The Effect of Providing Staff Training and Enhanced Support to Care Homes on Care Processes, Safety Climate and Avoidable Harms: Evaluation of a Care Home Quality Improvement Programme in England

Abstract

Older people living in care homes are at risk from avoidable harms, which may require hospital attendance or admission. This paper describes a mixed methods evaluation of a large quality improvement (QI) programme that provides skills training and facilitated support to staff in 29 care homes across two localities in the West Midlands, UK. The Safety Attitudes Questionnaire (SAQ) is used to assess changes to care home safety climate between baseline and programme end at 24 months. We use routinely collected data to assess pre- and post-programme avoidable harms and hospital attendance/admission rates. Semi-structured interviews with programme managers (n = 18), and staff (n = 49) in four case study homes are also used to assess perspectives on programme implementation. Our results show that safety climate scores increase by 1.4 points. There are significant reductions in falls (p = 0.0006), severe pressure ulcers (p = 0.014), UTIs (p = 0.001) and ‘any’ events (p = 0.0003). Emergency hospital attendances reduced, but admissions increased. Interview participants report improvements to teamwork, working practices, information sharing, knowledge and skills. Upskilling care home staff can improve working practices and attitudes towards resident safety and care quality, which may be associated with significant reductions in avoidable harms rates. Care staff turnover rates are high, which may impact the potential for longer-term sustainability of the changes observed.

Sustaining interventions in care homes initiated by quality improvement projects: a qualitative study

“…We suggest future studies assess whether organisational characteristics might have explanatory value with regard to sustainability. Alongside intervention sustainability, future studies should also examine the sustainment of other broader secondary outcomes which can result from QI projects, such as sharing of best practice across individual care homes and across wider network of care homes,28 continuation of the skills and capacity built,28 staff engagement,16 and teams developing action plans16.…”

An Integrative Review of Research Evaluating Organisational Culture in Residential Aged Care Facilities

“…Two interventions provided education and training to staff to improve safety culture/climate; one of these studies speci cally focused on the management of care transitions between hospitals and RACFs, but did not nd improvements in surveys scores among aged care staff 50 . The other had broader goals in upskilling staff and promoting a culture of continuous improvement, and while scores on the culture measure and other clinical outcomes improved, there was no control group comparison 51 . Two other studies focused on collaborative skills like teamwork and communication, both among staff and with residents and their families 52,53 .…”

The moderating effect of knowledge-sharing on learning organisation and quality improvement practices

“…Appropriately relayed, dedicated, and well-trained personnel with heightened cognisance can execute TQM and thus enhance the output from hospitals (Puthanveettil et al, 2021). Learning from QI training has been converted into evident upgrades to clinical activities within care residences (Damery et al, 2021). Practice-based training is essential to QI in HCOs (Lebcir and James, 2021).…”

“…, 2021). Learning from QI training has been converted into evident upgrades to clinical activities within care residences (Damery et al ., 2021). Practice-based training is essential to QI in HCOs (Lebcir and James, 2021).…”