The HUG Model of Family Integrated Care
NHS Greater Glasgow and Clyde
Partner organisations: Bliss Neonatal Charity, Glasgow Children's Hospital Charity, Scottish Book Trust, vCreate
Family Integrated Care (FIC) is an innovative model of neonatal care that supports families to be primary caregivers for their baby in partnership with the clinical team. This approach has proven benefits for sick babies, their families and health services. The Helping us Grow (HUG) group is a unique collaboration of staff and families who have been developing and implementing a model of FIC since 2016.
However FIC is a complex intervention that requires a change in staff practice and culture within busy neonatal settings. There is a significant challenge in trying to implement this complex intervention while also evaluating the wide-ranging potential impact.
The over-arching aim of this project was to provide FIC to all families receiving neonatal care in the Neonatal Unit at the Royal Hospital for Children Glasgow. Specifically: for 100% of families to be primary caregivers in the Neonatal Unit by September 2019.
The project was supported by grant funding from the ihub's Improvement Fund in 2017-2018.
- What was the approach?
This funding supported an existing collaboration of patient families and staff (the “Helping us Grow” team) to develop and test our model of family integrated care. Core to development was the employment of key staff in the team as “HUG” co-ordinators (a Senior Staff Nurse and a Nursery Nurse). The coordinators supported all staff to generate new improvement ideas, working closely with the wider HUG team of patient families and all staff in the Neonatal Unit as well as coordinating with partners including Glasgow Children’s Hospital Charity, Bliss (National Neonatal Charity), Scottish Book Trust, vCreate (video provider).
Engagement with staff and families was done through monthly, open HUG meetings. These forums allowed patient family voices and staff voices to be heard. Electronic surveys, social media campaigns and daily awareness sessions were also carried out to engage with families and staff.
- HUG co-ordinators attending local (NHS GGC) QI workshops, to develop practical QI and leadership skills
- mapping existing activities and improvement aims using driver diagram
- developing a measurement plan and measurement tools. These are a combination of process (“snapshot”) measures, and electronic patient and staff survey-derived outcome measures
- testing new ideas to support FIC, and select the most impactful to embed in our mature model
- sharing and spreading impact and learning, and
- identifying future areas for improvement.
- What was the impact?
Parents report feeling involved in their baby’s care, that staff understand what matters to them. Families are supported to provide kangaroo care, and there have been increased rates of breast feeding. Staff in our neonatal unit were empowered to lead change in the neonatal unit, with families, they developed and applied new skills in improvement methodology, project management, sharing and spreading our work. Many of the nursing staff in our team have used this experience to progress their careers and move into senior clinical roles. The team is happier, more cohesive and truly collaborative.
Wider neonatal, health and social care teams have been engaged with the share learning from the Family Integrated Care model. The model is an exemplar to other services and has been shared widely in the hope of providing practical examples of change and to inspire others.
The Help Us Grow (HUG) co-ordinators learnt new skills in improvement methodology, engaging colleagues, and leadership, which they continue to apply.
An evaluation of FIC has been developed. This is significant as FIC is not a single intervention, but a complex system change involving change in culture and practice. There were previously no existing established measures for this model of care. These mature measures are now embedded in this practice and have been shared with other centres.
Identification of areas for ongoing improvement is simpler using new measures. New areas for improvement during our project and for the future have been identified.
Collaboration across neonatal centres has increased. Collaboration as the model has been shared and a national Scottish FIC was held in March 2019 to support collaboration.
Now recognised as an example of the family-centred principles of Best Start (National Maternity and Neonatal Review) and of Realistic Medicine. Working with Scottish Government staff and families in the HUG team featured in a video to promote family centred neonatal care along with the Chief Medical Officer's Report 2017-18 as an example of Realistic Medicine.
- What was the learning?
- Social media pages are key to communicating across the wider care team (over 200 staff).
- Taking a ‘nudge’ approach and engaging staff through social and attractive activities was important in getting buy in across a large team.
- Developing work alongside existing clinical duties will support efficiencies.
- FIC measurement is complex and evaluation should be based on evidence-based components.
- Grass-roots engagement is vital to empower people, including staff.
- Senior staff need to fully support the development of new work.
- What are the next steps?
Through the success of this project, and in collaboration with patient families, three key objectives for the following 24 months have been identified:
- Objective 1: Develop training videos for staff and families., to give parents the practical skills and confidence to care for their baby in the NNU.
- Objective 2: Develop a “train the trainer” package, to teach staff how to positively interact, mentor and motivate families as carers.
- Objective 3: Develop a parent held log, containing their personalised information, record of parent training and involvement, and preparation for discharge.
Funding was secured for an additional 24 months from the Cattanach Charitable Trust to achieve these specific aims.