Improving the Quality of Care in Care Homes Using the Quality Improvement Collaborative Approach: Lessons Learnt from Six Projects Conducted in the UK and The Netherlands

Abstract

The Breakthrough Series Quality Improvement Collaborative (QIC) initiative is a well-developed and widely used approach, but most of what we know about it has come from healthcare settings. In this article, those leading QICs to improve care in care homes provide detailed accounts of six QICs and share their learning of applying the QIC approach in the care home sector. Overall, five care home-specific lessons were learnt: (i) plan for the resources needed to support collaborative teams with collecting, processing, and interpreting data; (ii) create encouraging and safe working environments to help collaborative team members feel valued; (iii) recruit collaborative teams, QIC leads, and facilitators who have established relationships with care homes; (iv) regularly check project ideas are aligned with team members’ job roles, responsibilities, and priorities; and (v) work flexibly and accept that planned activities may need adapting as the project progresses. These insights are targeted at teams delivering QICs in care homes. These insights demonstrate the need to consider the care home context when applying improvement tools and techniques in this setting.

How, why and under what circumstances does a quality improvement collaborative build knowledge and skills in clinicians working with people with dementia? A realist informed process evaluation

“…Devi and colleagues have identified how the multiple types of staff, the prescribed roles and differences about priorities, and negative perceptions around care homes, impacted on the use of QICs in UK. 63 Similar contextual influences were seen across services providing dementia care in this study. The QIC provided resources and opportunities for clinicians that were not usually available in their setting and met their needs for support, coaching, practice reflection and a flexible structure.…”

Care homes, their communities, and resilience in the face of the COVID-19 pandemic: interim findings from a qualitative study

“…This study adds to this by showing the essential leadership and brokering role that managers and staff played in maintaining continuity of care during the early stages of the COVID-19 pandemic. Many of the strategies adopted by managers, relying largely on their own experience and intuition in the absence of coherent national guidance, reflected those which were reported to be effective in controlling the pandemic in care homes during the initial COVID-19 epidemic in Wuhan Province, China [25]. These included establishing clear leadership hierarchies, regularly reviewing policies in light of emerging evidence, developing organisationspecific infection control policies, working to establish reliable supply chains in the face of shortages, and working with residents to maximise activity and engagement.…”

Care homes, their communities, and resilience in the face of the COVID-19 pandemic: interim findings from a qualitative study

“…Previous studies have shown how care home managers and staff play an essential role in brokering relationships between residents and relatives, and statutory health and social care providers. This has been shown to be the case for urgent and planned healthcare(21,22), in end-of-life care(23) and when working to improve and develop services(24). This study adds to this by showing the essential leadership and brokering role that managers and staff played in maintaining continuity of care during the early stages of the COVID-19 pandemic.…”