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Cohort 1

Introduction

The Care Inspectorate delivered the first cohort of the Care Home Improvement Programme (CHIP) between April and August 2024. Our aim was to support care home staff to apply quality improvement, to improve outcomes for people experiencing care.

This cohort focused on the Greater Glasgow and Clyde, and Forth Valley areas to allow care homes to build connections and peer support within their local area. Participation in the programme was voluntary. Adult care homes with a grade 3 from their most recent inspection were invited to apply to take part.

Programme structure

The programme included four in-person events in Glasgow:

  • Day 1: Self-evaluation and participation
  • Day 2: Quality improvement
  • Day 3: Leadership (supported by Scottish Social Services Council)
  • Day 4: Celebration

Participants were allocated an improvement adviser who supported them throughout the programme. Improvement advisers held individual and group support sessions in between the in-person events.

Participants undertook an improvement project related to an area for improvement from their last inspection report. Project topics were varied and included mealtime experience, meaningful activity, and documentation.

  • 37 care homes applied to take part
  • 30 care homes were shortlisted to participate
  • Participating care homes nominated two staff members to attend
  • 28 care homes completed the programme

Evaluation

We asked participants for their views and feedback throughout the programme.

At the end of days 1 to 3, we asked participants about their learning on the topics of self-evaluation, participation approaches, the Model for Improvement, measurement and leadership approaches. The average results were:

  • 92% of respondents thought that the learning will improve care in their service
  • 91% of respondents reported an increased level of knowledge
  • 84% of respondents reported an increased level of confidence to use the above approaches in their service.

The overall evaluation results for the programme as a whole were:

  • 91% of respondents said that the learning from CHIP will improve care in their service
  • 100% of respondents said that CHIP had increased their knowledge of quality improvement
  • 94% of respondents said that they had an increased level of confidence to apply quality improvement in their service as a result of completing CHIP

On day 1, 51% of respondents said that they had a positive relationship with the Care Inspectorate.

On day 4, 85% of respondents said that they had a positive relationship with the Care Inspectorate.

There was an increase of 34% over the course of the programme.

Feedback from participants

“Just like to add the course has been the highlight of my year and I personally have enhanced my knowledge and skills by attending the course.”

“We learned so much from the CHIP that will surely enhance and increase wellbeing of the residents.”

“I wanted to feed back that my inspector said my self-evaluation and improvement plan is probably one of the best he has ever seen. I need to thank you for that. I couldn’t have done it without your support and that of the rest of your team at CHIP. Please feed back that the CHIP programme is definitely having a huge positive impact on our services. Keep up the good work.”

“Learning about different leadership styles and sharing ideas with others.”

“We were able to focus on issues and look at trends. We were able to work with staff and raise awareness of these issues”

Download this information in PDF format here.

Day 1 - self-evaluation, equalities and participation

The theme of day 1 focused on self-evaluation, equalities and participation. The key questions addressed were:

  • How are we doing?
  • How do we know?
  • How can we ensure that everyone’s voice is heard?

Before attending day 1, participants had already met with their improvement advisor. On the first day, they were introduced to the broader CHIP team and connected with their peer group, consisting of six services.

Day 1 objectives:

  • Understand why self-evaluation is an essential starting point for planning an improvement project.
  • Learn ways to ensure that the voices of those receiving care are central to the self-evaluation process.
  • Confirm the specific area of improvement focus.
  • Plan the next steps related to self-evaluation.
  • Be clear on the actions required before day 2.

Day 2 - quality improvement

Before attending day 2, each service will have met with their dedicated improvement advisor individually and as part of a peer group. These meetings are designed to help them apply the learning from day 1, address any challenges, and prepare for the upcoming session.

Session aim

By the end of the day, participants will be able to apply quality improvement methodology to advance their improvement projects.

Session objectives

Participants will:

  • Understand the specific steps needed to progress their improvement project.
  • Identify the key individuals who should be involved in their project.
  • Participate in a demonstration of process mapping.
  • Grasp the importance of measurement in quality improvement.
  • Clarify how to effectively track progress in their improvement project.
  • Develop a draft aim for their project using the Model for Improvement.
  • Identify one change idea to test within their service.
  • Plan to use the PDSA (Plan-Do-Study-Act) cycle for their own improvement project.

Day 3 - leadership

Session aim

Participants will be more confident in their own leadership (regardless of role) and how their leadership supports improvement in care homes.

Session objectives

Participants will be able to:

  • Explain the positive impact of leadership.
  • Identify how you currently use your own leadership capabilities.
  • Describe some of the barriers and opportunities to leading improvement.
  • Identify steps to become even better at leading your improvement project.
  • Knowing the resources which are available to support leadership development.

Day 3 event.

Day 4 - celebration day

In preparation for the event, we provided information to services about the support we would offer over the summer and what to expect at the celebration event on 27 August.

  • Each care home was allocated four places at the event, which could be used by staff, colleagues, or others they wished to celebrate their improvement journey with. Some invited people living in their care home, while others included managers, staff, or family members of those receiving care. The choice was entirely theirs.
  • In the lead-up to the celebration, improvement advisers helped services submit their improvement project aim statements. This allowed us to connect care homes working on similar improvement projects, encouraging collaboration and shared learning.
  • We also provided a story template for services to complete and return before the event. These stories captured their improvement journeys, and we used them to create a booklet that was shared with all attendees on 27 August to celebrate their achievements.

Throughout the summer, improvement advisers regularly met with services in both one-on-one and peer group settings, offering ongoing support. These discussions covered the format of the celebration event, and services were encouraged to contribute their ideas.

On the day of the event, every service’s improvement journey was celebrated. Some services prepared slides and videos showcasing the improvements they had made for the people they support. Each service received a certificate of completion in recognition of their efforts.

It was truly inspiring to hear your stories and celebrate your success. Your hard work is making a meaningful difference in the lives of both those experiencing care and the staff who provide it.

We want to extend a heartfelt thank you and congratulations to everyone who participated in the first cohort of CHIP. Your enthusiasm for improvement and your willingness to share your insights have been invaluable.

Group photo.

Celebration stories

Springboig Care Home

Aim statement

By end of July 2024, Mr X will experience a 90% decrease in periods of distress each day. This is in accordance with HSCS quality indicators 1.2, 1.3 and 1.4.

What changes did we make?

  • Changes to environment (decorating the unit).
  • Providing a quieter environment for Mr X (using two lounges instead of one).
  • Reviewed current medication and made changes (added pain relief regularly).
  • Discussions with Mr X’s wife on things he used to enjoy.
  • Creating tailor-made activities to suit his needs which included walking, activities of daily living (washing dishes and setting tables), time with the iPad and quiet time in the garden.
  • Changed the timing of his morning medication to 7am.

What were the outcomes?

  • Mr X now enjoys and engages for much longer in group activities.
  • His distressed behaviour has decreased and more acceptable of support.
  • He presents calmer, he smiles now, actively listening and engaging, and his body language isn’t as tense.
  • He is no longer distressed during personal care and is now managing to carry out elements of this with much less support.
  • He has a better relationship with his peers and staff as he now spends time in other people’s company.
  • The relationship between his family and staff has improved now that the family has seen a vast improvement on how he previously presented.

What did we learn? 

  • Getting it right for each individual is important.
  • Things that don’t work for that individual may work for someone else.
  • Trying activities which were unsuccessful is okay because we learn from it and can try something else and have the evidence of what we have tried and the outcomes.
  • Being patient with the resident and letting them lead is important. Mr X’s engagement time started off as little as 10 seconds whereas now he will engage for half an hour.
  • Reviewing medication is important. We monitored the responses to a reduced dose of psychoactive medication, introduction of analgesic medication and discontinued antidepressant medication. The introduction of a painkiller had a positive effect for Mr X.

What are we most proud of? 

At the start, we thought we were not going to be able to meet Mr X’s needs. There was very little bond, and the distressed behaviours were increasing and having a negative overall impact on the other residents which was leading them to need PRN medication. However now Mr X is sitting engaging with his peers. He had been receiving PRN medication nearly every day and has now not required any for the last four weeks. The overall PRN medication usage within the unit has also massively decreased.