Quality improvement collaborative aiming for Proactive HEAlthcare of Older People in Care Homes (PEACH): a realist evaluation protocol

IntroductionThis protocol describes a study of a quality improvement collaborative (QIC) to support implementation and delivery of comprehensive geriatric assessment (CGA) in UK care homes. The QIC will be formed of health and social care professionals working in and with care homes and will be supported by clinical, quality improvement and research specialists. QIC participants will receive quality improvement training using the Model for Improvement. An appreciative approach to working with care homes will be encouraged through facilitated shared learning events, quality improvement coaching and assistance with project evaluation.Methods and analysisThe QIC will be delivered across a range of partnering organisations which plan, deliver and evaluate health services for care home residents in four local areas of one geographical region. A realist evaluation framework will be used to develop a programme theory informing how QICs are thought to work, for whom and in what ways when used to implement and deliver CGA in care homes. Data collection will involve participant observations of the QIC over 18 months, and interviews/focus groups with QIC participants to iteratively define, refine, test or refute the programme theory. Two researchers will analyse field notes, and interview/focus group transcripts, coding data using inductive and deductive analysis. The key findings and linked programme theory will be summarised as context-mechanism-outcome configurations describing what needs to be in place to use QICs to implement service improvements in care homes.Ethics and disseminationThe study protocol was reviewed by the National Health Service Health Research Authority (London Bromley research ethics committee reference: 205840) and the University of Nottingham (reference: LT07092016) ethics committees. Both determined that the Proactive HEAlthcare of Older People in Care Homes study was a service and quality improvement initiative. Findings will be shared nationally and internationally through conference presentations, publication in peer-reviewed journals, a graphical illustration and a dissemination video.

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Quality improvement through the paradigm of learning

Quality in Ageing and Older Adults ◽

10.1108/qaoa-02-2015-0009 ◽

2015 ◽

Vol 16 (4) ◽

pp. 195-207 ◽

Cited By ~ 6

Author(s):

Trish Hafford-Letchfield ◽

Peter Lavender

Keyword(s):

Quality Improvement ◽

Older People ◽

Social Care ◽

Care Home ◽

Care Homes ◽

Project Staff ◽

Content Type ◽

Health And Social Care ◽

Learning Interventions

Purpose – Achieving meaningful participation and co-production for older people in care requires radical approaches. The purpose of this paper is to explore an innovation where learning interventions were introduced into care settings and older people matched to community-based learning mentors to develop partnerships. The authors explore how the concept of learning might be used as a paradigm to raise the quality of care in institutionalised settings using a co-productive and relationship-based approach to promote wellbeing. Design/methodology/approach – A structured evaluation drew on qualitative data captured from interviews with older people (n=25) and learning mentors (n=22) to reflect on the potential benefits and challenges involved when introducing learning interventions in care settings. This was contextualised alongside data captured from stakeholders (n=10) including a care home manager, social care and education commissioners, trustees and project staff to assess the interdisciplinary contribution of lifelong learning to quality improvement. Findings – Introducing learning interventions to older people within care settings promoted participation, advocacy and relationship-based care which in turn helped to create a positive culture. Given the current challenges to improve quality in care services, drawing on a paradigm of learning may encourage older people to retain their independence as care homes strive towards a person-centred approach. Promoting social activities and leisure using learning was found to foster closer working relationships between older people and the wider community. These had a levelling effect through reciprocity, using an asset based approach. There were benefits for the care provider as the partnerships formed enabled people to raise both individual and collective concerns about care and support. Originality/value – Raising and sustaining the quality of support for older people requires input from the wider public sector beyond health and social care. Purposeful engagement with other disciplines such as learning and leisure offers the potential to realise a more sustainable model of user choice, person-centred support and user involvement. Being engaged through learning can nourish membership in the community for marginalised populations such as older people living in care homes.

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How quality improvement collaboratives work to improve healthcare in care homes: a realist evaluation

Age and Ageing ◽

10.1093/ageing/afab007 ◽

2021 ◽

Author(s):

Reena Devi ◽

Neil H Chadborn ◽

Julienne Meyer ◽

Jay Banerjee ◽

Claire Goodman ◽

...

Keyword(s):

Quality Improvement ◽

Care Home ◽

Realist Evaluation ◽

Care Quality ◽

Care Staff ◽

Care Homes ◽

Multidisciplinary Teams ◽

Effect Change ◽

Health And Social Care ◽

Quality Improvement Collaboratives

Abstract Background Quality improvement collaboratives (QICs) bring together multidisciplinary teams in a structured process to improve care quality. How QICs can be used to support healthcare improvement in care homes is not fully understood. Methods A realist evaluation to develop and test a programme theory of how QICs work to improve healthcare in care homes. A multiple case study design considered implementation across 4 sites and 29 care homes. Observations, interviews and focus groups captured contexts and mechanisms operating within QICs. Data analysis classified emerging themes using context-mechanism-outcome configurations to explain how NHS and care home staff work together to design and implement improvement. Results QICs will be able to implement and iterate improvements in care homes where they have a broad and easily understandable remit; recruit staff with established partnership working between the NHS and care homes; use strategies to build relationships and minimise hierarchy; protect and pay for staff time; enable staff to implement improvements aligned with existing work; help members develop plans in manageable chunks through QI coaching; encourage QIC members to recruit multidisciplinary support through existing networks; facilitate meetings in care homes and use shared learning events to build multidisciplinary interventions stepwise. Teams did not use measurement for change, citing difficulties integrating this into pre-existing and QI-related workload. Conclusions These findings outline what needs to be in place for health and social care staff to work together to effect change. Further research needs to consider ways to work alongside staff to incorporate measurement for change intoQI.

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Improving the Quality of Care in Care Homes Using the Quality Improvement Collaborative Approach: Lessons Learnt from Six Projects Conducted in the UK and The Netherlands

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17207601 ◽

2020 ◽

Vol 17 (20) ◽

pp. 7601 ◽

Cited By ~ 2

Author(s):

Reena Devi ◽

Graham Martin ◽

Jay Banerjee ◽

Louise Butler ◽

Tim Pattison ◽

...

Keyword(s):

Quality Improvement ◽

Care Home ◽

Care Homes ◽

Collaborative Teams ◽

Quality Improvement Collaborative ◽

Team Members ◽

Job Roles ◽

Healthcare Settings ◽

Home Context ◽

The Uk

The Breakthrough Series Quality Improvement Collaborative (QIC) initiative is a well-developed and widely used approach, but most of what we know about it has come from healthcare settings. In this article, those leading QICs to improve care in care homes provide detailed accounts of six QICs and share their learning of applying the QIC approach in the care home sector. Overall, five care home-specific lessons were learnt: (i) plan for the resources needed to support collaborative teams with collecting, processing, and interpreting data; (ii) create encouraging and safe working environments to help collaborative team members feel valued; (iii) recruit collaborative teams, QIC leads, and facilitators who have established relationships with care homes; (iv) regularly check project ideas are aligned with team members’ job roles, responsibilities, and priorities; and (v) work flexibly and accept that planned activities may need adapting as the project progresses. These insights are targeted at teams delivering QICs in care homes. These insights demonstrate the need to consider the care home context when applying improvement tools and techniques in this setting.

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A qualitative study of older people with minimal care needs experiences of their admission to a nursing home with Registered Nurse care

Quality in Ageing and Older Adults ◽

10.1108/qaoa-09-2014-0020 ◽

2015 ◽

Vol 16 (2) ◽

pp. 94-105 ◽

Cited By ~ 2

Author(s):

Alice K. Stevens ◽

Helen Raphael ◽

Sue M. Green

Keyword(s):

Decision Making ◽

Grounded Theory ◽

Qualitative Study ◽

Older People ◽

Registered Nurse ◽

Care Home ◽

Care Homes ◽

Care Needs ◽

Content Type ◽

Health And Social Care

Purpose – Residential care for older people in the UK includes care homes with and without 24-hour Registered Nurse (RN) care. Reduced autonomy and personal wealth can result when people assessed as having minimal care needs, enter and reside in care homes with RN care. The purpose of this paper is to explore the experiences of older people with minimal care needs admission to care homes with RN care. Design/methodology/approach – A qualitative study using a grounded theory method was undertaken. In total, 12 care home with RN care residents assessed as not requiring nursing care were interviewed. Initial sampling was purposive and progressed to theoretical. Interviews were analysed using the grounded theory analysis method of constant comparison and theory development. Findings – Two main categories emerged: “choosing the path”, which concerned the decision to enter the home, and “settling in”, which related to adaptation to the environment. Findings suggested participants who perceived they had greater control over the decision-making process found it easier to settle in the care home. The two categories linked to form an emerging framework of “crossing the bridge” from independent living to care home resident. Research limitations/implications – The findings contribute to the understanding of factors influencing admission of older people with minimal care needs to care homes with RN care and highlight the importance of informed decision making. Practical implications – Health and social care professionals must give informed support and advice to older people seeking care options to ensure their needs are best met. Originality/value – This study enabled older people with minimal care needs admission to care homes with RN care to voice their experiences.

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Handovers in care homes for older people – their type, timing and usefulness. Findings from a scoping review

Ageing and Society ◽

10.1017/s0144686x17001301 ◽

2017 ◽

Vol 39 (4) ◽

pp. 851-871 ◽

Cited By ~ 5

Author(s):

JO MORIARTY ◽

VALERIE LIPMAN ◽

CAROLINE NORRIE ◽

REKHA ELASWARAPU ◽

JILL MANTHORPE

Keyword(s):

Older People ◽

Scoping Review ◽

English Language ◽

Care Home ◽

Good Practice ◽

Care Quality ◽

Care Homes ◽

Regulatory Body ◽

Health And Social Care ◽

Care Quality Commission

ABSTRACTThere is a considerable body of literature on the importance of effective shift handovers in hospitals and other health-care settings but less is known about the transfer of information between staff starting and completing stints of paid work in care homes. In the first of two articles considering this under-explored topic, we report findings from a scoping review examining what is known about shift-to-shift handovers in care homes for older people and their equivalents. It is based on systematic searches of electronic databases of English-language journals on ageing and internet searches for material published between January 2005 and October 2016. Guidance from the regulatory body for health and social care in England, the Care Quality Commission, highlights the importance of handovers in care homes but the degree to which they are embedded into care home routines appears to be variable, influenced by factors such as workplace culture, shift patterns and the extent to which they involve all those on duty or just those with professional qualifications. Staffing shortages and whether or not members of staff are paid for their time attending handovers appear to be further constraints on their use. We conclude that there is considerable scope for further research in this field to identify and develop good practice.

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A realist evaluation of a collaborative model to support research co-production in long-term care settings in England: the ExCHANGE protocol

Research Involvement and Engagement ◽

10.1186/s40900-021-00257-2 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

K. Wilkinson ◽

J. Day ◽

J. Thompson-Coon ◽

V. Goodwin ◽

K. Liabo ◽

...

Keyword(s):

Formative Evaluation ◽

Care Home ◽

Realist Evaluation ◽

Project Delivery ◽

Future Research ◽

Framework Analysis ◽

Programme Theory ◽

Term Care ◽

Health And Social Care ◽

Collaborative Working

Abstract Background Collaborative working between academic institutions and those who provide health and social care has been identified as integral in order to produce acceptable, relevant, and timely research, and for outputs to be useful and practical to implement. The ExCHANGE Collaboration aims to bring together researchers and people working, living in and visiting care homes to build capacity, share and mobilise knowledge, and identify key areas for future research. This paper describes an embedded, formative, realist and theory-driven evaluation which aims to gather information about how successful the ExCHANGE Collaboration is perceived to be in achieving its aims. An existing realist programme theory from the literature – Closer Collaboration – will be supplemented by two substantive theories: Co-production and Knowledge Brokering. This will result in an initial programme theory which will be tested by this formative evaluation to refine understanding of how the ExCHANGE Collaboration works. Methods The evaluation will employ mixed qualitative methods, including: analysis of documents such as feedback forms, Knowledge Broker journal/diary, event attendance records, risk and issues logs and other relevant paperwork gathered as part of project delivery; observations of events/activities; and interviews with care home providers and staff, care home residents, residents’ family members, and researchers who are involved in the project (both project design/delivery, and also attendance or involvement in project activities/events). Framework Analysis will be used to interpret the data collected; analysis will be strategic, by focusing on particular key areas of importance in the developing theory of how the ExCHANGE Collaboration might achieve change. Results The results of this study are expected to be published in 2022. Discussion This evaluation will investigate how successful the ExCHANGE Collaboration is perceived to be in achieving its aims, in what way, in which contexts, and how this may differ for those involved. It will do this by testing an initial programme theory about how the collaboration works, for whom, under which circumstances, and in what way. Findings will be shared through written publication, an end of project learning event for those involved/interested in the project, and a lay summary to be made publically available.

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How, why and under what circumstances does a quality improvement collaborative build knowledge and skills in clinicians working with people with dementia? A realist informed process evaluation

BMJ Open Quality ◽

10.1136/bmjoq-2020-001147 ◽

2021 ◽

Vol 10 (2) ◽

pp. e001147

Author(s):

Lenore de la Perrelle ◽

Monica Cations ◽

Gaery Barbery ◽

Gorjana Radisic ◽

Billingsley Kaambwa ◽

...

Keyword(s):

Quality Improvement ◽

Reflective Practice ◽

Process Evaluation ◽

Aged Care ◽

Dementia Care ◽

Quality Improvement Collaborative ◽

Programme Theory ◽

Post Intervention ◽

Knowledge And Skills ◽

People With Dementia

In increasingly constrained health and aged care services, strategies are needed to improve quality and translate evidence into practice. In dementia care, recent failures in quality and safety have led the WHO to prioritise the translation of known evidence into practice. While quality improvement collaboratives have been widely used in healthcare, there are few examples in dementia care.We describe a recent quality improvement collaborative to improve dementia care across Australia and assess the implementation outcomes of acceptability and feasibility of this strategy to translate known evidence into practice. A realist-informed process evaluation was used to analyse how, why and under what circumstances a quality improvement collaborative built knowledge and skills in clinicians working in dementia care.This realist-informed process evaluation developed, tested and refined the programme theory of a quality improvement collaborative. Data were collected pre-intervention and post-intervention using surveys and interviews with participants (n=28). A combined inductive and deductive data analysis process integrated three frameworks to examine the context and mechanisms of knowledge and skill building in participant clinicians.A refined program theory showed how and why clinicians built knowledge and skills in quality improvement in dementia care. Six mechanisms were identified: motivation, accountability, identity, collective learning, credibility and reflective practice. These mechanisms, in combination, operated to overcome constraints, role boundaries and pessimism about improved practice in dementia care.A quality improvement collaborative designed for clinicians in different contexts and roles was acceptable and feasible in building knowledge, skills and confidence of clinicians to improve dementia care. Supportive reflective practice and a credible, flexible and collaborative process optimised quality improvement knowledge and skills in clinicians working with people with dementia.Trial registration numberACTRN12618000268246.

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Urinary catheterization in care homes for older people: self-reported questionnaire audit of catheter management by care home staff

Journal of Hospital Infection ◽

10.1016/j.jhin.2005.03.008 ◽

2006 ◽

Vol 62 (1) ◽

pp. 29-36 ◽

Cited By ~ 15

Author(s):

C.A.M. McNulty ◽

J. Bowen ◽

C. Foy ◽

K. Gunn ◽

E. Freeman ◽

...

Keyword(s):

Older People ◽

Care Home ◽

Care Homes ◽

Urinary Catheterization ◽

Care Home Staff

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An exploration of hydration practices in Maltese residential care homes for older people

Nursing and Residential Care ◽

10.12968/nrec.2021.23.11.3 ◽

2021 ◽

Vol 23 (11) ◽

pp. 1-12

Author(s):

Francesca Micallef ◽

Marisa Vella ◽

Alan Sciberras Narmaniya ◽

Glenda Cook ◽

Juliana Thompson

Keyword(s):

Older People ◽

Residential Care ◽

Care Home ◽

Good Health ◽

Care Homes ◽

Complex Needs ◽

Increased Risk ◽

Adequate Hydration ◽

Axial Coding ◽

Sugary Beverages

Background/aims The integral relationship between adequate hydration and good health is widely recognised. Older people with complex needs and frailty can struggle to maintain adequate hydration, with residents in care home settings being at an increased risk of dehydration. The aim of this study was to explore current hydration practices in residential care homes in Malta. Methods An exploratory qualitative approach was adopted to explore staff's views and approaches in supporting residents' hydration. Data was collected via semi-structured, individual and small group interviews with staff from two care homes from the central and southern region of Malta. A process of open coding, followed by axial coding, was used to analyse the data. Peer debriefing was performed throughout, until agreement was reached among the research team about the final themes and sub-themes. Results Three themes emerged from the data: culture of promoting fluid intake; challenges in supporting older people to achieve optimum hydration; hydration practices and approaches. Conclusions A hydration promotion culture was demonstrated through various practices adopted in the care homes. The strong focus on water intake, in response to concerns about consuming sugary beverages, has implications for the promotion of a person-centred approach to hydration care. Inconsistencies in monitoring of fluids and daily recommended targets highlights the importance of policies or guidelines to guide hydration practice. Challenges related to refusal of fluids and language barriers among non-native staff were evident and justify further research is this area.

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Hearing and vision care provided to older people residing in care homes: a cross-sectional survey of care home staff

10.21203/rs.2.21638/v1 ◽

2020 ◽

Author(s):

Wendy Andrusjak ◽

Ana Barbosa ◽

Gail Mountain

Keyword(s):

Older People ◽

Vision Loss ◽

Care Home ◽

Care Homes ◽

Eye Care ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Care Home Staff ◽

Chi Square Analysis ◽

Vision Care

Abstract Background: Hearing and vision loss in older people has proven to affect physical and mental health and increase the speed of cognitive decline. Studies have proven certain practices and aspects of staff knowledge increase the effective care of residents’ ears and eyes, yet it is not known which of these are being implemented in care homes. This study aims to identify the gaps in staff knowledge and underused practices evident in long term care homes when identifying and managing hearing and vision difficulties in older residents. Methods: This study used a cross-sectional survey design. Survey questions were informed by the existing literature and were focused on practices, staff knowledge, and other aspects that have shown to affect residents’ hearing and vision care. The survey was sent to care homes across England between November 2018 and February 2019 both via Email and in paper format for care home staff to complete. Descriptive statistics and Chi-Square analysis was used to assess the factors particularly influencing the current care being provided to care home residents. Results: A total of 400 care home staff responded from 74 care homes. The results revealed that screening tools are rarely used by staff to identify hearing and vision impairments, care homes have limited access to other assistive devices, and audiology services do not regularly assess care home residents. A majority of staff were also not entirely confident in their knowledge of ear and eye care. Responses were also affected by the respondents’ job role, length of time working in care homes and also the care home type and care home capacity revealing a lack of standardised practice and shared communication. Conclusion: This study identifies which practices known to facilitate ear and eye care are currently under used in care homes across England and what particularly staff are not knowledgeable on when it comes to ear and eye care. This can now inform future research of the areas requiring improvement to as effectively address to acknowledged slow identification and poor management of hearing and vision loss in older people residing in care homes.

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