The effect of using high facilitation when implementing the Gold Standards Framework in Care Homes programme: A cluster randomised controlled trial

Kinley, Julie; Stone, Louisa; Dewey, Michael; Lévy, J. P.; Stewart, Robert; McCrone, Paul; Sykes, Nigel; Hansford, Penny; Begum, Aysha; Hockley, Jo

doi:10.1177/0269216314539785

Cited by 59 publications

(75 citation statements)

References 12 publications

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“…5 Ongoing support from a clinician or team with relevant expertise was nevertheless important, depending on how this was delivered. Where the facilitator or lead clinician was able to be present and responsive to the needs of particular residents as they arose, and to engage staff in action learning that focused on issues of interest to them, there were higher levels of staff engagement and fidelity with training 26,104,137,140,141 than in interventions where the clinician input was episodic or task focused. 116,120,137,142 The mechanism identified here was one in which the HCP worked with staff as the 'bridge' to connect between interventions to improve health care of residents over time in a way that could be incorporated into existing patterns of working.…”

Section: Realist Synthesismentioning

confidence: 99%

Optimal NHS service delivery to care homes: a realist evaluation of the features and mechanisms that support effective working for the continuing care of older people in residential settings

Goodman

Davies

Gordon

et al. 2017

Health Serv Deliv Res

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Background: Care homes are the institutional providers of long-term care for older people. The OPTIMAL\ud study argued that it is probable that there are key activities within different models of health-care provision\ud that are important for residents’ health care.

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Objectives: To understand ‘what works, for whom, why and in what circumstances?’. Study questions\ud focused on how different mechanisms within the various models of service delivery act as the ‘active\ud ingredients’ associated with positive health-related outcomes for care home residents.

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Methods: Using realist methods we focused on five outcomes: (1) medication use and review; (2) use of\ud out-of-hours services; (3) hospital admissions, including emergency department attendances and length of\ud hospital stay; (4) resource use; and (5) user satisfaction. Phase 1: interviewed stakeholders and reviewed\ud the evidence to develop an explanatory theory of what supported good health-care provision for further\ud testing in phase 2. Phase 2 developed a minimum data set of resident characteristics and tracked their care\ud for 12 months. We also interviewed residents, family and staff receiving and providing health care to residents.\ud The 12 study care homes were located on the south coast, the Midlands and the east of England. Health-care\ud provision to care homes was distinctive in each site.

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Findings: Phase 1 found that health-care provision to care homes is reactive and inequitable. The realist\ud review argued that incentives or sanctions, agreed protocols, clinical expertise and structured approaches to\ud assessment and care planning could support improved health-related outcomes; however, to achieve change NHS professionals and care home staff needed to work together from the outset to identify, co-design and\ud implement agreed approaches to health care. Phase 2 tested this further and found that, although there\ud were few differences between the sites in residents’ use of resources, the differences in service integration\ud between the NHS and care homes did reflect how these institutions approached activities that supported\ud relational working. Key to this was how much time NHS staff and care home staff had had to learn how to\ud work together and if the work was seen as legitimate, requiring ongoing investment by commissioners\ud and engagement from practitioners. Residents appreciated the general practitioner (GP) input and, when\ud supported by other care home-specific NHS services, GPs reported that it was sustainable and valued work.\ud Access to dementia expertise, ongoing training and support was essential to ensure that both NHS and care\ud home staff were equipped to provide appropriate care.

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Limitations: Findings were constrained by the numbers of residents recruited and retained in phase 2 for\ud the 12 months of data collection.

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Conclusions: NHS services work well with care homes when payments and role specification endorse the\ud im...

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Section: Realist Synthesismentioning

confidence: 99%

Optimal NHS service delivery to care homes: a realist evaluation of the features and mechanisms that support effective working for the continuing care of older people in residential settings

Goodman

Davies

Gordon

et al. 2017

Health Serv Deliv Res

View full text Add to dashboard Cite

\ud \ud \ud

Limitations: Findings were constrained by the numbers of residents recruited and retained in phase 2 for\ud the 12 months of data collection.

\ud \ud \ud

Conclusions: NHS services work well with care homes when payments and role specification endorse the\ud im...

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“…The dwindling trajectory is recognised as one most commonly experienced by residents in care homes. 9,[15][16][17] In this study, residents with a dwindling trajectory experienced a higher number of hospital admissions (and healthcare costs). A dwindling trajectory can make it more challenging to specifically predict when an individual is dying.…”

Section: Discussionmentioning

confidence: 99%

“…Emerging evidence demonstrates the importance of co-design between care home staff and external professionals when introducing end of life care programmes. 7,9 Whilst our study is the most detailed of its kind, outpatient medication costs were omitted. This may have artificially inflated the total healthcare cost share of inpatient services, because inpatient NHS Reference costs do include most medications.…”

Section: Discussionmentioning

confidence: 99%

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The cost of providing end of life care for nursing care home residents: A retrospective cohort study

Ennis

Kinley

Hockley

et al. 2015

Health Serv Manage Res

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Background: The proportion of people dying in long-term care institutions is predicted to increase in future years. Establishing the costs associated with the provision of such care is important as it represents a potentially increasing burden. Aim: This study describes the end of life healthcare costs for nursing home residents. The study also explores the effects of resident characteristics on costs, through regression modelling. Setting: This study took place in south-east England. Participants: Thirty-eight nursing care homes took part in the study, comprising 2444 individual residents. Methods: Using a retrospective cohort design, end of life service use was recorded from residents' nursing care home notes. In this study, end of life was defined as the last six months of life, or from time of residency if this was less than six months. Costs were calculated assuming a healthcare payer perspective. Results: The total mean healthcare cost per resident was £3906. Hospital stays accounted for two-thirds (67%) of these costs. Fifty-six percent of these hospital stays occurred in the final month of life. Death in hospital vs. in the nursing care home was associated with an average increase in costs of £4223. Conclusions: Death in hospital is costly, and is seldom identified as a preferred place of death. Therefore, interventions are needed which help nursing care home staff to identify when an individual is dying, and have the skill and confidence to make difficult decisions regarding care provision at the end of life.

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“…Practice development entails evidence based, supported intervention designed to improve care quality and promote patient centred care (Perry, 2013). Direct relationships have been described between the quantity and quality of facilitation available, the context within which the development is to occur, and the degree to which practice change is achieved and sustained (Kinley, et al, 2014). Within PD, facilitation is used to create cultures which support nursing practice change (Crisp & Wilson, 2011;McCormack, Wright, Dewar, Harvey, and Ballantine, 2007).…”

Section: Introductionmentioning

confidence: 99%

Perspectives and experiences of nurses as facilitators within a Practice Development program

et al. 2018

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Background: Health services are challenged to change and adapt to meet the changing needs of the populations they serve. To support this, the 'Essentials of Care' Practice Development program was developed in Australia. Local facilitators play a key role in its delivery and achievements. Aims: This study aimed to gain insights into the experiences of clinical nurses in Practice Development facilitation roles in an acute hospital, including training for the role and changes occurring within themselves and their workplaces. Methods: A qualitative interpretive design used purposive sampling for a two-phase study using semi structured interviews and focus groups with data analysed using Framework Analysis. Results: Twelve Registered Nurses with an average of two years' experience in a facilitator role were interviewed and attended focus groups in 2011. Five key themes were identified: (1) facilitator as enabler, (2) the necessary team approach to facilitation, (3) valuing both internal and external models of facilitation, (4) preparation and training for role, and (5) perceived changes: to the facilitator and to the workplace. Individuals' ongoing development resulted from reflection, mentorship, role-modelling and co-facilitation; facilitation skills were recognised as relevant for nursing beyond their Program role. Ward culture gains were valued as distinct from measurable patient outcomes such as reduced medication errors. Conclusion: Findings provide insights into facilitators' experiences of this Practice Development role and contribute to better understanding of effective processes for nursing practice change in acute health services. Recommendations were proposed to support future role and post-holder development.

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The effect of using high facilitation when implementing the Gold Standards Framework in Care Homes programme: A cluster randomised controlled trial

Cited by 59 publications

References 12 publications

Optimal NHS service delivery to care homes: a realist evaluation of the features and mechanisms that support effective working for the continuing care of older people in residential settings

Optimal NHS service delivery to care homes: a realist evaluation of the features and mechanisms that support effective working for the continuing care of older people in residential settings

The cost of providing end of life care for nursing care home residents: A retrospective cohort study

Perspectives and experiences of nurses as facilitators within a Practice Development program

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