Transcript Document

George Coxon, Director CCH Devon Chair of
the Devon Dementia QKM steering group
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Diabetes Sans Frontiers! Meeting
26th March 2014
Residential Care Quality Kite-Mark (QKM)
The story so far in Devon…
How to start a movement and its application to
diabetes in residential care
George Coxon, Director CCH Devon Chair of
the Devon Dementia QKM steering group
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A few slide about the Devon
Residential Care Quality Kite Mark
George Coxon, Director CCH Devon Chair of
the Devon Dementia QKM steering group
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Quality Kite Mark in Residential Care Settings in Devon
The story so far…… priority focus on dementia care
• Commissioned in July 2012 by Devon PEN Dementia Task and Finish
Group
• Core group focus – 6 members – all opted in
• Scoping the priorities – early meetings Sept- Oct 2012
• ‘product development - construction’ work
• Project plan for priority workshops x3 -Nov- Jan
• Manageable wider engagement – ‘guest observers’
• Introduction of monthly peer review – April 2013- ongoing –
monthly programme
• QKM – ‘owner/ manager’ master class 3 day training – 2x annually
• The programme’s USP is ‘by providers for providers’
George Coxon, Director CCH Devon
Chair of the Devon Dementia QKM steering
group
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Quality Kite Mark in Residential Care Settings in Devon
Introduction, context and background
• Care competencies in care homes are very variable – this work
seeks to ‘level up’ care standards in residential care settings
• Developing a skilled and able workforce related to care in
residential settings across Devon is the main objective
• Providing ‘Reputation Enhancement’ for providers of the best
care in residential settings
• Devon wide ‘product development, construction work and roll
out’
• Developing and promoting a consistency in approach and
methods
George Coxon, Director CCH Devon Chair of
the Devon Dementia QKM steering group
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Quality Kite Mark in Residential Care Settings in Devon
Principles and Values
• Like mindedness
• ‘Person Centred Care’ focus
• Ensuring we remain ‘agenda central’ – risk of marginalisation and
exclusivity
• Peer review and support as key components
• Developing a ‘consensus statement’ on what we stand for
• Evidence based – inc 5 core influences (1), SW Dementia Partnership and
‘Progress for Providers’ guidance toolkit
• A phased approach
• Making sure we are part of the solution !! including …
…..KPOOH and GPOOH Keeping and Getting People Out Of Hospital
1) Rogers, Kitwood, Nolan, Sheard, Robbins
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George Coxon, Director CCH Devon Chair of
the Devon Dementia QKM steering group
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Quality Kite Mark in Residential Care Settings in Devon
The Phased Approach
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Scoping and initial construction work -Sept - October 2012
Skills based workshops – Nov- Jan 2013
Introduction of monthly peer reviews – Apr- ongoing
Master-class ‘owner / manager’ QKM training –May - 1st cohort
Wider engagement, consultation and recruitment meetings –June 2013 ongoing
2nd Wave of ‘owner / manager QKM training in the Autumn and twice yearly – next intake
April / May 2014
Variable added ‘products’ - manager mentoring, safeguarding avoidance and mgt support,
consortia purchasing via preferred provider, website
-Ongoing monthly steering group meetings and peer reviews
-Discussions with senior managers in social care re links with in house service
-Further presentations recently in Glasgow, Belfast, CQC Executives, today at the Care Show in
Bournemouth!
-A product specifically for Nursing Homes – work underway
George Coxon,
-Potential for a product for Domiciliary
Care Director CCH Devon Chair of
the Devon Dementia QKM steering group
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Quality Kite Mark in Residential Care Settings in Devon
Peer Review timetable
April – December 2013
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care planning ,training and education, activities , environment and atmosphere,
medication management and administration, basic care – nutrition, hydration and
personal care, long term condition management – (including diabetes), pain
management, end of life care
2014 schedule
• Person centred care plans, safeguarding processes and strategies, managing
challenging behaviour, Lewy Bodies Dementia, end of life care, skin care and
pressure sore mgt, mood disorders inc depression, dental and sight care, fall
prevention, night time lives issues, CVD inc stroke and renal care, medication
management
George Coxon, Director CCH Devon Chair of
the Devon Dementia QKM steering group
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Quality Kite Mark in Residential Care Settings in Devon
Peer Review
– 2 reviewers (owner and manager) reviewing a 3rd member
home
– Appreciative inquiry format
– Evidence based via ‘progress for providers’ tool
– Intention to ‘ask not tell’ and share to learn
– ‘observational best practice reports’ – done quarterly and
shared with the steering group
George Coxon, Director CCH Devon Chair of
the Devon Dementia QKM steering group
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Quality Kite Mark in Residential Care Settings in Devon
Master Class - Owner / Manager Training
• 3 days spread over 3 consecutive weeks
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Day 1- Leadership and Management
Day 2- Staff Development
Day 3- ‘Living well with Dementia’
Day 4- 3 months later – 3 themes – service improvement initiative
progress, ‘how to be a peer reviewer’ and follow up evaluation
Theory vignettes and participative workshop based
Workbook focused with homework and presentations
fully evaluated in 3 parts
3rd Cohort master class programme – 17 attendees booked – Apr/
May
George Coxon, Director CCH Devon Chair of
the Devon Dementia QKM steering group
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Quality Kite Mark in Residential Care Settings in Devon
External and Wider Interest
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SW Dementia Partnership,
South Devon and Torbay CCG (various projects),
‘NEW Devon CCG’ as a dementia aware organisation links
IDOP- Institute of Diabetes in Older People
Skills for Health and Skills for Care, local AgeUK
Bristol commissioner QKM scoping meeting
Eastern Devon Locality Clinical Executive, Local MH Trust and acute FT (RDE)
Gloucester commissioners and follow up events,
Various pharmaceutical organisations,
Local MPs – Anne Marie Morris and Dr Sarah Wollaston
CQC Executives – David Prior and Andrea Sutcliffe
Local MP interest – Norman Lamb recommended meeting with Martin Green,
ECCA
George Coxon, Director CCH Devon Chair of
the Devon Dementia QKM steering group
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What options and thoughts on adapting the
model for the Diabetes Stakeholder Network
and population ?
George Coxon, Director CCH Devon Chair of
the Devon Dementia QKM steering group
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Quality Kite Mark in Residential Care Settings in Devon
facts and stats about diabetes in hospitals and care homes
• 15% of OBDs
• 630,000 admissions in
November – 10% diabetics
– 63,000 people
• Average age 75yrs
• 50% of newly diagnosed
already have complications
• 10% of the NHS total care
budget
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Source - H&SCIC
Source Diabetes UK ‘Diabetes in Care Homes’
1:4 residents in care homes
23% screened on placement
28% annually reviewed
Little structured training for
care staff in care homes
• Every 25mins a care home
resident with diabetes has
an unplanned admission to
hospital
George Coxon, Director CCH Devon Chair of
the Devon Dementia QKM steering group
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Quality Kite Mark in Residential Care Settings in Devon
The West Berkshire – QKM diabetes scoping meeting
• Why care homes ? - facts and stats
• Cross over for care homes – dementia model used for
diabetes
• A ‘virtual network’ of likemindedness
• The ‘Devon model of initiation’ -identifying your 2.5% (1)
1. Everett Rogers (1962) – “ Diffusion of Innovation”– 2.5% innovators, 13.5% early adopters, 34% early
adopters, 34% late adopters, 16% laggards
George Coxon, Director CCH Devon Chair of
the Devon Dementia QKM steering group
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Quality Kite Mark in Residential Care Settings in Devon
But how portable is the model to diabetes?
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IDOP interest in a national programme
The principles are transferable
‘Share to learn’ – promoting and celebrating best practice
Things in common between dementia and diabetes
– Both are LTCs, both see huge increases in older age, both
see lots of avoidable admissions, both very common in
care homes.
George Coxon, Director CCH Devon Chair of
the Devon Dementia QKM steering group
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Quality Kite Mark in Residential Care Settings in Devon
What will encourage care homes to get involved?
– Building Trust and Transparency across the sector – ‘WIIT’
factor linked to ‘WIIFM’
– Reward for being proactive – reputation enhancement and
occupancy impact
– Producing a means for greater consistency of best care –
offering better likelihood of excellent CQC inspection
outcomes
– Cooperation can coexist with Competition
George Coxon, Director CCH Devon Chair of
the Devon Dementia QKM steering group
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Quality Kite Mark in Residential Care Settings in Devon
But what’s important?
‘Embedding the approach in a residential care culture shift’
– Trust and Transparency, Being Proactive and Imaginative, Happy
residents and Kind staff
– Greater consistency of best care – offering:
• better likelihood of excellent CQC inspection outcomes,
• reducing safeguarding problems and,
• keeping beds filled !!
– Choice, Safe and Fun, Best Value residential care for people with
diabetes
– ‘Aspiring to be Better’
– Links, partnerships and collaboration - including risk sharing
George Coxon, Director CCH Devon Chair of
the Devon Dementia QKM steering group
Devon Quality Kite Mark in the Care of Older People with Dementia
Lobby Certificate for participant homes
We are one of the coalition of residential and nursing homes in
Devon who are aspiring to provide the best possible care for
people with dementia. The values and principles we are
developing are based on:
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openness
continual internal review and improvement
peer review and support
using best evidence for the care we offer to our residents
Owner and Manager specialist masterclass training graduates
The principle of sharing to learn
George Coxon, Director CCH Devon Chair of
the Devon Dementia QKM steering group
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Quality Kite Mark in Residential Care Settings in Devon
Options for next steps considered
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other independent residential homes in Devon
domiciliary care -this was part of the original brief
specific module for nursing homes
specific clinical themes related to residential care inc diabetes, fall prevention,
skins care and pressure area management, end of life care
specific localities in Devon eg Eastern Locality of NEW Devon are interested in
work with their 46 care homes, 16 Brixham care homes looking at diabetes as a
focus
external organisations and bodies
accreditation, validation and gaining endorsement for the work
a commissioning tool to support improved care and recognition for providers.
Growth and expansion add on products for members
George Coxon, Director CCH Devon Chair of
the Devon Dementia QKM steering group
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Quality Kite Mark in Residential Care Settings in Devon
So….. How to do it
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Convene a ‘best care home diabetes SIG’
Identify your ‘hero innovator’ care homes
Convene a steering group
Agree best practice principles
Apply the Devon model of peer review and support
the work with positive endorsement
6. Involve me in some form supported by Gary and
MSD ?!
George Coxon, Director CCH Devon Chair of
the Devon Dementia QKM steering group
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George Coxon, Director CCH Devon Chair of
the Devon Dementia QKM steering group
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Quality Kite Mark in Residential Care Settings in Devon
Key Themes
• Partnership and collaboration
• Meaningful engagement with people receiving care and their
significant others
• Outcomes and positive impact focused
• evidence based approach
• Peer review and support
• To maximise certainty regarding CQC compliance and support
• ‘Consensus statement’ regarding values and principles of best care
• Local and independent validation - various options under
consideration
• To help inform the commissioning of the best care possible for
residential care for people with Dementia
• Having a consistent high standard of care
George Coxon, Director CCH Devon Chair of
the Devon Dementia QKM steering group
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Quality Kite Mark in Residential Care Settings in Devon
Consensus Statement
1. the overall aim is to drive up quality of care and support to people with dementia and their
families
2. the QKM will focus on a philosophy of sharing and learning from one another
3. those involved in the QKM work and development will adhere to greater partnership
working across health and social care systems
4. we are committed to sharing risk in how we enable people to receive the best care and
support including how we work together to keep people out of hospital where this is safe
and appropriate particularly avoiding emergency admissions through proactive working
5. we will give priority to embedding person centredness for people including those using
services and those providing services alike
6. we will provide a strong emphasis on peer review and support between and across provider
organisations
7. we will use, and be guided by, the best and most up to date evidence and local demographic
data available
George Coxon, Director CCH Devon Chair of
the Devon Dementia QKM steering group
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Quality Kite Mark in Residential Care Settings in Devon
Immersion, Embeddedness and Culture shift
• What does the culture shift look like?
• How to create an ‘appreciative inquiry model’ without
colluding, being defensive or defending inadequate care
providers and poor practice
• What the QKM advocates in terms of every day lives
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Person centredness
A ‘culture of improvement’ - it’s about aspiring to be better
Promoting ‘Good Care Habits
Being proud of what we do
Staff being kind
Residents being happy
George Coxon, Director CCH Devon Chair of
the Devon Dementia QKM steering group
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Quality Kite Mark in Residential Care Settings in Devon
Eligibility Criteria
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adherence to the QKM consensus statement
engagement in the process and be part of the QKM journey
attend 4 Devon Care Quality Forum events per year
attend at least 2 PEN meetings including the DCT annual training conference – Sept 2nd this
year - 2014
Owner and / or Home Manager must attend the 3 day master class QKM training
programme
must participate in the peer review and support programme
all members must join the Devon Dementia Care and Support Partnership
manager’s attending 1/2 of the 10 Manager Forums per year
George Coxon, Director CCH Devon Chair of
the Devon Dementia QKM steering group
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