Policies and Procedures – who are they for? What are they for?

Last week I posted these two questions here on Linked In and was taken aback by the level and energy of the debate around this – with nearly 12k views and over 115 comments.

John Kennedy summed up the challenge:

“Nobody really knows why or has thought it through. It just gets bigger and bigger. It’s a sort of mass proceduralism.”

He pointed to research from JRF that says,

“The balance between prevention of poor care and promotion of good care is out of kilter. Fuelled by fear and insecurity, care homes spend too much time attempting to cover themselves against blame or litigation.”

Are policies and procedures there to protect the organisation from litigation or blame?  Or are they to guide managers and staff in how to deliver what the law and the organisation expect? Or both?

1)   Policies and procedures exist to protect the organisation from litigation

A common practice is for new recruits to be given over 150 pages of policies and procedures in induction, and asked to sign a form that says that they have read them. This would suggest that the purpose is to protect the organisation from litigation, from a staff member saying that they did not know that something was policy. Policies are usually written defensively in legal sounding language.

Alison Waters put this succinctly: ‘Often times these documents serve the purpose of the ivory tower crew and insurance purposes even if you can understand the Dickensian tone most adopt.”

Tanya Clover puts it another way: ‘Multiple policies in legalese rarely guide the connection between the person receiving support and the person giving it.”

2)   Policies and procedures exist to guide managers and staff

If you were designing an organisation and wanted to answer the question ‘How can we make sure our staff know how to deliver our vision and purpose?” it is unlikely that you would decide to write 150 pages in formal language for staff to read and sign in their induction.

Several people gave examples of how they use handbooks, summaries and strategies to support staff to understand and use the relevant content from policies and procedures.

It seems to me that the primary reason is to safeguard the organisation, and people then translate the policies and procedures into ‘user friendly versions’, handbooks and use other ways to communicate the content.

Do we need policies and procedures?

This feels like a heretical question, however, not all organisations use lengthy policies and procedures this way, and have other ways to keep the organisation safe and ensure that staff are clear about what is expected of them.

For example, Netflix’s ‘policy’ on expenses is five words long ‘Act in Netflix’s best interests’.

In Ricardo Semler’s organisation, Semco, there are no rules or policy statements beyond a pictorial ‘survival guide’.

Jackie Le Fevre has some ideas about how other organisations can achieve this.

“If we had recruited individuals aligned to the values and purpose of the venture, and then enabled them to develop an effective shared sense of what is/is not like “us” – then the group would self-regulate seeking those solutions that honoured the values and purpose. That’s why in lots of start ups there are virtually no written rules because everyone not only ‘gets it’ but also supports it too.”

However, even if could be more like Netflix or Semco or start-ups, Tracey Bush brings us to the reality that:

‘policies are required not only by CQC but by CHC, Local Authorities, NHS, CCG’s Environmental Health, Health and Safety Executive to name but a few.”

Some people assume that the law requires us to have policies and procedures in the form that they are in. The Health and Care Act 2008 does not state that these are required, but CQC expect them as a way to demonstrate compliance with the law and commissioners and others have followed suit.

Is there another way? I think there are a couple of questions worth exploring and taking forward.

1)   If we have to have policies and procedures, can we write them so that people can understand them and use them?

I am not sure who Sparkles is, but I love the visual summary of challenges produced by Sonia Nosheen, and summarised here:

 ‘If Sparkles wrote policies’

·     They would not be so long or so many of them

·     They would not be used as weapon against staff

·     All tested on Sparkle’s Grandma to make sure everyone understood them

·     They would not be designed to be forgotton

·     They would not be written with robots in mind

·     They would grow and guide people not control and confuse

·     They would cut to the chase of what really matters

·     Instead of saying ‘policy not followed’ it would be ‘policy hard to follow’.

·     Policies would protect staff, users and people as well as the organisation

·     They would be right first time so that random bits were n’t continuously added

·     They would have a bit of colour in them

·     They would connect with hearts, values and emotions so people would be more likely to follow them

One of the recommendations from the JRF research mentioned earlier was “Geographical alignment – improving the consistency of approaches to inspection taken by commissioners and regulators in a local area”

We are working with two Local Authorities in Greater Manchester to do this, Wigan and Tameside. In both areas, we worked with all the providers and commissioners to explore what was working and not working in relation to delivering personalised outcomes within home care. One of the outcomes is to co-develop a user-friendly, best practice set of policies and procedures, in partnership with providers, commissioners and local CQC, therefore getting geographical alignment.

Is it possible to do that nationally as well?

We would like to see if this is possible. We could create a Google doc or Wiki and share the user-friendly policies (that could pass the Sparkles test) for anyone to comment on, help us improve but most importantly download and use for free.

We commit to having them available from the beginning of November for people to comment and use. If you would like to help set up a Wiki, please let me know.

2)   Could we produce a handbook that enabled people to put the policies into practice?

One of the ways that people said they were supporting staff to put policies into practice was to create a handbook that clearly described what people needed to do, and referred back to the policies and procedures.

I developed a handbook for colleagues in Dumfries and Galloway five years ago, taking the Local Authorities policies and procedures (nearly 200 pages of them) and turning this into a short booklet that described for each what people needed to know, what they needed to do, and what they needed to avoid.

My colleague Emily is updating this for Tameside, and again, we would like to share this, so that people can help us improve it through commenting, and anyone can freely download it and adapt it for their organisation.

3)   Could we produce a handbook that both kept the organisation safe and guided managers and staff, instead of two separate documents?

I know that if I had produced one document that combined the content of policies and procedures, and was a handbook as well, at my CQC registration interview last week that they would not have accepted it. They wanted each policy to be separately written. I had combined the Whistleblowing policy with the Duty of Candour policy, and they asked me to have these as separate policies.

I talked to Jo Willmott, Assistant Director in Wigan, whether such a document would be acceptable to the Local Authority, and she said it would.I am going to try and create a single document, and see if this can work in Wellbeing Teams.

Finally, if we go back to the original question, Who are they for? What are they for? What about people and their families and the public?

Leonie Seaborne made this point saying that policies and procedures public documents ‘their purpose and application benefits the organisation, employer/employee, stakeholders, clients AND the general public.’

Regulation 20, the Duty of Candour, requires organisations to be transparent and open. This specifically refers to incidents, but how can we apply this principle to our thinking about policies and procedures? I think we need a clear thread between how we deliver the regulations and our purpose, in policies, handbooks, the information we provide people who use our service and what we say on our website.

Finally, Amanda Dewes gives a health warning saying ‘Policies are in place for very good reasons, having attended several serious case reviews, it is not something to be blasé about, they are there not for people to think about, they are there for people to follow and demonstrate competence within their roles…poor practice is rife sadly so policies are a must and should be taken seriously.”

I think that there are better ways to enable people to know what is expected of them in their role, that would be robust enough to be used in serious care reviews. There is a whole different discussion about how we support people to continue to put this into practice. I am keen (and excited!) to see if collectively, as a community of people who want to improve care and support, and find better ways to support staff, we can co-create policies that work for people and handbooks that are clear and useful.

Please let me know what you think.

Thank you to everyone who commented on my post.

Tracey Viljoen, Karen Amos, Sonia Nosheen, Amanda Dewes, Karin Lockhart, Samuel Barrington, Jane Pightling, Jackie le Fevre, Antony Thorn, Cristie Madigan, Leonie Seaborne, Julie Harding, John Quinn, Alison Waters, Hazel Edwards, Jez Ashdown, Freddie Brockwell, Clare Sherlicker, Katherine Wynne, Jonathan Cunningham, Stuart Davies, Jacqueline Smith, Taruna Chauhan, Heidi De Wolf, Nikki Henderson, Peter Loose, Sue Thomas, Yvonne Stewart, Shelley Perry, Ben O'Toole, Derek O'Hagan, Amanda Hazelwood, Bernie Mayall, Angela Duce, Beth Scott, Joanne Warren, Charlie Jones, Koray Ismail, Shelley Watson, Ciaran Wyer, Jeanette Thompson, Samantha Leonard and John Kennedy