The matrix

THE PROBLEM

The Enhanced Care Homes Outcomes (ECHO) project integrated established care home support services with a new mental health ‘in reach’ service, aiming to enhance the quality of care and outcomes for people with dementia in Oxfordshire’s care homes.

As part of the ECHO programme, the diversity of skills, training or knowledge that staff required in their roles (AKA ‘core competencies’) had grown. This led to a review of the existing ‘competency framework’ and core competencies of care home staff, and how they were recorded and tracked.

A competency framework defines what knowledge, skills, and attributes people need within an organisation to perform their job effectively. Each individual role will have its own set of competencies needed.

It was apparent that the methods currently used to assess staff’s competence – that had worked successfully with the original team of nurses – needed to be revised and adapted for the new model of care that integrated both physical and mental approaches to assessment and treatment.

From the review, it was identified that staff knowledge and skills needed to be more clearly defined in both physical and mental health domains, and for the competency framework to be updated.

A new competency ‘matrix’ was developed, in partnership with care home staff.

The competency matrix took a more objective and accurate approach to measuring competence across physical and mental health domains of skills and knowledge. The matrix incorporated several key themes related to frail older people.

Specifically, this included undertaking comprehensive geriatric assessments, offering advice and management on specialist seating and posture management, undertaking mental health assessments and introducing therapeutic interventions.

The matrix was piloted on all new care home support service staff in the ECHO programme.

The project demonstrated that assessing competencies that identify both knowledge and skills in physical and mental health domains could be achieved, and that these can be simply applied by service managers and clinical mentors in a way which reflects the needs of the care home service.

The matrix is owned by the staff who helped develop it and has therefore had a positive impact on implementation, where such changes can often be met with resistance.

The new matrix has also increased clarity around performance expectations and established a clearer link between individual and organisational performance.

The competency training matrix has since been rolled out to all care home staff across our host trust, Oxford Health NHS Foundation Trust.

This work was shared in clinical services and with the learning and development department in our host NHS Trust and interest has been expressed in how the framework could be used as a basis for all staff working across all NHS services in the Trust, further broadening its impact.

This competency work has been proposed as an element of a study within a different service setting focusing on NHS and third sector service collaborations.