Providing practical support

95% of patients in 5 supported H&SCPs had a pressure ulcer prevention care plan in place

 

A major focus of the ihub work is practical support to enable organisations to implement changes that will lead to improvement.

 

  • We support delivery partners to use a systematic approach to testing and scaling up change
  • We design and deliver international improvement programmes that address common challenges across Scotland through a systematic approach to testing and then spreading at scale
  • We develop practical tools and guidance that support implementation of changes in agreed priority areas
  • We support delivery partners to build their capacity to apply change through commissioning training in improvement and providing practical coaching
  • We provide grants so delivery partners can test potential solutions to common priority improvement challenges across Scotland and develop guidance and tools that enhance that work
  • We provide allocations which allow delivery partners to develop their quality assurance infrastructures
  • We facilitate connections and collaboration between individuals working on common challenges (including uk-wide and international networks)
  • We work to ensure the national context supports, rather than hinders, the work of improvement

Examples of our work

National improvement programmes

We ran 31 national improvement programmes covering a diverse range of service areas, including mental health, dementia, housing, primary care, frailty in the community, intermediate care and reablement, ACP, person-centred care, and older people in acute care. We also ran the internationally acclaimed improvement programmes in patient safety, the Scottish Patient Safety Programme (SPSP), which covers acute care, maternity, neonates and children’s services, primary care, medicines and mental health.

Our national improvement programmes support delivery partners to practically implement improvements and include:

  • a mixture of providing advice on high impact changes that will lead to improvement in any given area
  • facilitating learning networks (face to face and virtual) that allow those working on a common topic to share knowledge and experiences about what is and isn’t working
  • developing practical tools to support implementation, and
  • supporting services to put data collection processes in place so they know whether changes are leading to actual improvements.

In 2016–2017, we worked with key partners to design and set up new national improvement programmes for palliative care, neighbourhood care and GP clusters.

We also worked with NHS Fife to evaluate the impact of their Frailty at the Front Door work which was supported by our Older People in Acute Care (OPAC) improvement programme.

NHS Fife – The Front Door Discharge Support Model

NHS Fife worked with partners in Fife Council to provide a responsive discharge support model designed around the whole person’s pathway rather than focus on the care people receive in hospitals.

The ability to meet the needs of people who are frail with instant access to reenablement discharge support services enhances their experience and care and allows them to be cared for in their own homes. Without this intervention, people in Fife would have to be admitted to a geriatric ward at Victoria Hospital, Kirkcaldy.

The Front Door Discharge Support Model was developed to test whether people who otherwise would stay in hospital for non-clinical care could be discharged with short term support to provide non-clinical care as an alternative to an inpatient stay.

The first test of change was in place for 10 weeks and successfully helped 87 people return to their home or homely setting avoiding the need to be admitted to a ward. The test of change intervention was a support for discharge package supplied by Fife Council with their partners at The Avenue care services. Health and social care staff worked together with the Fife Frailty Hub to co-ordinate care from within Victoria Hospital, facilitating assessment within 2 hours of referral. Only three people from the 87 required further assessment and provision of a package of care.

The ihub worked with NHS Fife to evaluate the model using economic analysis and measurement support to assess whether the changes led to improvements for older people presenting at A&E departments.

The support for discharge package was measured through a simple cost analysis carried out to assess the potential cost difference between discharges with support versus hospital admission.

A £250K efficiency saving was realised over the 10-week period and a further saving was identified as the winter capacity ward was not needed.

The ihub is enabling NHS Fife to spread the learning from this to other NHS boards by supporting the development of a frailty network across Scotland

Scottish Improvement Leader programme

The ihub funds 60 places a year for staff working in health and social care organisations on the Scottish Improvement Leader (ScIL) programme, run by NES. Since its inception, 40 organisations across Scotland have been able to access the ScIL programme. A recent evaluation of the training highlighted that, 12 months after the training ended, 86% of participants report they are confident in using their skills, 71% are using these skills and 70% feel supported by their organisations to apply them. One cohort alone (30 people) has facilitated quality improvement learning with over 500 people in the year following their training.

Find out more about the impact of this successful programme

Public Partners – essential and integral to the work of the ihub

Ongoing engagement, and working in collaboration, with service user and carer groups, and third sector groups is an essential and integral component of how the ihub works.

The SPSP-Mental Health programme is well established in working with Public Partners to ensure that its work is co-designed and delivered.

A current example is our ongoing support and participation from Voices of Experience who enable us to embed the views and influence of individuals with a lived experience of mental health issues throughout our work and, in particular, through the ongoing development and delivery of the patient safety climate tool.

The patient safety climate tool enables mental health patients to share the way they feel about their experiences and forms a powerful message that is helping staff working in wards and units to have a greater understanding of the complexity of the patients’ experience. The tool aims to minimise the possibilities of re-traumatisation and support the development of a service that is more responsive to the experiences of those who receive care and critically provides concrete, real ideas for improvement.

Gordon Johnston, Healthcare Improvement Scotland Public Partner and Director of Bipolar Scotland has led the voice of lived experience through this work and recognises the value of:

“Giving patients the chance to express their feelings and concerns about their safety while receiving care. This information will then allow services to make any improvements needed, resulting in a better patient experience.”

NHS Lanarkshire – reduction in admission to the neonatal unit

Cheryl Clark, a midwife from Lanarkshire, selected the project topic of thermoregulation (maintain a regular body temperature) of the newborn for her focus during the ScIL programme. She was supported by NHS Lanarkshire, as it is one of the NHS board’s priority improvements within maternity and neonatal care. At the beginning of the ScIL programme, Cheryl’s aim was a reduction in term admissions (babies born at or after 37 weeks) to the neonatal unit by 15% from ward 22, through implementation of the warm bundle of care, a key process change of the Maternity and Children Quality Improvement Collaborative (MCQIC). Applying appropriate quality improvement tools and techniques learnt through her experience of participating on the ScIL programme, she exceeded her initial aim and achieved a 40% reduction in admissions, as well as a reduction of 20% in unnecessary antibiotic administration. The impact of this work has meant ‘mum and baby’ experience uninterrupted bonding and attachment, which is critical for optimising outcomes at this early stage.

Examples of our work

5.3% of the population's Anticipatory Care Plans are now available to view electronically

As part of our work to support the implementation of Anticipatory Care Planning (ACP), we developed a standardised national template for ACP and a dedicated website – myacp.scot

Over 5.3% of the population's Anticipatory Care Plans are now available to view electronically by staff after patient admission. That's an increase of over 46,000 from last year - up from 4.5% and supports Integration Authorities to improve the provision of palliative and end of life care.

The ihub’s Living Well in Communities team helps partnerships promote new ways of delivering services that allow more people to spend time at home or in a homely setting that would otherwise have been spent in hospital. The work of the team includes improvement support for frailty and falls, pathways in the community, identification and co-ordination of palliative care, ACP, intermediate care, re-enablement services and testing models of neighbourhood care.

Working with multidisciplinary teams in the community to deliver reliable approaches to supporting individuals with frailty

In addition to our work on Anticipatory Care Plans, the ihub is also supporting Integration Authorities to identify and better support individuals who are frail. The evidence highlights that proactively identifying people in the community who are frail and then ensuring they have appropriate support to maintain their independence is key to reducing unnecessary hospital admissions.

In 2016–2017, our Living Well in Communities team supported the introduction of the eFrailty Index (eFI), developed by NHS England, into the Scottish context. This tool applies algorithms to existing GP data to produce a list of all individuals on the practice list who are either mildly frail, moderately frail or severely frail. However, knowing who falls into which category is meaningless if we don’t then do something with that data.

The following case study highlights how we are now working with services to develop tools and approaches to support them to use the information gathered to make more informed decisions about how to better support individuals to live well with frailty.

Midlock GP Practice

Midlock GP Practice has been working with the ihub to test the eFI in a Scottish context. The testing has involved working with a GP and other members of South Glasgow City Health and Social Care Partnership, including community nursing, social work, the rehabilitation team, carers’ support, housing, commissioning, older people’s mental health services and the voluntary sector.

Following stratification of their population using the eFI, the Midlock team then considered what interventions would be appropriate for individuals with different levels of frailty.

As part of this, a multidisciplinary team started to use the ihub falls and frailty tool to guide their frailty case reviews. The tool promotes an assets-based approach and holistic assessment across agencies, and provides useful prompts that help staff by signposting to partner agencies that could assist in care provision. Incorporating the tool in the case reviews led them to identify five key interventions which should be implemented for every individual identified as frail:

  1. frailty identification and coding on the GP system
  2. Anticipatory Care Plans uploaded to KIS
  3. ensure a key worker is allocated
  4. provide carer support and assessment, and
  5. conduct a falls and frailty conversation.

These interventions had previously not been happening for every person, every time.

All of the team have made commitments to support the work. Community nurses are engaging more in ACP conversations, and the voluntary sector feel valued and are now a core part of the multidisciplinary team, whereas previously they had been on the periphery. The team have changed the way that they work and are now able to more proactively target those most in need of support.

“It challenges me to think differently about the people I treat.”

“Working together has made us communicate with one another more regularly and avoid duplication of assessment.” – Midlock GP Practice team

 

NHS Ayrshire & Arran – reduction in avoidable admissions

Additional improvement support capacity was provided to acute services and the three Health and Social Care Partnerships in Ayrshire and Arran. One example of this improvement support was to test Allied Health Professional and nurse-led rehabilitation beds with a community multidisciplinary approach to ACP. They reported outcomes which include a reduced length of stay (Mean) from 50 days to 24 days in the rehabilitation beds and a reduction in avoidable admissions and self-reported patient wellbeing.