The first of three learning session events for demonstrator teams was held on Thursday 6 October 2016. The aim of the session was to:
create the opportunity for teams to meet with other demonstrator site teams
find out about the different units and build connections
learn about Experience Based Co-design, explore how this might work in the units, what support would be available and
start to think about local stakeholder engagement.
Who was there?
There were representatives from all 3 demonstrator units with a really good range of professional groups including:
Senior Charge Nurses
Allied Health Professionals
Specialist Palliative Care Nurse
Deputy Charge Nurses
Teams spent the morning getting to know each other and meeting teams from the other wards. Each of the demonstrator teams gave a short presentation about who they are and the improvements already made within their wards, including their aspirations for this improvement programme.
In the morning session, teams were asked how they were feeling about the improvement journey ahead and here is what they said:
“Good to meet and network with other demonstrator sites”
“Good venue, well facilitated, good networking”
“Enjoyed hearing from other sites”
The Healthcare Improvement Scotland team included some of the Focus on Dementia team as well as Diane Graham, Improvement Advisor in the Person Centred Health and Care Team who is leading the national testing of Experience Based Co Design (EBCD). The teams were introduced to EBCD and joined in some practical exercises to try out some of the tools – more information about EBCD can be found on the Kings Fund Website. Feedback from the teams was positive and included:
“Excellent introduction to EBCD”
“Really liked learning about EBCD”
In the afternoon, teams had time to reflect on the morning’s discussions and talk within their teams about how they could start using EBCD within their ward. Each team devised an action plan with timelines and are currently working towards these. Some of the actions included:
Setting-up a steering group
Feeding back to the wider teams about the event and EBCD
Putting posters up in ward area to try to involve patients, families and carers
Holding a local engagement event
68% of people who attended completed evaluation forms after the event and the Healthcare Improvement Scotland team are using the feedback to try to improve subsequent learning sessions…it was important to people attending to have the opportunity for more networking with other demonstrator sites and a venue where the sound can be maximised. Not to mention some food on arrival!
The Focus on Dementia teams held webexes on the 7th and 8th of June for demonstrator teams to hear more about the programme, meet each other (virtually!) and agree on the next steps. Visits were arranged with all teams following this – it was great to finally get to meet the people behind the applications and the enthusiasm and excitement was palpable…
On Tuesday 2nd August we headed East and met the team from Prospectbank in Findlay House, Edinburgh. There was a large group of staff from a wide range of professions. There was a lot of positive energy in the room and everyone there shared their ideas for the programme – a lot of preparation had gone into the visit and the team had put together a presentation as well as a list of possible options for improvement which had been prepared with the wider team in advance. The visiting team from Healthcare Improvement Scotland were given a tour of the ward and it was loveley to see examples of previous improvement works such as person centred environmental designs – the room doors which looked like front doors of houses made the ward look really homely and less clinical.
In the same week, on the 4th of August, Tom McCarthy and Eileen Moir from the Focus on Dementia team headed north to Aberdeen to visit Strathbeg Ward and met with Louise Torrance (Senior Charge Nurse), Julia Wells, (Nurse Consultant, Older Adults Mental Health) and the nursing team, followed by a tour of the unit. Louise and the team described the challenges and rewards of working with the people in their care at Strathbeg and their delight at being selected as a demonstrator site. The unit provides highly specialised dementia care with a major focus on reducing the stress and distress experienced by patients using therapeutic interventions. The team had a conversation around what success would look like at the end of the programme. Here’s a summary of the conversation:
Be recognised as a centre of excellence
Manage the patients’ physical co-morbidity within the unit (rather than transfer to acute hospital)
Enhance safety for patients and staff
Support staff development, morale and motivation
Enhance recruitment of staff to the unit
Increase therapeutic activities, palliative care and sleep solutions
Improve relationships with families and help them have more realistic expectations of what can be provided
Later in August (Thursday 18th), the Focus on Dementia team visited the Glasgow demonstrator site in Balmore Ward, Leverndale Hospital. Again, there was a meeting followed by a tour of the ward.The Balmore team described some approaches they have already taken to engage the team and families being supported by the unit. The unit provides highly specialised dementia care with a major focus on reducing the stress and distress experienced by patients. It was great to hear that the team have already set up a monthly implementation group to steer the improvement work which has met twice already. The team are keen that this programme builds on improvement work which has already taken place in the ward.
The visits were filled with positivity and ideas to take the improvement programme to the next stages. All teams were gifted a welcome pack which included some general information about the programme and contact details. We are looking forward to seeing these filling up with information about tests, improvements and data as the local improvement work gets underway.
April, May and June 2016 saw a lot of the administration being completed, such as:
standard interview questions being created
information governance being approved
lists of people to be interviewed compiled
This is all very necessary, but people were very keen to get the project moving – and to get started on observations and interviewing.
Alongside this administration, we also wanted to ensure that we – as a project group – were prepared for the practicalities of this work. HIS and Iriss therefore arranged a training session in Glasgow for the interviewers to undertake a SafeTalk (delivered by partners from North Lanarkshire Health and Care) and Video Interviewing Technique learning session. SafeTalk was extremely valuable and very sobering as people realised that there are simple but important interventions to be aware of to be able to support people and keep them safe at vulnerable points in their life. Find more information about SafeTalk training.
We were also very privileged to have a patient partner join our interview skills session – who shared her experiences with us. The evaluations from the day suggest that this was the most effective part of the session. Here are some of the comments received:
I liked the group work – gave you a chance to bounce ideas off each other
Very useful and informative
Fran! Thank you for sharing your experiences with us all today
The supportive learning atmosphere – there were some excellent questions asked and answered
There was a series of events held by Iriss in Stirling in late 2015 to select projects to take forward and although the North Lanarkshire project was not initially selected, it was at a later meeting in February 2016 decided that EBCD could be a useful approach to help enable greater understanding about the issues presented.
The partners involved in this project are very diverse which is a real strength as there are many perspectives enabling robust decision-making due to the diversity of input. In March 2016 the core group attended training on EBCD in Glasgow, led by Catherine Dale (Guy’s and St Thomas’ NHS FT), Joanna Goodrich (The Point of Care Foundation), Glen Robert (King’s College London) and Ioanna Xenophontes (Oxleas NHS Foundation Trust). After the training the group had some time to discuss and firm up who would be in the core group and what it’s first actions would be. The group was really keen to get started and filled with enthusiasm after completing the EBCD course.
The project involves working with a number of different agencies which gives you real insight into the different cultures and pressures other people work with. This is very valuable learning and increases your appreciation of the different restrictions and freedoms other agencies have. It can be challenging trying to make rapid progress, when working across so many agencies but the richness of input from the diversity of people and their skills really broadens the group’s wisdom and improves the project decision making and delivery.
I like friends who have independent minds because they tent to make you see problems from all angles.
It’s been a busy few months in the specialist dementia unit team since NHS Boards were invited to nominate a specialist dementia unit to become a demonstrator unit in the improvement programme. Nine boards submitted applications and these were reviewed by a wide range of people with expertise in dementia care. This included people with dementia and carers from around the country, supported by Alzheimer Scotland who shared their views on the applications and influenced the final decisions.
The final selection panel meeting on 25th of May resulted in 3 units being selected:
Balmore Ward, Leverndale Hospital (NHS Greater Glasgow and Clyde)
Prospectbank, Finlay House, (NHS Lothian)
Strathbeg Ward, Royal Cornhill Hospital (NHS Grampian)
We asked for some feedback about the process we used. One of the carer representatives commented:
Having the opportunity to be involved as a carer representative in the selection process has been a most informative and valuable experience… This is just the start of the project and continued proactive carer involvement will ensure that improvements are influenced by the voices of carers, sharing their lived experiences to improve quality of life for all involved.
(National Dementia Carers Action Network representative)
What happens next?
We are working with the selected demonstrator sites to begin this work
We will be selecting a 4th demonstrator site in the summer
We are looking forward to launching the improvement network. We want to co-create this and we will be coming back to you with details on how we do this
We are in the process of recruiting national clinical leads (Psychiatry and Allied Health Professional) to provide clinical expertise to the Focus on Dementia programme including the specialist dementia unit improvement work.