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Overcoming the barriers to creative engagement


We have found that the more creatively engaged residential aged care staff become, the benefits flow on to the bottom line with improved organisational business performance, writes Dr Maggie Haertsch.

When people ask me, “what is meant by creative engagement” I tell them the story of Mary. With advancing dementia, her previous cheerful personality had withdrawn to the level of not speaking at all. When it was discovered that Mary was a school teacher and had loved using puppets, that’s what was used for creative engagement. By communicating through one of her old stick puppets, Mary was transfixed with a smile and began speaking back. “How lovely,” she exclaimed. This success continued to the delight of both Mary and facility staff.

How is it that such an approach can powerfully improve clinical outcomes for certain older people and trigger organisational culture change so that sick leave is reduced, staff become happier and more empowered in their role?

What we have found in aged care facilities is that the more creatively engaged the care staff become, the benefits flow on to the bottom line with improved organisational business performance. Blue Care’s Better Practice Innovation Award for Play Up illustrates the point as do the results of the SMILE Study, a world-first Australian randomised control trial of creative engagement, referred by the researchers as humour therapy delivered by specially trained comedic improvisation actors.

It may sound simple, yet systemic barriers in aged care services can make creative engagement difficult to implement. The set routines, the schedule of tasks and the patterns of every day, evening and night are designed for staff management and system control. These structures may fail to really consider the individual needs and preferences of residents in aged care.

I was a speaking with a chef in such a facility who wanted to see more of the elders cook, serve food and pour their own drink at a BBQ. He was bewildered to see that these same behaviours of being waited on and being fed were also happening in the outside dining space. Both the residents and the staff seemed to be conditioned to interact this way. It is not unusual to see people clocking in for their meals and waiting for their plate of food to land on their table, three times a day. This is a pattern of life that needs stimulation.

Families can also have other similar reinforcing patterns such as a belief that good care is a shower every morning. All are implicit reinforcers that impede on meeting the personal preferences and choices of the individual.

Some excellent models of care have successfully disrupted these implicit behaviours of routine. Take a look at the dedicated staffing model developed in Arcare and initiatives at UnitingCare Ageing’s Starrett Lodge.

Steve Lundin, the FISH! Philosopher. Photo: Nicola Ward

Steve Lundin, the FISH! Philosopher. Photo: Nicola Ward

When Steve Lundin, the FISH Philosopher, put a call out to any aged care provider to use his help to create more meaning and purpose for both staff and elders, Australia’s Blue Care responded.

Steve Lundin’s mission is to create a better way of engaging in life and especially at work. When visiting Seattle’s Pike Street Fish Market 15 years ago, he was astounded to discover how they had turned a monotonous, boring, laborious job into a place of fun and full of positive energy. The fish market has since transformed into a lucrative and world-famous fish retailer and tourist attraction. FISH! is based on the four key workplace attributes Steve observed at the fish market, and he and his colleagues have since toured the globe delivering talks and workshops spreading this thinking in banks, hospitals and corporations.

Lundin’s influence is extraordinary and during his last visit to Australia he presented at the Arts Health Institute’s Creative Ideas in Ageing Convention at Luna Park. In his rousing address he described the Play Up Valets as “little fish”, modelling the four key attributes of the FISH! Philosophy. These are: choosing your attitude; being there (providing 100% focus to the person, your client); play; and making someone’s day.

The valet’s work is the embodiment of the SMILE study intervention. While it is not yet world famous, the evidence backing its impact implies that it should be. Through meaningful play, the valets improve residents’ happiness and wellbeing as well as staff morale, by educating them in the art of creative engagement. This is proving highly beneficial even when the model of care remains task focused and entrenched in institutional norms and behaviours.

So what are the conditions needed to creatively engage with someone? Steve describes that all four attributes are needed in equal measure to have a transformational effect. He says the hardest to master is that of being playful. Play sparks the imagination, it promotes teamwork and diffuses difficult situations. It also fosters creativity. We know that by being playful powerful emotional connections can be invoked. For people living with dementia playfulness, when put to work, changes their mood and increases their moments of connection with another human being.

To creatively engage, start with a “snapshot” of one aspect of a person’s life. Discover something you did not know before and use that hook to connect with them. You are creatively engaging by simply thinking outside your own routine and by being mindfully present with the person as you do so. Such a change of attitude will no doubt give immediate results and have a long lasting effect on all around you.

It starts with yourself, committing to making that difference is the first step.

Dr Maggie Haertsch is executive director and CEO of the Arts Health Institute, a non-profit organisation working to improve lives through the integration of the arts into all aspects of health and age care environments. 

Australian Ageing Agenda is media partner of the AHI.



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4 Responses to Overcoming the barriers to creative engagement

  1. Brent71 February 11, 2015 at 2:03 pm #

    You call it ‘creative engagement’ I call it common sense and emphathy. Yet another
    example of need to label what was previously standard human reaction as something ‘special’. Absolutely ridiculous. Previously it was ‘person centred care’ but in reality no one actually treated older people with dementia as though they were people. Anyone can come up with the latest trendy catch phrase..getting people to actually do it is an entirely different matter. Why dont we start with ensuring that basic human rights are not violated before moving to ‘creative engagement’.

  2. niggle February 12, 2015 at 11:19 am #

    That’s the point, Brent71. Whatever it’s called (’emphathy’ or not), more of it is needed. Much more. The systemic and ‘institutionalised’ barriers to creative human engagement in residential care – notably routines and schedules – have to be managed in such a way that the needs of ALL individuals (residents, staff and managers) are supported, not compromised. That’s not easy, and so far the systems, not the individuals, are winning. Creativity, fun, spontaneity and yes – empathy .. all need to be championed, and attitude change is fundamental to that. Bring it on!

  3. KB1 February 12, 2015 at 1:01 pm #

    Well said niggle. Empathy can only be created when we understand the other person and what they are going through. People living with dementia may lose their communication skills and connection to the outside world so to reconnect with them requires lateral or creative thinking. This is engaging creatively and at its heart is empathy and respect. Sounds like we believe in the same things Brent71.

  4. Allforfun February 12, 2015 at 1:19 pm #

    That is exactly it! Common sense and empathy used to create special connections between people who would otherwise be withdrawn and isolated. Taking time to explore a person’s past to find out what is meaningful for them, them developing an approach that is respectful of their personhood. This is exactly the type of thing we need to appreciate if we are to care for people to ensure both their basic human rights are met and their lives continue to be meaningful.

    In response to the above comment it is important to think about all aspects of human rights. Human rights respect many aspects fundamental to our living meaningful lives. “Everyone has the right freely to participate in the cultural life of the community, to enjoy the arts and to share in scientific advancement and its benefits.” Arts and creative approaches to care seek to address the basic human need for meaningful engagement with other humans. Whatever the name.

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