Reena Devi1, Neil H Chadborn2,3, Julienne Meyer4, Jay Banerjee5, Claire Goodman6,7, Tom Dening2, John R F Gladman2,3,8, Kathryn Hinsliff-Smith9, Annabelle Long2, Adeela Usman2, Gemma Housley10, Sarah Lewis2, Matthew Glover11, Heather Gage11, Philippa A Logan2,3,8,12, Finbarr C Martin13, Adam L Gordon2,3,4,8. 1. School of Healthcare, University of Leeds, Leeds, UK. 2. School of Medicine, University of Nottingham, Nottingham, UK. 3. NIHR Applied Research Collaboration - East Midlands (ARC-EM), UK. 4. School of Health Sciences, City University of London, London, UK. 5. University Hospitals of Leicester NHS Trust, University of Leicester, Leicester, and Loughborough University, Loughborough, UK. 6. School of Health and Social Work, University of Hertfordshire, Hatfield, UK. 7. NIHR Applied Research Collaboration - East of England (ARC-EoE), UK. 8. NIHR Nottingham Biomedical Research Centre, Nottingham, UK. 9. Faculty of Health and Life Sciences, De Montfort University, Leicester, UK. 10. Nottingham University Hospitals NHS Trust, Nottingham, UK. 11. Surrey Health Economics Centre, University of Surrey, Guildford, UK. 12. Nottingham CityCare Partnership, NHS Provider Service, Nottingham, UK. 13. Population Health Sciences, King's College London, London, UK.
Abstract
BACKGROUND: Quality improvement collaboratives (QICs) bring together multidisciplinary teams in a structured process to improve care quality. How QICs can be used to support healthcare improvement in care homes is not fully understood. METHODS: A realist evaluation to develop and test a programme theory of how QICs work to improve healthcare in care homes. A multiple case study design considered implementation across 4 sites and 29 care homes. Observations, interviews and focus groups captured contexts and mechanisms operating within QICs. Data analysis classified emerging themes using context-mechanism-outcome configurations to explain how NHS and care home staff work together to design and implement improvement. RESULTS: QICs will be able to implement and iterate improvements in care homes where they have a broad and easily understandable remit; recruit staff with established partnership working between the NHS and care homes; use strategies to build relationships and minimise hierarchy; protect and pay for staff time; enable staff to implement improvements aligned with existing work; help members develop plans in manageable chunks through QI coaching; encourage QIC members to recruit multidisciplinary support through existing networks; facilitate meetings in care homes and use shared learning events to build multidisciplinary interventions stepwise. Teams did not use measurement for change, citing difficulties integrating this into pre-existing and QI-related workload. CONCLUSIONS: These findings outline what needs to be in place for health and social care staff to work together to effect change. Further research needs to consider ways to work alongside staff to incorporate measurement for change into QI.
BACKGROUND: Quality improvement collaboratives (QICs) bring together multidisciplinary teams in a structured process to improve care quality. How QICs can be used to support healthcare improvement in care homes is not fully understood. METHODS: A realist evaluation to develop and test a programme theory of how QICs work to improve healthcare in care homes. A multiple case study design considered implementation across 4 sites and 29 care homes. Observations, interviews and focus groups captured contexts and mechanisms operating within QICs. Data analysis classified emerging themes using context-mechanism-outcome configurations to explain how NHS and care home staff work together to design and implement improvement. RESULTS: QICs will be able to implement and iterate improvements in care homes where they have a broad and easily understandable remit; recruit staff with established partnership working between the NHS and care homes; use strategies to build relationships and minimise hierarchy; protect and pay for staff time; enable staff to implement improvements aligned with existing work; help members develop plans in manageable chunks through QI coaching; encourage QIC members to recruit multidisciplinary support through existing networks; facilitate meetings in care homes and use shared learning events to build multidisciplinary interventions stepwise. Teams did not use measurement for change, citing difficulties integrating this into pre-existing and QI-related workload. CONCLUSIONS: These findings outline what needs to be in place for health and social care staff to work together to effect change. Further research needs to consider ways to work alongside staff to incorporate measurement for change into QI.
Authors: Philippa A Logan; Jane C Horne; Frances Allen; Sarah J Armstrong; Allan B Clark; Simon Conroy; Janet Darby; Chris Fox; John Rf Gladman; Maureen Godfrey; Adam L Gordon; Lisa Irvine; Paul Leighton; Karen McCartney; Gail Mountain; Kate Robertson; Katie Robinson; Tracey H Sach; Susan Stirling; Edward Cf Wilson; Erika J Sims Journal: Health Technol Assess Date: 2022-01 Impact factor: 4.014
Authors: Guy Peryer; Sarah Kelly; Jessica Blake; Jennifer K Burton; Lisa Irvine; Andy Cowan; Gizdem Akdur; Anne Killett; Sarah L Brand; Massirfufulay Kpehe Musa; Julienne Meyer; Adam L Gordon; Claire Goodman Journal: Age Ageing Date: 2022-03-01 Impact factor: 10.668
Authors: Pip A Logan; Jane C Horne; John R F Gladman; Adam L Gordon; Tracey Sach; Allan Clark; Katie Robinson; Sarah Armstrong; Sue Stirling; Paul Leighton; Janet Darby; Fran Allen; Lisa Irvine; Ed C F Wilson; Chris Fox; Simon Conroy; Gail Mountain; Karen McCartney; Maureen Godfrey; Erika Sims Journal: BMJ Date: 2021-12-07