Cohort 2

We delivered the second cohort of the Care Home Improvement Programme (CHIP) between October 2024 and March 2025. Our aim was to support care home staff to apply quality improvement, to improve outcomes for people experiencing care.

Cohort 2 focused on the NHS Tayside and NHS Fife 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 Perth:

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

Participating care homes nominated two staff members to attend the programme. Participants were allocated an improvement adviser who provided support throughout the duration of the programme. Improvement advisers facilitated both individual and group support sessions between the in-person events.

As part of the programme, participants undertook improvement projects. These projects were intended to address requirements or areas for improvement identified in their most recent inspection reports. The projects covered topics such as medication management, personal plans, record keeping, and meaningful engagement.

In Cohort 2, out of the 24 care homes that applied and were shortlisted to participate, 19 completed the programme, resulting in a completion rate of 79%.

Evaluation

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

Days 1 to 3 evaluation

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:

• 99% of respondents thought that the learning will improve care in their service
• 98% of respondents reported an increased level of knowledge
• 94% of respondents reported an increased level of confidence to use the above approaches in their service.

Overall evaluation of Cohort 2

The evaluation results for the programme as a whole were:

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

Relationship with the Care Inspectorate

On day 1, 63% of respondents said that they had a positive relationship with the Care Inspectorate.

On day 4, 96% of respondents said that they had a positive relationship with the Care Inspectorate.

This was an increase of 33% over the course of the programme, and suggested that the programme had a positive impact on the relationship between participating care homes and the Care Inspectorate.

Feedback from participants

“I have really enjoyed and learned a lot from the programme”

“Learning in an engaging environment. Given tools to increase critical thinking. Learning also from the experience of other participants”

“I have taken a lot of good ideas about leadership and how to improve my leadership role”

“Local peer groups has been a massive positive, in understanding you are not alone.”

“I have thoroughly enjoyed being part of it. Felt very daunted at the beginning but quickly realised there were no trick questions”

“The information wasn’t overwhelming but the learning and the lessons were great. Provided confidence to make the next steps to improve”

“Very supportive, informative and will benefit me in my service”

“Sharing experience and knowledge with other services. Realising others share your issues. Being guided to take the steps and breaking down the problem”

“Really enjoyed the programme, good energy, it all came together and can't wait to show our inspector.”

“Overall can't express what a difference the programme has already made in our service. A lot more than expected and sometimes we don't realise it until we discuss it”

“Thank you for allowing us to be part of this project. It will help continuously improve the work we do but also make changes in a planned manner”

Day 1 - self-evaluation, equalities and participation

Day 1 concentrated on self-evaluation, equalities, and participation. The key questions explored were:

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

Prior to attending day 1, participants met with their improvement advisor and were introduced to the broader CHIP team and connected with their peer groups on the first day .

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 adviser both individually and as part of a peer group. These meetings are intended to help them apply learning from Day 1, address any challenges and prepare for the upcoming session.

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

Day 2 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

The aim of day 3 is for participants to 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 4 - celebration day

To prepare for the event, we provided services with details about the support available and what to expect at the celebration event on 25 March.

• Each care home was given four places at the event, which could be used by staff, colleagues, or anyone they wished to celebrate their improvement journey with. Some invited residents, while others included managers, staff, or family members of those receiving care. The choice was entirely up to them.
• Leading up to the celebration, improvement advisers helped services submit their improvement project aim statements. This allowed us to connect care homes working on similar projects, fostering collaboration and shared learning.
• We also provided a story template for services to complete and return before the event. These stories documented their improvement journeys, and we compiled them into a booklet that was shared with all attendees on 25 March to celebrate their achievements.

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.

We extend our heartfelt thanks and congratulations to everyone who participated in the second cohort of CHIP. Your commitment to improvement and your openness in sharing your experiences have been truly remarkable.

Celebration stories

Aim statement By the end of March 2025, 95% of medication audits will be compliant in adhering to policy and procedures necessary for our service and residents. This is aligned to QF for Care Homes for Adults and Older People 2.2: Quality Assurance and Improvement is led well.

What changes did we make?  · We used the Care Inspectorate Self-Evaluation guidance to review our auditing process and identified that our area for improvement should focus on our MAR medication sheets. · We also spent time re-educating staff on our PRN protocol sheet which looks at signs and symptoms to justify PRN, checking with the GP to follow up and ensuring this will not adversely affect current medications. A more robust auditing process which is now in place and lets us easily check whether there are any missing or incorrect information from the MAR. We’ve made up individual audit checklist folders for each floor, which we review every week, A full audit is done on each floor and the manager will look at all medication audits. We also use an outcome plan if any mistakes are identified, looking at the issue, any concerns arising, actions taken and outcomes. We have worked hard on creating a no-blame system for staff to let us know in a timely way if they have made any errors and we make sure that staff who need additional support receive this in a supportive way.

What were the outcomes? We have a much healthier staff culture now with less blame because we have spent more dedicated time with staff 1:1 to demonstrate that it’s safe to own mistakes and to be shown the right way to practice We have achieved our 95% aim on our most recent check of all audits in terms of compliance and have found that 80% of staff adhere to the PRN protocol sheet – this is due to bank and agency staff being a necessary addition to the home currently.

What did we learn? We realised that staff won’t fully learn or feel accountable for their roles unless we help them practice in a supportive manner. We learned to pass accountability to all staff, educate them on potential outcomes and support understanding. There is much less blame when errors happen, and the mistakes on audits are now minimal. Staff understand how much more satisfying and enjoyable their jobs are when decisions and accountability lie with themselves.

What are we most proud of? Achieving our aim – errors are minimal now compared to what we experienced in the past. The MAR sheets are clearer and easier to read. and staff have noticed the difference. We are proud of our staff group for how well they’ve adapted to the changes and how well they’re now communicating to management and in many ways to ensure the smooth running of the home.