Empower local leadership in older person friendly care
There was a recognised need for multi-level leadership to provide strategic and practical support for older person friendly practices. However, there was a lack of confidence in executive leadership and accountability, and challenges with governance structures which support existing organisational silos.
“I think it’s in the back of everyone’s mind but no-one’s had the ability, if you like, to move it forward.” P6, nurse, manager “We’re going to have to have a new way of thinking about how we structure our governance. Even though I might have a service line to look after, my remit for the older person might have to be across the organisation and if that’s the case then the other services have to be prepared for me to paddle in their place a little bit.” P2, nurse, manager
As a result, change and advocacy were driven predominantly by passionate informal leaders, limited by time constraints of their ‘real job’ and their individual capacity to galvanise action. Poor role recognition and slow progress often led to frustration, but establishing alliances across traditional discipline and department boundaries helped gain momentum. There was also strong reliance on local champions, particularly nurse unit managers. They provided local leadership through motivating staff, setting expectations, coaching and modelling, but required continuing support.
“Unfortunately he’s a one-man band… This is a huge organisation and as enthusiastic as one person is, there are still real limits around how quickly you can start.” P12, nurse, academic “I would go to geriatric things and come back all keen and try to get basic age friendly principles into place, basic signage, and I had no traction.” P20, nurse, clinician