say that is in December, on a Teams call, I met with our CEO Kenny Steele at Highland Hospice and Donna Bell, Director of Social Care and National Care Service Development from the Scottish Government. The reason was to propose developing a national centre for Echo across Scotland, re-galvanising some of our existing hubs, restructure our training and commission a new website.
ECHO is recognised within My Health-My Care- My Home, Healthcare Framework for adults living in care homes, as one of several tools for staff learning and development and allows staff to share expert knowledge in a supportive, online environment.
We would develop four areas for evaluation and the ECHO audience would be care home staff. No problem, said I. We have a well-established communication formula, said I. We are now experts at engagement and retention in ECHO after years of learning about what works , said I.
A partnership with the Scottish Government’s adult social care improvement team, who have responsibility for My Health My Care, My Home, began in January 2023. They may have worked out quickly:
- I write a lot and draw a lot of diagrams (why use five words when you can use a hundred?)
- I'm very digitally reliant (fun fact: I gave my desk phone to another department last year as Teams and Zoom have taken over)
The first area to establish was our own territory in Highland. We knew that would be tough because COVID had slowed our ability to continue to engage the Highland care home audience, albeit briefly during the height of the pandemic, and the world we knew before 2020 was no more. Gone was the luxury of planning intuitively with familiar communities of practice. In its place is a landscape of uncertainty, fatigue, and low resources. The needs of care home residents have increased in complexity in recent years. Practice has changed, some of it forced by COVID, and care home managers are fighting a losing battle in staff retention, with the lure of other sectors at a time when many will have to choose money over 'the love of the job'.
Three weeks into our digital communications campaign the air didn’t move at all. Where we enjoy numerous online registrations from clinical colleagues for just about everything we put out via e-mail, the 'in-box' was pretty silent. I was urged by the local NHS team to have telephone (ah yes- that thing I gave away!) discussions with care home managers and realised this was a sector, by default, immune to my carefully crafted e-mails and eye catching e-flyers. Most managers were washing their hands to come to the phone because they were helping with lunches and dinners and personal care.
“I sometimes get 100+ e-mails a day, the chances I can see yours, and revisit it, are slim. Just tell me what to tell the staff and I’ll speak to them, it helps us if we do it this way ”.
At the same time, because I possibly applied around that good mood time at Christmas , I took my chance to do a NES funded post graduate course on leadership in digital transformation for Scotland at the University of Edinburgh. The first reminder from that was the need to understand the non digital world of people and groups to create online transformation.
The next reminder was an often seen infographic called ‘above and below the waterline’. The infographic has been tweeted (or X’d??) several times by Helen Bevan and is a warning that transformation can falter if we don’t understand and embrace the hidden cultures of beliefs, myths, norms and relationships and value the positive contributions to change they represent. Her NHS Horizons blogs talk about it as ‘new power’, informal and relational, as opposed to ‘old power’ which is established and process driven. (Bevan, 2019)
The culture of care homes today, in my own opinion, is ‘new power’. Relational and willing. They may not even consider power to be the right word. But it was evident when I had to call every home manager in Highland individually and apologetically to ask them to consider ECHO, while they’ve got the phone in one hand and trying to hold on to staff, provide the best care they can, be safe and meet standards with the other. There was no hostility from anyone. Only support and good advice and a real willingness to support ECHO. But I was very aware I was the learner and ‘old power’. Perhaps even ‘….beautifully equipped for a world that no longer exists.’[If you know the quote from Eric Hoffer.]
We got our ECHO in Highland off the ground with almost 40 people in attendance on the launch night and the collaboration between our lead facilitator and care home staff has led to new plans to take forward education in and out with ECHO . Now we’ve passed the baton to our colleagues in Ayrshire. Their approach has been evolved a step further too. They took their ask to care homes via telephone and conferences, they developed a much wider steering group and the road has been smoother leaving the ECHO Centre team to move into the background while each hub takes the reigns in their own locale. We are gathering new information all the time to build relationships with the hardest to reach care staff. Changing our ideas about pitch, presentation, tone and working to earn our place. We are also looking ahead to welcome our next ECHO hubs in Dumfries and Galloway and the Borders into this project in the coming weeks.
ECHO is designed to create safe spaces to talk and exchange knowledge about the challenges and complexities of patient care. A perfect ground for ‘new and old power’ to collaborate and transform. Then we all become ‘new power’ because our facilitators and presenters and attendees (care staff, nurses, GPs, AHPs and specialists) are listening and talking 'below the water line' all the time in an all teach all learn forum, in every session and on every subject.
Remind me to make plans after Christmas though! And this is not AI generated!