Outdoor space Care culture map tool

Central to Step Change Design’s support for care settings is an understanding of the care culture in operation. This then guides the level and type of design support that may be required. To help make this process more tangible, they produced a poster-sized care culture map tool to identify and plot the current care culture position along a spectrum of care practices from task-oriented care towards the bottom of the map all the way up to relationship-centred care and beyond. This tool was designed to make

care culture more visual and easier to grasp. It aims to help the care setting to articulate the inevitable advances and retreats that a culture change journey entails, to map the journey ahead

values, routines and attitudes towards the outside space in the overall care culture of the setting that will encourage staff and residents to engage with these spaces more actively. Culture is another way of saying ‘the

way we do things here’. Although culture is subtle - it works at the level of our subconsciousness - it manifests in all the things we do and do not do. It is the things we value, or prioritise, and those that we do not. Culture is made up of many elements:

routines and habits, values and priorities, beliefs and attitudes, processes and policies, past historical experiences and more recent ones too. So, while care culture might be hard to grasp for those who are in it, for those who are not part of that culture, the actions and behaviour of those working and living at the setting can easily reveal this subtle phenomenon at play. At Step Change Design, an important

part of our approach is to read a setting’s care culture by simply walking around the whole site, both indoors and outdoors, observing how residents and staff live and work there and relate to the outdoors. We do this, for example, by trying the

doors, looking at routes to the outside space, signage and navigational cues and views from the windows, checking actual practice against the policies and procedures, and observing what might be provided to aid garden visits and speaking with a range of people across the setting.


clearly and to ensure that everyone is on board. This in turn enables any necessary design support to more closely match the current capabilities of a care setting, to represent good value for money and to be

As outsiders, we are able to notice

contradictions or routines that do not make sense, for example, a framed open door policy on the wall that does not translate into doors which are routinely unlocked and unrestricted access outside. A new garden design may be required,

but it is important to understand the reasons why the current one was underused or neglected and address any organisational practices and attitude changes before undertaking potentially expensive redevelopments.

The use of outdoor space during Covid What a care setting does outdoors, and how often and how easily residents and staff engage with the outside space, reveals a lot about how care is delivered across the whole setting. For us, this is a clear indicator of not just the current care culture but also how advanced its wider care practices might be too. This is because we discovered in

our research a correlation between more advanced care culture practices – for example, person-centred and relationship-centred care - and higher engagement levels with the outside space regardless of how pretty, tidy or well- designed it might be. Contrastingly, those care settings

practising a more task-oriented care approach in our research, tended to be more fearful about health and

more responsive to the care setting’s journey towards greater person- centred care and engagement outside. research/the-map/

safety issues and to deploy greater conditionality around accessing the outside space. This insight helped us identify a spectrum

of care cultures across our study and a corresponding relationship between activation levels of the outside space. For us, then, the garden becomes a mirror of the care setting’s overall care culture With this in mind, we could see that the pandemic has resulted in an abnormally rapid and enforced culture change process within care settings, for both staff and residents. Care settings - and every other organisation to a greater or lesser degree - have had to change very quickly how they deliver their care practices. It is probably not an exaggeration to

say that no other event has probably had the scale, severity and speed to alter almost completely the way a care setting does things. There was no choice but to change many practices, processes and procedures and embed new habits, routines and priorities to the way they delivered care. The resulting changes to care practice are understandably profound and possibly still settling in for many care settings. We can predict from past experience of

more planned, deliberate culture change journeys that there would be one of two possible outcomes for care settings that had previously struggled to use their gardens actively. For some of these care settings, the • June 2021

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