Collaborative quality improvement: consumers, carers and mental health service providers working together in service co-design

Paton, Nicola; Callander, Rosemary; Cavill, Marina; Ning, Lei; Weavell, Wayne

doi:10.1177/1039856212465347

Cited by 10 publications

(4 citation statements)

References 3 publications

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“…Interviews were only conducted with family carers as some family carers expressed that they did not wish to take part in focus groups. Co-design is a technique adopted from product development [ 36 ] which has tangible benefits in developing or redesigning health services [ 37 – 40 ]. The co-design task was to develop heuristics with only few attributes that operate under three rules: 1) search through cues in a pre-determined order; 2) stop searching as soon as a cue leads to an exit; and 3) classify the object of concern accordingly [ 35 ].…”

Section: Methodsmentioning

confidence: 99%

A co-design process developing heuristics for practitioners providing end of life care for people with dementia

et al. 2016

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BackgroundThe end of life for someone with dementia can present many challenges for practitioners; such as, providing care if there are swallowing difficulties. This study aimed to develop a toolkit of heuristics (rules-of-thumb) to aid practitioners making end-of-life care decisions for people with dementia.MethodsAn iterative co-design approach was adopted using a literature review and qualitative methods, including; 1) qualitative interviews and focus groups with family carers and 2) focus groups with health and care professionals. Family carers were recruited from a national charity, purposively sampling those with experience of end-of-life care for a person with dementia. Health and care professionals were purposively sampled to include a broad range of expertise including; general practitioners, palliative care specialists, and geriatricians. A co-design group was established consisting of health and social care experts and family carers, to synthesise the findings from the qualitative work and produce a toolkit of heuristics to be tested in practice.ResultsFour broad areas were identified as requiring complex decisions at the end of life; 1) eating/swallowing difficulties, 2) agitation/restlessness, 3) ending life-sustaining treatment, and 4) providing “routine care” at the end of life. Each topic became a heuristic consisting of rules arranged into flowcharts. Eating/swallowing difficulties have three rules; ensuring eating/swallowing difficulties do not come as a surprise, considering if the situation is an emergency, and considering ‘comfort feeding’ only versus time-trialled artificial feeding. Agitation/restlessness encourages a holistic approach, considering the environment, physical causes, and the carer’s wellbeing. Ending life-sustaining treatment supports practitioners through a process of considering the benefits of treatment versus quality-of-life and comfort. Finally, a heuristic on providing routine care such as bathing, prompts practitioners to consider adapting the delivery of care, in order to promote comfort and dignity at the end of life.ConclusionsThe heuristics are easy to use and remember, offering a novel approach to decision making for dementia end-of-life care. They have the potential to be used alongside existing end-of-life care recommendations, adding more readily available practical assistance. This is the first study to synthesise experience and existing evidence into easy-to-use heuristics for dementia end-of-life care.Electronic supplementary materialThe online version of this article (doi:10.1186/s12904-016-0146-z) contains supplementary material, which is available to authorized users.

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Section: Methodsmentioning

confidence: 99%

A co-design process developing heuristics for practitioners providing end of life care for people with dementia

et al. 2016

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“…Co-design is a technique developed from the technology design and product development industry [ 21 ] and has benefits for developing or redesigning health and care services [ 22 – 25 ]. It has been adopted by health and care based research and systems as ‘experienced based co-design’.…”

Section: Methodsmentioning

confidence: 99%

Guiding practitioners through end of life care for people with dementia: The use of heuristics

et al. 2018

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BackgroundEnd of life care (EOLC) for people with dementia can present a multitude of challenges and difficult decisions for practitioners. These challenges may include assessment and management of difficulties with eating and swallowing, responding to agitation, treating pain, and managing recurrent infections. Practitioners sometimes lack both confidence in making end of life decisions and guidance. This study developed an alternative to lengthy guidelines, in the form of heuristics which were tested in clinical settings. The aim of this study was to test the usability and acceptability of a set of heuristics which could be used by practitioners providing EOLC for people with dementia in a variety of clinical and care settings.MethodsA three phase co-design process was adopted: 1) Synthesis of evidence and outputs from interviews and focus groups with family carers and practitioners, by a co-design group, to develop heuristics; 2) Testing of the heuristics in five clinical or care settings for six months; 3) Evaluation of the heuristics at three and six months using qualitative individual and group interviews.ResultsFour heuristics were developed covering: eating and swallowing difficulties, agitation and restlessness, reviewing treatment and interventions at the end of life, and providing routine care. The five sites reported that the heuristics were simple and easy to use, comprehensive, and made implicit, tacit knowledge explicit. Four themes emerged from the qualitative evaluation: authority and permission; synthesis of best practice; providing a structure and breaking down complexity; and reassurance and instilling confidence.ConclusionUse of heuristics is a novel approach to end of life decision making in dementia which can be useful to both experienced and junior members of staff making decisions. Heuristics are a practical tool which could overcome a lack of care pathways and direct guidance in end of life care for people with dementia.

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“…The educational intervention was developed following the Medical Research Council’s recommendations for complex interventions [32], with strong elements of codesign modified by nominal groups to gain the insights and experiences of a range of practitioners [33]. Codesign is a technique adopted from product development, which has tangible benefits in developing or redesigning health services [34-37]. The educational needs assessment deployed in this trial is an example of a strategy aimed to improve quality of care by overcoming the translation block that obstructs the diffusion of clinical guidelines and knowledge into practice [38].…”

Section: Discussionmentioning

confidence: 99%

Tailored educational intervention for primary care to improve the management of dementia: the EVIDEM-ED cluster randomized controlled trial

Wilcock

Iliffe

Griffin

et al. 2013

Trials

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BackgroundEarly diagnosis of dementia is important because this allows those with dementia and their families to engage support and plan ahead. However, dementia remains underdetected and suboptimally managed in general practice. Our objective was to test the effect of a workplace-based tailored educational intervention developed for general practice on the clinical management of people with dementia.MethodsThe tailored educational intervention was tested in an unblinded cluster randomized controlled trial with a pre/post-intervention design, with two arms: usual/normal care control versus educational intervention. The primary outcome measure was an increase in the proportion of patients with dementia who received at least two documented dementia-specific management reviews per year. Case identification was a secondary outcome measure.Results23 practices in South-East England participated. A total of 1,072 patients with dementia (intervention: 512, control: 560) had information in their medical records showing the number of reviews within 12 months (or a proportion of) before intervention or randomization and within 12 months (or a proportion of) after. The mean total number of dementia management reviews after the educational intervention for people with dementia was 0.89 (SD 1.09; minimum 0; median 1; maximum 8) compared with 0.89 (SD 0.92; minimum 0; median 1; maximum 4) before intervention. In the control group prior to randomization the mean total number of dementia management reviews was 1.66 (SD 1.87; minimum 0; median 1; maximum 12) and in the period after randomization it was 1.56 (SD 1.79; minimum 0; median 1; maximum 11). Case detection rates were unaffected. The estimated incidence rate ratio for intervention versus control group was 1.03 (P = 0.927, 95% CI 0.57 to 1.86).ConclusionsThe trial was timely, coinciding with financial incentives for dementia management in general practice (through the Quality Outcomes Framework); legal imperatives (in the form of the Mental Capacity Act 2005); policy pressure (The National Dementia Strategy 2009); and new resources (such as dementia advisors) that increased the salience of dementia for general practitioners. Despite this the intervention did not alter the documentation of clinical management of patients with dementia in volunteer practices, nor did it increase case identification.Trial registrationNCT00866099/Clinical Trials

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Collaborative quality improvement: consumers, carers and mental health service providers working together in service co-design

Cited by 10 publications

References 3 publications

A co-design process developing heuristics for practitioners providing end of life care for people with dementia

A co-design process developing heuristics for practitioners providing end of life care for people with dementia

Guiding practitioners through end of life care for people with dementia: The use of heuristics

Tailored educational intervention for primary care to improve the management of dementia: the EVIDEM-ED cluster randomized controlled trial

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