collaborative – Living Well in Communities blog

Meet Paulo Nunes de Moura!

Published on 3 March 2020 by Living Well In CommunitiesLeave a comment

Here’s a short introduction from Paulo Nunes de Moura, who has recently joined the Living Well in Communities team.

I’m delighted to have joined the LWiC team as a project officer, and I’m focusing on the Living and Dying Well with Frailty Collaborative. I’m enjoying learning the work, and feel that I also have a lot to contribute because of my previous work experience, both paid and voluntary.

Previously, I worked as an events coordinator, being the lead organiser of the 8^th European Alcohol Policy Conference, which took place at the Royal College of Physicians of Edinburgh. Other positions include working as a policy officer at the European Alcohol Policy Alliance, and in administrative posts at the University of Edinburgh.

I enjoy learning, and over the recent years I did complete Open University programmes for French and Spanish, completed a part-time master’s degree in Social Justice at Queen Margaret University, and graduated with a Bachelor of Laws from Robert Gordon University.

I also volunteered until recently at the Castlemilk Law Centre, where I completed detailed benefit application forms for clients living with complex physical and / or mental health conditions. This gave me an invaluable insight into the health issues that people face, as well as an appreciation for NHS online resources. I explored these with clients to identify information on conditions, as varied as schizophrenia, osteoarthritis and chronic obstructive pulmonary disease (COPD), with a view to gathering evidence to meet the necessary legal tests to access benefits.

Going off-topic a bit, another memorable experience from volunteering was meeting Queen Silvia of Sweden at a charity event in London, with whom I spoke briefly in Portuguese, as we are both Brazilian!

I’ve been enjoying working with many talented colleagues, who are very generous in sharing their great knowledge and enthusiasm about the fantastic work being done here. I’m also excited about having been given the opportunity to work with different professionals from organisations across Scotland. We are all focusing on improving people’s lives.

If you have any questions, then please do get in touch.

Meet Sarah O’Shaughnessy!

Published on 18 December 2019 by Living Well In CommunitiesLeave a comment

Sarah O'Shaughnessy

Sarah O’Shaughnessy, one of the project officers in our team, talks about her role and what she enjoys about the job. It’s all about the people!

I started working with the Living Well in Communities (LWiC) team at the end of July, having been project officer with the Mental Health Improvement Team in the six months before that. I have been working at Healthcare Improvement Scotland (HIS) for two and a half years.

The thing that I really enjoy about my job is working with people. Some of my favourite experiences since starting with the LWiC Team five months ago have been engaging with stakeholders. This might be in person or over the phone, discussing how they can put their skills together and achieve the goal of improving the lives of people in Scotland.

At the moment one of my main pieces of work if the Living and Dying Well with Frailty Collaborative. I am responsible for supporting my colleagues and the teams in the west. I am gradually getting to know the teams and really enjoy the opportunities I get to speak with team members more. From my point of view, the better I know the teams, the better I can support them. What I like to know is how people like to be communicated with? Do they prefer a phone call or an email, do they like reminders, do they use Twitter, how do they find using the Knowledge Hub? If you are one of the people in these teams, please feel free to get in touch and let me know how I can communicate with you more effectively!

I have recently started working with some of my colleagues on our anticipatory care planning (ACP) documentation. This has been quite a steep learning curve for me, but it has been fascinating. I am particularly enjoying seeing how ACP can be used to support work across Health and Social Care Partnerships, and we have had some invaluable feedback on how it is currently being used and how it could be used better in future.

While I am finding both projects interesting, the thing that I am really enjoying is the people. The passion and the knowledge of the people I work with, both within and outside of HIS, never ceases to amaze me. In the last few months I have learned so much because of people around me and the opportunities that I have been given.

My hope is that my learning will continue and that people will continue to let me engage with them. I would love to hear back from people about what interests them about the work they do, if you are someone I engage with, let me know how I can do this better too! If you are on Twitter my handle is @SarahOShaughne3 Feel free to follow me, especially if you like the occasional update on the Glasgow Warriors!

Living and Dying Well with Frailty Collaborative – Learning Session One

Published on 3 October 201914 January 2020 by Living Well In Communities1 Comment

On 19 September 2019, 21 teams taking part in the Living and Dying Well with Frailty Collaborative came together for the first learning session where they learned how to test their ideas using a range of improvement methods, and how to measure their activities and the impact they make. They also heard from each other about the frailty work being undertaken in the various Health and Social Care Partnerships and GP practices, and had time as a team to look at their project charter and develop their plans for their next test of change during the learning session action period.

Living with Frailty

People are at the heart of what we do, so we started the day by hearing from those living with frailty. We heard about the experience of Mr Lucas, who featured in our video. He spoke about how the support that he receives from services and family helps him to live independently with frailty. Mr Lucas is one of Dr Paul Baughan’s patients, the Living Well in Communities (LWiC) National Clinical Lead for Palliative and End of Life Care and GP at Dollar Health Centre.

“I hope I’m as able as Mr Lucas when I have moderate frailty. I love how it was the carers, reading and music that helped him live well with frailty.”

We also had Hugh Donaghy join us for the day. Mr Donaghy is a carer for his mother and spoke to Professor Graham Ellis, the LWiC National Clinical Lead for Older People and Frailty, about his experience of providing care to someone living with frailty. Hugh discussed how technology is helping him to support his mother in her home, the blurred line between being a carer and a relative, and the challenges of hospital stays: each time his mother comes out of hospital, her frailty increases.

“Carer experience of mum with long term conditions going in to hospital ‘each time she comes home she’s that bit frailer’ – how can we build resilience when someone comes back home?”

I want to be involved in the Frailty Collaborative because…

Alec Murray, Associate Improvement Advisor, led a short ice breaker with the teams using Slido to ask the teams how they felt about being involved in the collaborative, creating the word cloud below…

LS1 Word Cloud

It was great to see people and care at the centre.

Throughout the day there were a number of questions asked on Slido. We didn’t have the opportunity to respond to all of these on the day, so we’ve pulled together our answers in this form: Slido Questions and Answers

Learning about Improvement

The teams then had the opportunity to learn about Quality Improvement Methods and Measurement for Improvement, led by the Living Well in Communities Improvement Advisors and Associate Improvement Advisors (Nathan Devereux, Scott Purdie, Dianne Foster, Tom McCarthy and Michelle Church).

Quality Improvement Methods

When we designed this session we wanted to explore with the teams a range of Quality Improvement concepts and tools. We held an introductory WebEx where we polled the teams to find out how much knowledge and experience everyone had in using QI tools. The teams told us that there was a real mix of skills and experiences in the room, and the results indicated that we should spend a little bit more time on the change package. Therefore the session was designed to give everyone a flavour of some of the approaches that might help teams in the action period.

At the end of the session, the teams were asked for their lightbulb moments:

“Build on existing practice and evidence with data”

“Small steps to improvement are better than a leap of faith”

“Even failed attempts are learning and a critical part of improvement”

“Don’t reinvent the wheel – SHARE”

“In order to spread change, you need to explain to others why it’s important, how it works and have a narrative”

Measurement for Improvement

As this was the first session we aimed to get everyone on the same level, so that teams were prepared for the first action period. We covered some of the practical elements of measurement for this collaborative, including the data collection method.

The collaborative is focused on three core measures, which represent an increase in involving people in conversations about their needs and care, and also a shift to more planned activity.

In the session we introduced the measurement plan tool designed to help teams collect this data and also provided time for teams to consider what their measurement priorities are, including local priorities and measures which take account of interventions (such as polypharmacy).

It was great to discuss measurement of the collaborative at the first learning session and particularly to hear the views of teams about how best to approach what can be one of the trickiest parts of improvement – measuring whether you make a difference.

Learning from Across Scotland

We had 15 teams and national organisation representatives host tables where they presented on what work they have undertaken on frailty in their area. This was ‘world café’ style, where everyone had an opportunity to go to three tables and hear about work in other areas and ask questions.

There were some great discussions, and the feedback we received indicated this was a very popular session. It was beneficial for them to hear about what is happening in other areas and have the chance to discuss challenges faced, as well as successes.

For example, Rebecca McLaren and Eileen Downham from the Angus team presented work on their Enhanced Community Service and community multidisciplinary team (MDT) meetings. The challenge faced in Angus is that a person can be registered to any of eight GP practices because practice boundaries overlap. The group were particularly interested that a medicine for the elderly consultant from hospital attends the community MDT meetings. If a consultant can’t attend then an advanced nurse practitioner attends in their place.

North Lanarkshire HSCP has been working with hospital at home and 30 GP practices to test MDTs. They found the challenges were around data and how home visits can be recorded. Also whether it is possible to measure the quality of ACPs, and creating an infrastructure to support people wishing to stay at home.

For a full list of these topics please click here. For more information about anything which was discussed, please get in touch via email – hcis.livingwell@nhs.net – and we can put you in touch with the relevant team.

Team planning

Teams were then given time to work together on their project charter and action planning for the first action period of the collaborative.

If you are undertaking similar improvement work you may find the below resources helpful:

National Change Package

Project Charter Template

RACI Action Plan

“Fantastic reasons to be at #LWiCFrailty today. But “a goal without a plan is just a wish” so now time for action! Thanks for a useful day of sharing & learning @LWiC_QI @eFI_Midlothian”

What next?

Away teams will share their learning with the Home Teams and begin their tests of change, or continue with any tests already underway. They will be documenting their progress and recording data over time, with the support of the Improvement Advisors and Associate Improvement Advisors who are area leads for each of the teams.

For more information about the collaborative please visit https://ihub.scot/improvement-programmes/living-well-in-communities/our-programmes/living-and-dying-well-with-frailty/

For the PowerPoint slides from the day from all sessions, please click here.

Introducing our Living and Dying Well with Frailty Collaborative

Published on 14 May 201925 October 2019 by Living Well In CommunitiesLeave a comment

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Thomas Monaghan, our Portfolio Lead, discusses our Living and Dying Well with Frailty Collaborative

People in Scotland are living longer than ever before, which is to be celebrated. This means that we all get to spend more time with our loved ones. However, people are not just living longer: they are living longer with more complex health needs and conditions, such as frailty. While we welcome spending more time with our loved ones, we also recognise that it can increase pressure on families, on carers and on our health and social care services to support people to have the best possible quality of life.

Improving care for people with frailty

Supporting people with frailty to have the best possible quality of life is becoming increasingly difficult, as there are growing numbers of older people in Scotland who need support: there will be 25% more people age 65 or over by 2029, and almost 80% more people age 75 or over by 2041.

If we want every older person in Scotland to have the best possible quality of life, then we need to start changing how we support people with frailty to live well in their community.

Our support

At Healthcare Improvement Scotland we want to help health and social care services to make changes so more people with frailty can have a better quality of life in their community. This will help to avoid crises that can lead to poor outcomes and increase pressure on families, carers and health and social care services.

We can do this by helping health and social care services to use evidence and quality improvement methods to:

find people who are becoming frail before they reach crisis point
have anticipatory care planning conversations with people with frailty to understand their wishes for future care, and
work with a range of health, social care, third sector, independent sector and housing providers in local areas to support people with frailty to achieve what they want for their future.

Our Living and Dying Well with Frailty Collaborative

If you want to work with us to help people with frailty to have a better quality of life and reduce pressures on individuals and services, then get in touch. We can talk about how you could be part of our Living and Dying Well in Communities improvement collaborative.

To find out more, get in touch by emailing us at hcis.livingwell@nhs.net, calling us on 0131 314 1232 or tweeting us @LWiC_QI.

Looking forward to hearing from you!