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Home Improvements

Home Improvements
8 December 2014

Patient quality and safety reporting, and monitoring of improvement in care homes, has historically received less emphasis than acute care settings. With public confidence shaken by national media coverage of abuse of vulnerable people in care settings across the country, the level of scrutiny has increased. 

Patient quality and safety reporting, and monitoring of improvement in care homes, has historically received less emphasis than acute care settings. With public confidence shaken by national media coverage of abuse of vulnerable people in care settings across the country, the level of scrutiny has increased. 

Government inquiries into the recent cases of abuse culminated in the publication of the Francis, Berwick and Winterbourne reports. Findings called for an improvement in patient quality and safety standards in care settings, as well as a need to report these as part of a culture of shared learning and transparency.
Working with clinical commissioning groups (CCGs) in Coventry and Warwickshire, NHS Arden Commissioning Support has developed a quality monitoring tool designed to improve care home quality standards across a number of areas. 
In developing the system, the desire to improve quality, monitoring and training had to be balanced with an understanding of the existing workload faced by care homes, particularly in relation to Care Quality Commission (CQC)  inspections. Working closely with a pilot group of homes was therefore key to delivering a solution which would meet the commissioners’ contract monitoring needs without becoming too onerous for the providers. 
The challenge
The majority of care homes in Warwickshire and Coventry are owned and managed by independent providers and local authorities. CCGs who contract their services have equal responsibility to ensure the safety of residents. 
In Warwickshire and Coventry alone, there are 257 care homes with 6,722 beds. It has been extremely difficult to maintain adequately high levels of contract monitoring visits in order to determine whether the provider is delivering high quality and safe care. Equally, care homes were finding it time consuming and difficult to complete complex spreadsheets, which meant returns were often inconsistent. 
To resolve this challenge, NHS Arden Commissioning Support developed an easy-to-use performance monitoring and guidance tool known as the Care Homes Dashboard. The system has been in use within nursing homes across Coventry and Warwickshire for 12 months and has recently been rolled out across Worcestershire. A further 60 providers will begin using the dashboard over the next few months as part of a new contract to provide continuing healthcare services to CCGs in Buckinghamshire.
Developing the solution
With extensive input from clinicians, care homes, the local authority and other stakeholders, we developed the Care Homes Dashboard to cater for both care homes and commissioners. 
Recognising the need for a system that was both readily accessible and easy to use for those with limited computer skills, we worked with a software consultancy to create a bespoke system. We piloted the dashboard in 25 homes and incorporated user feedback to further shape the design. The final result is a system that can be accessed via any computer with internet access, with a simple layout to make it intuitive and user friendly.
The dashboard is a self-assessment tool that is completed by care home providers on a quarterly basis. It provides assurance on a range of local and national clinical key performance indicators, such as infection control, falls, pressure ulcers and serious incidents. The questions are based on NHS and Social Care contracts, making the dashboard unique in that it provides assurance to both agencies and reduces duplication.
The dashboard also includes a ‘Serious Incidents’ and a ‘Never Events’ reporting portal, where providers can alert the local patient safety team of an incident in their care home.
The system has been developed to meet Information Governance guidelines. No patient identifiable information is recorded on the system’s database, meaning both NHS information governance guidelines and multiple CQC outcomes are met.
Integrated working and shared learning
The data received via the dashboard is checked for accuracy against other sources and any incidents or concerns are raised with CCG and local authority leads. 
For example, using the quality dashboard and hospital data, we were able to highlight that a large number of falls occurred within homes. As a result, an occupational therapist and a physiotherapist were employed to provide guidance and support to homes in the area, and to deliver a bespoke training package. 
Alongside the Care Homes Dashboard, we have created a care home learning resource website known as the Care Homes Portal. Based on the same indicators as the dashboard, our clinical team has created specific advice and guidance materials. These include information on issues such as what do to in case of an infection outbreak and posters on the management of patients with a pressure ulcer. Providers can also access policies and guidance on possible areas of development to help drive quality improvement. 
Improving outcomes
Developing the dashboard hasn’t been without its challenges. Although care homes recognise the need to improve monitoring and transparency, they have finite resources and there were concerns about the additional time required to use the tool. Equally, homes were keen to avoid duplication with CQC inspections. Taking those concerns on board, the Care Homes Dashboard has been designed to be as flexible as possible. 
The minimum reporting requirement amounts to half a day each quarter (just two days per year). There are also additional reporting options, for example reporting daily bed availability to help the homes ensure empty beds are occupied quickly. The dashboard has been designed to reflect CQC outcomes and should therefore support homes in providing evidence of their compliance with CQC inspections and standards of care. We have had positive feedback from providers, many of which have shown a real willingness to engage with the programme. Galanos House Nursing Home Manager, Jo-Anne Wilson, told us “The dashboard allows us to submit information to both provide assurance as well as identify areas of support. It is easy to use and we can access learning material through the dashboard. The dashboard is a great way to improve quality of care delivered within care homes.” 
The Care Homes Dashboard was initially launched to 63 nursing home providers in Coventry and Warwickshire in August 2013. The roll out was supported by a series of events which gave an insight into the NHS standard contract, and a coaching session on how to use the dashboard. These were followed up with extensive on-site training and support.
Providers have been required to submit quality information for three quarters. To date, all of the 63 providers have submitted data, a 100% compliance rating. 
Future developments
Having been successful in Coventry and Warwickshire, the Care Homes Dashboard has since been introduced to nursing homes in Worcestershire, with the first set of data due back this autumn. The next rollout, to providers in Buckinghamshire, is currently being finalised, and will take place over the next few months. 
We are also looking at adapting the dashboard to cater for the bespoke requirements of residential homes, mental health and learning disability care homes and hospices. There are no geographical limitations to the system and so the scope for type and location of providers is potentially vast.
Feedback from providers shows that the dashboard is not just seen as a performance management system, but as a support and learning tool. Our clinical support team responds to data submitted on the dashboard and offers support and guidance to the providers to improve patient outcomes.
The system has encouraged reporting and transparency without being a punitive measure and even serves as a filing system for providers so that they can do their own trend analysis over time. 

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