The Deputy Chief Nurse at Southampton City Clinical Commissioning Group (CCG) developed and implemented a Registered Care Home Manager leadership programme for managers in the local area. The programme has led to transformational improvements for the homes, their staff, residents and carers.
Where to look
The State of Care Report (Care Quality Commission, 2018) highlights that the hallmark of high-quality care is good leadership and governance, a strong organisational culture that embraces learning, and good partnership working –services looking to work with others and share learning and experience. The report describes how a change in management, or changes in leadership teams can have an impact on the quality of a service, particularly in smaller organisations.
An outward-looking leadership approach can also help to support improvement. The CQC state that during their inspections, leaders who demonstrate a willingness to learn from and engage with other services, and who acknowledge problems and resolve to tackle them, can be more likely to make positive change to the quality of services.
The Deputy Chief Nurse at Southampton City CCG recognised there was a higher than average turnover of registered care home managers, as well as CQC inspections with associated sanctions observable within the local area. This was having an impact on service provision. Linked to this, the Deputy Chief Nurse identified local unwarranted variation in delayed transfers of care from the acute hospital to care homes and observed areas for improvement to support patient flow.
What to change
Southampton City CCG is part of an integrated commissioning unit with Southampton City Council. The CCG’s Quality Team led by the CCG Deputy Chief Nurse focuses on ensuring the people of Southampton receive high quality care across health and social care.
The nursing leads at the CCG explored leadership across the area. There were variations in the quality of care to support care home residents. Anecdotally, there were frequent changes in leadership, with care home managers not staying long in post. This made service improvements to support CQC sanctions being lifted difficult. Discussions with care home staff also revealed that interaction, collaboration or communication with other care homes was not routine or fully established and so wasn’t a collective voice in the area.
Approaching care homes on the borders of other local authority areas and with neighbouring CCGs provided an opportunity to share learning. The nurse leaders could also use this method to look at where processes could be standardised to support care homes who work across CCGs and to reduce duplication.
The Deputy Chief Nurse and CCG nursing leads identified the need to strengthen the support available for registered care home managers, to support consistent leadership across the care homes in the local area and deliver high quality care for all residents.
How to change
A programme of work was established to offer education, training and support to local registered managers. With the support of Thames Valley and Wessex Leadership Academy, the nursing leads devised a bespoke programme of education and this was reviewed, amended and agreed before roll-out across Southampton.
The education programme creates a learning environment where peer-to-peer support is encouraged. Leadership principles and practical issues such as managing staff and systems were included, all to advocate bringing the homes together as a collective. The five-day programme offers practical examples of how strong leadership (e.g. in hospital discharges) can empower care home managers to improve care delivery.
A targeted approach by the team has meant that homes that have been rated as ‘requires improvement’ by the CQC engage with leadership training. Similarly, those homes looking to achieve an ‘outstanding’ rating are supported to look at next steps on their journey. More widely, the approach also supports homes to become a cohesive collective across the city.
The nursing leads work collaboratively with local CQC inspectors, the Local Authority commissioners and quality teams as well as with patient and public representatives to ensure the packages meet the needs of the home and local population.
Better outcomes – Following the introduction of the education and training as a part of this programme, there has been a marked reduction in CQC sanctions; no care homes in the locality are now under sanctions. Of the 60 care homes in the city, 56 are now rated as good by the CQC, with one home rated outstanding. In real terms, this is a 130% improvement. The programme has supported peer support across the services within Southampton. This has meant services and their leads now have a much better understanding of each other’s remits which means collaborative working is now much easier. Several quality improvement initiatives have been delivered locally as a result of this programme. It has also supported care homes to access appropriate care and treatment through other services which is showing signs of reducing the need for acute hospital admissions.
Better experience – An evaluation of the programme suggests the programme has been well received. For example, one cohort showed that 100% of participants would recommend the programme to other Care Home Managers. Feedback has also included:
- “I have gained confidence and feel empowered”
- “I have learned to think about how to ask questions when problem-solving”
- “It boosted my confidence that I’m doing the right thing – everyone makes mistakes but acknowledge that and learn from them is the way forward.”
- “My personal growth has developed in ‘leaps and bounds’. This training was invaluable and greatly pleased that I attended and will reflect on this training in my workplace”
Better use of resources – The programme is positively addressing delayed discharge as well as care home manager retention. The programme has also supported development of an ‘Enhanced Care and Quality Team’. This team now provide a swift and coordinated offer to care homes where concerns are raised. Equally important, however, the team provides support and education to those that are reaching for ‘outstanding’. The nursing leads are now building on successes and are working on a pilot project to support nursing homes with access to the local shared electronic health records, introducing the red bag scheme as well as other quality improvement initiatives to further support them in delivering high quality care.
Challenges and lessons learnt for implementation
Providing consistently good quality care for care home residents is key and by working collaboratively, using strong local knowledge and leadership, we can make a real difference for staff and residents alike.
People who feel that we have invested in them, feel valued. Positive partnerships and professional working relationships need to be nurtured and developed and this pays dividends not only in the availability of beds but the quality of care that care home residents receive.
Find out more
For more information contact:
- Lindsay Rugman, Enhanced Health into Care Homes Manager (Quality Team), Southampton City CCG, firstname.lastname@example.org
- Carol Alstrom, Associate Director of Quality/Deputy Chief Nurse, NHS Southampton City Clinical Commissioning Group/Southampton City Council Integrated Commissioning Unit, email@example.com