Q Exchange

Enhancing Care in Care Homes

Sustaining and spreading the successful enhanced care homes programme through co-production, digital technology and improvement methodology.

Read comments 24

Proposal
2020

Meet the team

Also:

Michelle Beddows, Communications Lead, Walsall Together
Sara Bailey, Deputy Chief Nurse, NHS Walsall CCG
Donna Roberts, Clinical Intervention Team Lead
Gary Perry, Head of Patient Relations
Tracie Wilson, Quality Team, Walsall CCG
Simon Cooper, Walsall Together Project Manager
Dan Hodgkiss, Deteriorating Patient Workstream, WMAHSN
Jane Rumble, CQC Representative

What is the positive change that has emerged through new collaborations or partnerships during Covid-19 that your project is going to embed?

During the first wave, Care Homes faced huge challenges and unprecedented numbers of deaths.

In response the Walsall Together Integrated Care Partnership built on our published work to develop a multi-agency Enhanced Quality in Care Team (EQiCT) from across health and social care.

EQiCT made daily contact with care homes, working with staff to spot and manage deteriorating patients. We provided infection control training, supported the supply of PPE and provided psychological support. Care home staff became more autonomous and were making well-informed decisions faster.

Within weeks there was a drop in the number of COVID related deaths, a reduction in hospital admissions and staff said they felt supported and more confident.

We saw positive changes in working relationships between organisations with historical resistance due to the nature of commissioner/provider relations. Our work at EQiCT was also recognised by the CQC as an example of excellent practice.

What does your project aim to achieve?

We will build on similar work done in this sector to improve outcomes for care home residents. Care home staff will co-design the interventions from the start based on their needs and then be taught frameworks such as the Model for Improvement.

Measures of participation:

number of care homes teams recruited onto the programme
attendance at the QI training sessions
participation in online discussions on the (closed) Hexitime group
Number of ideas, offers and requests for help responded to on Hexitime

Feedback from the sessions:

individual satisfaction following sessions
overall satisfaction with the programme

Impact on healthcare staff using:

Outcomes for residents:

Patient Reported Outcome and Experience Measures
Number of emergency calls/month
Variation in outcomes between care homes

Sustainability

Number of graduates who become champions
Funding to continue the programme after completion
Improved Care Homes CQC Ratings

How will the project be delivered?

Test and Refine Initiative Jan 2021-Mar 2021

Understand context and feasibility
Reframe project around care home needs

Care Home Recruitment campaign: Apr 2021-May 2021

Stratification of Care Homes by health outcomes
Invite those with worse outcomes to participate
Multidisciplinary team applications
Modest financial incentive to participating teams

QSIR Virtual Cohort 1: Jun 2021-Aug 2021

Theme- Managing deterioration
Eight 1-hour sessions, coaching, action learning sets and QI Café
Online community of practice on Hexitime
Incorporate upcoming regional digital programme

QSIR Virtual Cohort 2: Oct 2021-Dec 2021

Theme- Reducing inequity within homes
Trainers from EQUiCT and Hexitime
Format and training material reviewed

QSIR Virtual Cohort 3: Feb 2022-Apr 2022

Theme- TBC
Trainers from EQiCT team and Hexitime
Format and training material reviewed

Walsall Together Report Jun 2022

Outcomes and lessons learnt
Sustainability plans
Translation to LD and residential homes

Celebration and Learning Events Jul- Aug 2022

Virtual conference
Recognition of most improved care homes
Institute of Healthcare Management and AHSN case studies

How is your project going to share learning?

Local care homes forum
Black Country and West Birmingham care homes app
Quality review service and Frailty Working group
Walsall Together Integrated Care Programme Board overview
Academic publications and conference presentations

The care home forum will be a way of sharing the learning from care homes involved in the project.

The app is already available on the App Store and could host all the resources, information and shared learning required to deliver enhanced care within a care home.

The local QRS, Frailty Working Groups and and ICP programme boards will offer challenge to the project group and ensure the outputs are aligned with local and regional priorities.

Project Group includes members from the CQC, AHSN and Institute of Healthcare Management and hence there are opportunities to share case studies through regional and national events. Care Home delivery is a WMAHSN priority, so there is significant regional support.

How you can contribute

We appreciate this is a national challenge. We would therefore appreciate if you could put us in touch with other Q members who are working in this area, so we can collaborate and avoid reproducing good work already done and hence utilise the funds productively.
If you personally have had experience of a friend or relative in a care home over the last few months then your story would be very valuable to us in refining our focus and developing our training materials.
One of the areas we would like us to focus on is using quality improvement to build equity in care provision in care homes. How have you seen QI in this setting?
What work have you seen to reduce disparity of health outcomes on the basis of race, ethnicity and language of care home residents, for example? How can we measure and improve equity in this group?

Plan timeline

1 Dec 2020	Test and Refine the Intervention
1 Mar 2021	Recruitment of Care Home Teams
1 Jun 2021	QI Cohort 1
1 Oct 2021	QI Cohort 2
1 Feb 2022	QI Cohort 3
1 Jul 2022	Celebration and Learning Event

Comments

Jen Gilroy-cheetham 12 Apr 2021
Excellent project idea and support where it is needed, as helping to support skills and knowledge with the care home workforce is key to helping improving quality of care.

Some interesting projects/reports which I'm sure you'll have seen
- https://www.ahsnnetwork.com/app/uploads/2019/09/Care_Homes_Report_WEB.pdf
- https://www.innovationagencynwc.nhs.uk/news/care-home-academy
The measures are well thought out and practically achievable.

Wishing you lots of luck!
Thomas John Rose 20 Oct 2020

Hesham,

This is a great idea and I do hope that you take it forward. I'm sure that you will. If you need any process visualizations done then please let me know as I'd love to help. Good luck with your idea.

Tom
John Lodge 17 Oct 2020

The pandemic has shown just how much support care homes need, and it's great to see QI folk from the Q community rising to the challenge with initiatives like this one
Issac Theophilos 13 Oct 2020

Hi Hesham,

Great to structure some support for care homes in this scale. More than happy to support you.
1. Hesham Abdalla 15 Oct 2020
  
  Thanks, Isaac. I'll message you directly for your thoughts and recommendations.
Jane Brightman 1 Oct 2020

Hi Hesham, really like the idea for this project and my area of expertise is social care, so please do let me know if I can support in any way. I facilitate a large national network of care managers if helpful. All the best Jane
1. Hesham Abdalla 15 Oct 2020
  
  Thanks for offering such a wealth of experience and expertise, Jane. I've added you to the project team!
2. Hesham Abdalla 2 Oct 2020
  
  Thanks Jane, I've messaged you with a link to talk it through.
Nicola Payne 29 Sep 2020

This sounds like a great idea and I would be more that happy to share the work I have done locally in Nottingham and also as part of a HEE project that covered West Midlands last year.

I am currently working with West Midlands Care Association who I am sure would be interested in this development and also Skills for Care. Happy to make the connections if needed.
1. Hesham Abdalla 29 Sep 2020
  
  Thanks, Nicola.
  
  I really would value those connections and sharing your experience both in Nottingham and the HEE project that covered the West Midlands.
  
  I'll message you to set up a Zoom call.
Marie Lewis 28 Sep 2020

fantastic idea and very much needed. Good luck, I am fully supportive.

Is there a way to use EQiCT to enhance training and education in care homes by implementing maybe a variation on the AIMS course for early deterioration? Also wandering about cross organisation training to enable understanding by the acute setting of the roles and experience of care home staff/ acute staff to support care of the patient utilising the best skills from both.
1. Hesham Abdalla 29 Sep 2020
  
  Thank you for your support, Marie.
  
  Managing deterioration, including picking up on soft signs, methodical observations and the challenges of communicating them to other healthcare professionals is just as much a problem as in acute settings, so I am sure that there is a lot we can learn from the AIMS course.
  
  Thanks for the prompt.
Sharon Wiener-Ogilvie 23 Sep 2020

Hi Hesham, we have adapted the AHRQ to look at team culture as part of our value management work. i have a short paper I can share with you where we compared different tools in case its of any help. I don't seem to be able to attach it here but can e-mail you if its helpful
1. Hesham Abdalla 23 Sep 2020
  
  Thanks, Sharon.
  
  Yes, please do send it to me: Hesham.abdalla@walsallhealthcare.nhs.uk
  
  I've also been thinking that we need to record staff self-defined goals and then understand whether they have been achieved through the collaboration.
Elizabeth Beech 22 Sep 2020

Hi Hesham

I have led the ToDipOrNotToDip improving the management of UTI in care home residents QI programme and host a network of 600+ keen folk on a Slack app. Its full of resources and shared learning and has really helped spread, adopt and adapt the initiative. Happy to send you an invite if that would be helpful.

There is a NHSEI medicines optimisation care home funding stream so great opportunity to include these pharmacists in your area to support your proposal
1. Hesham Abdalla 22 Sep 2020
  
  Yes, do send an invite to the group, Elizabeth! I've messaged you with my email address.
  
  A pharmacist would be a really valuable addition to our group, so please do connect us medicines optimisation stream.
Tim Benson 22 Sep 2020

We have done quite a bit of work in care homes. Do have a look at two papers in BMJ Open Quality. There are others, but I think these are the most relevant:

https://bmjopenquality.bmj.com/content/8/2/e000621 (Monitoring work well-being, job confidence and care provided by care home staff using a self-report survey)

https://bmjopenquality.bmj.com/content/9/1/e000789 (Measure what we want: a taxonomy of short generic person-reported outcome and experience measures (PROMs and PREMs))

We would be glad to help.
1. Hesham Abdalla 22 Sep 2020
  
  Brilliant that have published this work, Tim.
  
  The taxonomy of PREMs and PROMs gave us some real insight and we would love to adopt the staff measures you used in care homes, so with your permission I'll add that to our project plan.
sharon wiener-ogilvie 22 Sep 2020

Really interesting project , clearly there we need to do more work to support care homes and your proposed collaborative work can be a good example. I wonder if its worth broadening your evaluation approach to capture what changes have been made as a result and also what particular organisational conditions enable these? It will be interesting to understand under what conditions coaching is more effective
1. Hesham Abdalla 22 Sep 2020
  
  Hi Sharon, good question.
  
  Pre-COVID, we were an early starter as an Integrated Care System, with a framework for collaboration and key stakeholders mostly on the same page. The pandemic has accelerated the change from theory into practice and building of trust.
  
  I wonder if there is a measure of trustworthiness or Teamwork that we can adopt or adapt?
David Low 22 Sep 2020

Hi Hesham,

I see that you have requested some help with the measures (for improvements) for your project. Would you be able to give me a little more detail so I may perhaps contribute (in my very limited capacity) to support? I am also working in the care home sector and has experience with patient flow in the acute sector :)

Regards,

David
1. Hesham Abdalla 22 Sep 2020
  
  Hi David, our long term goal is to reduce the number of care home patients admitted into hospital, either by acting before they deteriorate, or by identifying their end of life and avoiding escalation.
  
  What are the process measures should we be monitoring? How do we identify (and mitigate) unintended harm?
Malcolm Roper-Moore 22 Sep 2020

Hi Hesham,

I have read the paper above and agree wholeheartedly with the ideas and work that is required to do this. It is an essential element of the Walsall Together programme and covers a wide variety of actions / requirements that can easily be broken down into discrete packages / elements.

I will be glad to support this further with whatever my skills etc will allow me to do.
1. Hesham Abdalla 22 Sep 2020
  
  Thanks, Malcolm. That's really encouraging.
  
  Whether or not it wins, we'll tap into your skills :-)

Comments are now closed for this post.

Enhancing Care in Care Homes