More than 18,000 care homes in England provide support for over 386,000 people. Many of these people have complex healthcare needs, with multiple long-term conditions, disability and frailty.
Care home teams work hard to support residents but generally there is a high turnover of staff and limited investment in developing skills. Systematic approaches to improving quality, which are becoming more commonplace in the NHS and other sectors, are virtually unknown in care homes.
Facing the challenge
The PROSPER programme was set up to test whether quality improvement (QI) methods could be implemented in care homes to improve safety and reduce harm for vulnerable residents at risk of admission to hospital or significant deterioration.
Initial funding for the PROSPER programme was provided by The Health Foundation, whose support was secured by a persuasive bid written by UCLPartners in collaboration with Essex County Council staff, care home managers, academics and Clinical Commissioning Group leaders.
From 2014-2016 PROSPER was delivered collaboratively by care homes teams in Essex, Essex County Council, UCLPartners and Anglia Ruskin Health Partnership. The programme used QI methods to reduce preventable harm from three of the most common safety issues in care homes: falls, urinary tract infections and pressure ulcers.
Ninety care homes participated in the initial programme which comprised:
- Training in QI methods
- A toolkit of ideas and information specifically designed to support care home staff to implement QI
- Tools to help monitor change in resident outcomes
- Opportunities to share learning with other homes
- Support visits from Council improvement facilitators
The care homes collected baseline data prior to implementing improvement ideas. Teams used Plan Do Study Act cycles to conduct small tests of change, collecting data to assess if the changes were effective in the reduction of harms.
Dedicated support from Essex County Council, informed by expertise from UCLPartners, was provided to the care homes for six months. In the time following, teams continued to receive support through a community of practice, regular newsletters, ‘champion’ study days and ad-hoc meetings.
When The Health Foundation funding came to an end, Essex County Council decided to make an ongoing investment into the programme, swayed by strong evidence advocating the model penned in part by UCLPartners experts and published in the Journal of The Royal Society of Medicine and BMJ Quality and Safety.
This ongoing funding has enabled the PROSPER model has spread through care homes in Essex, with 164 homes now using the model. Since implementing the approach, four homes have received an outstanding rating by the CQC, with much praise attributed to their QI activity in the reports.
Since joining Longfield Care Home as a new manager four years ago, I’ve found PROSPER invaluable. Falls are a problem for many care home residents.
Through the Community of Practice events, our staff have gathered a host of ideas to help reduce falls, such as sharing the ‘Good Footwear Guide’ with relatives, resulting in more of our residents wearing adjustable, well-fitting shoes. We’ve also painted the brick wall that our wooden handrail is attached to white, reducing falls in the visually impaired. PROSPER has had a hugely positive impact on the culture in our home.
Improvement is now ingrained in all we do. Our staff take great pride in their ‘PROSPER board’ which displays the impact changes have had on residents’ wellbeing and they relish the challenge to do more to make our care even better. I wouldn’t hesitate to recommend PROSPER to any home. It is tremendously beneficial for staff, relatives and most importantly, residents. Gina Copsey, Home Manager, Longfield
A survey, interviews, participant observations and data from documents compiled during the programme were all used to evaluate its impact.
Results showed that the programme helped to increase knowledge and awareness of resident safety amongst care home staff and encouraged new approaches. Two-thirds of participating care homes made changes to their working practices and changed the way they thought about their role with respect to safety.
Care home staff of all levels reported feeling more empowered to suggest new ideas for improvement.
Changes made during the programme included:
- Helping residents to personalise their walking frames, known as ‘Pimp the Zimmer’, which resulted in a greater sense of ownership and increased use
- Buying new rubber ends for walking sticks to make them less likely to slip
- Offering jelly to residents with dementia who had problems drinking fluids
- Introducing coloured drink mats to remind staff to encourage high-risk patients to remain hydrated
PROSPER has generated valuable learning about transferring QI approaches from the healthcare to the social care sector and shown that these approaches can be successfully implemented in care homes, with careful adaptation and support.
The key success of PROSPER was the care homes were in control of how the initiative progressed, they were the experts in care delivery, not myself or my team, and therefore we shaped the programme and the tools used according to their feedback. Lesley Cruickshank, Quality Innovation Manager, Essex County Council
Plans for the future
Following the success of this programme, Essex County Council have created a new Quality Improvement Team who continue to develop the QI support offer for care teams in the area.
In addition to the support package created through the PROSPER programme the team now offer an extensive ‘train the trainer’ programme and continuous professional development support for registered nurses.
The team are now expanding PROSPER’s reach, rolling out the QI support offer to learning disability services and domiciliary care providers.