Living and Dying Well with Frailty Collaborative – Learning Session One

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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.

(In order to make this video accessible we are editing a final version with subtitles so this will be made available when this has been done).

 

twitter-logo (2)“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.

 

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“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?”

 

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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.

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

National Change Package

Project Charter Template

RACI Action Plan

 

twitter-logo (2)“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.

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Neighbourhood Care Steering Group

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Our recent Neighbourhood Care Steering Group took place on 21st November at The Studio, Glasgow. This session focused on measurement and provided an opportunity for our test sites to update each other on their progress and any challenges encountered since our last meeting.

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Care Experience Measurement

Our public partners, recently attended training on Care Experience, delivered by the Person Centred Care team in the hope that each public partner will link up with an active test site and assist them in capturing care experience in their local area. A further training session will happen in the New Year and those from the HSCP pilot sites are welcome to attend.

The group was shown an example of a “Care Experience Map” and asked if this would be helpful in developing one for each active site, with 1 or 2 patients being interviewed (Aberdeen City, Scottish Borders and NHS Highland). The Care Experience Maps would be used to capture the current care received from Neighbourhood Care teams, and could highlight opportunities for quality improvement work for local teams.

Knowledge Hub

The Steering Group have previously expressed that they would like to have a platform to share information around Neighbourhood Care in between the Steering Group meetings. As a result, the Living Well in Communities (LWIC) team have created a Knowledge Hub site. It provides a chance for those interested in testing similar models to network and share ideas and will be open to all roles in all areas.

The LWiC team had brain stormed these folders and suggested some sub folders, as well as uploading a few examples of documents that sites may find useful to share. Everyone was invited to “test” out the page and offer suggestions that would help improve the page before it gets shared more widely with local test site teams. Sites were asked to feedback their suggestions to the LWiC team and nominate a member of their team as ‘administrator’ who will be responsible for updating and uploading documents to their site’s folder.

Measurement

A small NC Measurement sub-group formed on the back of the last Steering Group and met to develop a set of common measures for all sites based on the 7 common themes of measurement:

  • Re-ablement
  • Customer satisfaction/experience
  • Staff satisfaction
  • Procedures
  • Workforce
  • Professional Autonomy
  • Community impact

The steering group was briefed on the 10 suggested measures and asked if they would be both useful and easy for Neighbourhood Care teams to measure. Some of the measures included:

“The percentage of time spent by nurses and carers that:

 is directly person facing time or Involves person centred activities”

“The average number of team/staff members visiting each person per day/per week”

“The percentage of attendees who join the regular team meetings that discuss and plan care/case load”

“Number of steps in a process that require approval to be sought [before a  neighbourhood care team/control group and with a neighbourhood care team”? I.e. “How many barriers removed?”

All suggestions were useful and would be of particular interest to team members, but some may prove challenging to capture. Neighbourhood Care Test Sites will now test ways to capture some of these measures and have been asked to help define them more precisely.

For any further information on any of the above, please feel free to contact one of the team:

hcis.livingwell@nhs.net