1. in Acute Care Collaborative Evaluation
Older People
in Acute Care Collaborative
Evaluation
Pat O’Connor, Clinical Director R&D, NHS Tayside

3. Scotland’s Pop. 5.1 million 14 health Boards 150,000 staff
Orkney
Shetland
Western
Isles
And
7 Special Boards
NHS24 NHS Education Scotland NHS Health Scotland NHS Healthcare Improvement Scotland Scottish Ambulance Service
State Hospital National Waiting Times Unit
Highland
Grampian
Tayside
Fife
Greater
Glasgow Clyde
Forth Valley
Lothian
Lanarkshire
Borders
Dumfries &
Galloway
Ayrshire
& Arran

4. Challenges
Increase in the elderly population NHS Tayside 60-70% of inpatients are over 65
Acute hospital care not set up or designed specifically for the elderly
Poor experience data older people and their carers of hospital care
Patient population: 60-70% over 65 years
50% over 75 years
15-20% over 85 years

5. Aim
To improve the experience of older people in acute care through the delivery of a person centred approach by
November 2013
Goals:
95% of patient satisfaction scores are excellent
300 days between formal complaints
95% of appropriate patients receive a standardised
screening

6. Public
Mrs V died aged 80 in hospital on December Following her death an independent doctor (psychiatrist) raised concerns regarding aspects of Mrs V's care with the Mental Welfare Commission, in particular, her lack of nutrition during a sustained period.

7. Government Level
Improving the assessment of people who might have dementia who are admitted to hospital;
Improving patient information systems
Patient centred -about the person, including their likes, dislikes and routines;
Reducing unnecessary admissions of people with dementia; facilitating timely discharge;
Better assessment, treatment and management in hospital of frail elderly people
Improving access to telecare, intermediate care services and re-ablement.

8. IHI Breakthrough Series
Participants
(14 Teams)
Select Topic (Develop Mission)
Prework P S A D P S A D P S A D
Develop
Framework
& Changes
Expert Meeting
LS 1
June 2012
LS 2
January
2013
LS 3
May 2013
LS4
December
2013
Holding the Gains
Planning
Group
Photo 1 – master class for opac planning group with improvement methodology
LS1 – Mr potatoe head –stracathro
LS2 – pitoddrie – top and bottom – snow, had visitor from oz, who skyped in
LS3 – westpark doing the chinese whispers and bottom
LS4 – how do we hold the gains and keep doing the great work we have been doing. Fireworks here to celebrate
AP1
AP2
AP3 4 4 4

9. NHS Tayside/NHS Grampian Older People In Acute Care Collaborative
Aim
Screening tool
Reliable comprehensive assessment:
Medical health (e.g. medicine
reconciliation)
Functioning
Psychological
Social function
Risk identification
Person centred
assessment
& plan of care by the
multidisciplinary team
To improve the
experience of older
people in acute
care through the
delivery of a
person centred
approach by
November 2013
Goals:
1. 95% of patient
satisfaction scores are > 4
days between formal
Complaints
3. 95%patients receive a
standardised screening
Increase family and carer involvement in care
Review revise environment of care
Optimise use of volunteer services
Delivery of patient family
centred care
Promote open communication among MDT,
patients, carers and families
Optimise efficiency in handoffs and discharge
process
Promote use of patient, family, carer feedback to
improve care
Equip staff with the appropriate knowledge and
skills to care for patients with dementia
Collaborative
multidisciplinary
team and person
centred
Culture
Develop infrastructure to support teams QI work
Provide oversight of collaborative
align position collaborative with wider
organisational agenda
Develop infrastructure to work in partnership
with teams across NHS Tayside and
NHSGrampian
Leadership framework
to support
improvement
progress

10. s

11. Collaborative Model
Leadership group
Medical Director
Nurse Director
CEO
Senior Manager
Ward Team lead
Patient and carer
Medical
Nursing
Pharmacy
Support services
Porters
Volunteers
Dedicated locally developed change package of interventions

12. Evaluation
Aim
To critically evaluate the of the implementation of the older peoples collaborative in NHS Tayside
Mixed methods case study
Analysis of design and implementation plans and arrangements -: local structure, minutes, actions and, reflective diaries
Participation and observation in learning sets
Focus group and semi structured interviews with Tayside attendees of learning sets (n= 70)
Analysis of measurement data recorded by frontline staff

13. Research Questions
Is the programme or intervention in place reaching the people as intended?
What are the challenges to implementing the programme?
What appears to be working so far?
How satisfied are people with the delivery of the intervention services?
What do they like most, and what are they concerned about?
Cost and value considerations?
Leaders and mainstream managers views of OPAC?

14. Evaluation Being present, and seeing staff in action
Conducting the interviews with the teams
Listening to contributions that people were able and willing to make in terms of their work and responsibilities
Hearing the openness with which people spoke about their work and the Older People and thier families in their care
Learning about some of the examples/innovations developed in response to OPAC

15. Staff Interviews
“Something about this method(PDSA and collaboration for learning) that works”
“Better communication”
“Improved environment” Large clocks coloured doors picture signs toilet etc
“Improved handover”
“Faster and more complete patient assessments for our most vulnerable patients”
“We’re making it better form the inside out”

16. Enhancing Care
Cutting meal distribution down from 1½ hours to 12 minutes
Weighing Older Persons on admission then settling them into bed rather than vice versa
Domestic and Auxiliary Staffs’ role in risk assesment and safety briefing assisting Older Persons’ hydration and in pre-meal hand washing
Increased use of “This is Me” and Butterfly Scheme

17. The Butterfly Scheme
reaching out to people with dementia

18. Planned Date of Discharge (PDD)
Safety / patient info boards

21. OPACC – Ward Information Board

22. AMU
Percentage of patients screened using a standardised screening tool
Poster highlighting importance of screening for patients > 75 years of age on wall.
Education for nursing staff by by Senior Charge Nurse and Nurse Consultant
New nursing staff.

23. Arbroath-% of patients who have received an initial screening for a SAM assessment
Embedded in clerk in document
Results shared with nursing staff so more on board
review of form
Testing patients
introduced screening form for self admin of medications
Team joins OPAC and starts testing

24. MDT-Staff Involvement in Safety Briefs
Taped handover introduced including safety brief
Domestic support symbols introduced for safety brief
Whiteboard-symbols introduced
Weekly
This illustrates the involvement of a variety of staff groups within the safety briefings also captured each week since July 2013.
At the commencement the team were hoping all staff would be involved in safety briefs but there were difficulties with everyone being available at the same time,
For example the AHPs –OTs and physiotherapists did not participate as this was difficult due to the geographical areas they cover across Angus. The ward tested and implemented a taped handover with safety brief at the start which can be listened to by the physios and Ots. Nursing staff also listen to this at the handover.
It was also recognised that information on the white boards did not always relate to safety issues and the list not always updated. The introduction of magnetic symbols on the whiteboards has made it much quicker and easier for MDT members to understand information on the board.
The domestic staff also the safety board and have devised symbols transferring the symbols onto the board in the domestic support room to ensure support staff are also aware of safety issues within the ward. This is held twice a day.

25. 5 Wards are more than 300 days since their last complaint, one achieving > All show improvement.

26. Staff Feedback “it’s brought back some of the personal elements”
“[it allows us] to take action rather than create action plans”
“it provides an opportunity for deep reflection”
“support has been phenomenal”
“enjoying patient interaction”
“the [Ward] is relentlessly busy and…it’s difficult to step back and consider BUT the collaborative has provided a structure for reflection on quality”
“[we have] more sense of worth [as] part of the team”
“[we’re] seeing barriers breaking down”
“we can incorporate each other’s ideas”
“it’s infectious!”

27. How much did it cost?
Staff member
Cost
Consultant
£410.92
Pharmacist
£195.88
Senior Charge Nurse
£164.17
Physiotherapist
£137.08
Staff Nurse
£109.37
Nursing Assistant
£71.60
Porter
Domestic
£65.95
Local collaborative accommodation for learning sets
Staff time out cost per day
Additional funding for local environment and signage improvements £35K
Evaluation £10K

28. Conclusions Some evidence of improvement in all participating wards
High level of patient experience scores in participating ward areas
Sense of purpose and team vitality for participating staff groups
Action oriented programme of work
Real ‘can do’ attitude for change and improvement

29. Conclusions cont.
Understanding of the programme and collaborative goals not widely understood senior leadership.
Sustained change not yet evident in all areas for the goals set
Some Middle and Senior managers often felt left out of the main stream collaborative work

30. The work continues
Older peoples implementation groups operational changes at scale integrated health and social care
More cohesive and inclusive approach
Team vitality been maintained (pic) Quality award

31. Contact
Dr Anne Fearfull Dr Pat O’Connor

32. Table Exercise
Find at your tables large post-it notes – some yellow, some blue – and take some of each color
Using the post-it notes, answer the following questions:
On the yellow post-it notes: What am I doing that is like this?
On the blue post-it notes: What would we like to do that incorporates this idea and moves it forward?
At the break, place your post-it notes the driver diagram so people can walk around and read them