Supporting person-centred care during COVID-19 via quality improvement and learning | 16 June 2020
By the Evidence and Evaluation for Improvement Team (EEvIT) at Healthcare Improvement Scotland's Improvement hub (ihub).
EEvIT is working in diverse ways in the current context with colleagues to share and capture learning about the health and social care system. Examples particular to the person-centred health and care programme include supporting collation of current innovations in supporting person-centred care in COVID-19 situations and carrying out regular scans of research literature relating to person-centred care in the context of COVID-19.
Here, we outline a new International Journal for Quality in Healthcare editorial by Staines and colleagues which emphasises the skills which QI and patient safety experts can contribute to health services in an accelerated process of organisational change, and link suggested actions with some examples of current innovations in the NHS.
Deploying skills during COVID-19
The editorial suggests that in order to respond to the COVID-19 pandemic, many healthcare systems have had to reorganise rapidly, with limited time to consider the roles assigned to quality improvement (QI) and patient safety (PS) experts, as those staff with clinical backgrounds were redeployed to directly support the delivery of clinical care or specific programmes were paused.
Five step strategy
The authors report that understanding systems theory, complexity of healthcare systems, human factors and reliability theories, and change methodologies is crucial to the success of any transformation programme.
They outline a five-step strategy and actions through which QI and PS experts can contribute during a pandemic using their core skills to support patients, staff and organisations.
|Step||Strategy||Overview of actions which QI/PS experts can contribute|
|1||Strengthen the system and environment||Assessing readiness, gathering evidence, setting up training, promoting staff safety and bolstering peer support.|
|2||Support patient, family and community engagement and empowerment||Engaging with citizens, patients and their families (particularly where citizens are required to undertake preventive interventions).|
|3||Improve clinical care||Separation of flows, flash workshops on teamwork and the development of clinical decision support.|
|4||Reduce harm||Proactively managing risk to both patients with COVID-19 and other patients.|
|5||Boost and expand the learning system||Capture improvement opportunities, adjust very rapidly and develop resilience.|
We now outline the actions related to Steps 1 and 2 and highlight some related innovations relevant to person-centred care.
Strengthening the system and environment: actions and innovations
|Step 1 action||Example of QI knowledge/skills|
|Identify an appropriate readiness checklist and assess the situation||Promotes rapid identification of areas to improve.|
|Gather experience and evidence, filter, summarize and brief||QI experts are often in a unique position to gather international experience via international connections and affiliations.|
|Set up just-in-time training and simulation on infrequently used skills||Development of instructions and simulations on donning and doffing personal protection equipment (PPE) or environmental disinfection.|
|Advise and support distributed leadership||Support with system thinking and learning.|
|Promote staff safety, well-being and psychological safety||Advise on staff needs and connect with occupational health services.|
|Organise peer support||Develop or support peer support programme.|
Selected examples of current NHS innovations related to staff safety, wellbeing and psychological safety, and peer support include:
- NHS Grampian has opened a staff wellbeing centre within Aberdeen Royal Infirmary via the clinical psychology team.
- NHS Greater Glasgow and Clyde has set up an Acute Psychology Staff Support Service that offers 'psychological first aid' for hospital staff.
- NHS Louisa Jordan has set up a 'check in, check through, check out' process to connect staff and enhance their wellbeing.
Innovations related to supporting patient, family and community engagement and empowerment
|Step 2 action||Example of QI knowledge/skills|
|Facilitate the co-production of solutions for prevention, isolation, treatment and recovery||Working and communicating with people and their loved ones to develop self-management and prevention solutions.|
|Help identify, develop and disseminate patient self-management tools||Especially where people with long-term conditions have lost access to care.|
|Leverage or establish patient partnerships||Identify potential coaches (people who have recovered or have lived experience of another epidemic disease).|
|Advise leaders on person-centredness during a pandemic||Supported by patient partners, provide advice to leaders on developing or maintaining person-centredness, including linguistic and ethical considerations.|
|Assess equity in patient care and safety||Consider gender, class, socio-economic status and ethnicity and consequences of social and economic inequity.|
|Optimize visitation policy||Identify methods and feasibility of family support and virtual visitation. Support solution-finding for visits for patients at end of life.|
Selected examples of current NHS innovations related to assessing equity in patient care and optimising visitation policy include:
- The East London NHS Foundation Trust has developed a framework for each service, together with its service users, to begin defining the future shape of the service (building on existing quality impact assessment) using a population health and equity lens.
- NHS Greater Glasgow and Clyde has developed an organisational policy to support person-centred virtual visiting in wards while in-person visiting is suspended.
Whilst we have limited space to outline them here, the editorial describes a number of specific actions for steps 3 to 5 in detail. The final step of the strategy centres on boosting and expanding learning systems.
Healthcare Improvement Scotland continues to understand the importance of this in the current context, for example via the Health and Social Care Learning in Scotland repository. The recent publication of our evolving approach to supporting the redesign and continuous improvement of health and care services is intended to facilitate further discussion and critique with colleagues working across health and social care in Scotland and the UK and the wider international context.