A pan of porridge: learning and developing to enhance choice

At James Page House, we always thought that our practices weren’t ‘institutionalised’, but through conversations with the other care home teams at the first Teaching Care Homes workshop, it soon became clear that although we were providing good physical care for residents, this care was often based on routine and tradition, not so much on choice. We realised that every morning ‘the porridge pan’ would come out, and let’s be completely honest, around 9 out of 10 residents were given porridge without asking because we had assumed they liked it. This was quite an emotional time. We experienced a feeling of failure as we realised that we had forgotten to pay attention to the smaller details; details that are so important to the dignity of and respect for residents.

However, we recognised that this was an opportunity to facilitate change, and so there was lots to talk about on the train home, realising that we needed to work with the staff to get them on board. And so we held a staff meeting. Our cook made 5 bowls of porridge at our request and we started the meeting by asking who didn’t like porridge. Three members of staff raised their hands and so they were given the porridge to eat. When asked to describe their experience, each individual expressed they now had an even greater dislike of the creamy warm breakfast.

Everyone agreed that we hadn’t been offering choice and there was an interested silence when we announced that breakfast would now be on the basis of residents being able to have:

• What they want
• When they want
• How much they want

Very importantly, this meant, no more porridge pan!!

But the changes went beyond breakfast time. As staff listened, they became more enthusiastic and suggestions were made and discussed by the whole team. It gave them the opportunity to stop and reflect on how things had been and how we could move forward. They agreed that staff would no longer wait at the hatch at 12.30pm and 5pm, ready to serve meals. Instead, although the meals were prepared, residents would now be in charge of when they wanted to eat their dinner and tea. If there was nothing on the menu that they fancied, then the cook offered to provide a choice of toasties, omelettes etc.

The impact this has had on the residents and their families has been amazing. One lady told me that she loves Crunchie Nut cornflakes, but didn’t know she could ask for them. Rest assured, we now have plenty in stock for her. When we discussed this with staff, some said that they felt that they had let her down. But now, it is so refreshing coming in to work and seeing and hearing staff really listening to residents, enabling them to have choice. Porridge is still available, but it is a choice, not the main focus of the mornings.

Whilst the initial recognition felt uncomfortable, we now appreciate the opportunities for learning and development that meeting others from outside our service has stimulated. It has given us the chance to ‘step back’ from the everyday routines that become so familiar that we no longer see them, to challenge our practices from the perspective of the residents. With an open mind and support for each other, we can move beyond seeing the ‘porridge’ as doing something wrong, to learning and recognising opportunities for change or improvements. It has been great to see the team embrace this as they are now starting to ask questions about other aspects of care and to initiate other improvements.