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Abstract
Background Hospice Community Specialist Palliative Care Services are required to adapt to growing demand and to patients living and dying at home with increasingly complex needs. We need to ensure that our service meets future demand and continues to deliver high quality patient care. A project to look at improvement in community services began with the NHS Improvement Academy in 2022/23.
Aims
Deliver a measurable improvement in team working, safety culture, job satisfaction and patient experience.
Develop skills in quality improvement (QI) methodology and increase improvement capability.
Build a strong quality improvement case study to support development of future QI approach within the hospice.
Methods Measured team working and safety culture using a validated survey (quantitative data) (Marsh, et al. Testing a toolkit that uses patient experience feedback to improve care. Nurs Times. 2021;117(1):39–43). Patient and team members’ experience was measured using qualitative data gathered in semi-structured interviews (Sexton, Helmreich, Neilands, et al. BMC Health Serv Res. 2006;6:44). This phase identified Community Triage as the focus for improvement. Improvement methodologies of small-scale tests of change were implemented to experiment with new ways of working and an iterative cycle of plan, do, study, act cycles was applied. A second round of diagnostic measurements with staff was undertaken to evaluate learning and impact of the project while working with the Improvement Academy to identify the knowledge and skills acquired and opportunities to continue to apply them.
Results Redesigned triage process to reduce duplication and improve efficiency. Allocation of referrals linked patients to the nurse specialist in their locality straight away. Staff reported an enhanced confidence and competence in undertaking quality improvement work. Staff saw tangible benefits for patients, in terms of relationship building. Members of the project group completed accredited Bronze and Silver Award QI training.
Conclusions Frontline staff were empowered to participate in quality improvement, driving improvement in clinical services and improved job satisfaction.