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Auditing integrated stroke care to support quality improvement activities: development of a peer-to-peer audit framework
- Authors:
- BUIJCK Bianca, et al
- Journal article citation:
- Journal of Integrated Care, 30(2), 2022, pp.160-171.
- Publisher:
- Emerald
Purpose: To organize stroke care, multiple stakeholders work closely together in integrated stroke care services (ISCS). However, even a well-developed integrated care program needs a continuous quality improvement (CQI) cycle. The current paper aims to describe the development of a unique peer-to-peer audit framework, the development model for integrated care (DMIC), the Dutch stroke care standard and benchmark indicators for stroke. Design/methodology/approach: A group of experts was brought together in 2016 to discuss the aims and principles of a national audit framework. The steering group quality assurance (SGQA) consisted of representatives of a diversity of professions in the field of stroke care in the Netherlands, including managers, nurses, medical specialists and paramedics. Findings: Auditors, coordinators and professionals evaluated the framework, agreed on that the framework was easy to use and valued the interesting and enjoyable audits, the compliments, feedback and fruitful insights. Participants consider that a quality label may help to overcome necessity issues and have health care insurers on board. Finally, a structured improvement plan after the audit is needed. Originality/value: An audit offers fruitful insights into the functioning of an ISCS and the collaboration therein. Best practices and points of improvement are revealed and can fuel collaboration and the development of partnerships. Innovative cure and care may lead to an increasing area of support among professionals in the ISCS and consequently lead to improved quality of delivered stroke care. (Edited publisher abstract)
Facilitators of, and barriers to, personalisation in care homes in England: evidence from Care Quality Commission inspection reports
- Authors:
- DAMANT Jacqueline, et al
- Journal article citation:
- International Journal of Care and Caring, early cite February 2022,
- Publisher:
- Policy Press
The personalisation of residential care services is based on three broad principles of valuing personal identity, empowering resident decision-making and fostering care relationships. We analysed 50 Care Quality Commission care home inspection reports to identify factors that the reports indicate facilitate or hinder the delivery of personalised residential care in England. Findings suggest that the provision of personalised services is affected by staff skills, attitudes and availability, as well as the quality of care home leadership. Future care policy should consider addressing external pressures facing the care home sector, including inadequate funding and too few staff, to mitigate barriers to delivering high-quality, personalised care. (Edited publisher abstract)
Are we starting to ‘think family’? evidence from a case file audit of parents and children supported by mental health, addictions and children's services
- Authors:
- McCARTAN Claire, et al
- Journal article citation:
- Child Abuse Review, early cite February 2022, p.e2738.
- Publisher:
- Wiley
The Health and Social Care Board in Northern Ireland commissioned an audit of social work case files from across service teams to establish whether Think Family Northern Ireland (Think Family NI) and FFP have become embedded across three different services (Community Mental Health Teams (CMHTs), and addictions and children's services). The audit sought to: identify the extent to which these services co-worked to support families; highlight good practice; and identify areas for improvement. Sampling: each Trust sampled 30 files (10 from each service; total N = 120 files). Case file profile: of the 103 families in the final sample, the mother was the primary focus in 85 per cent of cases and, in total, parents had caring responsibilities for 258 children, the majority of whom were aged under 16 years. Cases were complex, with problematic substance use (50%) and personality disorder (16%) the most commonly reported difficulties. Most parents had significant co-morbidities (including self-harm/suicide attempts (32%) and anxiety/depression (13%) in the past 12 months). Evidence of FFP: over half of the files examined showed evidence of joint working across services, with CMHTs being more likely to demonstrate collaboration than either children's services or addictions services. Key Practitioner Messages: cases are complex and families can feel overwhelmed by the number of agencies and referrals involved; systemic, family-focused practice can lead to improved outcomes; efforts to promote interagency collaboration include: clear job descriptions; co-locating services; home visits; interprofessional education; and joint training; joint decision-making can help acknowledge and value everyone's role and contribution; and better recording and sharing of data can support informed, complex decision-making and optimise support services. (Edited publisher abstract)
Regulating and inspecting integrated health and social care in the UK: scoping the literature
- Authors:
- RODGERS Mark, et al
- Publisher:
- NIHR Health Services and Delivery Research
- Publication year:
- 2020
- Pagination:
- 142
- Place of publication:
- Southampton
The integration of care, particularly across the health and social care sectors, has been a long-standing policy objective in the UK. We sought to scope the evidence related to the regulation and inspection of integrated care. There are a number of regulatory bodies responsible for overseeing the quality of health and social care services across the four countries of the UK. Among other activities, these bodies conduct inspections in different health and social care settings. Separately, a number of professional regulators oversee the conduct of different health and social care professionals (e.g. doctors, nurses, pharmacists, dentists, social workers). In recent years, in the UK and other countries, there has been a move toward a more “integrated” way of delivering health and social care. This involves better co-ordination between different parts of the NHS, and between the NHS and other organisations. In some cases, having a more joined-up health and social care system has changed the ways in which care professionals work with each other and with the public. It also means that care is sometimes provided outside traditional settings. These changes have raised questions about how the traditional regulation and inspection of health and social care services should also change. We searched the international literature to identify any evidence on the regulation and inspection of integrated care. While we found relevant publications, very few of these provided evidence to indicate how effective different approaches to regulation might be. There was also relatively little evidence on professional regulation in general. However, with appropriate planning, it should be possible to collect such evidence in the future. (Edited publisher abstract)
Rapid literature review on effective regulation: implications for the Care Quality Commission
- Authors:
- MARSDEN Jillian, et al
- Publisher:
- Care Quality Commission
- Publication year:
- 2020
- Pagination:
- 39
- Place of publication:
- London
This report presents the findings of a rapid literature review on what constitutes effective regulation. The review has been conducted to inform development of the Care Quality Commission’s forward strategy. The review used a ‘berry-picking’ approach to identify appropriate literature – an iterative approach to discovering the most appropriate publications, rather than using defined search terms to identify a complete body of material to review. The evidence suggests that there isn’t an ideal way to regulate. Rather, a regulator needs to strike a balance between different options and employ a theory-based approach to understanding why they are choosing one set of options over a different set. The report draws out some of the main findings from across the reviewed literature and identifies learning for CQC. These include: taking a flexible approach to regulation and adapting it to the circumstances of different providers; building ongoing relationships with the providers we regulate; working with other parts of the system to achieve improvements in quality; meaningfully involving people who use services in our regulation; ensuring relevant regulation by keeping pace with the digitalisation, technology, and innovations in the system. (Edited publisher abstract)
Joint targeted area inspection of the multi-agency response to children’s mental health in Milton Keynes
- Authors:
- OFSTED, et al
- Publisher:
- OFSTED
- Publication year:
- 2019
- Pagination:
- 15
- Place of publication:
- Manchester
Findings from a joint inspection about the effectiveness of partnership working and of the work of individual agencies responding to children’s mental health in Milton Keynes. The inspection was undertaken by HMI Constabulary and Fire & Rescue Services, Ofsted, the Care Quality Commission and HMI Probation. The report sets out the key strengths of partnership working and identifies areas for improvements. The report indicates that the partnership in Milton Keynes is clearly focused on driving improvements to ensure the appropriate recognition and response to children with mental ill health. Children can access a wide range of services to help them with their emotional wellbeing and mental health needs. A variety of partners, including schools, provide services, and different approaches are being developed to ensure better access to support, including web-based counselling service. Partners have worked together to produce a Local Transformation Plan (LTP), which, together with a recent children’s mental health needs assessment and an NHS improvement review of the local mental health provision, provides a good basis to develop and improve services. However, the report finds that there is still more to do to ensure that strategic leaders have a clear overview of all services within Milton Keynes, and partners cannot yet be assured that there are enough of the right services to meet the needs of children with mental ill health. In addition, some frontline staff have not had enough training about children’s mental health. For some children who have been involved with agencies for some time and who have complex needs, progress of plans to improve their health, well-being and safety is not sufficiently well monitored to ensure that children are making progress. (Edited publisher abstract)
Joint targeted area inspection of the multi-agency response to children’s mental health in Sefton
- Authors:
- OFSTED, et al
- Publisher:
- OFSTED
- Publication year:
- 2019
- Pagination:
- 16
- Place of publication:
- Manchester
Outlines the findings from one of a series of joint targeted area inspections to investigate the effectiveness of partnership working and of the work of individual agencies in responding to children living with mental ill health in Sefton. The inspection included an evaluation of the multi-agency ‘front door’, which receives referrals when children may be in need or at risk of significant harm. The report outlines both strengths and areas for improvement. It found there was: ineffective partnership working at both strategic and operational levels; poor information-sharing about children’s needs; and that children are unable to access support from the child and adolescent mental health service (CAMHS) quickly enough. Due to weaknesses in partnership working, the report outlines areas for priority action. (Edited publisher abstract)
Implementing participation‐focused services: a study to develop the Method for using Audit and Feedback in Participation Implementation (MAPi)
- Authors:
- KOLEHMAINEN Niina, et al
- Journal article citation:
- Child: Care, Health and Development, 46(1), 2020, pp.37-45.
- Publisher:
- Wiley
Background: It is widely agreed that children's services should use participation‐focused practice, but that implementation is challenging. This paper describes a method for using audit and feedback, an evidence‐based knowledge translation strategy, to support implementation of participation‐focused practice in front‐line services, to identify barriers to implementation, and to enable international benchmarking of implementation and barriers. Method: Best‐practice guidelines for using audit and feedback were followed. For audit, participation‐focused practice was specified as clinicians' three observable behaviours: (a) targets participation outcomes; (b) involves child/parent in setting participation outcomes; and (c) measures progress towards participation outcomes. For barrier identification, the Theoretical Domains Framework Questionnaire (TDFQ) of known implementation barriers was used. A cycle of audit and barrier identification was piloted in three services (n = 25 clinicians) in a large U.K. healthcare trust. From each clinician, up to five randomly sampled case note sets were audited (total n = 122), and the clinicians were invited to complete the TDFQ. For feedback, data on the behaviours and barriers were shared visually and verbally with managers and clinicians to inform action planning. Results: A Method for using Audit and feedback for Participation implementation (MAPi) was developed. The MAPi audit template captured clinicians' practices: Clinicians targeted participation in 37/122 (30.3%) of the sampled cases; involved child/parent in 16/122 (13.1%); and measured progress in 24/122 (19.7%). Barriers identified from the TDFQ and fed back to managers and clinicians included clinicians’ skills in participation‐focused behaviours (median = 3.00–5.00, interquartile range [IQR] = 2.25‐6.00), social processes (median = 4.00, IQR = 3.00–5.00), and behavioural regulation (median = 4.00–5.00, IQR = 3.00–6.00). Conclusions: MAPi provides a practical, off‐the‐shelf method for front‐line services to investigate and support their implementation of participation‐focused practice. Furthermore, as a shared, consistent template, MAPi provides a method for generating cumulative and comparable, across‐services evidence about levels and trends of implementation and about enduring barriers to implementation, to inform future implementation strategies. (Publisher abstract)
The multi-agency response to child sexual abuse in the family environment
- Authors:
- OFSTED, et al
- Publisher:
- OFSTED
- Publication year:
- 2020
- Pagination:
- 37
- Place of publication:
- Manchester
This report summarises findings from six joint targeted area inspections to examine how well children’s social care, health professionals, youth offending services, the police and probation officers work together to keep children who are sexually abused in families safe. The inspections were conducted by Ofsted, HMICFRS, Care Quality Commission and HMI Probation between September 2018 and May 2019. Inspectors visited six local authorities: Bracknell Forest, Cornwall, Derby City, Islington, Shropshire and York. The findings cover the areas of prevention, identification of child sexual abuse, protection of children when abuse has occurred, and support for children and families. Key findings include that: child sexual abuse in the family environment is not a high enough priority; professionals find this area of practice very difficult; preventative work is limited or focused on known offenders; and practice is too police-led and not sufficiently child-centred. The report concludes that more needs to be done to prevent the sexual abuse of children in the family environment and for agencies to work better to protect and support victims and families. The report also calls on professionals to give sexual abuse a higher priority in local areas, through improved training and awareness-raising of the problem. (Edited publisher abstract)
Youth custody service safeguarding review
- Authors:
- BROOKS Sonia, et al
- Publisher:
- HM Prison and Probation Service
- Publication year:
- 2019
- Pagination:
- 71
- Place of publication:
- London
A national review of safeguarding practices from the youth secure estate in England and Wales. The review focuses on the responsibilities of the Youth Custody Service but also considers the relationship with other agencies in safeguarding children and young people in custody. The review covers all three sectors of Youth Custody Service (YCS), including five Young Offender Institutions (YOIs), three Secure Training Centres (STCs) and eight Secure Children’s Homes. The high level review focused on a number of key themes, including: commissioning and contracts; quality assurance; equality, diversity and inclusion; leadership and culture; placements and transitions; staff training; information sharing; and allegations and complaints. The report highlights examples of good practice throughout and includes recommendations for the future of safeguarding practice. It concludes that YCS leaders should continue to develop towards a child-centred, rehabilitative culture, with safeguarding seen as an overarching aspect of all roles and functions. (Edited publisher abstract)