ANNEX SIX: CASE STUDY 5: BUILDING CAPACITY TO FACILITATE THE USE OF DATA IN PRACTICE SETTINGS.
The integration of health and social care teams is intended to provide flexible and responsive client centred care. Academics from a project facilitated by the Scottish School of Primary Care ( SSPC) have worked collaboratively with two such integrated teams; Rapid Response Teams working with the elderly in the Borders, Fife and West Lothian and a Community Mental Health Team in Dumfries and Galloway in order to build their capacity for self evaluation.
This was part of a three year initiative to bring research closer to primary care service development, which was a joint venture between Primary Care Trusts and their partner organisations and a number of Universities, facilitated by the SSPC.
This work involved the practitioners collecting systematic data about their practice in order to produce learning that can be shared throughout their organisations. The approach was designed to generate evidence, improve communication about the service and link audit, management and service development. Analysis of the initiative as a whole undertaken by the SSPC provides wider learning about how to undertake research-based development in Scotland.
A programme of evaluation was designed to link research with ongoing development to inform change and strategic direction. It was based on the idea of 'care pathways' which refers to a client's journey through the services. This concept was used to assist teams to reflect on and articulate the service they provide. The idea of 'pathways' helped the teams to think about the service in terms of a sequence of inter-linked inputs and events that enabled teams to better understand how the different components affect each other; concentrate on one part at a time and look at it without losing sight of the service as a whole and consider what areas of the system could be worked on to improve a specific part.
The SSPC team ran a series of workshops to help teams to draw up their care pathway and identify potentially problematic points on the pathway to improve communication and problem solving. Teams were then trained in qualitative and quantitative methodologies including significant event analysis and the use of routine data.
What is significant event analysis?
Team members often share experiences in daily practice informally over coffee and in corridors. These insights and discussions often contain lessons about practice such as something that worked well or a situation that was problematic. Significant event analysis ( SEA) is a systematic method that allows these experiences to be recorded, interpreted and discussed in order to highlight potential changes to the process of care delivery to improve the quality of patient care. This is a particularly useful tool to use with new procedures such as the Integrated Care Pathways, which bring together paperwork and procedures from social work and health. SEA provides a forum to consider and negotiate how these procedures actually work in practice. It can also be used to systematically identify difficulties and problems with the system during implementation.
A general practitioner is called to an emergency on Saturday afternoon to see an asthmatic patient. When she arrives she finds the patient to be shocked, sweaty and with a nearly silent chest. The ambulance arrives and gets the patient to hospital just in time. Over coffee on Monday morning the doctor describes the frightening experience to colleagues who sympathise and carry on with their work. If this event was recorded as a 'significant event' then the practitioners could discuss what caused this emergency to happen and what lessons can be learnt for the future.
These approaches were used to identify discrepancies from an assumed or ideal model, problem solve issues, devise strategies to address barriers and evaluate the effects of service change. An example is the highlighting of inappropriate referrals to teams, which led to follow up work to evaluate, monitor and problem solve on the issue of referral.
These methods are flexible and have the advantage that they work with the existing levels of dynamics and relationships within the particular context. In this way, the programme helped to facilitate the use, analysis and uptake of data in practice settings. The approach helped to empower and build the skills of staff and enabled them to be more articulate about practice issues and the use of evidence. It created a dialogue between teams and managers to resolve issues and to use evidence in service development. Such approaches are applicable to a range of professional settings where integration of services, better partnership working and use of evidence is desired.
For more information:www.rdspc.org.uk