Leading change

The Clinical Governance Manager at Somerset Care Ltd led a programme of work to improve clinical governance and nursing leadership at the organisation. This initiative has positively influenced practice which is improving outcomes, experiences and use of resources.

Where to look

Somerset Care Ltd is a care provider and not-for-profit care company in Southern England. It has 26 care homes across the region as well as a range of care and support services to help people remain independent in their own home. This includes a ‘Realise’ and ‘Petals’ service, specialised learning disabilities and dementia care teams. The Clinical Governance lead identified unwarranted variation across the group of care homes regarding clinical outcomes. This presented an opportunity to introduce an improvement programme to advocate evidence based care provided by qualified, competent and confident staff.

This initiative addressed a challenge identified in a ‘clinical input to care home’ guide (NHS England, 2015) which highlighted that “residents in care homes often experience difficulties accessing the right care at the right time”. Through improving the clinical input into a home and tailoring care around the diverse needs of individual residents, professionals can improve the quality of care and quality of life for people, and reduce unnecessary hospital admissions”.

What to change

The clinical governance lead reviewed clinical information as well as wider information about the service provision across the group of care homes. This investigation identified areas for improvement:

• Re-structure and improve the recruitment process for nurses, including a robust induction programme for new starters;
• Survey staff to help identify learning needs in the workplace and identify gaps;
• Create a training and development framework for clinical leads;
• Identify opportunities to improve clinical reporting and governance at both home and group level to support ongoing learning and change management;
• Monitor improvement in three key clinical outcome measures: unplanned hospital admissions, infections and pressure ulcers;
• Align improvement work with national frameworks and initiatives

How to change

The clinical governance lead developed relationships and listened to managers and clinical leads through developing an ‘improving outcomes working group’. This not only supported the improvement initiative, but also advocated shared learning and working across the group.

A nurse induction programme was developed with the support of clinical leads to promote nurse leadership skills, effectiveness of practice and clinical governance. Alongside this, local training was sourced, including online clinical skills modules and competency assessment in the workplace. The training also includes the “transition to care home nursing” (The Queens Nursing Institute) tool. In synergy with this, clinical supervision sessions were established for all clinical leads, to support them to develop their leadership skills.

To monitor residents’ clinical outcome data, a robust reporting system was developed. This included developing guidance for clinical reporting on a new reporting tool that enables local teams to analyse their clinical data and support ongoing improvements in practice.

Adding value

Better outcomes – An overarching improvement of the use of data and enhanced training / induction has supported staff to care for residents and meet individual needs. This includes evidence based practice across the group of care homes. To date the evidence of clinical improvement is anecdotal. However, staff report a reduction in unplanned hospital admissions and average length of stay in hospital. Staff are also monitoring reductions in infections and pressure ulcers. The programme is enhancing nurse knowledge and competency in managing complex health needs of residents in the care home setting; this will be supported by improved clinical outcome data for unplanned hospital admissions. Local initiative participation has also been beneficial. For example, the care homes have rolled out the “Red Bag” scheme, implemented the Somerset Treatment Escalation Plan and embedded the “Restore2” tool, which includes identification of soft signs of deterioration, National Early Warning Score and appropriate and timely escalation using SBARD (Situation, Background, Assessment, Recommendation and Decision).

Better experience – Staff, residents, carers and families have all responded positively to the new approach to quality improvement. Staff are confidently leading in care provision and observable experience improvements are occurring.

Better use of resources – A key strength of the collaborative approach has been shared learning and engagement. This has led to decreased duplication and staff development. Reduced admissions to hospital has positive system-wide implications. The training offer supports nurses to develop a skillset to address the challenge of caring for increasingly complex needs of residents.

Challenges and lessons learnt for implementation

Continued engagement of nursing colleagues across the organisation is needed. Good communication and liaison supports the focus and ongoing success of the improvement initiative.

Clinical leads and managers have significant workloads and training and development is additional to this. There is a real need for organisational support to support the initiative’s focus.

Find out more

For more information contact:

• Julia Heneker, Clinical Governance Manager, Somerset Care Ltd, Julia.Heneker@somersetcare.co.uk