Learning point 1: Facilitating a discussion between partners about the ACP improvement approach, roles, responsibilities, specific commitments and support available is essential to the subsequent success of participating in the programme. A clearly defined agreement signed by all parties is required before participation in the care home ACP improvement programme can commence.
Learning point 2: Defining the learning objects for different skill levels and tailoring the training accordingly enables each team member to understand their ACP role and encourages a focus on how non-trained staff can facilitate ACP discussions.
Learning point 3: Contracting the 2-hour training session to 1 hour is challenging from a training perspective and not the optimum approach, however in some cases this may be necessary to ensure all relevant staff are able to benefit from ACP training.
Learning point 4: Local and lateral leadership through care home champions was a critical success factor of the ACP improvement programme. Providing a virtual care home ACP champion network in partnership with St Columba’s Hospice and Project ECHO enabled shared learning, reflective practice and peer support which would otherwise not have been possible given the demands on care home staff time.
What went well?
- Enthusiasm and participation of care homes and GP practices. We had hoped to work with 18 care homes and had more care homes wanting to work with us than we had the capacity to support. We managed to support 20 care homes and their aligned GP practices through phase 3 of the ACP improvement programme.
- The care home ACP improvement approach was successful in enabling testing, reflection and evaluation with improvement outcomes that exceeded all our expectations.
- There is now a shared understanding of the importance of ACP for unpaid carers. The partnership’s carer support team is taking forward ACP improvements.
- Acute care teams are keen to work together to improve ACP across the service interface (ongoing tests of changes re developing inpatient ACPs based on the care home model/testing ACP information provided at discharge and accessed on admission, etc).
- Interest from health and social care teams in developing and testing a structured approach to improving ACP has been more widespread than we’d anticipated, with a range of services now interested in working together to develop an ACP community pathway/improving ACP for people living at home with long term conditions.
What were the challenges?
- Service capacity to design and test ACP improvements is an ongoing challenge. With care homes we had the advantage of two preceding improvement phases when the improvement approach was designed and tested with a few care homes. Learning from phase 1 and 2 informed a structured ACP improvement approach enabling us to work with 20 care homes, with the benefit of being able to predict and address challenges (staff turnover/different skills levels/communication across the interface/technical (digital systems) barriers etc)
- Phase 3 learning has started to inform the service capacity within the integrated health and social care setting and the particular challenges associated with taking forward a structured ACP improvement approach. There is now a clear will and shared aim to improve the ACP community pathway, the challenges experienced during phase 3 can inform future partnership working (eg QI capacity/competing integration priorities/understanding the benefits of ACP for all relevant patient and client groups, etc).
Learning event
To celebrate progress and share approaches to improving ACP, a learning event was held at the end of phase 3, bringing together care home teams, multidisciplinary health and social care teams, third sector partners, and carers involved in improving ACP across Edinburgh’s community. The event was held on Wednesday 6 March 2019 and attended by more than 140 delegates.
Following the event health and social care teams have asked for improvement support to improve ACP. We are considering the best approach to taking forward improvements without continued funding/ dedicated ACP improvement resources.