"Our transformation as a service required time, effort, and commitment."

"We had a few particularly critical years, between 2017 and 2018, because there was a very significant widespread discontent. Those were years, for example, with high rates of use of mechanical restraints. At that time, we realized that we were facing a failure in the effectiveness of other alternatives for reducing behaviors and situations that put people's lives at risk."

With the support of external experts, we undertook an in-depth analysis of our organization, the intervention approaches we were using, and the possible alternatives to explore. The result of this analysis was not positive: we were serving unhappy people with frustrated and overwhelmed professional teams, who experienced their work with a constant sense of insecurity. We found that we were still operating under institutionalization models typical of the 1970s, which highlighted the urgent need for a paradigm shift to guarantee a more dignified life for the people we served. This challenge became a firm commitment undertaken at all levels, from management to the professional teams.

"Exactly, and, although it may sound strange, this was the best thing that could have happened to us. We thought things were going to be very bad, but it was quite the opposite. The situation forced us to change our care model. One of the measures we implemented was grouping people into small functional units, based on their affinities. We also managed to reduce the use of mechanical restraints by more than 75%, among other improvements. It was a very positive boost because we all saw the value of continuing to promote a different model than the one we had."

Overcoming resistance to the rights-based care model

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"The first step was to train ourselves to promote a quality of life model focused on the positive. This in itself is a challenge because we had spent years working with a different approach, following traditional behavioral models centered on behavior modification and restrictions associated with negative behaviors."

It was therefore a matter of changing the perspective and the mindset, of adopting a different approach: a model that promoted prevention, the analysis of behavior and its environment, the search for understanding the person and the functionality of the act, and the management of positive alternatives aimed at self-control and self-awareness.

Put that way, it seems like a simple change, but in practice it meant a profound transformation. Modifying a deeply rooted culture is not easy, and our transformation required time, effort, and commitment.

“We’ve been talking for some time now, in general, about working with person-centered models, but I think it’s sometimes difficult to implement it 100% because challenges and difficulties arise at different levels. For me, the real challenge was driving profound change, not only among the professional teams, but also among the people we serve, who were used to a reactive rather than a preventative approach. So it’s about a shared change and learning process at all levels . Another frequent resistance was inertia. When the argument arises that ‘this has always been done this way, why should it change?’ These are natural human reactions, but the results and the evidence have been key to breaking down those barriers.”

Natalia Kazah Soneyra

Psychologist. Specialized inpatient unit for intellectual disability (UHEDI)

Parc Sanitari Sant Joan de Déu

"When you train in QualityRights, you start to question many of your practices."

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“We currently provide residential care for 90 people and day care for 10. I would especially highlight the positive impact on the well-being of the people we serve and their families. They are now people who make decisions, enjoy life, have control over their lives, advocate for themselves, propose solutions, evaluate… They have spaces for real participation, and this has been a radical change, a change from which there is no turning back. We have improved in quality of life scores and also in satisfaction surveys, where we have high rates, reaching 97% this past year.”

Regarding the professional teams, what I value most is the change in how we see things, how we approach our daily work. Being able to feel that this isn't just a workplace, but the home of the people who live here, and that we are their support network.

I believe we've managed to balance the relationship between the professional teams and the people we serve, leaving behind the traditional view where the former made all the decisions, while the people we serve were "patients" who obeyed and had no say in their lives. We've moved beyond the idea that knowledge and decision-making power belong exclusively to the professional teams, and that the people we serve are merely passive recipients, forced to accept and wait. Now they can choose who they want to live with, who they want to be their direct care providers, what activities they want to participate in, and so on. This shift in perspective is undoubtedly the most transformative we can experience. Furthermore, you realize that this new outlook has a multiplier effect. In our case, we're in a center that includes a hospital, and all this change is also somehow spreading there.

"Absolutely, and I'm convinced that's the direction we need to take. We must abandon paternalistic models and find new ways to empower people. However, it's important to remember that this transformation must be comprehensive, with a cross-cutting commitment accompanied by funding."

If we want inclusive societies, we need social policies that promote genuine inclusion, that understand that people in vulnerable situations of dependency should not be isolated but connected to the community. To achieve this, we need to discuss support-centered models that allow us to move forward while respecting their rights as citizens and without losing their sense of belonging.

"Well, sometimes it's necessary to broaden your perspective to recognize what aspects aren't working, to accept failure. To have the humility to acknowledge that everything can be improved and to investigate what alternatives exist, what other way of doing things is possible."

In our case, the outside perspective was very helpful, as it helped us cultivate a constructive critical attitude. Managing a cultural shift in the services sector isn't easy, which is why it's important to involve people, manage personal resistance, and adapt to the pace of change as we move forward. It's not a transformation that happens overnight, and the leadership style, based on credibility, ethics, data-driven evidence, and fairness, is crucial.