An evaluation of a safety improvement intervention in care homes in England: a participatory qualitative study

Abstract

Objective: A growing proportion of older people live in care homes and are at high risk of preventable harm. This study describes a participatory qualitative evaluation of a complex safety improvement intervention, comprising training, performance measurement and culture-change elements, on the safety of care provided for residents. Design: A participatory qualitative study. Setting: Ninety care homes in one geographical locality in southern England. Participants: A purposeful sample of care home managers, front-line staff, residents, quality improvement facilitators and trainers, local government and health service commissioners, and an embedded researcher. Main outcome measures: Changes in care home culture and work processes, assessed using documentary analysis, interviews, observations and surveys and analysed using a framework-based thematic approach. Results: Participation in the programme appears to have led to changes in the value that staff place on resident safety and to changes in their working practices, in particular in relation to their desire to proactively manage resident risk and their willingness to use data to examine established practice. The results suggest that there is a high level of commitment among care home staff to address the problem of preventable harm. Mobilisation of this commitment appears to benefit from external facilitation and the introduction of new methods and tools. Conclusions: An evidence-based approach to reducing preventable harm in care homes, comprising an intervention with both technical and social components, can lead to changes in staff priorities and practices which have the potential to improve outcomes for people who live in care homes.

Quality improvement in long-term care settings: a scoping review of effective strategies used in care homes

“…75 articles were included in the review, with only two articles being grey literature (a list of excluded articles is available on request to the authors). Six studies have multiple articles, so 65 studies are reported [ 12 , 15 , 23 – 95 ].

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“…Most studies ( n = 35) reported single arm intervention studies with comparison of quantitative data captured about clinical outcomes before and after the quality improvement project was carried out [ 23 – 57 ]. Qualitative studies were the second largest group ( n = 19) [ 12 , 23 , 27 , 30 , 58 – 72 ], including the following methods: participatory action research ( n = 2) [ 12 , 63 ], observational ( n = 4) [ 62 , 73 – 75 ], interviews ( n = 1) [ 64 ], questionnaire ( n = 1) [ 69 ]. Eleven studies were interventional studies with a comparator arm, with quantitative outcome measures, including; 8 randomised controlled trials, all of which were cluster randomised at care home level [ 76 – 83 ].…”

“…These were not duplicate publications, but rather publications of complementary descriptions and analyses of, often complex, QI projects. The six studies were SCOPE (Safer care for older persons (in residential) environments) [ 23 , 65 , 90 ], Connect for quality [ 77 , 91 ], INTERACT (Interventions to Reduce Acute Care Transfers) [ 59 , 79 , 92 , 93 ], PROSPER (PROmoting Safer Provision of care for Elderly Residents) [ 12 , 15 , 72 ].…”

“…The review team did, however, identify weaknesses in study design and reporting. We found 35 studies either had deficiencies in methods [ 24 , 30 , 33 , 37 , 39 , 50 – 55 , 57 , 69 , 70 , 73 – 75 , 82 – 84 ] or were descriptive without process or outcome data [ 12 , 15 , 43 – 50 , 61 , 62 , 66 , 67 , 71 , 72 , 76 , 88 , 89 ]. Weaknesses included small sample size (for example, one care home sampled), no comparator or baseline, and number of participants not reported.…”

“…There is increasing recognition of the interdependence of the care home sector and the much smaller acute hospital bed base [ 10 ]. These observations, coupled to increased emphasis on integration of health and social care by central government [ 11 ], have led to a number of initiatives to improve quality of care in care homes [ 12 – 14 ]. However, the extent and level of development of quality improvement (QI) in care homes has not been well described.…”