In 2015 Four Seasons Health Care (FSHC) launched their innovative Quality of Life (QOL) system in 350 care homes across England, Scotland, Wales and Northern Ireland. As the name suggests the primary goal of the system is to enhance quality of life for our 16,000 residents in the UK. Using Apple IPads and Wi-Fi, the QOL provides live feedback from residents, care partners, visiting professionals and our care staff. The QOL system also prompts senior members of the team to conduct mandatory digital audits which form the basis of quality assurance (e.g. medication audit, weight loss & health and safety).
1. Over 350 care homes in group - difficult for leadership team and board to have visibility about the quality of care our residents (customers) receive.
2. Throughout our organization there were a number of care homes that were carrying out different practices (for example, in relation to weight-loss, some homes contacted dieticians when a resident loss 2.5kg and others contacted a dietician after the resident loss 5% of their body weight). In short, it was difficult to ensure that practice was standardized.
3. There was a recognition that the experts in care are our residents and resident families - despite this we had no mechanism in place to ascertain their feelings across the organization as a whole.
4. As an organization we wanted to support our care homes that were delivering outdated practices or whose residents had a low quality of life. In addition, we wanted to showcase, celebrate and learn from our care homes that were delivering exemplary standards of care.
1. Development of expert membership group to guide quality of life framework (senior clinicians, care home nurses, care home managers, residents in our care homes, family members from our care homes and multidisciplinary colleagues).
2. Piloting of QOL programme across 20 sites in the UK. Modification of tool based on findings and input from pilot site.
3. Dissemination of pilot findings to all care homes, appointment of regional QOL champions and structured education sessions to staff within care homes throughout our homes.
4. Company-wide delivery of IPads to all care homes - along with ensuring wifi was available in every home prior to formal launch.
5. Launch of QOL programme in early 2015.
1. Over 52,000 pieces of feedback have been received from residents, care partners, visiting professionals and our care staff across our 350 homes. Some have been positive and some have generated actions which have led to improvements in our resident’s experience of our care.
2. Over 100,000 actions, from the mandatory digital audits, have been found and fixed over the past year. These actions have been generated from categories which include: health and safety, home governance, house-keeping, human resources, information governance, medication audit, regional manager, resident care (includes mobility, wounds, challenging behaviour, pain, depression, dementia and palliative care audits) and weight loss.
3. On average it takes our homes an average of 7 days to resolve an action – meaning that any deficits in the resident’s experience, or the quality of care we afford, are addressed very quickly.
4. Over 35% of care home managers (across 350 sites) have stated that the QOL tool has identified issues they were not previously aware of.
5. All members of the board, leadership team and regional support staff have access to every one of the company’s 350 home providing ‘bed to board’ visibility. This function also allows for identification of regional patterns.
1. The total cost of operationalising this system was approximately £1 million. This cost included: installation of Wi-Fi across 350 care homes, purchase of multiple IPads for each care home and regional members of the care team, fee to Meridian who provided the interface for the FSHC designed QOL system and staff education sessions about how to use the tool.
2. We have seen our customer satisfaction survey scores consistently increasing as we find and fix issues quickly, as a result our group occupancy and income has increased over the last year to 87.5%, a two-year high and compares to an average of 85.3% during 2015.
3. Since using QOL, no home operating the programme has received an embargo. We are receiving consistently positive feedback from our regulators about the impact of the programme in meeting customer needs.
4. 90% of staff said that the Programme has reduced paperwork freeing up to 8 hours per week of Home Manager’s time, which can now be spent with their teams and residents focusing on their experience of care.
5. Earnings rose from 25% to £13.6 million in the second quarter of this year, which was its best quarterly performance since 2014.
In March 2015 a robust pilot scheme took place,
in April 2015 updates and improvements were made based on the pilot results,
throughout May to September 2015 Wi-Fi was installed across all 350 care homes within FSHC. Throughout this period over 1000 key members of our care team were trained face-to-face on how the tool works, how to generate feedback, how to resolve feedback or audit actions and how to disseminate knowledge within the organisation or within their care home.
By mid-September 2015 the tool was in operation across all 350 care homes. Since the launch of our QOL system we have seen a rise in our average overall resident satisfaction (from across our 350 care homes) from 91% in May 2015 to 97% in May 2016.
In the past year the QOL tool has also reduced the number of embargoes within our organisation from over 30 to 0 this past year. The QOL system has been at the heart of this transition as it provides a comprehensive overview about what is correct and what needs to be improved. The tool encourages care home teams to take ownership and resolve their problems quickly. In addition, 90% of staff said that the Programme has reduced paperwork freeing up to 8 hours per week of Home Manager’s time, which can now be spent with their teams and residents focusing on their experience of care.
The QOL system has the benefit of being able to generate a lot of data, as such the technology enables regional care support staff to identify trends across our 350 care homes.
With relation to national trends the following issues across were identified:4% of choking risk assessments not completed or reviewed, 3% of monthly care review plans not completed and 2% of monthly resident weight checks. These became national priorities for FSHC so as to promote awareness about the importance of choking risk assessments, care planning and weight checks and, at the time of writing, are no longer of concern.
The QOL tool has also has the ability to identify trends at a regional level, for example within Northern Ireland in January 2016, the main areas of concern related to: catheter care, information governance, spirituality and wound care. As a member of a clinical specialist team we were tasked with providing direct support, through education and supervision, to care homes in Northern Ireland on these issues.
The following are snippets from qualitative data we have generated about QOL: “The manager told us the new system was introduced…. to enable managers to find and fix issues quickly and prevent them from happening again.” “This information was transmitted in real time to the manager so they could quickly find and fix any care issues or consider any suggestions for improvements.” “The manager told us they also used the system to listen to the views and opinions of staff so that they could better understand how they need to support them.” Further information of the feedback element of QOL: Residents, Friends and families, Visiting professionals and Colleagues are asked to provide their feedback, comments and suggestions quickly and easily, via a static or mobile iPad which is prominently displayed at the entrance of every FSHC care home.
Feedback is also gathered from colleagues as we know happy and supported teams are vital to positive resident experiences. The system records these comments and makes them available immediately to the home and support teams so as any feedback, whether positive or negative, can be appropriately resolved or responded to. Nationally FSHC have made it mandatory for at least one piece of feedback (from either a resident, relative, visiting professional or colleague) to be received per day.
Further information on mandatory digital audits: These are known as ‘Resident TRaCA’s (Thematic Resident and Care Audit)’. They are based on the experience of that individual resident. Every audit starts with talking to the resident and asking for their input into the care they are receiving. It is completed by various members of the team (including nurse managers, deputy nurse managers, nurses and healthcare assistants) on iPads. Importantly, and as illustrated, there is a plethora of TRaCA’s which cover multiple aspects of a resident’s clinical care.
Finally, it should be noted that our QOL system is constantly evolving owing to the increases in resident experience and quality of care. Most recently, FSHC now require all resident risk assessments to be completed within QOL (eliminating the need for completing these on paper documentation). This has proved to be extremely beneficial as once assessments (e.g. MUST, Braden, Abbey Pain Scale, Cornell Scale for Depression etc.) are completed the QOL system will direct the user to an action. This has eliminated a number of errors that we have encountered in the past (for example an Abbey Pain Scale of 5 has not always been understood as something that requires investigation or onward referral).
To conclude, the QOL system has had micro, meso and macro level benefits as it pertains to our individual residents (micro-level), the care homes in which they live their lives (meso) and the national care home organisation in which they are part of (macro-level).