Dementia Centred

By Professor June Andrews

June 4th, 2013

5 Rules to Change Dementia Care

When I took up post the areas of concern about people with dementia had not changed since I was a student nurse.  In the last century we were talking about improving dementia care.  We still are.

Nurses are aware of the needs for people with dementia.  Although I’ve worked with staff who seemed institutionalized and not wanting to change, it has usually been the result of working in systems which seemed designed to dehumanize them and the patient.  Although they knew what was needed, they didn’t know how to make it happen.

The DSDC provides amazing amounts of information about dementia, but increasingly we are asked by staff for skills in “how to make change happen.”  These are the basic rules which make change happen.

Rule one - Know your stuff

To make change happen it is important to be knowledgeable.  For example you could just say “You are not paying enough attention to dementia”. That is merely an opinion.  Better to be an expert who says, “Research shows that in the UK we spend more on dementia than cancer, heart disease and stroke put together?  In the light of that, do you focus enough on dementia issues?”   Make sure you are better informed than the person you are persuading.

Rule two - Know the system

You need to know who in the system has the power to make change happen.  For example, you might be having difficulties over meal times because the trolleys get whisked back to the kitchen too early.  Don’t spend any time complaining to the porter, because he is only carrying out his instructions.  Find out who does the planning of the logistics and negotiate with them.  You may discover that they rush your meal delivery because of delivery pressures from a completely different department, like the pharmacy.  It may be that negotiating with the chief pharmacist is the best move.  How could you have known that without knowing the system?   Find out “who’s who?” in your world.

Rule three - Be known

You have to be known for the right things, like being professional and well informed.  When you ask the decision maker for something, it’s better if you don’t have to establish your credentials.  Bring yourself to the attention of those in power by simple things like introducing yourself at the end of a meeting.  Say hello and be nice.  Senior people get moaned at all the time and you’ll be refreshing.

Rule four - Use high impact communication

The decision maker that you have to persuade is really, really busy.  They don’t have time to read a big long paper, so be concise.  They don’t have time to listen to a big story, so crunch your story down into twenty five seconds.  You may have difficulty in getting an appointment, so use every chance encounter.  Think.  What would you say if you were stuck in the lift with your chief executive for half a minute?  Apply the first three rules.  Be nice.  Be professional.  Make sure you introduce yourself (don’t assume they will remember who you are from the last time…they’re busy).  If you are “selling” them a new idea start with whatever is probably keeping them awake at night. 

For example, if your organization is short of cash, how effective would it be to ask the Chief Executive for money for extra staff?   She’s thinking “No!” before you stop talking.  Try saying to her “If I could show you a way of saving money, would you be interested?”    Of course she says “Hmmm. Maybe…”   And you say, “We could reduce adverse incidents that increase length of stay and therefore total costs by £300k per year, at the cost of two more staff nurses.”  They might not say yes at once, but at least you are talking and she is listening.

Rule five - Be lucky

The best luck is what you make yourself by being persistent and never giving up.  Good luck!

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