Evaluating impact and spreading the learning

15 mental health wards showed a reduction in the rates of violence of up to 80% since 2012

The ihub is supporting services and systems to evaluate the impact of their changes and to spread the learning about what has and hasn’t worked.

  • We provide advice on how to embed evaluation across improvement work, including support for developing the business case for improvement.
  • We identify good practice and promising practice, capturing and sharing information on the ‘what and how’.

Examples of our work

ihub’s Evidence and Evaluation for Improvement Team

We continued to develop our new Evidence and Evaluation for Improvement Team (EEvIT) which draws on the significant expertise that sits within Healthcare Improvement Scotland’s Evidence Directorate. This small team (5.1 WTE) combines analytical expertise in economics, research, information science and evaluation.

As well as providing advice to the ihubs national improvement programmes, EEvIT has also worked directly with health and social care partnerships to advise on the evaluation of their local improvement work.

Working with people with complex health and social needs in Midlothian

Since September 2015, the House of Care Wellbeing Service, provided by the Thistle Foundation and NHS Lothian, has been working with people with complex health and social needs in Midlothian. Initially provided in two GP practices in September 2015, the service was extended in January 2017 to a further six GP practices. The approach is based upon having a good conversation, focusing on personal outcomes and building on people’s strengths, assets and community supports. The service is provided on a 1:1 basis and through group support. People are also supported to access local services.

The Tailored and Responsive Improvement Support Team (TRIST) and EEvIT worked with Midlothian Health and Social Care Partnership to assist with the evaluation of their wellbeing service, in partnership with NHS Lothian, the Thistle Foundation and NSS. We supported an outcome monitoring approach to help determine the benefits of the service. Interim findings from the evaluation show:

  • 87% of people involved identified a personal outcome, with data showing that this has helped the service to support people to access community-based support and services, and
  • a measureable increase in people’s mental health, wellbeing and confidence as a result of their involvement with the service.

We are continuing to support this work by analysing patient data on their healthcare use before and after using the wellbeing service.

 

NHS Lothian and Edinburgh Health and Social Care Partnership – Adults with Incapacity (AWI) pilot saves £1 million per year

In March 2016, 253 patients across Scotland had their discharge from hospital delayed because they were waiting for a welfare guardian to be appointed; 24 of these were within the City of Edinburgh Council area.

In order to address this challenge for services, the following month the City of Edinburgh Council, NHS Lothian and the Scottish Government met to agree a plan to reduce the numbers and length of stay of those patients going through the guardianship process. Subsequently, the Scottish Government and NHS Lothian approved funding for the City of Edinburgh Council to appoint two Mental Health Officers posts to aim to reduce the numbers in this category. Total staff costs were approximately £100,000 per year.

The ihub’s Evidence and Evaluation for Improvement Team (EEvIT) provided support to evaluate the impact of this change. The evaluation process demonstrated that the AWI pilot was a success – the new team and process facilitated a reduction in the numbers of individuals delayed (from 28 to 9) and associated length of stay of delayed patients (3,605 bed days to 827 from April 2016 to March 2017). The positive impact on individuals and their families from reducing unnecessary time spent in hospital, with all the associated distress, was significant. While the number of people delayed may be relatively small, the delays were some of the longest in Edinburgh. Based on the reduction in patients waiting each week and the associated cost per week of an inpatient stay, the AWI pilot represents an efficiency gain in excess of £1 million per year.