Introduction Effective leadership is necessary to meet end-of-life care needs in Nursing Homes. This requires appropriate training and support.

An action learning set (ALS) was set up for this purpose, funded by the SHA, in partnership between a Hospice and University, facilitated jointly by Hospice CEO and University Senior Lecturer.

The presentation sets out:

• ▶ Process

• ▶ Rationale for the ALS over competency-based approaches

• ▶ Resulting outcomes for staff, clients and families

• ▶ The significant impact of a simple framework

• ▶ Sustainability issues

• ▶ Insight into QIPP agenda and preferred place of care.

Methods

• ▶ 12 participants from 10 homes took part over 8 months

• ▶ Participants worked on real problems and met on equal terms as a peer coaching group for goal setting, planning and reflection

• ▶ Impact was evaluated by compiling changes and improvements.

Results

• ▶ Linking professional and personal attitude to mortality

• ▶ More confident conversations about future planning

• ▶ Greater engagement of residents and families

• ▶ More consistent care planning – improved systems

• ▶ Improved bereavement support

• ▶ Night staff better equipped to support residents' wishes

• ▶ Residents and families better heard.

Discussion

• ▶ As only eight homes were finally involved, successes and difficulties provide an incomplete picture.

• ▶ Good quality changes in practice have been sustainable due to culture, attitude and confidence being addressed.

• ▶ It has been difficult to sustain the ALS without ongoing facilitation. Attendance issues constantly challenge.

• ▶ Trust developed quickly in the ALS and proved an empowering factor.

Conclusion The ALS approach provides an empowering, safe environment for setting stretch goals and achieving sustainable change. Ongoing improvement may require a longer period of facilitated support. The partnership of Hospice and University proved effective for developing trust for issue sharing and exploration.