Quality of Care Ltd

The Systems Building Block

As the head of your care home business, one of your main aims should be to become expendable. When I say this, I’m usually greeted with raised eyebrows and the odd, “huh?”

When I first started teaching business owners on how to establish certainty and control by building their business on a foundation of strategy and leadership, I would, for example, run a workshop and my attendees would enthusiastically take it all in, take away the material and months later achieve very little.

When I initially worked with individual business owners, I would leave them with actions and later find that few had been completed. When I asked why, I would invariably receive the same answer – the daily needs of the business had sucked them back in.

They had crises to manage, issues to resolve and a desk piled up with things needing their attention. It’s not that they didn’t want to carry out the steps I’d shown them or complete the actions we’d set. It’s just that their business wouldn’t let them. They would go back to their business and immediately face issues they needed to resolve. They’d gone straight back to reacting to the demands their business was putting on them.

The root of the problem was that no one else in the company could solve these issues. No one else had the experience, knowledge and expertise that these owners had, nor guidelines to follow. The businesses depended on their owners being there and so not only were they indispensable, but they were also trapped.

It became clear that for the foundation to be built, businesses had to run effectively without the owner in it every day.

Systemisation of the business was essential and so became the third fundamental foundation building block.

To be able to step back from your business, you need it to run efficiently and effectively. You need everyone who works in it to know what needs to be done, when and to what standard. Your business also needs to be transparent enough for you to see that what needs doing is getting done.


To achieve this your business needs to be systemised.


Systemisation is not a strategy, it’s not a creative, differentiating initiative – it’s a necessity.

Systems and processes that help your business run smoothly might not be a strategy, but they are vital for a strategy to work. By creating a system, comprising a number of processes, for every major activity of your business you are creating a blueprint for how your business should run.

Franchises like McDonald’s are prime examples of a well systemised business. If you go into any one of thousands of McDonald’s restaurants in pretty much any part of the world, you know when you order a particular meal, how it will look and taste. There are systems and processes for everything, from recruitment and training to taking a customer order, to portion sizes and to cooking and serving the food.

Good systems, such as a car, a rainforest or the human body, work well most of the time. Your business should be no different. If systems can be put in place to make it work, then you don’t need to be in it every day making sure that it does work.

The above are examples of primary systems. They are whole systems that are made up of a number of connecting sub-systems. For example, a car, as a primary system, will comprise sub-systems such as the engine, the gearbox, wheels and suspension, steering, climate control, lights and so on.

These sub-systems are cause-and-effect stages of the primary system. A car engine sub-system can be broken down further into their own sub-systems that are responsible for say, starting the engine, the combustion of fuel, the transfer of power from the piston to the wheels and so on.

Finally, sub-systems become a collection of processes, each of which have a start and an end and are responsible for achieving a single task – like getting fuel to the engine.

An efficient system comprising these cause-and-effect stages has a flow to it. A good business has the same flow. Get this right and your business will naturally flow through key stages and your aims will be realised.

This image shows how a business can flow. I’ve broken down this flow into 6 key stages. You can have more, or fewer stages and re-define them as best suits your care home business.

business flow chart

Aims and Targets.

At the top of the flow there are your targets or aims. For a private business like yours, that aim or those targets will focus on ensuring the business is healthy and sustainable.

For a care home business in particular, this should first include your financial health – target revenue and profits. Other targets would include meeting standards – the quality of care delivered and being rated at least ‘Good’ by CQC.

For a public organisation, a college or a not-for-profit organisation like a charity, this aim could be their mission.

Convert and Retain.

To hit your financial targets, you have to convert prospects into paying customers. Having met their needs you then want to make sure that you keep them. For a care home business, customers are those who pay your bed fees such as LAs, CCGs and private clients.



To convert ideal prospects to paying customers you need to identify and attract them. For a care home this is more about being a registered care provider and your referrer knowing what kind of care you deliver and how many empty beds you have. But, for people who lack capacity, relatives also have a say and so you want them to choose your care home over a competitor’s.



To attract and convert prospects you need to be able to deliver the quality product or service you’ve promised.



You need to create that product or service – to create this value that you want customers to pay for. In your case, what quality service for the types of clients under your care do you need to create, maintain and improve upon?


Resources and Capabilities

In order to create this value, you need to have the necessary resources and capabilities. You’ll need to have tangible assets such as money, property, equipment and people. And intangible assets, such as expertise, knowledge, relationships, a brand and reputation.

As you see from the diagram above, the cause-and-effect flow is closed. Excess profit is fed back into the resources and capabilities so that better products and services can be created and delivered, and more customers attracted and converted.

A good business should flow like a river through these key stages. Your systems and processes are like the streams, estuaries and tributaries, the currents and eddies that make up the river.


Systemise Your Care Home Business

Your care home business is a primary system full of sub-systems, broken down further into a collection of processes or individual tasks. For example, would be one sub-system that has a number of processes or tasks from preparation to delivery to documentation. Assessment and admission of a new client would be another as would ensuring your staff receive the training they need.

Systemising your entire business or organisation will take time. You start with identifying your sub-systems and break them down into key processes. As time goes on you identify gaps and fill them with secondary processes.

As soon as you start to put the key processes in place, the impact can almost be immediate, and you can begin to step away.

For example, every day, week and month you have audits that you need to carry out. Imagine you had a system that made sure they were carried out on time and to the right standard and recorded in such a way that at any time, from your computer, you could see audit results and what subsequent actions are being carried out. Without needing to physically check or get a manager to check, you could see if an audit has been missed. You could set targets to reduce the mistakes these audits reveal, ensure compliance and improve the service overall.

Of course, you would still carry out spot checks to see the standards you’ve set for yourself, but a system like this could reduce a big chunk of work and possibly even stress because you now have the transparency to see that required tasks are being carried out.


Silos and Systems

Every organisation has a structure comprising areas or functions of work, such as Finance, HR, Administration, Operations and so on.

Functions are important, especially for large companies, because they define the type of work done, areas of responsibility and help to create the right organisation infrastructure.

But they can become insular, autonomous ‘silos’. Walls are built, work is thrown over them from one department to another and fingers pointed over these walls if work is late or poor.

For example, if a sales contract was lost it was the fault of the marketing department or the engineering department. If a piece of marketing collateral was late it was because the engineers hadn’t given them all of the information they needed.



Systems and processes flow horizontally across these vertical departments or silos. They represent how a business really flows.

Systems and processes help to keep the managers of separate departments in touch with all other areas of the organisation. They and their team gain a better understanding of how their work fits into the whole and the impact they can have on the rest of the organisation.

The image above shows some key horizontal systems covering engagement, conversion and so on for a technology company. Depending on the systems and processes involved, some of the functions will be more involved than others, such as Engineering for a new product development and Marketing, Sales and Operations for a product launch and delivery.

In your care home a system for assessing and taking in a new person wouldn’t simply sit in your Care or Nursing silo. It would include those but also Domestics – who need to get a room ready, Kitchen – who need to know any dietary needs – Finance, who need to add the client details and bed fee to their system, HR – who may have needed to recruit extra staff in preparation for the client’s arrival.

By thinking through the flow from start to finish and creating the processes that represent that flow you ensure that everything that needs doing is done and nothing is forgotten. Your people work more effectively, mistakes are reduced or eliminated, your client receives a better service and your stress levels reduce. It also mirrors better how we actually think.

Think of the sub-systems that flow through your care home and the processes that need to be created within. Break down sub-systems and larger processes into manageable, single processes. Once you’ve identified these single processes, document them.

By yourself or with your core team create mind maps of your key systems and processes based on the key stages of the business flow. A3 sheets of paper and coloured pens are great for mapping out these systems.


Process Flows

Because processes flow in a step-by-step manner, it makes much more sense to show them that way. It also helps you compare how something should work against how it actually works.

I’ve been in companies that have thick manuals of procedures and processes written in text with bullet points detailing how a task should be done. There’s usually one manual in the office and almost no one digs it out and uses it. And even if they did, the way the process is written isn’t always easy to understand.

Instead of simply writing out the steps for each task in text, which isn’t always easy to follow, draw it out as a simple flow diagram. The flow becomes much clearer to understand and remember.

A process flow diagram comprises a few simple elements. There’s a START/END box, an ACTION box, a DECISION box, arrows and swim lanes.

Here is a simple process flow for arranging and running a supervision meeting.


Supervision flow


The green box represents the start and end of the process. All paths start and end with one of these for clarity and to ensure that a path doesn’t lead to nowhere.

The flow commences with an action step (blue boxes) until a decision needs to be made (red diamond) or something needs to be confirmed. In the above case, the supervisor needs to book the meeting and add it to the duty rota so that the person receiving the supervision isn’t expected on her shift during that period and that her duties are covered.

This might sound like a trivial step to include but it was actually a problem in a care home that I was helping; the deputy manager would arrange a time directly with the member of staff without informing anyone else, which would then impact the rest of the team who would have to carry out her duties.

The simple check in the flow (red diamond) meant the process couldn’t continue until it was cleared by the person managing the rota and hence the person’s absence expected and catered for. (Actually, that simple step alone eased pressures and tension between peers and for those running the shifts because there were no unexpected surprises.)

If the process wasn’t followed the person running the shift had authority not to let that person disappear for the supervision, which the Deputy Manager, in this example, would have to accept because she hadn’t followed the rules. This rule eliminated potential disputes between the Deputy Manager and the person running the shift.

The flow also ensured that the supervisee received her form before the meeting and, against set questions, was able to score her performance and be better prepared for the meeting itself. The form also had a column for the supervisor to score against the set questions and once that column was completed the meeting could go ahead.

Again, the steps became clear and if not carried out, either party was empowered to not go ahead with the meeting – no ifs or buts and no arguments.

Finally, in the meeting each question was discussed, scores compared and used as part of the discussion, and a third score column would be filled in with an ‘agreed score’.

The vertical line separates the process into two “swim lanes”. The person in that swim lane is responsible for carrying out that part of the process until it moves out of their swim lane. More complex processes can easily require more swim lanes.

The process, along with the new way of scoring, resulted in supervision meetings that were better prepared, more relaxed, more constructive sessions rather than an ill-prepared, let’s-just-get-through-this waste of time.

Process flows can also eliminate excuses. I’m sure you’ve had a person carry out a task wrongly, like how to aid a person out of a chair, to then tell you that he was never shown how to do it properly.

As part of the initial 12-weeks on the job, a person’s supervisor or manager can ensure they go through all relevant process flows and show the person the correct way to carry out a task. That person can then be observed to perform it correctly and both then sign off that they have been trained on, and know how to carry out, the task. No more excuses.

The beauty of process flows is that they are easy to create, easier to ratify, easier to teach and easy to follow, learn and remember. With all tasks drawn out in this way, no one can use the excuse that they didn’t know how to do something or give credible reasons why they performed the task differently.

The other beauty of a process flow like this is that it’s a template for all process flows, same boxes, same colours, etc. That way, individual styles stay out of the equation and staff get used to seeing and interpreting them.

Have your heads of department draw out all the tasks that their teams have to carry out. They can do this on paper drawing out the shapes by hand and have a secretary or hire a student during a holiday period, to draw them out properly and consistently using a tool like PowerPoint™.

Once you have the flow drawn out you can create an image of it and paste it into an official document that includes a title for that flow, a reference number, revision number and date it was created or updated.

Official Supervision procedure

You should create a contents page of all the processes with their unique reference numbers for easy searching. This will also make it easier to check later if a particular process has been created or needs to be created. Excel works fine for this.

Each department should have all of their processes collated into a department “operations” manual.

These process flows may seem laborious, but they really do make a difference. With clearer guidelines, that they can easily learn during induction and their first 12 weeks and refer to when needed, people become more confident in their work. They know that they’re doing things the right way and they become more productive and motivated.

Those that continue to get things wrong cannot use the excuse that they didn’t know and, if necessary, the processes help you to manage these people out of the organisation. This in turn keeps morale and motivation high amongst those who do perform the tasks correctly and want to do well. It also helps to keep things like accidents, incidents and complaints down and your residents safer from wrong practice.

Where processes cut across functions, and provided authority and responsibilities are clearly mapped out, these process flows can eliminate confusion and help cross-functional teams work better together. They help align effort and can help with the allocation of responsibility, resources and funding.

Drawing out processes like this reduces mistakes. You would expect to see step-by-step guidance on how to use dangerous machinery, thus reducing the possibility of mistakes or injury and increasing best practice and the quality for the work.

Hence, step-by-step guidance for all the key tasks in your business will do the same for you, your staff and most importantly your residents.

Here’s an example of a process flow for destroying medicine, this flow helps ensure your clients are safe, your staff protected, and your business doesn’t suffer some kind of legal action.


Destroy medicine flow


A process flow will highlight a problem more clearly. If the process flow and reality of the task don’t match, is the problem with the flow or is the flow highlighting a problem? Either way, the inconsistency is easier to spot and resolve. The problem might be resolved with guidance and training or it might be a bottleneck that can be eliminated with some rules.


Systems Leadership Flow


Mapping out how your care home business flows helps you to systemise it so that it runs more efficiently and effectively, with fewer mistakes and without the need for your day-to-day intervention.

That frees you up to be able to step back and create the strategy that will make this flow work and guide you to your next strategic destination and to be the leader you need to be to steer your ship and keep it on course.