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How to use Essence of Care

2010

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DEPARTMENT OF HEALTH

Essence of Care 2001, Communication, Promoting Health and Care EnvironmentEssence of Care 2001 Gateway No. 4656 and 8489

1ST OCTOBER 2010PCT CEs, NHS Trust CEs, Care Trust CEs, Foundation Trust CEs , Directors of Nursing, Local Authority CEs, Directors of Adult SSs, PCT PEC Chairs, Special HA CEs, Allied Health Professionals, GPs, Communications Leads, Emergency Care Leads, Directors of Children's SSs, Universities UK, RCN, RCM, AHPF, SHA Lead Nurses, SHA AHP Leads, Patient Organisations

PCT CEs, NHS Trust CEs, Care Trust CEs, Foundation Trust CEs , Directors of Nursing, Local Authority CEs, Directors of Adult SSs, PCT PEC Chairs, Special HA CEs, Allied Health Professionals, GPs, Communications Leads, Emergency Care Leads, Directors of Children's SSs, Voluntary Organisations/NDPBs, Universities UK, RCN, RCM, AHPF, SHA Lead Nurses, SHA AHP Leads, Patient Organisations

Essence of Care 2010 includes all the benchmarks developed since it was first launched in 2001, including the latest on the Prevention and Management of Pain. All the benchmarks have been reviewed to reflect the current views of people requiring care, carers and staff

For Recipient's Use

ESSENCE OF CARE 2010

LS2 7UE

0

1132546056

Gerry BolgerCNO Directorarte - PLT5E58, Quarry HouseQuarry Hill, Leeds

www.dh.gov.uk0

14641

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How to use Essence of Care 2010

1


Benchmarks for the fundamental aspects of care

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2

Published by TSO (The Stationery Office) and available from:

Onlinewww.tsoshop.co.uk

Mail, Telephone, Fax & E-mailTSOPO Box 29, Norwich, NR3 1GNTelephone orders/General enquiries: 0870 600 5522Fax orders: 0870 600 5533E-mail: [email protected] 0870 240 3701

TSO@Blackwell and other Accredited Agents

Customers can also order publications from: TSO Ireland16 Arthur Street, Belfast BT1 4GDTel 028 9023 8451 Fax 028 9023 5401

Published with the permission of the Department of Health on behalf of the Controller of Her Majesty’s Stationery Office.

© Crown Copyright 2010

All rights reserved.

Copyright in the typographical arrangement and design is vested in the Crown. Applications for reproduction should be made in writing to the Office of Public Sector Information, Information Policy Team, Kew, Richmond, Surrey, TW9 4DU.

First published 2010

ISBN 9780 11 322872 0

Printed in the United Kingdom for The Stationery Office.

J002352920 cXX 09/10

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Contents

Quick Start 4

How to use Essence of Care 2010 6

Why is benchmarking practice and care necessary? 8

What is a benchmark and benchmarking? 9

Focus of Essence of Care 2010 benchmarks 10

Where can the Essence of Care 2010 benchmarks be used? 11

Content of Essence of Care 2010 benchmarks 12

Example of overall outcome, factor and indicator 13

APPENDIX ONE Ideas and tips 14

APPENDIX TWO Making changes possible and sustainable: Ideas and tips 26

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Quick StartThe following is a ‘quick start’ guide for using the Essence of Care 2010 to improve practice and care.

Identify which aspect of practice and/or care needs improvement

Questions to ask:

■■ What do people requiring care and/or their carers complain or raise issues about most?

■■ Why have incidents or accidents happened?■■ What areas have national or local surveys highlighted as being

of concern?■■ For example, have there been any complaints about people requiring

care not being helped to eat?

Look at the benchmarks, factors and indicators to see what people requiring care and carers say needs to be in place

Things to think about:

■■ Are there any benchmarks that link with the area of concern identified above? For example, Benchmarks for Food and Drink.

■■ Are there any factors that link with the specific area of concern? For example, ‘People receive the care and assistance they require with eating and drinking’ (Assistance – Factor 9).

■■ Review the indicators for practical ideas of how to achieve the factors. For example, ‘A system is in place to identify that people requiring assistance to eat and drink receive it’ (indicator 9b).

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Review and change practice and/or care

■■ Ascertain whether current practice meets the indicators. For example, identify whether there is a system in place that identifies people requiring assistance to eat and drink. If current practice does not meet the indicators change practice so that it does. For example, introduce a system where food is delivered on red trays for people requiring assistance.

Evaluate practice and/or care from perspective of people requiring care, their carers and staff

Questions to ask:

■■ Do people requiring care and/or their carers think that care has improved? Are they happy with the standard of care? For example, are people and/or carers satisfied with the assistance given to help people eat and drink? Is there evidence that people requiring care are well nourished?

Establish improved practice and care or revise further

■■ Establish improved practice and care across the team, organisation or organisations or improve practice and care further where it does not meet the indicators.

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How to use Essence of Care 2010Essence of Care 2010 identifies best practice and highlights how this can be achieved. Essence of Care 2010 was developed in partnership with people1 and carers2 and as such reflects the views of their health and social care needs and preferences.

It is important to note at this point that Essence of Care 2010 is a very versatile tool that can be used in a number of ways and at different levels. For example, it can be used as:

■■ a quality assurance or benchmarking tool (see below)■■ a reference document or checklist – Essence of Care 2010 includes what

people, carers and staff3 agree is best practice and care and this can, therefore, be referred to in order to understand people’s and carers’ perspectives and what might need to be improved to accommodate these

■■ an audit tool – as a foundation and focus for audit data collection tools used to assess practice and care (linked to above)

■■ a dissemination tool – to spread current good practice and care across organisations

■■ a root cause analysis tool – when examining incidents and complaints or addressing risks

■■ an education tool – to educate and train staff of all levels about people’s and carers needs and preferences, and to highlight the areas where specific competencies are required to provide care

■■ to provide evidence of compliance with registration criteria for the Care Quality Commission

1 For simplicity, the term ‘people requiring care’ is shorted to people (in italics). People includes babies, children, young people under the age of 18 years and adults. This is consistent for all sets of benchmarks except those covering the Care Environment.

2 The term ‘carers’, refers to those who ‘look after family, partners or friends in need of help because they are ill, frail or have a disability. The care they provide is unpaid’ (adapted from Carers UK, 2008). Carers can include children and young people aged under 18 years.

3 The term ‘staff’ refers to any employee, or paid and unpaid worker (for example, a volunteer), who has an agreement to work in that setting and is involved in promoting well-being.

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■■ to provide evidence of achievement and best practice and care – for example, to the regulator or Health Service Ombudsman, for the National Cleaning Standards, when using the National Service Frameworks, or in commissioning assurance.

Essence of Care 2010 can be used by individuals, teams, directorates, and within and across organisations of all sizes. It can also be used locally or strategically, or ideally, both. It has universal application.

When using Essence of Care 2010 it is important to remember to:

■■ make it work for people and their carers• focus on areas of concern for people and carers• use Essence of Care 2010 flexibly to make improvements• ensure involvement from people, carers and all staff concerned with

the delivery of care■■ make it work for staff and/organisations

• save time and effort and integrate Essence of Care 2010 work with other projects and initiatives, such as those required for the National Cleaning Standards, reports for regulators, infection control guidance, mixed sex accommodation guidance, Dignity Champions work, governance, Patient Environment Action Teams’ guidance, National Institute for Health and Clinical Excellence (NICE) guidance, electronic handover, and Better Metrics Projects, etc

• use within commissioning assurance■■ do not reinvent the wheel – be ‘smart’

• share and compare best practice and care (locally, nationally, other team’s work etc)

• where possible use evidence already in existence (for example, current audit data)

• use valid tools that already exist and• use evidence gathered for one set of benchmarks, for instance

those concerning, ‘Respect and Dignity’, to provide evidence for other sets of benchmarks such as ‘Communication’ and ‘Food and Drink’. This applies both to goals that are more specific as well as goals that cover topics such as diversity, consent and confidentiality, people’s involvement, leadership, education and training etc.

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Much of Essence of Care 2010 is centred on benchmarks and benchmarking for practice and care. The following text discusses this in more depth. In addition, there are more detailed ideas and tips on ‘Using Essence of Care 2010 Benchmarks’ in Appendix One and ‘Making Changes Possible and Sustainable’ in Appendix Two.

Why is benchmarking practice and care necessary?Many people have care that is very effective and appropriate to their needs and preferences. There are lots of examples of compliments being written or made to health and social services staff. However, practice and care is not correct all of the time and, therefore, needs improvement. Poor care is evidenced by, for instance, complaints, untoward incidents, and increased death and illness rates. Therefore, staff, teams and/organisations need to look at how they are working in order to improve practice and care.

Benchmarking is important because it is a systematic process that can be used to improve practice and care.

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What is a benchmark and benchmarking?In the context of this document a benchmark is:

‘a standard of best practice and care by which current practice and care is assessed or measured.’

Following from this benchmarking is:

‘a systematic process in which current practice and care are compared to, and amended to attain, best practice and care.’

Briefly the steps involved are:

■■ establish priorities for improving practice and care within the environment or organisation

■■ establish and agree best (evidence-based) practice and care for people within the organisation

■■ ascertain current practice and care■■ compare the differences, and identify the gaps and barriers between,

current and best practice and care and identify achievements■■ develop a plan of what goals need to be met to achieve best practice

and care, that is, working out what needs to be done and how■■ implement the plan (that is, change things, for example, activity,

perspective, approach, culture, education and training, environment, etc) to meet the goals

■■ evaluate practice and care by assessing and measuring whether goals have been met

■■ establish improved practice and care across a team, or organisation(s)■■ establish priorities and further goals to continuously improve

quality of practice and care, that is, go through the steps again.

(see also Appendices One and Two)

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Focus of Essence of Care 2010 benchmarksThe benchmarks are focused on 12 topics. These were chosen because the evidence indicated that people were unhappy with these fundamental aspects of care. The 12 sets of benchmarks are:

■■ Bladder, Bowel and Continence Care■■ Care Environment■■ Communication■■ Food and Drink■■ Prevention and Management of Pain■■ Personal Hygiene■■ Prevention and Management of Pressure Ulcers■■ Promoting Health and Well-being■■ Record Keeping■■ Respect and Dignity■■ Safety■■ Self Care

The overall person outcomes, specific factors and indicators (or goals) within the benchmarks have been developed, reviewed extensively and agreed by people, carers, association representatives and staff as vital to providing best practice and care. The result is sets of benchmarks which are truly person-focused. This is because the areas covered are important to people and carers, and the indicators are focused on what people and carers say they want and expect.

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Where can the Essence of Care 2010 benchmarks be used?These benchmarks are designed to be used wherever health and social care is planned, managed and/or delivered. For example, it can be used in the following settings and environments:

■■ people’s homes■■ hospitals■■ day centres■■ clinics■■ care homes■■ ambulances■■ prisons■■ GPs’ surgeries■■ schools

In the following areas:

■■ care for acutely ill people■■ care for chronically ill people■■ emergency care■■ long term care■■ short term care■■ care of people with learning disabilities■■ care of children and young people■■ care of people with a range of conditions such as cancer, diabetes,

medical and surgical problems■■ care of people with wounds■■ care in pregnancy■■ care of people with mental health problems■■ care of people who are terminally ill■■ care of people who are in pain■■ care of people who are vulnerable

and in the settings and areas in which you work.

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Content of Essence of Care 2010 benchmarksThe Essence of Care 2010 benchmarks comprise:

■■ an overall person-focused outcome that expresses what people and carers want from care in a particular area of practice

■■ definitions of terms as appropriate ■■ general indicators, or goals, for best practice■■ a number of factors, or topics, that need to be considered in order to

achieve the overall person-focused outcome

Each factor consists of:

■■ a person-focused statement of best practice and care which is placed at the extreme right of the continuum

■■ a statement of poor practice and care which is placed at the extreme left of the continuum

■■ indicators, or goals, identified by people, carers, association representatives and staff that support the attainment of best practice and care

An example is shown on the next page.

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Example of overall outcome, factor and indicatorBenchmarks for Prevention and Management of Pain

Agreed person-focused outcome

people and carers experience individualised, timely and supportive care that anticipates, recognises and manages pain and optimises function and quality of life

Factor 1 – Access

Indicators of best practice for factor 1The following indicators support best practice for managing pain:

a. general indicators (see page 4 in each benchmark) are considered in relation to this factor

b. up-to-date information about pain management and services, and how to access them, is readily available in all care environments and (where applicable) given in advance of care. Information is provided in a suitable format and in plain language

c. ..........

d. add your local indicators here

Poor Practicepeople and carers do not have access to timely and appropriate pain management

Best Practicepeople experiencing pain, or who are likely to experience pain, and carers receive timely and appropriate access to services to manage pain

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APPENDIX ONE

Ideas and tipsEssence of Care 2010 benchmarking is a systematic process in which the current practice and care of health and social organisations, teams or individual staff are compared to, and amended to attain, best practice and care. Changes and improvements focus on the indicators, or goals, within the factors, since these are the items that people, carers and staff believe are important for achieving best practice and care.

This section includes ideas and tips that have proved useful in taking forward the Essence of Care. It is not an exhaustive list of activities that must be followed.

The steps involved are listed in the tables on the following pages:

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How to use Essence of Care 2010St

eps

for

Ben

chm

arki

ng

:

Step

Act

ivit

yId

eas

and

Exa

mp

les

Step

On

eEs

tab

lish

pri

ori

ties

for

im

prov

ing

prac

tice

and

care

w

ithin

the

env

ironm

ent

or

orga

nisa

tion

Be

stra

teg

ic in

cho

osin

g a

set

of b

ench

mar

ks (

or a

fac

tor

or a

n in

dica

tor)

on

whi

ch t

o fo

cus

effo

rt t

hat

is r

elev

ant

and

appr

opr

iate

.

Dec

isio

ns o

n w

hat

to f

ocu

s on

sho

uld

be

base

d on

evi

den

ce s

uch

as:

■■

incr

ease

d co

ncer

ns a

bou

t pr

actic

e an

d ca

re h

ighl

ight

ed b

y pe

ople

, car

ers

and

/or

staf

f

■■

lack

of

satis

fact

ion

of p

eopl

e or

car

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(for

exa

mpl

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du

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surv

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■■

incr

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d ris

k to

saf

ety

of p

eopl

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arer

s an

d/o

r st

aff

(for

exa

mpl

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colle

cted

as

the

resu

lt of

inci

den

ts)

■■

incr

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d or

hig

h nu

mb

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f co

mpl

aint

s

■■

iden

tific

atio

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rec

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hed

evid

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of

bes

t pr

actic

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d ca

re;

■■

iden

tific

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an

exem

plar

of

go

od

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tice

and

care

with

in

the

orga

nisa

tion

■■

new

gui

danc

e fr

om o

rgan

isat

ions

suc

h as

Nat

iona

l Ins

titut

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r H

ealth

an

d C

linic

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xcel

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ICE)

, the

Nat

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rel

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Pat

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ecis

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of t

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s, o

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, co

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s or

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horit

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6838 How to use v0_12.indd 15 24/09/2010 12:01


16

Step

Act

ivit

yId

eas

and

Exa

mp

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For

exam

ple,

the

fol

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s co

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pa

rt v

ia t

he B

ench

mar

ks f

or P

reve

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n an

d M

anag

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Pre

ssur

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s (s

uch

as F

acto

r 1,

indi

cato

r b

):

■■

peo

ple

do

not

exp

ect

to d

evel

op

pres

sure

ulc

ers

in a

car

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viro

nmen

t

■■

the

team

wan

ts t

o id

entif

y an

d m

anag

e m

ore

effe

ctiv

ely

the

care

of

peo

ple

at r

isk

of d

evel

opi

ng p

ress

ure

ulce

rs

■■

the

orga

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wan

ts t

o re

duce

the

inci

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f pr

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pre

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dist

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equi

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■■

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orga

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s or

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to im

prov

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l wel

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of

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with

in a

n ar

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■■

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axim

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prov

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nd

wel

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out

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stra

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th

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bet

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s o

f p

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and

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as

wel

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se c

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cern

ed.

6838 How to use v0_12.indd 16 24/09/2010 12:01

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epA

ctiv

ity

Idea

s an

d E

xam

ple

s

It m

ay b

e ap

pro

pria

te f

or t

he o

rgan

isat

ion

to s

et u

p an

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ence

of

Car

e 20

10 S

teer

ing

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up

. Thi

s st

eeri

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gro

up

can

pro

vid

e st

rate

gic

focu

s an

d di

rect

ion

for

the

Esse

nce

of C

are

2010

initi

ativ

e an

d su

ppor

t st

aff

thro

ugho

ut t

he o

rgan

isat

ion

(s) t

o im

prov

e th

e fu

ndam

enta

l asp

ects

of

care

. The

ste

erin

g gr

oup

can

also

be

used

to

mon

itor

pro

gres

s, f

acili

tate

ev

alua

tion

and

rep

ort

on b

ench

mar

king

act

iviti

es t

o th

e b

oar

d. In

add

ition

, th

e st

eerin

g gr

oup

coul

d ha

ve a

rem

it to

ens

ure

that

the

Ess

ence

of

Car

e 20

10 in

itiat

ive

is in

tegr

ated

with

the

org

anis

atio

n’s

othe

r pr

iorit

ies

and

com

mit

tees

. Lea

d m

emb

ers

can

liais

e w

ith o

ther

org

anis

atio

ns a

t re

gion

al

and

nati

onal

leve

ls t

o sh

are

go

od

prac

tice,

idea

s an

d to

dis

sem

inat

e m

etho

ds o

f im

prov

emen

t. t

he S

teer

ing

Gro

up

cou

ld h

ave

a re

mit

to

ensu

re t

hat

the

Esse

nce

of C

are

2010

initi

ativ

e is

inte

grat

ed w

ith t

he

orga

nisa

tion

’s o

ther

pri

oriti

es a

nd c

omm

itte

es.

ESSE

NC

E O

F C

AR

E 20

10 S

TEER

ING

GR

OU

PS

Esse

nce

of C

are

2010

Ste

erin

g G

roup

mem

ber

ship

can

incl

ude:

■■

peo

ple

and

/or

care

rs

■■

repr

esen

tati

ves

from

ass

oci

atio

ns, s

uch

as A

ge

UK

■■

exp

erts

in c

hang

ing

prac

tice

(for

inst

ance

, lea

d m

emb

ers

of t

he p

ract

ice

dev

elo

pmen

t, s

ervi

ce im

prov

emen

t, in

tegr

ated

gov

erna

nce

and

/or

qual

ity

team

s)

■■

com

mis

sion

ers

of s

ervi

ces

■■

staf

f w

ho w

ork

dire

ctly

with

peo

ple

and

/or

care

rs

■■

seni

or m

anag

ers

of s

ervi

ces

■■

supp

ort

serv

ice

staf

f

■■

bo

ard

mem

ber

s

6838 How to use v0_12.indd 17 24/09/2010 12:01


18

Step

Act

ivit

yId

eas

and

Exa

mp

les

Rem

emb

er: C

on

sid

er r

eso

urc

e im

plic

atio

ns

– th

ere

is n

o b

ott

om

less

p

ot

of

mo

ney

!

Step

Tw

o

Esta

blis

h a

nd

ag

ree

bes

t (e

vid

ence

-bas

ed) p

ract

ice

and

care

for

peo

ple

with

in

the

orga

nisa

tion

Gu

idan

ce f

or

bes

t p

ract

ice

and

car

e is

pro

vid

ed b

y th

e sp

ecifi

c an

d g

ener

al in

dica

tors

(g

oal

s) t

hat

peo

ple

and

care

rs h

ave

stat

ed a

re im

por

tant

fr

om t

heir

per

spec

tive

s. S

ome

of t

hese

go

als

are

abou

t pu

ttin

g pr

oce

sses

in

plac

e an

d ot

hers

are

the

out

com

es t

hat

peo

ple

and

care

rs w

ant

and

exp

ect.

Exam

ples

of

go

als

are:

■■

peo

ple

are

addr

esse

d as

the

y w

ish

and

spok

en t

o us

ing

thei

r pr

efer

red

nam

e (B

ench

mar

ks f

or R

esp

ect

and

Dig

nity

, fac

tor

4, In

dica

tor

b)

■■

reso

urce

s to

aid

com

mun

icat

ion

and

und

erst

andi

ng a

re a

vaila

ble,

for

ex

ampl

e, h

earin

g lo

ops

, tex

t ph

one,

larg

e pr

int

text

, pic

ture

s, b

ook

s,

toys

, Bra

ille,

mul

tilin

gual

lite

ratu

re a

nd o

ther

ele

ctro

nic

met

hods

of

com

mun

icat

ion

(Ben

chm

arks

for

Com

mun

icat

ion,

fac

tor

5, in

dica

tor

b)

■■

inci

den

ts, s

uch

as a

cts

of v

iole

nce,

agg

ress

ion

and

secl

usio

n ar

e re

view

ed

and

eval

uate

d an

d th

e kn

owle

dge

is u

sed

to im

prov

e ca

re (

Ben

chm

arks

fo

r Sa

fety

, fac

tor

6, in

dica

tor

d)

■■

peo

ple

and

care

rs k

now

how

to

acce

ss s

ervi

ces

and

reso

urce

s,

for

exam

ple,

by

usin

g th

e C

itize

n’s

Ad

vice

Bur

eau,

NH

S D

irect

etc

(B

ench

mar

ks f

or S

elf

Car

e, f

acto

r 6,

indi

cato

r c)

■■

peo

ple

who

are

iden

tifi

ed in

itial

ly a

s ha

ving

pre

ssur

e ul

cers

or

who

are

vu

lner

able

to

the

dev

elo

pmen

t of

pre

ssur

e ul

cers

sho

uld

rece

ive

a fu

ll as

sess

men

t us

ing

an e

vid

ence

-bas

ed t

ool

(B

ench

mar

ks f

or `P

reve

ntio

n an

d M

anag

emen

t of

Pre

ssur

e U

lcer

s, f

acto

r 1,

indi

cato

r d

).

6838 How to use v0_12.indd 18 24/09/2010 12:01

19


epA

ctiv

ity

Idea

s an

d E

xam

ple

s

N.B

. No

t al

l th

e g

oal

s ar

e ap

plic

able

to

all

hea

lth

an

d s

oci

al s

etti

ng

s an

d e

nvi

ron

men

ts a

nd

oth

ers

may

nee

d t

o b

e ad

apte

d.

It is

oft

en im

po

rtan

t to

ag

ree

wh

at c

on

stit

ute

s b

est

pra

ctic

e an

d

care

acr

oss

a t

eam

, an

org

anis

atio

n o

r o

rgan

isat

ion

s in

ord

er t

o

ensu

re im

pro

vem

ents

are

ach

ieve

d a

nd

su

stai

nab

le a

cro

ss h

ealt

h o

r so

cial

car

e se

ttin

gs.

For

inst

ance

:

■■

in r

elat

ion

to p

ress

ure

ulce

r m

anag

emen

t an

d g

oal

s, a

gree

men

t m

ay

have

to

be

reac

hed

abou

t w

hat

is m

eant

by

the

term

‘vul

nera

ble

to

deve

lopm

ent

of p

ress

ure

ulce

rs’ a

nd w

hat

cons

titut

es a

‘fu

ll as

sess

men

t’

or a

n ‘e

vide

nce-

bas

ed t

ool

’. Th

is m

ay in

volv

e se

ttin

g up

an

‘Exp

ert

Wo

rkin

g G

rou

p’ (

see

bel

ow) t

o pu

t fo

rwar

d st

anda

rds

and

asse

ssm

ent

tool

s w

hich

can

the

n b

e ag

reed

thr

ough

out

the

team

, an

orga

nisa

tion

or

orga

nisa

tion

s

■■

the

goal

of

‘nat

ure

and

qual

ity

of li

ghtin

g an

d us

e of

col

our

in f

urni

shin

gs

and

deco

ratio

ns s

upp

ort

a th

erap

eutic

and

/or

heal

ing

envi

ronm

ent’

(B

ench

mar

ks f

or C

are

Envi

ronm

ent,

fac

tor

3, in

dica

tor

c) w

ould

req

uire

an

‘Exp

ert

Wo

rkin

g G

rou

p’ o

f p

eopl

e an

d ca

rers

as

wel

l as

a ra

nge

of s

taff

incl

udin

g th

ose

del

iver

ing

care

and

tho

se m

anag

ing

the

phys

ical

en

viro

nmen

t, s

uch

as e

stat

e m

anag

emen

t st

aff

etc.

In a

dditi

on, s

taff

m

anag

ing

budg

ets

wou

ld n

eed

to b

e in

volv

ed t

o su

ppor

t or

san

ctio

n an

y co

st

■■

the

go

al o

f ‘b

arrie

rs t

o ac

cess

ing

info

rmat

ion,

ser

vice

s an

d su

ppor

t ha

ve

bee

n id

entifi

ed a

nd a

re b

eing

add

ress

ed’ (

Ben

chm

arks

for

the

Pro

mot

ing

Hea

lth a

nd W

ell-

bei

ng, f

acto

r 5,

indi

cato

r c)

may

req

uire

an

‘Exp

ert

Wo

rkin

g G

rou

p’ i

n or

der

to a

scer

tain

the

bar

riers

and

how

bes

t to

ad

dres

s th

em.

6838 How to use v0_12.indd 19 24/09/2010 12:01


20

Step

Act

ivit

yId

eas

and

Exa

mp

les

EX

PER

T W

OR

KIN

G G

RO

UPS

Exp

ert

Wor

king

Gro

up m

emb

ersh

ip c

an in

clud

e:

■■

peo

ple

and

/or

care

rs

■■

repr

esen

tati

ves

from

ass

oci

atio

ns, s

uch

as A

ge

UK

■■

exp

erts

in t

he t

opi

c un

der

rev

iew

(for

inst

ance

, if

dev

elo

ping

bes

t pr

actic

e an

d ca

re f

or p

eopl

e w

ho d

o no

t sp

eak

Engl

ish,

rep

rese

ntat

ives

fr

om o

rgan

isat

ions

tha

t pr

ovid

e co

mpe

tent

inte

rpre

ters

cou

ld b

e in

volv

ed)

■■

staf

f w

ho w

ork

dire

ctly

with

peo

ple

and

/or

care

rs

■■

man

ager

s of

ser

vice

s

■■

supp

ort

serv

ice

staf

f

■■

bo

ard

mem

ber

s, t

rust

ees

and

gov

erno

rs

Ther

efo

re, t

his

ste

p u

sual

ly n

eces

sita

tes

the

wo

rk o

f a

gro

up

wit

h

som

e ex

per

tise

or

kno

wle

dg

e o

f th

e to

pic

un

der

rev

iew

(n

.b. t

his

in

vari

ably

incl

ud

es p

eop

le a

nd

/or

care

rs),

in o

rder

to

dis

cuss

an

d

defi

ne

bes

t p

ract

ice

and

car

e. In

ad

dit

ion

, so

me

mem

ber

s o

f th

e g

rou

p a

lso

nee

d t

o h

ave

an o

vera

ll vi

ew o

f th

e m

anag

emen

t o

f ca

re

in a

par

ticu

lar

area

an

d o

ther

mem

ber

s w

ill h

ave

the

auth

ori

ty (

or

acce

ss t

o a

uth

ori

ty)

to o

bta

in a

gre

emen

t fo

r th

e g

rou

p’s

dec

isio

ns

fro

m t

he

rele

van

t co

mm

itte

es w

ith

in t

hei

r o

rgan

isat

ion

(s).

6838 How to use v0_12.indd 20 24/09/2010 12:01

21


epA

ctiv

ity

Idea

s an

d E

xam

ple

s

Step

Th

ree

Asc

erta

in c

urr

ent

prac

tice

and

care

Cur

rent

pra

ctic

e an

d ca

re c

an b

e as

cert

aine

d in

a n

umb

er o

f w

ays.

Fo

r ex

ampl

e:

■■

obs

erva

tion

of

care

(su

ch a

s w

heth

er p

eopl

e ar

e sp

oken

to

usin

g th

eir

pref

erre

d na

me,

or

whe

ther

the

y ha

ve t

he n

eces

sary

com

mun

icat

ion

aids

)

■■

revi

ewin

g d

ocu

men

tati

on (

such

as

to a

scer

tain

whe

ther

inci

den

ts a

re

revi

ewed

, eva

luat

ed a

nd u

sed

to im

prov

e ca

re, o

r w

heth

er t

hose

who

ar

e vu

lner

able

to

dev

elo

ping

pre

ssur

e ul

cers

rec

eive

a f

ull a

sses

smen

t)

■■

mon

itorin

g ac

cess

to

serv

ices

(su

ch a

s lo

cal i

nter

pret

ing

serv

ices

or

N

HS

Dire

ct)

■■

mon

itorin

g ou

tcom

es o

f ca

re (

such

as

prev

alen

ce w

wan

d in

cid

ence

of

pres

sure

ulc

ers)

■■

surv

eys

of p

eopl

e’s

and

care

rs’ v

iew

s an

d sa

tisfa

ctio

n (s

uch

as a

ttitu

de

and

help

fuln

ess

of s

taff

).

It is

imp

ort

ant

to d

ecid

e h

ow

(cr

iter

ia a

nd

met

ho

d)

curr

ent

pra

ctic

e an

d c

are

will

be

mea

sure

d o

r as

sess

ed. T

here

may

be

stan

dard

way

s of

ac

hiev

ing

this

(su

ch a

s th

e N

atio

nal P

atie

nt S

urve

y Pr

ogr

amm

e or

exi

stin

g se

rvic

es u

ser

surv

eys)

or

loca

l crit

eria

and

met

hods

may

nee

d to

be

used

. Fo

r ex

ampl

e, w

hat

crite

ria w

ill b

e us

ed t

o as

sess

whe

ther

peo

ple

are

spok

en t

o us

ing

thei

r pr

efer

red

nam

e? It

cou

ld b

e th

e nu

mb

er o

f tim

es

that

a p

erso

n’s

refe

rred

nam

e w

as u

sed

as a

per

cent

age

of h

ow t

hey

wer

e re

ferr

ed t

o du

ring

an e

piso

de

of c

are;

or

a p

erso

n’s

per

cept

ion

of

whe

ther

the

ir pr

efer

red

nam

e w

as u

sed

‘not

at

all’,

‘som

etim

es’,

‘mos

tly’

or

‘all

the

time’

etc

. The

met

hod

used

cou

ld b

e o

bser

vati

on a

nd t

akin

g no

tes,

or

reco

rdin

g ev

ents

by

cam

era,

or

by a

skin

g p

eopl

e or

sta

ff. I

t is

im

per

ativ

e th

at t

he

crit

eria

an

d m

eth

od

use

d r

eflec

t th

e to

pic

un

der

in

vest

igat

ion

th

at is

, is

wh

at is

bei

ng

mea

sure

d o

r as

sess

ed w

hat

is

sup

po

sed

to

bei

ng

mea

sure

d o

r as

sess

ed?

6838 How to use v0_12.indd 21 24/09/2010 12:01


22

Step

Act

ivit

yId

eas

and

Exa

mp

les

The

Bet

ter

Met

rics

Pro

ject

(H

ealth

Car

e C

omm

issi

on 2

007

) and

Sta

te

of

the

Art

Met

rics

fo

r N

urs

ing

: A R

apid

Ap

pra

isal

(N

atio

nal N

ursi

ng

Rese

arch

Uni

t, K

ing’

s C

olle

ge

Lond

on 2

00

8) m

ay p

rovi

de

som

e us

eful

idea

s in

ter

ms

of m

easu

rem

ent.

Rem

emb

er t

o k

eep

th

e ev

iden

ce!

Step

Fo

ur

Co

mp

are

the

dif

fere

nce

s,

and

iden

tify

the

gaps

and

ba

rrie

rs, b

etw

een

curr

ent

and

bes

t pr

actic

e an

d ca

re

and

iden

tify

achi

evem

ents

Use

th

e ev

iden

ce c

olle

cted

on

curr

ent

prac

tice

and

care

to

asse

ss

achi

evem

ent

tow

ards

bes

t pr

actic

e an

d ca

re. E

vid

ence

can

incl

ude

that

co

llect

ed f

rom

, for

exa

mpl

e, t

he N

atio

nal P

atie

nt S

urve

y, P

EAT

pro

gram

mes

, ot

her

nati

onal

and

loca

l ini

tiati

ves.

Do

no

t d

up

licat

e!

Iden

tify

th

e g

aps.

For

exa

mpl

e, if

onl

y 50

per

cent

of

rece

ptio

n st

aff

spea

k to

peo

ple

usin

g th

eir

pref

erre

d na

me,

the

re is

evi

den

tly

a ga

p b

etw

een

this

and

bes

t pr

actic

e an

d ca

re w

here

eve

ryon

e is

sp

oken

to

usin

g th

eir

pref

erre

d na

me.

Iden

tify

bar

rier

s to

bes

t p

ract

ice

and

car

e. T

o co

ntin

ue t

o us

e th

e ex

ampl

e ab

ove

– in

ord

er t

o id

entif

y w

hy r

ecep

tion

sta

ff a

re n

ot u

sing

a

per

son’

s pr

efer

red

nam

e a

man

ager

may

cho

ose

to d

iscu

ss t

his

with

the

st

aff

mem

ber

s. T

he b

arri

ers

may

tur

n ou

t to

be

that

the

pre

ferr

ed n

ame

was

not

ask

ed f

or o

r w

as n

ot e

nter

ed in

to t

he c

ompu

ter

data

base

by

the

staf

f as

sess

ing

the

per

son.

6838 How to use v0_12.indd 22 24/09/2010 12:01

23


epA

ctiv

ity

Idea

s an

d E

xam

ple

s

Step

Fiv

eD

evel

op

a p

lan

of

wha

t g

oal

s ne

ed t

o b

e m

et t

o ac

hiev

e b

est

prac

tice

and

care

tha

t is

, wor

king

out

w

hat

need

s to

be

don

e

and

how

Pro

du

ce a

n a

ctio

n p

lan

det

ailin

g:

■■

the

chan

ges

tha

t ne

ed t

o b

e m

ade

to m

eet

go

als

(for

inst

ance

, the

co

mpu

ter

need

s to

indi

cate

the

nee

d fo

r a

‘pre

ferr

ed n

ame’

to

be

ente

red

onto

a p

erso

n’s

reco

rds)

■■

any

reso

urce

impl

icat

ions

and

how

the

se w

ill b

e m

et (f

or e

xam

ple,

how

m

uch

time

the

abov

e w

ould

tak

e to

org

anis

e an

d to

ent

er)

■■

who

is r

esp

onsi

ble

for

lead

ing

the

chan

ges

■■

the

time

scal

e in

whi

ch t

hese

sho

uld

occ

ur.

Act

ion

s sh

ould

be:

■■

real

istic

■■

achi

evab

le (

but

do

not

let

that

lim

it yo

ur v

isio

n of

wha

t is

pos

sibl

e)

■■

mea

sura

ble

or a

sses

sabl

e.

N.B

. Th

e ‘E

ssen

ce o

f C

are

2010

Ste

erin

g G

rou

p’ a

nd

/or

‘Exp

ert

Wo

rkin

g G

rou

p’ (

see

Step

s O

ne

and

Tw

o)

can

be

use

d t

o f

acili

tate

th

e ab

ove

wit

hin

a t

eam

, an

org

anis

atio

n o

r o

rgan

isat

ion

s. T

hin

k d

iffe

ren

tly!

It is

imp

ort

ant

to c

on

sid

er p

ract

ice

and

car

e fr

om

p

eop

le’s

an

d c

arer

s’ p

oin

ts o

f vi

ew (

see

also

Thi

nkin

g D

iffe

rent

ly, N

HS

Inst

itute

for

Inno

vati

on a

nd Im

prov

emen

t, 2

007

).

6838 How to use v0_12.indd 23 24/09/2010 12:01


24

Step

Act

ivit

yId

eas

and

Exa

mp

les

Step

Six

Imp

lem

ent

the

pla

n

(tha

t is

, cha

nge

thin

gs,

for

exam

ple,

act

ivit

y,

per

spec

tive

, app

roac

h,

cultu

re, e

duca

tion

and

tr

aini

ng, e

nviro

nmen

t et

c) t

o m

eet

the

go

als

Car

ry o

ut

the

pla

n.

Kee

p t

he

evid

ence

(d

ocu

men

t, d

ocu

men

t, d

ocu

men

t):

■■

acti

viti

es

■■

any

impr

ovem

ents

■■

pro

blem

s

■■

unex

pec

ted

obs

erva

tion

s.

N.B

. Th

e ‘E

ssen

ce o

f C

are

2010

Ste

erin

g G

rou

p’ a

nd

/or

‘Exp

ert

Wo

rkin

g G

rou

p’ (

see

Step

s O

ne

and

Tw

o)

can

be

use

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6838 How to use v0_12.indd 24 24/09/2010 12:01

25


epA

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gley

GJ,

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an K

M, N

orm

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ost

LP a

nd N

olan

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(19

96

) The

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de: A

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ctic

al A

ppro

ach

to E

nhan

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aniz

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nal P

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rman

ce

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ey-B

ass

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rs: U

SA c

ited

in M

od

erni

sati

on A

gen

cy, 2

002

).

6838 How to use v0_12.indd 25 24/09/2010 12:01


26

APPENDIX TWO

Making changes possible and sustainable: Ideas and tips

Things to put in place:

Organisation Team Individual

Culture The culture of the organisation actively supports benchmarking the fundamental aspects of practice and care.

People’s and carers’ involvement and perspectives are ensured wherever the fundamental aspects of care are considered.

The culture of the team actively supports benchmarking the fundamental aspects of practice and care.


Individual staff actively support benchmarking the fundamental aspects of practice and care.


Structure There is an organisation-wide structure that supports benchmarking the fundamental aspects of practice and care.

Teams and team leaders are an integral part of the organisation-wide structure.

Individuals liaise with their local teams and team leaders and, as appropriate, with organisation and commissioning teams.

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27



Mechanisms Organisation-wide mechanisms are in place to manage the benchmarking process and to integrate this with other quality initiatives and priorities.

Team mechanisms are in place to manage the benchmarking process locally and to integrate this with other quality initiatives.

Individuals manage relevant parts of the benchmarking process. This may involve activities such as taking part in audits, surveys etc.

Responsibility The organisation takes action to meet its responsibilities in terms of benchmarking the fundamental aspects of practice and care.

The chief executive officer (CEO) (or registered person in a social care service) is ultimately responsible for ensuring that the fundamental aspects of practice and care are met.

The team takes action to meet its responsibilities in terms of benchmarking the fundamental aspects of practice and care.

The team leader is ultimately responsible for ensuring that the fundamental aspects of practice and care are met within their team.

Every member of staff is responsible for supporting activity towards benchmarking and delivering the fundamental aspects of practice and care.

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Leadership There is a designated post or role at senior management level to lead the Essence of Care Initiative. The post-holder is the link between commissioners, the board, managers, team leaders and staff working directly with people and carers.

There is a specifically designated role to lead the Essence of Care Initiative within teams.

Individuals have access to support and advice from the designated leader and also support the leader in their work.

Commissioning Assurance

Benchmarks of the fundamental aspects of practice and care are central and integral to how services are planned, commissioned and delivered.

Teams are able to demonstrate that fundamental aspects of care are part of how services are planned and delivered.

Individuals contribute to the planning and delivery of the fundamentals of care

Resources Sufficient human and financial resources are provided to sustain the benchmarking process in the fundamental aspects of care and to maintain improvements in care.

Teams can provide evidence of probity in managing human and financial resources to support improvements in the fundamental aspects of care.

Individuals can provide evidence of probity in delivery of care to support improvements in the fundamental aspects of care.

6838 How to use v0_12.indd 28 24/09/2010 12:01

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