What was the issue you were addressing or working on?
To facilitate integrated working and improve practice in the care of older people.
What you did?
A health and care network of Action Learning Sets comprising GPs, local team managers and practitioners was established in 11 areas in Aberdeenshire. This created opportunities for constructive challenge and improvement in practice, behaviours and pathways of care for older people with the shared outcome of shifting the balance of care. 172 people regularly attended the meetings which were scheduled on a 6 weekly cycle. Locums were funded to enable GPs to participate. Relationships between health and social care staff have improved and each ALS has taken a number of actions to improve care for older people.
In the first phase (August 2011 – March 2012) 42 ALS meetings took place. Examples of topics discussed:
- understanding the reasons for delayed discharges,
- implementing ACPs,
- medicine management in the community,
- opportunities to improve day services through co-production,
- improving hospital MDT meetings,
- improving communication processes (locally and with secondary care),
- opportunities to exploit use of telehealthcare,
- improving discharge processes for out of area patients,
- using rehabilitation and enablement (REACH) pilots,
- understanding factors contributing to average length of stay,
- impact of inappropriate discharges from secondary care to community hospitals and the community,
- impact of 5 day physiotherapy services in community hospital on discharge from secondary care and length of stay,
- implementation of the Falls Screening Programme,
- accessing the Signposting Service.
Phase II (April 2012 – March 2013) introduced an improvement methodology (DMAIC – Define, Measure, Analyse, Improve, Control) to ALS. Work continued to assist the groups to address local issues most of which concentrated on improving processes, implementing policies and procedures, improving communication, sharing information, sharing good practice and understanding the joint strategic aims of the two statutory agencies.
What were the outcomes - benefits or otherwise?
Significant progress has been made with improved communication and positive relationships within and between health and social care staff. In part ALS achieved this through awareness raising and understanding of role boundaries, operational/ organisational constraints and consensus about how to achieve greater flexibility within individual roles that resulted from the discussion and challenges in the ALS. Each ALS took a number of actions to improve processes for the benefit of patients, service users and staff.
Those ALS which used DMAIC focused on a number of issues e.g. understanding factors contributing to multiple admissions. Data analysis showed that all 3+ admissions for people 75+ in the preceding 12 months had been clinically appropriate and none were as a result of a lack of social care, family pressure or failure of out-of-hours systems all of which had been previously stated as being causal factors. Another example is ‘length of stay’ – data analysis showed that although on a particular ward, lengths of stay were greater than the 12 day target, 65% of the patients who passed through the ward during the 12 week capture period had a length of stay which was fewer than 12 days and average figures were heavily skewed by issues of guardianship and lack of available care in the community rather than by issues of clinical practice. Understanding the local data enabled staff to appreciate the good work being done and provided clarity of where to focus efforts that would reduce length of stay.
Relationships between health and social care staff improved as the understanding behind contributing factors were discussed.