Autumn Speakers Series: Under what circumstances, and in what ways, is a quality improvement collaborative likely to succeed in a care home setting?

Dr Reena Devi is a research fellow in the Division of Medical Sciences and Graduate Entry Medicine at the University of Nottingham. She is working on the PEACH (‘ProactivE heAlthcare for older people living in Care Homes) study, which is led by Dr Adam Gordon, and funded by the Dunhill Medical Trust. She will be speaking at the upcoming BGS Autumn Meeting in London. She tweets @_DrReenaDevi 

Improving healthcare services delivered to older people is high on the national agenda. Nationwide initiatives are currently focusing on this, for example, six of the Vanguard projects set up in response to the 5 year forward view are specifically devoted to delivering new models of healthcare into care homes. Smaller scale initiatives are also being carried out in local settings, such as the PEACH project.

The PEACH project is using improvement science to bridge the gap between what we know and what we do in terms of the healthcare services delivered to care homes in South Nottinghamshire. The project is working with 4 clinical commissioning groups and their associated healthcare and care home providers, and is focusing on bringing healthcare services closer in-line with the Comprehensive Geriatric Assessment (CGA) model of care. The Breakthrough-series quality improvement collaborative method is being used, bringing together local and key care home related stakeholders. This includes commissioners, GPs, geriatricians, nurses, pharmacists, specialist therapists, AGE UK representatives, care home workers, and lay people. Together, with their expertise, experience and knowledge they have examined current services and identified ways to better align services closer to the CGA model. Once the collaborative have identified gaps, and then planned their quality improvement initiatives, they then start implementing them in a small way, testing whether they achieve improvement with each cycle. The PEACH quality improvement collaborative started in September 2016 and members are following a structured programme, consisting of large meetings, training and coaching in quality improvement, support with organisational tasks, and backfill payment for GPs/care home workers.

One aspect of the project involves evaluating the processes around how the collaborative operates and, specifically, examining the extent to which groups are effective (or not) in implementing their plans. A realist evaluation approach is being used to explore the contextual and mechanistic factors which either facilitate or block effective working. I am working closely with the collaborative members, observing their meetings, carrying out interviews and focus groups and reviewing relevant documentation.  By doing this I am gaining an insight into how the collaborative are working together, and the contexts and mechanisms influencing outcomes. It is envisaged that this work will inform an understanding of the different circumstances and mechanisms that bring about successful outcomes when working to improve the healthcare services delivered to older people living in care homes. At the BGS Autumn Meeting in London I will present preliminary findings from this work.

If you’d like to get in touch, or find out more about the PEACH quality improvement collaborative work please contact reena.devi@nottingham.ac.uk

Register for the BGS Autumn Meeting 22 – 24 2017 at Excel in London