Staff and The "Did I do that?" Syndrome

Direct care staff makes up the cornerstone of the ICF/IDD (Intermediate Care Facility for individuals with intellectual disabilities)  world.  Every home needs competent, qualified, caring, and dedicated staff to work shifts from midnight to mid-day.   Since the ICF/IID program is required to provide 24-hour supervision, these critical workers have an opportunity to work directly with the ICF population.  Often the staff working becomes friends with people served, informal counselors, trusted confidants, and almost family.  Because of this close relationship, it often becomes easy to forget that the staff is just that...staff.  They are hired to work with the people we serve, and as such, there are certain expectations.   Unfortunately, expectations do not always equal positive, expected outcomes. 

In the 1980s, there was a Friday night comedy where one of the main characters was always making huge, although unharmful, mistakes that made the other cast members look bad.  Whenever that character would be confronted by his fellow cast members, usually with something like, "Steve" drawn out with the sound of frustration, Steve would respond, "Did I do that?"  His voice was squeaky, annoying, and the audience almost always looked for it in each episode.  The remark, "Did I do that," was funny. It became a household saying for a lot of kids when they got in trouble.  Sometimes, it seems that our staff in the ICF should be responding in the same voice, "Did I do that" when they do things less than expected.  The supervisors are usually left shaking their heads and wondering what staff was thinking when they acted.  You can hear the rise of the voice, "Did I do that," as all concerned end up amazed. 

Unfortunately, the "Did I do that" moments almost always occur during the annual survey.  The administration team receives the deficient practice list with words like, "DCS A took client 1 to the living room to clean his face," or "DCS B left the bathroom door open while assisting client 3."  Whatever the case may be, the supervisors have usually found themselves asking, "Why did you do that?"   The end result is a POC, monitoring, training, and staff being instructed to "never do that again." 

The fact remains though that many of the staff working are good...indeed many of them are great.  So, why do they make these mistakes that result in deficient practice, and the "Did I do that" syndrome?  There are actually several potential reasons:

1.  Staff was never trained on how a procedure needs to be done to be compliant with standards.
2.  Nobody monitored staff regularly to ensure issues or concerns were addressed.
3.  It may have been some time since the last training and staff may have forgotten.
4.  Someone else said, "This is how we do it," even though how they showed "it" was wrong.
5.  Staff may just not care.

If you read the above potential reasons, you will find a common factor in all of them.  No Supervision intervention is seen.  An old saying that a friend of mine used a lot is "People do what you inspect, not what you expect," and she is right. 

1. If the staff is never trained, whose fault is that?  Supervisors.
2. If nobody monitors the staff and offers correction, whose fault is that?  Supervisors.
3. If there are considerable gaps in training dates, whose fault is that?  Supervisors.
4. If another staff showed the new staff the wrong way, whose fault is that?  Supervisors.
5. Finally, if the staff does not care and they are working, whose fault is that?  Supervisors.

As you can see, unless your supervisor is involved with staff, when that staff takes a person served to the living room to brush his teeth, or wash his face, right in front of the state surveyor, then that supervisor has no place to complain to anyone.  The fact is, the supervisor failed in some way. 

Do you want to cut down on the "Did I do that" moments?  If you do, then get your supervisors involved.  Have them train, monitor, and train again regularly.  If they do this, your issues in this area will drop, or you will find out quickly that you have a staff that simply may not care.  If you have the staff that does not care, then maybe its time for that staff to find another area for work.