Round up for March 2019

Evidence of what works support to enable continuity and coordination in palliative and end of life care

A new resource has been published as result of our work with the Living Well in Communities programme to support understanding of what works to support continuity and coordination in palliative and end of life care. The Living Well in Communities team has been working with a number of test sites to support improvement of palliative and end of life care as part of delivering the Scottish Government’s Strategic Framework for Action on Palliative and End of Life Care. The resource summarises the systematic review level evidence in relation to a number of different approaches contributing to improving continuity and coordination of palliative and end of life care.

The identification of approaches was informed by the World Health Organisation's practice brief on continuity and co-ordination of care. Many of the approaches that aim to improve care coordination are not well defined or researched, limiting the certainty of the evidence supporting their use. However, the resource is intended to provide a clear overview of the rationale and expected benefits from the best available evidence in relation to the following:

  • Early integrated palliative care
  • Collaborative planning of care and shared decision making
  • Case management for people with palliative and end of life care needs
  • Intermediate palliative care at home
  • Technology to support continuity and care coordination
  • Building workforce capability

Pathway redesign quality improvement methodology

A rapid literature review has been produced to help inform a pathway redesign quality improvement methodology for Scotland. This literature review described the different methods that have been applied to pathway redesign and summarises their impact. A number of systematised quality improvement approaches have been applied including whole systems flow, microsystem approaches and approaches that integrate lean methodology. Successful approaches to redesigning care pathways which have resulted in improved outcomes including waiting times, have adopted various quality improvement methodologies with lean methodologies being common. 

Spotlight on developments in evaluation 

Rapid evaluation driving improvement
The use of rapid evaluation approaches to drive improvement in health services have been in the spotlight recently as evaluators and commissioners came together to share their learning at an event in collaboration between the Nuffield Trust and three national Rapid Evaluation Centres. Rapid evaluation has an important role because of how quickly innovations can change during their implementation and how timely feedback from evaluation can enhance how innovations are being tested.

Rapid evaluation has been found to work well when sites are developing how to improve and a longer-term approach to monitoring outcomes is important to develop alongside rapid approaches. A further key message from experiences of those adopting rapid approaches is how this requires evaluators to take on a coaching role unlike in traditional approaches. The presentations from the day outline the challenges and opportunities that rapid evaluation brings.

Improving evaluation planning using Evaluability Assessment
Evaluability assessment is an approach that is increasingly being used in Scotland to improve evaluation planning. The overall purpose of an Evaluability Assessment is to inform how and when an evaluation should be carried out in order to produce credible and useful results. What Works Scotland have published a briefing on their application and development of Evaluability Assessment in Scotland in partnership with NHS Health Scotland and the Scottish Collaboration for Public Health Research and Policy at the University of Edinburgh. The briefing describes important lessons about how the approach should be used to improve evaluation planning.